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How do I choose a dentist to treat my snoring and sleep apnea? How do I know they are qualified?

Obstructive sleep apnea is a serious medical problem that can impact your health and well-being. A dentist qualified to treat obstructive sleep apnea with oral appliances should have a strong background in sleep medicine and oral appliance therapy. He or she should have experience with many different oral appliance designs and have strong professional relationships with medical doctors involved in treating snoring and obstructive sleep apnea.

The Dentists in the PDSM Network have been actively treating patients in the tri-state area for many years and receive referrals from sleep centers, physicians and dentists on a regular basis. They are Board-Certified in dental sleep medicine and their offices are Nationally Accredited in dental sleep medicine. Each is a member of the American Academy of Dental Sleep Medicine.

Is snoring and sleep apnea really a problem? Do I really need treatment?

Sleep-disordered breathing (snoring and obstructive sleep apnea) is a very serious medical problem. Snoring and obstructive sleep apnea are caused by collapsing airway passages during sleep which may deprive the body of oxygen and disrupt sleep. Research has shown that untreated sleep apnea is associated with cardiovascular disease, diabetes, depression, decreased libido, excessive daytime sleepiness, automobile accidents, injuries in the workplace and diminished quality of life and social stigma. Both snoring and obstructive sleep apnea should be treated.

What about the cheap oral appliances I see advertised on TV or the Internet?

The cheap oral appliances available through TV advertising or the Internet may be somewhat effective for some people some of the time. However, more often than not, they are problematic for many reasons. Because they are not custom-made to fit you properly, they are typically big and bulky and not as comfortable as a custom-made appliance. In addition they typically do not stay on the teeth properly during sleep rendering them annoying and ineffective most of the time. They also lack the mechanical ability to move the lower jaw properly into the correct position to maximize effectiveness. Complicating all these problems is the fact that a properly trained dentist is not available to oversee and monitor the process. Most of the time a diagnostic sleep study has not been performed initially to actually assess the degree of the sleep apnea and a follow-up sleep study is not performed to objectively assess the effectiveness of the appliance. Furthermore, certain side effects are possible with any oral appliance therapy and a physician and properly trained dentist should always be part of the team managing snoring and obstructive sleep apnea. Several research papers bear this out.

Does sleep-disordered breathing affect children?

Unfortunately, sleep-disordered breathing affects children as well as adults. Obstructive sleep apnea in children is a serious disorder that may result in health problems as well as behavioral and academic problems.

Is snoring dangerous?

Yes, snoring can be dangerous. Snoring is the vibrational noise arising from the throat when breathing passages begin to collapse during the relaxing influence of sleep. Research has shown that snoring alone can result in sleep deprivation for the sleeper and the bed partner. Snoring is always a danger sign that breathing is not normal during sleep.

How can sleep apnea give rise to an increased risk of cardiovascular disease such as high blood pressure, heart attack and stroke?

During sleep apnea episodes, the breathing passages collapse completely preventing air from entering the body. When this happens, the oxygen levels in your blood fall significantly. This creates a panic response because your brain thinks you may suffocate and die. The panic response results in release of certain chemicals that create a rapid heartbeat, a spike in blood pressure and eventual arousal from sleep. Once breathing starts again the oxygen levels in the blood return to normal while the heart rate and blood pressure do as well. This often happens hundreds of times per night which places great stress on the cardiovascular system.

Doesn’t everyone have some degree of airway collapse during sleep?

Yes, the relaxing influence of sleep results in some degree of airway collapse in everyone. Generally, this does not happen to the extent where the breathing passages begin to vibrate (causing snoring) or collapse completely depriving the body of oxygen disrupting sleep. However, certain people have an exaggerated collapse of their breathing passages which can result in snoring and possibly obstructive sleep apnea. Risk factors can include an anatomically small airway due to large tonsils, a large tongue, a large uvula or skeletal issues such as the lower jaw that is set back. Sleep apnea is typically more prominent in males and can worsen with weight gain. Often times sleeping in the supine position (on your back) can make sleep apnea worse. Alcohol later in the evening can selectively relax the upper airway muscles and make snoring and apnea worse.

Is snoring normal?

