I don’t think I breathe right when I sleep; what can I do?
Read about the seriousness of sleep apnea. Be assured that the condition is completely treatable with excellent success rates; ask your physician to refer you to a sleep specialist as soon as possible or schedule an appointment for a screening. A screening questionnaire can be downloaded from our webpage and taken into your primary doctor, as well. When it is your significant other in question, they may not be aware of their problem, or its effect on you and your relationship, so a positive presentation of the issue to them will help in their acceptance process as well.
How do I know if I could be helped with my frustrations?
If you snore (loud or soft), wake up several times during the night, suffer from headaches in the morning, experience sleepiness regularly during the day, or if you are intolerant of a CPAP machine and are exhausted from trying to get yours to work comfortably, you could benefit from an oral appliance. People who clench and grind their teeth, or have night time gastric reflux (GERD) or heart rate irregularities should also discuss a sleep evaluation. An evaluation by a trained dental provider is recommended for evaluation of your teeth and gums, and whether or not they can support an appliance. Clenching and grinding are often associated with an obstructed airway, so even if you already wear some sort of appliance for those signs, the cause may be coming from the airway, and both issues can be treated simultaneously.
What treatment options are available for someone who has been diagnosed by their doctor as having sleep apnea?
Therapies currently being used are CPAP / BiPAP, surgery, oral appliances, and herbal remedies. In most cases, reversible methods should be explored before irreversible procedures are considered. The simplest method for treating sleep apnea includes loosing weight and changing habits such as sleeping position, and not having alcohol or heavy meals after 8 p.m. Severe apnics are recommended to go to CPAP first. Mild to moderates may not be given any treatment recommendations, but oral appliances may help decrease the progression to a severe condition prophylactically. If CPAP is not recommended because your condition is not severe enough, you can request a referral for an oral appliance.
How does an oral appliance work?
There are two types of oral appliances that can be used. One is a tongue retaining device, which often uses suction to pull the tongue forward in the mouth. The type most commonly used is a small, usually plastic, device that fits over the upper and lower teeth, similar to an orthodontic retainer or mouth guard. The appliance is worn during sleep to prevent the soft tissues of the throat from collapsing and obstructing the airway. Mandibular advancement appliances work by moving the lower jaw forward, which in turn pulls the base of the tongue forward and opens the airway to allow improved breathing, reduced snoring and reduced apneas during sleep.
How well does an oral appliance work compared to a CPAP machine?
A dental appliance is can be a very effective therapy for mild to moderate sleep apnea. Acceptable control of the oxygen levels has been obtain in severe apnics as well, but it is not as straight forward with severe levels. Modifications in appliance designs have greatly improved their dependability and comfort from earlier versions. In some cases, an oral appliance designed to open the airway has been just as effective as CPAP without its inconvenience or discomfort. CPAP machines are 100% effective when titrated properly, and worn as recommended. Neither method will work if it is not worn. Oral appliances can also help CPAP machines be more tolerable, allowing the titration pressure to be decreased. Oral appliances are endorsed by medical professionals and accepted by patients. Most patients have better compliance with an oral appliance than a CPAP machine.
I have tried to wear CPAP but can’t; can I get an oral appliance?
If you are unable to adjust to wearing your CPAP mask, and you have made an effort to try other types of masks or pressure applications, the first step is to tell your physician. That is a very important step. Your physician must know of your dissatisfaction with the recommended treatment of CPAP. If you can not find resolution to your issue(s), request that he/she refer you to a dentist who specializes in dental appliances. Putting your CPAP in the closet and doing nothing will increase your potential to progress to cardiovascular issues, increase if medications, and further breakdown of your overall health. The dentist should review your history, perform a diagnostic evaluation of your upper airway (which may include radiographs and/or sound waves), take measurements, determine jaw positioning & other physical attributes. The health of your jaw joint is very important, as an oral appliance will be controlling your jaw position while you are sleeping. You may be asked to treat an existing joint issue before being able to comfortably wear a sleep appliance.
What are the chances of the appliance working for me?
If the problem is snoring only, the appliance is approximately 85% effective. When treating apnea, an appliance is 65-70% effective, depending on the severity of the condition. The appliance tends to be more effective for mild to moderate obstructive sleep apnea than for severe cases. Appliances can also be used in conjunction with CPAP or other PAP appliances such as the alternating pressure unit known as Bi-PAP, to decrease the amount of pressure needed to obtain an acceptable saturation level.
Does it take a long time to get fitted for an appliance?
Creating a custom dental appliance usually requires about 3 - 5 appointments. First we'll need to determine if you're a candidate; if you are only concerned with snoring, simply contact us to make an appointment. If you suspect you might have sleep apnea, we can refer you to a sleep disorder specialist for a medical evaluation and sleep study. . Once titration is verified with a repeated take home sleep study, it is recommended that it be verified in a certified sleep center for effectiveness. Thereafter, you will be placed on an annual or semi-annual recall.
How do you know if an oral appliance will work for me?
