Comprehensive Sleep Apnea & Snoring Frequently Asked Questions

Is it dangerous to snore?

We’re used to thinking of snoring as a problem that primarily affects the frustrated bed-partners of snorers rather than snorers themselves. But snoring can indicate serious medical problems that can result in illness and even death if not properly treated.

The National Sleep Foundation found that about one third of U.S. working adults report snoring at least a few nights each month. Snoring generally worsens with age so the rate increases among the elderly. Contrary to common perceptions, it’s nearly as common in women as men. Menopause and being overweight are important factors. Yet many who regularly snore don’t realize that it could be bad for their health.

According to the scientific literature, snorers experience

  • A higher incidence of stroke and cardiovascular disorders;
  • A 40 percent greater risk than non-snorers of suffering from high blood pressure;
  • A 34 percent greater risk of having a heart attack; and
  • A 67 percent greater chance of having a stroke.

What causes snoring?

Sleep Apnea, a disruption of breathing while asleep is often the cause of loud snoring. The sleep and oxygen deprivation experienced by someone with sleep apnea can have a significant impact on their well-being. 50% of those with loud snoring suffer from sleep apnea and should be checked and treated. Snoring occurs because of an obstruction or a narrowing of the airway. The more the airway narrows or is blocked, the harder the body has to work to push air out, putting increased pressure on the heart. Over time, this increased pressure on the heart will have a detrimental effect on the heart muscle, leading to conditions such as high blood pressure, heart attack or stroke.

The research linking hypertension, heart problems and loud snoring is relatively new and awareness of sleep apnea is growing. But it is a condition that remains vastly undertreated.

What is obstructive sleep apnea?

Obstructive sleep apnea syndrome (OSAS) is a debilitating sleep and breathing disorder defined as the cessation of breathing for 10 seconds or more (an apnea) at least 5 times per hour of sleep. During sleep, the body’s muscles relax, which can cause excess tissue to collapse into the upper airway (back of the mouth, nose, and throat) and block breathing. Obstruction of the upper airways can be due to several factors. A septal deviation in the nose can be a cause of apnea as can redundancy of the soft palate, tongue enlargement, or an obese neck. It is important for the snoring patient to be examined by an otolaryngologist to determine which part the upper airways is compromised. Fortunately there are simple procedures that can successfully address each of these issues.

When breathing is interrupted by an obstruction in the airway, the body reacts by waking enough to start breathing again. These arousals may occur hundreds of times each night but do not fully awaken the patient, who remains unaware of the loud snoring, choking and gasping for air that are typically associated with obstructive sleep apnea.

Obstructive sleep apnea sufferers never get “a good night’s sleep” because repeated apneas and arousals deprive patients of REM and deep-stage sleep, leading to chronic daytime exhaustion and long-term cardiovascular stress.

What’s the difference between mild, moderate and severe Sleep Apnea?

Mild Sleep Apnea = AHI between 5 and 15
Moderate Sleep Apnea = AHI between 15 and 30
Severe Sleep Apnea = AHI > 30

Is it possible that I snore and don’t have apnea?

Yes. Sleep disordered breathing is a full spectrum of breathing disorders. After normal breathing, there are two classes of “primary” snorers. The first, Non-Sleepy Snorers, snore but do not suffer any ill-effects health wise. The second group, Sleepy Snorers, suffer fatigue and/or excessive daytime sleepiness without the cardiovascular damage caused by apnea.

Is it possible that I have apnea even though I don’t snore?

Yes. That is the reason why a late night TV infomercial or dentist who merely dispenses a “snoring appliance” without follow-up and testing is doing a potentially dangerous and life-threatening disservice to the snoring patient. Recent studies have confirmed that up to 25% of patients that have successfully stopped snoring using an oral appliance still experience obstructive apnea events at dangerous levels. Follow-up testing and adjustments are mandatory in order to achieve long-term success and to decrease the health risks and excessive daytime sleepiness that accompany Obstructive Sleep Apnea.