Snoring is never normal. It is always a danger sign that breathing passages are collapsing during sleep which may deprive you of oxygen and healthy sleep.

What is the difference between snoring and obstructive sleep apnea?

Snoring is the vibrating noise that the upper airway makes when it is partially collapsed during sleep. It is the danger sign that something is wrong. Obstructive sleep apnea results when the upper airway is completely collapsed during sleep and no air at all can pass into your lungs even though your body is trying to breathe.

Can snoring be detrimental to the bed partner who has to listen to it all night?

Snoring is an obnoxious irritation to all sleepers within earshot of the snorer. Recent studies have shown that the bed partner’s mood, daytime alertness, quality of life and personal relationship with the snorer is improved when the snoring is resolved.

Can snoring make me feel tired during the day even though I don’t have any sleep apnea?

Yes, snoring alone can disrupt your sleep resulting in sleepiness during the day. This happens when the muscles forming the breathing passages relax during sleep causing partial collapse of the upper airway. This partial collapse causes loud vibration (snoring) and a reduced volume of air entering the body. The noise from the vibration and the diminished oxygen intake can disrupt sleep to the extent that you do not feel refreshed the next day. When this happens, it is termed “upper airway resistance syndrome” or UARS.

How can sleep apnea cause increased risk for depression or diabetes?

During sleep apnea episodes, the breathing passages collapse resulting in inadequate oxygen intake to the body. Because of this, sleep is disrupted throughout the night and many times “deep sleep” is absent. Deep sleep is very important to health and well-being because it is during this stage of sleep that numerous hormones are secreted responsible for regulation of mood and blood sugar. Appetite and sex drive can also be adversely affected by the absence of deep sleep for the same reason.

Are oral appliances effective in treating snoring and sleep apnea?

Oral appliances have been used to treat snoring and sleep apnea for over 30 years. Hundreds of research studies have shown that oral appliances can be effective in many cases. Choosing a well-educated, experienced dentist who utilizes quality oral appliances can maximize the effectiveness of your therapy. Oral appliances work best for mild and moderate sleep apnea cases but also work many times for severe sleep apnea.

How do I know which oral appliance is best for me?

Presently, there are well over 150 different oral appliance designs available to treat snoring and obstructive sleep apnea. The associate dentists at Pittsburgh Dental Sleep Medicine are well-versed in oral appliance design and have, over the years, become familiar with those appliances that work best for most people. The severity of your sleep apnea, the condition of your dentition and jaw joint among other factors will determine the appliance best for you.

Will it be easy for me to get used to wearing an oral appliance during sleep? When can I expect to see results?

The vast majority of people accommodate quite well to the oral appliance within the first few days or a week. Some people actually see positive results (decreased snoring and more refreshing sleep) within the first week. Most other people will see results in the next few weeks as the appliance is adjusted to become more effective.

Will oral appliance therapy move my teeth, change my bite or hurt my jaw joint?

20 years of published research shows that while very minor tooth movement and bite changes can occur, they typically are not problematic over time. In rare instances, teeth can move and your bite may change significantly. Therefore, it is necessary to choose an experienced sleep-disorders dentist with the knowledge and experience to recognize and manage these side effects. The research has also shown that harm to the jaw joint typically does not occur. If jaw joint tenderness does occur, discontinuing use of the appliance in most cases will reverse the symptoms.

Will my insurance cover the cost of oral appliance therapy?

Most insurance plans will cover the vast majority of the cost of oral appliance therapy if rendered by a qualified dentist and appropriate protocol is followed. Pittsburgh Dental Sleep Medicine has many years of experience with insurance processing and can maximize your insurance benefits.

Is treatment covered by my dental insurance or medical insurance?

Since obstructive sleep apnea is a medical condition, treatment is covered by your medical insurance. Pittsburgh Dental Sleep Medicine dentists are in-network with most medical insurance plans.

Can I use my dental insurance to cover the cost or an oral appliance?

No, since obstructive sleep apnea is a medical condition it is covered by medical insurance not dental insurance.

Does medical insurance cover the cost of an oral appliance?

