Rob Veis, DDS
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Perhaps 10% of adults snore. Although most of those afflicted have no serious medical consequences, habitual snoring can be the first indication of the potentially life-threatening disorder obstructive sleep apnea.
It is estimated that more than 38,000 people in the U.S. die each year from the effects of obstructive sleep apnea. Clearly there is a problem, a nation-spanning problem that demands immediate and qualified attention.
What to do?
Don’t wait to take action. Don’t ignore the problem. Don’t put off treatment. Sleep apnea can lead to heart failure, stroke, seizures, and even sudden death. If you suspect that a patient has sleep apnea, begin with a screening.
Your initial sleep screening should include the following questions for patient and partner:
- How many hours of sleep to you typically get?
- When you wake up, do you feel refreshed?
- Do you often feel sleepy or fatigued during the day?
- Do you ever experience a headache or dry mouth upon awakening?
- How often do you snore?
- Does your snoring disturb the sleep of others?
- Are there periods or intervals when snoring and breathing stop?
- Do you ever gasp or snort during sleep?
Pass this information on to a sleep specialist and request a complete medical workup, in the interest of identifying conditions and problems that may be caused or aggravated by OSA. Also, get a sleep test, e.g., polysomnogram (PSG).
As the patient sleeps, the PSG measures ventilation, gas exchange, cardiac rhythm, number and length of breathing stoppages, sleep stages, and arousals. Most major medical insurers will require patients to undergo a full PSG study in a sleep lab before paying for treatment. However, in recent years, ambulatory (and more affordable) sleep study devices have entered the market.
Treatment options
Results of the screening, exam, and sleep test will yield a diagnosis of snorer (no apnea), mild apnea sufferer, moderate apnea sufferer, or severe apnea sufferer. What are the options?
- Snoring (without apnea) — A snoring appliance that prevents rolling into a supine position during sleep
- Mild apnea – CPAP (continuous positive airway pressure) or an oral appliance
- Moderate apnea – CPAP or oral appliance
- Severe apnea – CPAP, appliances (in instance of CPAP failure), or surgery
CPAP involves wearing a mask tightly over the nose during sleep. Forced air through the mask creates a pneumatic splint, keeping the airway open and allowing a person to sleep normally. Common surgical procedures are UPPP (uvulopalatopharyngoplasty), LAUP (laser-assisted uvulectomy), somnoplasty (radio frequency surgery), or orthognathic procedures.
Dental treatment: the new frontier
Sleep disorder therapy is no longer an ill-served adjunct of the medical GP. Dentists are at the forefront of a new technological treatment wave, and rightfully so. Numerous appliances are now available and viable for treating snoring and OSA, with many more to come.
Research has shown that sleep appliances are very effective and can now be considered a viable treatment alternative for snoring and mild to moderate OSA. Relatively inexpensive, noninvasive, easy to fabricate, and well accepted, they are ideal for patients who cannot tolerate a CPAP or are unwilling (or unable) to endure surgery.
Sleep appliances can deliver CPAP intraorally. They can reposition the soft palate, bring the tongue forward, or lift the hyoid bone. As they reposition, they may also act to stabilize the tissues, preventing airway collapse. Appliances seem to increase muscle tone. They can be used singly or in conjunction with CPAP or surgery to provide the desired result. The variety of sleep appliances available ensures that the needs of every individual can be met.
A final, yet key consideration
Sleep appliance therapy is a golden opportunity for you to 1) help your patients, 2) embrace new technology and techniques, and 3) GROW YOUR PRACTICE. Treating just one patient per month can add as much as $60,000 to your gross annual income. Treat one per month and the rest will come.
Dr. Rob Veis is CEO of the Applicance Therapy Group® (ATG). Reach him through www.appliancetherapy.com or by calling (800) 423-3270.