Who gets sleep apnea?

Sleep apnea occurs in all age groups and both sexes but is more common in men (it may be under diagnosed in women) and people over 40 years of age. People most likely to have or develop sleep apnea include those who snore loudly and also are overweight, have high blood pressure, or have some physical abnormality of the nose, throat, or other parts of the upper airway.

Can sleep apnea be cured or will it go away?

In some individuals, sleep apnea is reversible. Treatments such as weight loss or surgery may correct the problem. However, for most people, sleep apnea will always be present and require treatment. Generally, a CPAP, oral appliance, or positional device will need to be used every night to get the quality sleep your body needs and to prevent the serious complications of sleep apnea.

What happens to my body when I have an apnea?

An apnea in the simplest terms is when you stop breathing. Your body responds to an apnea in several ways. The lack of air flow causes the oxygen levels in your blood to drop. As a result, your pulse rate increases trying to get more oxygenated blood to your body. Your brain will rouse itself so that your body adjusts and re-opens your airway. This awakening keeps your body from reaching the deeper restorative parts of sleep.

This can leave you with a weakened immune system and many other serious health complications. It also can cause a hormone imbalance as sleep deprivation causes the release of stress hormones like cortisol, which can harm your body.

What are the health implications of obstructive sleep apnea?

Obstructive sleep apnea has a profound impact on an individual’s health. Excessive daytime sleepiness caused by disruption of normal sleep patterns leads to a significant increase in the rate of accidents for obstructive sleep apnea patients, including a sevenfold increase in automobile accidents. Over the long term, obstructive sleep apnea is associated with greater risk of hypertension and cardiovascular disease and the National Commission on Sleep Disorders Research estimates that 38,000 cardiovascular deaths due to sleep apnea occur each year.

In addition, loud snoring and intermittent breathing interruptions can affect the quality of sleep of the apnea patient’s bed partner. Witnessing an apnea can be a frightening experience because the apnea patient appears to be suffocating. Frequently, it is the sleep-deprived bed partner who convinces the patient to seek medical help.

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Who suffers from obstructive sleep apnea?

Well over 30 million Americans, including 24% of adult men and 9% percent of adult women, are estimated to have some degree of obstructive sleep apnea. Of these, 6 million are estimated to have cases severe enough to warrant immediate therapeutic intervention. However, obstructive sleep apnea was not well understood or recognized by primary care physicians until recently, and only a fraction of these 30 million obstructive sleep apnea patients have been diagnosed and treated by a physician.

While obstructive sleep apnea is commonly associated with obesity and male gender, it affects a broad cross-section of the population. Other risk factors result in habitual snoring, which is often a precursor of more serious upper airway disorders such as obstructive sleep apnea. In fact, results from a recent study indicate that 1 in 3 men and nearly 1 in 5 women who snore habitually suffer from some degree of obstructive sleep apnea.

What types of testing is available?

Patients can get tested for sleep apnea in a hospital setting or in the comfort and privacy of their home.

How much does sleep apnea testing cost?

Sleep Studies are always covered by insurance companies but co-pay and deductibles apply. Average yearly deductibles for diagnostics can be anywhere between $1000-5000. A hospital Sleep Study can cost as much as $2000 to you whereas a Home Sleep Test will not cost you more than $350.

Do I need to have an overnight study in the sleep lab?

Yes. The purpose of the sleep study (Home Sleep Testing or In-Clinic Sleep Study) is to eliminate any other neurological problems that may be coexisting with the obstructive sleep apnea and to assess the severity of your sleep apnea.

What is a polysomnogram?

