Answers to Frequently asked Questions
Why do we snore?
The sound of snoring occurs when air cannot flow freely in and out of your throat. This is due to a narrowing of the passages at the back of the mouth and nose. During sleep, muscle tone decreases throughout the body. When your throat muscles relax, the soft palate and uvula (the fleshy structure that dangles from the roof of the mouth) vibrates as you breathe in and out. Snoring tends to become worse with alcohol or sedative consumption before bedtime, weight gain and a blocked nose. Snoring often increases with age.
How is snoring related to obstructive sleep apnea?
While snoring is caused by a partial obstruction, obstructive sleep apnea (OSA) is a temporary but complete closure of your throat during sleep. It results in repeated episodes of stopping breathing (apnea) during which you continue to make efforts to breathe. Loud snoring is the most common symptom of OSA. The sound occurs as you briefly waken at the end of the apneic period and begin to breathe. Some OSA sufferers are described as making snoring or gasping sounds when they resume breathing.
A history of snoring often precedes the development of other symptoms which include excessive daytime sleepiness, fatigue, memory impairment, morning headache, poor work performance and loss of sexual interest. Severe OSA can result in serious complications including high blood pressure, heart rhythm disturbances and heart failure. The diagnosis of OSA is confirmed by specialized testing. An overnight sleep study is required to confirm the diagnosis and determine its severity.
Snoring without apnea is not usually harmful to your health and many snorers who have none of the above symptoms do not have significant OSA. However, many people with OSA are unaware they have it. Thus, careful medical attention is required to ensure the OSA is properly diagnosed and treated.
How do I know if I have Sleep Apnea?
A visit to your family Physician to discuss the symptoms you are experiencing is the first step. Your family Physician can refer you to a Sleep Specialist who will take a thorough medical and sleep habits history. Once they have the results of the overnight study, a diagnosis is made and the different treatment options are discussed.
What is a sleep study?
A sleep study is an overnight study called a Polysomnogram, which measures several bodily functions such as heart rate, oxygen saturation, EEG, as well as any Apnea episodes during the different sleep stages. The data collected during the study will determine whether or not you have sleep apnea or any other of the many sleep disorders.
Is a sleep study painful?
No. Throughout the sleep study process no needles, drugs, x-rays or invasive procedures will be used – making this a very safe and painless process.
What is a CPAP?
CPAP stands for Continuous Positive Airway Pressure. Using a face or nasal mask a CPAP machine delivers airflow at a set pressure to open the upper airway for a patient.
How long must I wear a CPAP?
CPAP machines are not a permanent cure for snoring and OSA but if worn during sleep will usually prevent either or both from occurring. Regardless of how long it is worn, the symptoms of OSA and/or snoring will return when the CPAP is not worn.
Payment for CPAP machines and supplies?
Most insurances cover some or all of the costs for CPAP machines and supplies required to treat sleep disorders, but this is entirely dependent on your insurance company and specific plan coverage. SleepMed Therapies staff will be happy to help you determine what coverage your plan offers.
What is an oral appliance?
An oral appliance is a small device, similar to an orthodontic retainer or an athletic mouthguard. It is worn in the mouth during sleep to prevent the soft throat tissues from collapsing and obstructing the airway. Some appliances hold the lower jaw forward during sleep while others have direct effect on tongue position.
Oral appliances relieve OSA and snoring by realigning the jaw and/or tongue in relation to the head. Although oral appliances do not work on everybody, a well-made, well-fitted appliance may reduce or eliminate snoring, and may significantly relieve symptoms of OSA.
Since the 1800’s, over 50 different oral appliances have been invented that have been used with varying degrees of effectiveness to treat snoring and Sleep Apnea. Appliances fall into two main categories; those which hold the tongue forward and those which reposition the lower jaw (and the attached tongue) forward during sleep. Sleep aids can be bought off the shelf at Pharmacies, such as Snoreban and Breathe Right strips, and others that are usually most effective are made by dentists and/or orthodontists. Some appliances are what are referred to as "boil and bite" appliances that are softened by placing in boiling water for a length of time, and then placed in the mouth and bitten into, and others are custom fit adjustable mandibular repositioning appliances that hold the lower jaw forward during sleep. There have been several research studies completed that have compared the effectiveness of various appliances and it has been shown that the adjustable appliances that reposition the lower jaw forward during sleep are more effective than non adjustable appliances.
