Patients who snore or have frequent episodes of day time drowsiness and fatigue may be suffering from Obstructive Sleep Apnea. Only a physician can make a diagnosis of OSA. There are a group of dentists who have taken advanced courses and mini residencies to be more aware of the signs and symptoms of OSA (Obstructive Sleep Apnea). Dr. Graf dentist near you has obtained the highest level of recognition of the American Academy of Dental Sleep Medicine, Diplomate. He is one of only 6 dentists in the Greater Houston area to attain this level of expertise.
In our practice we routinely screen for OSA and when applicable we refer our patients to a sleep physician for evaluation and diagnosis. If a diagnosis of OSA is made by the physician there are usually several options of treatment. One of which is an oral appliance that is worn at night to position the lower jaw in a more advantageous position to facilitate keeping the airway open.
Snoring is a sign of a lack of oxygen, and is a strain on your heart and other organs. Making sure you get the proper amount of oxygen allows you to get better rest than you would get when lacking the proper amount of oxygen. This will result in you feeling healthier every day.
Once a diagnosis of obstructive sleep apnea has been made by a sleep physician, patients are usually given choices of treatment. With a diagnosis of Mild or Moderate Obstructive Sleep Apnea (OSA) sleep physicians usually will consult with patients in helping them choose between two treatments. The first is CPAP (continuous positive airway pressure). This is a mask that patients wear over their face that forces air into the throat to provide a ” pneumonic splint”. In other words the air pressure coming from the mask forces the collapsed and narrowed airway to open up. This approach works well for many people, however there is a significant percentage of the population of patients with sleep apnea who cannot tolerate this mode of treatment. Which brings us to the second major path of treatment, oral appliances. Oral sleep appliances are good choices for patients whose sleep study showed mild or moderate sleep apnea. If you and your sleep physician decide on oral appliance therapy, a prescription will be given to Dr. Graf to take impressions for the sleep apnea oral device. These impressions will be used to fabricate upper and a lower splints which are connected together. This device is adjustable and allows Dr. Graf to orient the upper and lower jaws to the most optimal position for providing the maximum opening of the oral airway in the reclined position during sleep. At night our brain and endocrine systems need to cleanse, detoxify, and reprogram. The brain does this in the deepest stages of sleep, primarily REM stage sleep. REM stage sleep accounts for only a small portion of a patients total sleep time. It is the most important part of our nights rest.
Patients with OSA will experience airway collapse several times during the night. When this occurs the brain will wake the patient up so that a deep breath can be taken. As these events occur with some frequency all across the total time in bed, at some point the REM stage sleep will be interrupted. Taking the patient out of the most important stage of sleep has an extremely negative health consequence, as the rejuvenating and regeneration process our bodies require is stopped. In most patients REM sleep in rarely reacquired, and if it is it is for a significantly shortened period of time. Many of these patients end up either beginning to have heart, vascular/cholesterol, kidney, pancreatic, and dementia problems. The overlap of all patients with the medical conditions just mentioned with Obstructive Sleep Apnea is over 60% according to the latest data available to medical researchers.
So sleeping well is not just a luxury, but an absolute necessity for long and healthy life.
Sleep is a physical and mental resting state in which a person becomes relatively inactive and unaware of the environment. Sleep is characterized by two distinct states: Non-REM sleep and REM sleep. These alternate in 90 to 110 minute cycles. Normal sleep pattern has 4-5 sleep cycles throughout the night. Sleep has been determined to be biologically necessary for life due to the healing and repair that occurs.
OSA is a chronic condition that occurs when your muscles relax during sleep, allowing soft tissue to collapse and block the airway. This can cause you to stop breathing hundreds of times per night for anywhere from a few seconds to more than a minute. Repeated breathing pauses may result in reduced oxygen levels and disturbances in sleep.
Approximately 54 million adults in the US have OSA.
OSA is more common in men, but it can occur in women too. Having excess body weight, a narrow airway, or misaligne jaw can increase the risk of OSA. Snoring, choking sounds while sleeping, intermittent snoring with pauses, excessive daytime sleepiness, awakenings with gasping, poor memory, irritability, and morning headaches may be signs of OSA. Your should schedule a visit with your physician to discuss these symptoms.
After discussing your symptoms, your physician or a board-certified sleep medicine physician will complete a sleep evaluation and may schedule an overnight sleep study at a sleep facility or a home sleep apnea test. The physician will interpret the data from your sleep study to make a diagnosis.