A polysomnogram is a sleep test usually conducted at a sleep center or hospital. A polysomnogram measures: brain waves, eye movement, chin muscle tone, heart rate, leg movements, breath, breathing effort, oxygen level as well as audio and video of the room. During the test, sensors are placed on parts of the body, and these gather measurements. Polysomnograms are used to help diagnose several disorders such as hypersomnia, insomnia, narcolepsy and obstructive sleep apnea. Your doctor will be able to tell you whether a polysomnogram is appropriate for you.

If you do get a polysomnogram, do not take any sleeping pills, alcohol or caffeinated beverages before the test because they will throw off the accuracy of the polysomnogram. When you start the polysomnogram many sensors will be placed over parts of the body to gather the necessary measurements. Most people are able to sleep with the sensors on because they’re small and unobtrusive. The testing area is typically set up as like a bedroom, so patients can feel comfortable.

What is AHI?

AHI stands for Apnea-Hypopnea Index and it measures how many times breathing is disrupted. AHI can sometimes be misleading because disruptive sleep may appear in the form of increased blood pressure, rather than stopped breathing. Although it is not a definitive measurement, it can be a good indication that treatment is needed. An AHI measurement of less than 10 can be considered normal. Measurements between 10-20are in a “gray area” in which it might indicate a sleep disorder. AHI measurements of over 20 usually indicate some type of sleep disorder.

What is OAT, Oral Appliance Therapy?

OAT is a plan that treats snoring and Obstructive Sleep Apnea using a dental appliance that opens the airway during sleep. This opening is accomplished by a variety of means in which the lower jaw is protruded in much that same way that jaw is manipulated into position in Rescue Breathing for CPR (Cardio-Pulmonary Resuscitation).

How long have oral appliances been used to treat OSA?

In 1995, the American Academy of Sleep Medicine (ASM) issued a position paper stating that oral appliances were the second line of treatment for CPAP non-compliance patients. In February 2006, however, the ASM published a position paper stating that oral appliances are now the gold standard for mild to moderate cases of Obstructive Sleep Apnea and should be used prior to opting for a surgical procedure for severe Obstructive Sleep Apnea.

How does the oral appliance work?

Oral appliances are worn in the mouth to treat snoring and OSA. These devices are similar to orthodontic retainers or sports mouth guards. Oral Appliance Therapy involves the selection, design, fitting and use of a custom designed oral appliance that is worn during sleep. This appliance then attempts to maintain an opened, unobstructed airway in the throat. Repositioning the lower jaw, tongue, soft palate and uvula. Stabilizing the lower jaw and tongue.

Will this oral device help my snoring?

Oral devices have been used since the early 1980’s for patients with snoring. The initial device will reduce the amount of snoring to a point that it is tolerable for the bed partner and hopefully will eliminate snoring completely.

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How do I know that the oral appliance will benefit me?

Our Oral and Maxillofacial Surgeon will evaluate you to determine whether or not the jaw position change will be beneficial. If sufficient improvement in the airway is not possible, then the patient will not be deemed a candidate for oral appliance therapy at this time. Our sleep disorder doctor has a 95% chance of obtaining success using oral appliance therapy.

Why hasn’t my sleep physician and PCP ever mentioned OAT as a treatment choice?

The average Medical School in the United States spends exactly 4 hours teaching their future graduates about sleep—the one part of the human existence that takes up (or should take up) one-third of our life. There isn’t enough time in a 4-year medical curriculum to cover everything in depth—that’s why residencies, specialty training and continuing education exist.

If you did broach the subject of an oral appliance with your physician, did he/she merely pass it off? Was there a consideration that surgical options are laden with risks (and only about 40% effective) or that you’re not sleeping anyway because you can’t use the CPAP? The CPAP is, will be, and always has been the “gold standard” in sleep medicine because it works 100% of the time–but only in 25% or so of the population that needs it–so it is hardly “gold standard-worthy” in the eyes of many. If one can’t use a CPAP and surgical procedures don’t work–what other choice does one have? OAT can be the answer delivered by our experienced oral and maxillofacial surgeon.