We provide diagnosis and treatment planning in three phases to increase the probability of success in your treatment with an oral appliance. The first is a comprehensive exam of the mouth, including the health and stability of your teeth, jaw joint and gums. This is very important as you would not want to invest in the rest of the process if you did not have the parts to hold the appliance in place. The second is a screening of the airway using radiography, electronic tests of the jaw joint, and acoustic sonography. These are done to see if moving the jaw can help with the general size of your airway and if your jaw can tolerate it without further treatment to it. Duplication of the collapse that occurs during sleep can not be duplicated in the clinical setting, but this gives us a general idea of the probability of success. The screening portion includes an ambulatory (take-home) sleep evaluation. There is no guarantee that an appliance will work, however, every effort will be made to select the most likely appliance to work with your condition. The third appointment, completion of pre-treatment physical characteristics is completed, along with the impressions and specific bite position calculation and verification radiographs for the appliance deemed most suitable for you. It usually takes approximately 2 weeks to get the final appliance back from the laboratory for delivery. The number of follow-up appointments will vary on the number of adjustments needed. Diagnosis and treatment can be discontinued at any point up to the final impression appointment. Once the final impression appointment is started, you are committed to the appliance financially.
Will it hurt my teeth?
A properly fitted appliance typically does not hurt the teeth. If your teeth are sore after initial use, they can usually be adjusted for your comfort. Do not assume that it will wear away; an adjustment is usually required. Proper homecare and regular follow-up appointments with you general dentist are manditory to maintain the health of your teeth as well.
How much does treatment with an appliance cost?
The cost is not just that of the appliance itself. There are diagnostic tests, radiographs and an extensive evaluation completed in the process of selection of your oral appliance. There are several appliances that we use, which are customized to each patient's situation. They are adjustable to allow us to gain optimal comfort and jaw position to achieve maximum success. The fee for the appliance will vary based on the complexity of the appliance. Payments are expected for the treatment rendered at each appointment. This information is given to you in detail when the appointments are set up so that you will be prepared for each appointment.
Does my insurance cover appliance treatment or will it only cover CPAP?
Most insurance companies have coverage for treatment of obstructive sleep apnea with an oral appliance. Keep in mind that medical insurance only pays for diagnosed medical conditions; treatment for snoring is not covered. However, OSA (Obstructive Sleep Apnea) is a medical condition that requires a physician's diagnosis and an overnight sleep study in a credential sleep study center. This is usually in a hospital setting. Typical insurance reimbursement with an OSA diagnosis is 65% - 80%. Along with a Letter of Necessity from your physician, and a referral to an out-of network provider, our appointments and your oral appliance will be covered, too. Most dental insurance companies do not cover treatment of obstructive sleep apnea, it would come from your medical insurance carrier. We encourage you to call and check with your medical insurance company. We will be happy to send information to your insurance company regarding your situation to request a determination of benefits, however this does not guarantee payment by them.
Does this office participate with insurance companies?
Alpha Omega Dental Center does not participate with any insurance companies, medical or dental. We will, however, generate all medical insurance communications and claims for your reimbursement. All medical claims will be given to you, for submission to your insurance carrier. This removes the “we never received it” component from the insurance process: you know it was sent in. We will include postage for you, as well.
How do I take care of it once I get it?
Once they're properly fitted and adjusted, custom made appliances (using high-quality materials) are durable, portable, easy to use and maintain. Following brushing your teeth, it is recommended that you brush your oral appliance and return it to its protective case, out of reach of small children and pets. Once a week, it is recommended to soak it in denture cleanser during the day to remove any bacteria build-up that could cause odor or stains. Certain appliances this soaking process is NOT recommended, so verification by your dentist is recommended. If your appliance has metal hinge or clasp, a cleaner designed for partial dentures with metal frameworks should be used. Specific instructions for appliances used in this office can be found on their own pages.
How long does it take to get used to wearing the appliance?
Most patients will adapt to the appliance within 2-7 days. It will take a few days to get used to having something in your mouth during sleep. You may find that you drool when you are sleeping. That is a normal response to having something in your mouth. Your saliva glands think it is food, and turn on. After a few nights, they usually figure out that the trigger is not going anywhere, and the drooling decreases.
How long do these appliances last?
We usually tell our patients that appliances last 2-5 years, but many will last longer. It is being worn 6-8 hours a day, in the toughest environment in the body, so they can and do wear down. The condition of your teeth can change as well, so the appliance may need to be replaced in the future. Most insurance companies will cover the replacement of an appliance, but it is recommended that you verify this with your individual insurance carrier.
Do I need to do anything after it is fitted and verified that it is working?
After the appliance is verified as effective in stabilizing your oxygen levels at an acceptable level, we recommend that you are seen by this office annually for verification that it is still effective in helping you to breathe, and that your TMJ is still stable. We also emphasize the importance of maintaining your recommended semi-annual visits with your regular general dentist. We will send requests for treatment to them if we find a dental issue during out evaluation as well. These may be simple cavities or issues that will directly effect the stability of the retention of your appliance and completion of the recommended treatment is not to be ignored.