Treating OSA is incredibly important. When left untreated, OSA can cause excessive daytime fatigue, morning headaches, and memory loss. In addition, studies suggest that untreated OSA Increases the risk of numerous health issues, such as hypertension, congestive heart failure, atrial fibrillation, coronary artery disease, stroke and type 2 diabetes.
Snoring is a major symptom of OSA, so all cases of snoring should be evaluated by a physician to determine whether or not you have OSA
An oral appliance is a custom-fit, mouth-guard-like device worn only while you sleep. It keeps your airway open and unobstructed by supporting your jaw in a forward position to keep the upper airway from collapsing and blocking the airway.
CPAP therapy involves wearing a mask that covers the nose and mouth and is connected to a tube that allows air pressure to keep the airway open during sleep. Oral appliance therapy consists of wearing a custom-fit mouth-guard during sleep to support the jaw in a forward position to help maintain an open airway.
Many patients consider an oral appliance to be more comfortable to wear than a CPAP mask. Oral appliances are custom-made to fit your mouth and made of lightweight material. To enhance the effectiveness of your oral appliance, follow-up visits with your dentist will be needed to ensure the optimal fit of the oral appliance. The oral appliance will be adjusted over time to ensure maximum comfort and effectiveness.
Oral appliance therapy is an effective, non-invasive treatment that fits easily into your lifestyle. Oral appliances are comfortable, quiet, portable, easy to wear, convenient for travel and easy to care for. Additionally, oral appliances do not restrict movements while sleeping, work with any patient sleeping positions, can be used for patients that are CPAP intolerant, do not require electricity, and require no consumable parts to replace.
More than 100 oral appliances have received FDA clearance, meaning they have undergone and passed a rigorous safety and effectiveness assessment process. Your dentist will recommend the appliance that is best for you.
Your physician will write a prescription for you to receive a custom-made oral appliance. A dentist, qualified in dental sleep medicine, will take Impressions of your teeth to build a model. This model will be sent to a dental lab where the oral appliance is made.
Oral appliance therapy is covered by Medicare. Most private insurance plans cover oral appliance therapy, but you should check with your insurance provider and review your plan details to ensure coverage.
Under Medicare, as well as the policies of most private insurers, the oral appliance must be custom-fabricated to be covered. Medicare and other insurers also have specific documentation requirements, so you will need to work with both your physician and dentist to ensure that you have everything you need to ensure coverage.
It is essential to note that oral appliance therapy is covered by medical insurance, not dental insurance, as obstructive sleep apnea is a medical condition that is treated collaboratively by dentists and physicians. As such, when reviewing insurance coverage policies, make sure to ask your provider about their medical coverage policies and requirements for oral appliance therapy.
Education in dental sleep medicine is required for dentists to provide safe, quality care to patients using oral appliance therapy for sleep-related breathing disorders. At minimum, dentists should meet the educational requirements defined by the AADSM to be a "Qualified Dentist in dental sleep medicine. To find a qualified dentist near you, visit the AADSM's website.
Dentists should screen patients for OSA using questionnaires and evaluating the airway and then refer the patient to a physician for an evaluation. Since OSA is a medical condition, dentists should not diagnose sleep disorders. If oral appliance therapy is determined by the physician and patient to be the most appropriate treatment option, the physician will write a prescription for an oral appliance and refer the patient to a qualified dentist who will provide and monitor oral appliance therapy as part of a treatment team with the physician. The qualified dentist will monitor and treat potential side effects of oral appliance therapy and provide follow-up to ensure the optimal fit of the oral appliance. Patients should return to their physician to confirm the treatment efficacy of oral appliance.
Oral appliances are customized using digital or physical impressions and models of your teeth. These models are sent to a dental lab where the oral appliances are made. Once the oral appliance is ready, you will return to your dentist's office for a fitting. Your dentist will adjust the appliance to maximize its comfort and effectiveness. Your dentist will then teach you how to clean and maintain the oral appliance. A sleep study may then be scheduled by our physician to verify treatment success.
Treating snoring or OSA with oral appliance therapy can help you feel like a new person. You will find that your symptoms and your quality of life can improve dramatically when you remain committed and use your appliance each night. You will likely sleep better, have more energy, and feel sharper throughout the day.