What’s the general consensus among physicians regarding the effectiveness of OAT?

It’s unusual in 2012– nine years after the American Academy of Sleep Medicine granted acceptance to oral appliance therapy for OSA treatment, especially in cases where the CPAP is not tolerated– for a doctor to report that oral appliances don’t work for significant apnea. The majority of my patients have confirmed up to half of all apnea sufferers can’t tolerate a CPAP. To add to the dilemma, half of all those who can tolerate it, can’t where it all night!

The rest of our patients are post-surgical patients (only 40% or so of surgical procedures are effective) that still can’t breathe at night, or those who can’t put up with the hassles, stigma, or claustrophobia that accompanies the use of a CPAP in bed every night.

Are there patients for whom Oral Appliance Therapy does not work?

Oral appliance therapy (OAT) is not 100% effective–especially in those patients who have severe sleep apnea, but the results in my practice don’t support a total disregard of the therapeutic option. My most severe and successfully treated patient had an RDI (Respiratory Disturbance Index–a rough correlation of the number of times one stops breathing or breathing is interrupted each hour) of 60.

Do I need to see my PCP first?

The diagnosis of primary snoring or OSA (obstructive sleep apnea) is made by a Sleep Medicine Physician after reviewing an overnight diagnostic sleep study. Once a diagnosis is established, the patient will review the recommendations for treatment with their PCP in consultation with the Sleep Physician. If an Oral Appliance is deemed appropriate, the PCP should refer you to our office, ORA Oral Surgery, Sleep Disorder & Implant Studio so that dr. Steven Koos D.D.S., M.D. can initiate appliance therapy.

How do I start the OAT process?

Once the diagnosis is confirmed, the patient can contact our office to initiate therapy. Dr. Koos’ office will set up a consultation with you to review the process of OAT and provide a set of sleep related questionnaires to be completed online. Your first appointment with Dr. Koos will include a detailed consultation and oral evaluation to determine suitability for OAT.

How will I know if my appliance is working?

The initial goals of OAT are a substantial (70%) reduction in snoring and comfort of the TMJs (“jaw joints”). Your bed partner will notice less noise and, hopefully, fewer gasping apneic events. You will begin to have more energy, to feel more rested in the morning and to have a clearer mind. The myriad of medical issues that are caused by sleep apnea will slowly start to improve. For example, mood may improve, depression may decrease, blood pressure will begin to fall and you will notice fewer headaches in the morning.

Does my insurance cover treatment?

It depends on the type of insurance you have. If you have an HMO, you are required to get clearance from your primary care physician for initial evaluation, referral to the sleep lab for the diagnosis, and referral to our oral surgeon for the oral appliance. If you have a PPO or Traditional insurance, it will depend on the policy coverage.

How much does the treatment cost?

The total cost of treatment will depend on the course of treatment, whether or not you have insurance, and what type of insurance coverage you have.

Does Medicare cover the treatment?

Yes, but it is a different process than other insurance; however, oral appliance therapy does tend to be covered.

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How long does the treatment take?

From the first time that the patient receives the diagnosis of Obstructive Sleep Apnea and sees the oral surgeon, the length of treatment is three to six weeks depending on the availability of the patient for appointments.

Will I be required to return to the same office for follow-up care?

The patient is encouraged to return to our oral surgery office on a six month basis for the first year and then yearly after that to determine the efficacy of the appliance.

I have full upper and lower dentures, can I still have an oral appliance?

Yes. Duplication of the upper and lower dentures can be completed in the dental office and the oral appliance is fitted directly to the duplicated dentures. An oral appliance can also be made that replaces the dentures at night, which is a much better solution.

I haven’t had dental care in awhile. Must that be taken care of beforehand?

A provisional or transitional appliance can be fabricated prior to dental treatment being completed. This will allow the patient to have the oral appliance throughout any subsequent dental care.

Is there an extra fee for the provisional appliance?

