Sleep Apnea Treatment

What is Sleep Apnea?

• A common condition where your breathing stops and restarts several times throughout the night during sleep.

When you refer to us:

• 90 days of follow-up included in appliance fee
• Titration studies done after appliance is fitted to ensure effectiveness
• Slim, comfortable materials used

Additionally:

• All patients will need a dental exam and radiographs first to make sure they are a candidate
• We will request a prescription for E0486 (oral device/appliance), and initial PSG (in-laboratory, attended polysomnography _ also referred to as a sleep study), all your Doctor's notes for before and after the PSG was done.
• We submit to insurance to get a breakdown of benefits for patients, it is billed out as a medical code, not a dental code.
• Medicare patients that have supplement plans will have no out of pocket cost. (In Network Provider with Medicare)
• No charge for the first 90 days after delivery of OAT- oral appliance therapy (included with fee for appliance) adjustment period. They will need to see us often in the beginning.
• When the patient is ready (feeling refreshed, sleeping better, not snoring and comfortable) we will refer them back to their Doctor’s office for a follow-up PSG to make sure that their appliance is in the correct position.
• The Pharyngometer is used in sleep disordered dentistry because of its ability to identify narrow, obstructed and collapsible airways as well as its ability to determine proper position of the mandible for oral appliance therapy.
• Rhinometer is a tool used frequently by Dentist’s and Otolaryngologists to measure nasal airway size and identify obstructions in the nose that could be contributing to the sleep disordered breathing problem. This is a quick non-invasive test that can be done in seconds providing the Doctor with valuable information.

What is OSA?

• Root cause sleep apnea = flexible airway (about how you are built not by how big or small you are)
• Can cause; fragmented sleep, shorter life span, reduced quality of life and even death!
• When left UNTREATED, can take 12-15 years off your life
• Over 80% of nocturnal strokes related to OSA
• Increases high blood pressure risk by 45%
• OSA is a well-known cause of serious, possibly fatal heart conditions such as chronic hypertension, coronary artery disease, atherosclerosis (fatty deposits in the aorta) and even congestive heart failure, to name a few.
  • OSA can occur at any age
  • 2 types of OSA: obstructive and central
  • Very under diagnosed
  • When ignored or untreated, sleep apnea can cause serious health problems. The problems include HBP, heart disease, Type II diabetes, stroke and depression.
  • A common type of sleep apnea in children, OSA, is caused by an obstruction of the airway (such as enlarged tonsils and adenoids)
  • 50% of children with ADHD had signs of sleep-disordered breathing
  • OSA impacts men two to three times more often than women.
  • Not every man who has sleep apnea is overweight or particularly unhealthy, with many star athletes suffering from these conditions.
  • Risk for OSA increases dramatically with pregnancy and menopause
  • It’s estimated that up to 83% of patients with type 2 Diabetes suffer from unrecognized OSA.
  • OSA can cause sleep deprivation (Effects of sleep deprivation: memory issues, weakens immunity and mood changes)
• There is also a well-studied connection between sleep apnea and a higher mortality rate for cancer (1).

Signs and Symptoms of OSA:

• GERD
• Headaches
• Nocturia
• Sexual Dysfunction
• Social Problems
• Type II Diabetes
• Clenching
• Bruxing
• Scalloped Tongue

There is a strong relationship between dementia and OSA, a USC study showed 70% dementia patients had OSA

Sleep Apnea Increase Risks of:

• High Blood Pressure
• Heart Failure
• Heart Rhythm Disturbance
• Atherosclerotic Heart Disease
• Pulmonary Hypertension
• Insulin Resistance
• Sudden Death
• Memory Problems
• Depression
• Anxiety
• GERD

Depression or OSA:

• Depression is a common mental disorder based on symptoms. Women are diagnosed with depression much more often than men.
• Patients may tell their Doctor “I don’t have the energy I used to, I’m constantly tired and fatigued, I’m not sleeping well.” Doctor’s seem to jump to the conclusion of depression versus Sleep Apnea.
• Doctor’s tend to stereotype “obese old men” as having OSA, not a young fit female.
• As a Dentist we see more of these patients, young fit males and females, and pick up the possibility of sleep apnea by asking specific questions and finding oral issues that may be caused by sleep apnea.
• We refer our patients to a sleep Doctor to get them the help they need while also staying in touch with the Doctor to come up with a customized treatment option for our patient. (Ex: “This patient exhibits multiple signs that point to sleep apnea, please follow up with a sleep study”)
• Obesity is a contributing factor, not a cause!

What is OAT?

• Custom, removable sleep appliance
• Comfortable and effective option for treating OSA
• Appealing alternative to CPAP (continuous positive airway machine)
• Compliance is 95%
• Oral appliance therapy works for 80% of people, some can’t go too far forward or open too much, there is an adjustment period.
• 15% of patients are non-responsive to repositioning, OAT is not the best option for these patients
• Can only treat obstructive sleep apnea, not central sleep apnea
• Important patient can breathe through their nose when using oral appliance

Other Indications for OAT:

• An adjunct to CPAP – For use during tavel and for use when electricity is not readily available (camping/hunting)
• In combination with CPAP to help reduce necessary pressures or eliminate head gear (combination therapy)
• As a predictor of success of orthognathic surgery or also known as “bi-max advancement” surgery

• With a sleep appliance in place, the lower jaw is prevented from falling backward, keeping the tongue forward and airway open
• Often this will reduce or eliminate snoring and OSA, providing the body with deep and restful sleep

Side effects of OAT:

• Can change/effect your bite and the space between your teeth
• Morning aligner we make for all patients with appliance to have them check their bites
• Side effects are also minimized by using bite tab and flossing