Yes, in most all cases medical insurance will cover most of the cost of your appliance. Your out of pocket payment would include any deductible, coinsurance or copays your plan may require for treatment. We will explain your benefits to you and any out of pocket costs you may have before we begin treatment.
Oral appliance therapy is now a widely accepted treatment for obstructive sleep apnea. There are very few medical insurance companies that do not cover this treatment.
We are an in-network provider with most all insurance companies. Some of the insurance companies we have contracts with are Blue Cross Blue Shield, UPMC Health Plan, United Health Care, Aetna, Cigna, TriCare, Medicare and Medicare Advantage Plans. We work closely with many other insurance companies so that you receive the highest level benefits for treatment reducing your out of pocket costs.

What will my out of pocket costs be?

Your out of pocket costs will vary depending on your specific insurance plan. Out of pocket costs are your deductible, coinsurance and copays. We will check your benefits for you and will find out what your deductible is and if you have met any of it for the year. We will also check to see what your coinsurance is (it is a percentage). Depending on your insurance plan your plan may pay anywhere from 100%, 90%, 80% or 50% of their allowed amount for treatment. Some plans will require a copay (the amount that you pay for specialist office visits).
Our highly trained staff will work with you to maximize your medical insurance benefits.

Does my medical insurance cover oral appliances for snoring only?

No, medical insurance will only pay for an oral appliance if you have been diagnosed with obstructive sleep apnea. A diagnosis of sleep apnea is made by a physician after reviewing the results of your sleep test.

Do I need a referral from my physician?

We will need to obtain an order for the oral appliance from your physician. We will work closely with your physician to get the appropriate medical documentation required by your insurance company.

Does Medicare cover oral appliance therapy?

Yes, Medicare does cover treatment and we must meet all Medicare medical documentation requirements before we can begin treatment. Our highly trained staff will work with you and your physician to make sure we have all the proper medical documentation.

How do I get a sleep test?

You will need to see a physician. Any physician (MD or DO) can order a sleep test for you.
The results will be sent to your physician. Most insurance companies will allow you to receive an oral appliance as a first line treatment for mild to moderate sleep apnea. This means that you do not need to try a CPAP or BiPAP mask and machine first. If you are diagnosed with severe sleep apnea, most insurance companies will require that you try CPAP first. If you cannot tolerate CPAP or BiPAP, or are claustrophobic to using a face mask you will be able to be treated with an oral appliance.

What if I do not want to go to a sleep lab for a sleep test?

No problem! Most insurance companies now pay for a home sleep test. This is a simple testing machine that you can use to diagnose sleep apnea while sleeping in your own bed!

I have full dentures. Can I have an oral appliance?

In most instances, no. Ideally, many healthy, strong teeth are needed to support the appliance. Occasionally, an appliance can be made to rests solely on gum tissue but odds of success are relatively low. Sometimes a “tongue retaining device” can be made that attaches directly to your tongue rather than your teeth, but these devices are generally uncomfortable and not well accepted.

My dentist told me I need extensive dental work. Can I still get an oral appliance?

If you need extensive dental work such as crowns and or bridges we would want you to complete your dental work before we could begin oral appliance therapy.

Do I have to try CPAP or BiPAP before my insurance plan will pay for treatment?

Some insurance plans require that you try CPAP or BiPAP treatment first before they will pay for an oral appliance. Medicare and some other plans DO NOT have this requirement. Our staff will check your insurance plan for you to see if they require that you try CPAP or BiPAP before you make an appointment with us.

I use my CPAP machine most nights at home but I would like to have an oral appliance for when I travel. Will my medical insurance cover an oral appliance for travel so I don’t have to take my CPAP machine with me?

Unfortunately, if you are successfully using your CPAP or BiPAP machine your medical insurance will not cover an oral appliance for travel. If you want an oral appliance just for travel you would have to pay for it yourself.

I have used CPAP for a while but I cannot stand to use it any more. Can I get an oral appliance and will my insurance pay for it if they already paid for a CPAP machine?

Yes. We will need to get documentation from your physician that you are not tolerating or have discontinued using CPAP or BiPAP and a signed order from your physician before we can provide you with an oral appliance for sleep apnea. If Medicare has paid for your machine in the last five years, they will not pay for an oral appliance.