Provisional appliances are usually in the $400 to $800 range and can be fabricated in one office visit.

If I am claustrophobic, can I still have an oral appliance?

There are many appliances that deal with patients who have claustrophobia to allow for adequate tongue movement to ensure that the condition is not a problem.

I have a latex allergy, can I have an oral appliance?

Yes. Most appliances are either vinyl or acrylic and will not cause any allergic reaction.

I am presently taking medication for reflux. Will OAT help or reduce my usage?

There is sufficient literature to show the high percentage of reflux is directly related to Sleep Apnea. Successful treatment may lead to reduced usage of the medication.

I am presently taking medication for hypertension. Will OAT help or reduce my usage?

Your blood pressure may be monitored at your appointments in this dental surgery office. You will be referred back to your cardiologist (or other specialist whose care you are under) to determine if there is a need to reduce or eliminate the hypertensive medication.

Are there any long-term problems with the use of an oral appliance?

Yes. Oral appliances that are not fabricated correctly can cause gum disease, space between teeth and/or change in the biting surface of the teeth. However, if the appliance is fabricated by an experienced oral surgeon, following accepted protocol, this will be kept to a minimum if not totally eliminated.

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What are the side effects of use of an oral appliance?

Initially, there will be an increase in saliva, which will normally cease in one to two weeks. The patient may also experience some sore teeth until the appliance is adjusted properly. If any jaw pain results upon wakening, the patient is instructed to return to the dental office immediately.

How often will my appliance have to be remade, and will my insurance cover it?

If patients frequently have extensive dental work done which will require the oral appliance to be remade. However, sometimes we can get a pre-determination from the patient’s insurance carrier explaining the reason for the re-fabrication of the appliance. In some instances, the medical insurance carrier will replace oral appliances on a three-to-five year basis with an explanation as to the reason for replacement.

Does my dental insurance cover any of this treatment?

No. All of these fees will be submitted under your medical insurance. Any deductibles that are required by the medical insurance company must be satisfied. Your full payment will be due prior to the onset of making your oral appliance and if your medical insurance covers the claim, you will be reimbursed by our office at that time, less your deductible.

Does Medicare cover OAT?

Medicare has recently (2008) accepted OAT as an acceptable and reimbursable therapeutic option for patients who suffer from OSA. However, it is especially difficult because they act as a secondary to so many companies. My office is a non-participating provider for Medicare, so co-pays apply, are generally paid by secondary/Gap insurance plans or by the patient as an out-of-pocket expense.

How many appointments will it take to complete OAT?

OAT is a course of therapy, not an appliance. There are multiple appointments necessary to assure fit and function of the appropriate appliance chosen for the patient’s specific needs, to adjust the appliance to the proper setting and to evaluate progress.

What are the side effects of OAT?

There are few permanent side effects, but several temporary ones. The most common long-term side effect is a change in the bite. Though minor, and often not a functional problem, it can be annoying. The most common complaint is that the teeth shift slightly and create a spot for food to impact or get stuck between.

Another common side effect is jaw discomfort in the morning. Similar to the stiffness one might experience in the knees/hips when trying to stand up after a long movie, the jaw is not permitted to return to its fully seated position in the socket. Some muscle stiffness is common in the morning. Most patients report that the symptoms dissipate within several hours or so. This is a small price to pay for being able to sleep soundly and silently all night long and to minimize the health risks of apnea. Other minor considerations include dryness of the lips and mouth, irritation of the cheeks/gums, and, though exceedingly rare, allergic reaction to the materials in the appliance.

Will my jaw feel sore?

Initially it may but with gradual adjustments it will resolve.

Will I salivate at night?

In the beginning this may occur but will improve when the patient becomes more accustomed to the appliance.

Will I be able to make my own adjustments?

Yes. You will be able to make adjustments to the appliance after the first few office visits.

Will I have permanent bite changes?

If you use the exercise bite tabs every morning after using the appliance you will reduce the risk.