The appliance we use is unique from all others because it not only repositions the jaw but, more importantly, prevents the tongue from falling back and obstructing the airway. Unlike many appliances that are simply custom formed to the teeth then left alone, our approach involves consistent care and follow-up to ensure that we are getting optimal results. We will modify and adjust your appliance to find the exact positioning that best suits your body and achieves the greatest reduction in your apneic events. It is FDA approved and has many patents protecting it’s unique nature. This is the only appliance Dr. Greenburg uses because of the tremendous success he has had with his patients.
How long must I wear the appliance?
Oral appliances are not a permanent cure for snoring and OSA but if worn during sleep will usually prevent either or both from occurring. Regardless of how long it is worn, the symptoms of OSA and/or snoring will return when the appliance is discontinued.
Do I have to wear the appliance all night?
Yes. Studies indicate that OSA is most severe during the early morning hours. It is, therefore, very important for you to use the appliance at all times during sleep. During the first few weeks while you are adjusting to the appliance, it may be necessary to start with shorter periods and gradually increase the length of time until you can comfortably wear the appliance all night. Many patients are able to wear the oral appliance on the first night and experience no discomfort.
What are side effects associated with the use of an oral appliance?
Patients may experience morning soreness in the teeth or jaw muscles while adjusting to the appliance. In addition, some patients experience excessive salivation. All of these side effects improve within a few weeks of regular use and some adjustments of the appliance. Patients with arthritis or jaw joint dysfunction may have difficulty tolerating an oral appliance. These possibilities need to be discussed with your practitioner before the appliance is fabricated. Colds and allergies where the nose is blocked can interrupt the effectiveness of the oral appliance but this stops once the nasal passages are clear again.
How do I start oral appliance therapy?
If you are interested in trying an oral appliance you can simply schedule an appointment for a consultation with our office. At that time we will discuss the treatment options for you and, if you do not have a recent sleep study, arrange one for you. We will also utilize a specialized tool called a pharyngometer (developed by Harvard University) to measure the volume of air moving through your airway. This will give us an indication of how effective an oral appliance will be for you before you commit to moving forward with appliance therapy treatment.
How do oral appliances work?
Oral appliances work non-surgically to open the airway during sleep by realigning the tongue and jaw in relation to the head. The appliance we chose to use has an added feature unlike any other appliance marketed. Using a small, posterior tongue restrainer it prevents the tongue from falling back and blocking the airway, which is a major contributing factor to obstructions. An appliance must be worn each night to produce the desired effect.
Their role is to prevent the snoring and/or obstructive apnea during sleep and they must be worn each night to produce the desired effect. More than 60 types of oral appliances have been marketed but two specific types have been found to be most effective dependent on each specific airway and mouth as evaluated by the dentist/orthodontist.
What will the dentist do?
On your first visit, the dentist will thoroughly examine your teeth and mouth and take a series of x-rays to see the condition of your airway, sinuses and TM joints. Dental impressions are required to fabricate an oral appliance, which are then sent to the laboratory where the appliance is made. Once the appliance is made, it will be inserted by the dentists who will show you: how to insert and remove it yourself, how to clean it and care for it when you are not using it.
He will then see you on a weekly or bi-weekly basis to determine the effectiveness of your positioning with the appliance and make adjustments accordingly. Once you have been using the appliance regularly and have notable relief from symptoms, such as improvement in daytime sleepiness and elimination or lessening of snoring has occurred, we will do a follow-up sleep study to obtain concrete data on the effectiveness of your appliance on your sleep apnea. You will continue to visit us at regular intervals and we will work with you to maintain and modify your oral appliance so it remains effective.
Can I wear an oral appliance if I have a bridge or denture?
Sufficient healthy teeth are required to anchor an appliance (at least 10 in each the upper and lower jaws) Patients with crowns or bridges can be successfully fitted with an appliance. Adjustments are made in the appliance to ensure that fragile crowns and bridges are not harmed. Patients with partial dentures can also be successfully fitted with an appliance as long as there are enough teeth to anchor the appliance. Patients with full upper or lower dentures may be candidates and are evaluated on a case by case basis.
Payment for oral appliances?
Oral appliances for sleep apnea are a medical treatment billed to your medical insurance, not your dental insurance. Many insurance companies cover this treatment, but that is entirely dependent on your insurance company and the specifics of your plan. The amount of coverage varies with each plan. (Medicare covers the entire treatment.) We also have financing available through two independent companies, Care Credit and Capital One. These require only a short application, which we can process for you at the time of your consult if you desire.