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How do I clean the appliance?

Use a regular toothbrush and cool water with antibacterial soap.

What is CPAP?

CPAP (continuous positive airway pressure) is a type of therapy used to effectively treat obstructive sleep apnea in which an air compressor forces air through the nose and airway.

CPAP treatment consists of three parts: the CPAP compressor, tubing and a special CPAP mask or cannula. The CPAP Machine is essentially a quiet air compressor that continually forces air thorough the tubing to the mask or cannula (cannulas are small tubes that fit within the nose). The continuous air pressure forces the airway to remain open, which allows for normal breathing for the entire night. Difference between Bi-level and Auto CPAP machines: Bi-level CPAP machines have two different settings, one for inhalation and one for exhalation. Auto CPAP machines automatically adjust to the resistance a patient’s breath gives and provides the appropriate amount of pressure. While Bi-level CPAP machines will work without problems, Auto CPAP machines provide maximum comfort.

What is an AutoPAP?

An AutoPAP uses an internal regulator that adjusts pressure rather than remaining at one fixed setting. These machines are able to offer lower pressures and increase the pressure when they “sense” an event.

What is a Bi-level/BiPAP Machine?

A Bi-level, also known as a BiPAP, switches from higher to lower air pressure during the exhalation, making breathing easier for some. Often insurance companies require you to “fail” using CPAP before paying for this machine as it is more expensive. People that need higher pressure often benefit from bilevels since the pressure can be adjusted at a wider range.

What type of mask should I use?

There are three types of CPAP headgear: full-face masks, nasal masks and nasal pillows. Full-face masks cover both the nose and face. For patients who breathe through their mouths or have sensitive nasal passages, a full-face is the best solution. The disadvantages of full-face masks are that they are bulky and it can be difficult to find a good fit that doesn’t leak air. Nasal masks are similar to full-face masks, but only cover the nose. Because nasal masks only cover the nose, they are less bulky than full-face masks. The disadvantages of nasal masks are that they don’t cover the mouth and that some people feel uncomfortable having their nose covered. For patients who feel claustrophobic with masks, nasal pillows are ideal. Nasal pillows are small tubes that fit within the nose and have connectors on the ends, so they fit securely within the nose. Of the three mask options, nasal pillows have the least amount of bulk and work well with heated humidifiers. Nasal pillows are not recommended for people with sensitive nasal passages because the pillows can be irritating. This problem, for some, can be solved with a moisturizer or lubricant, like KY Jelly.

Which type of mask you use depends on your individual needs. If you breathe through your mouth, you will most likely want a full-face mask. If the bulkiness of the mask is uncomfortable for you, nasal pillows might be appropriate.

Can you give me some tips about using my CPAP machine?

Adjusting to the CPAP machine in the first month can be difficult. Proper use of the CPAP machine can go a long way to eliminating uncomfortable side effect. The Sleep Foundation reports that most problems with CPAP are mask related. Often CPAP masks are too tight or loose. If the CPAP mask is too tight, you will feel uncomfortable. If the mask is too loose, continuous pressure isn’t being applied and the treatment is not working. For the proper fitting of the mask, adjust the headstrap and pads until they fit snugly, but not uncomfortably. You may also have to buy a smaller or larger CPAP mask if the adjustments aren’t enough. Another mask-related problem is that you might start feeling claustrophobic wearing the CPAP mask. The Sleep Foundation recommends to try and wear the CPAP mask while doing a task that requires attention, such as reading or watching TV, for short periods of time. By wearing the CPAP mask for short periods of time, patients get accustomed to wearing the mask.

Probably the second-most common side effect of CPAP treatment is the dry or congested nasal passages. There are several solutions to this problem. One solution is to use a CPAP machine that has a CPAP Heated Humidifier. The heated humidifier, with the help of the CPAP machine, blows wet, warm air through the nasal passages, which helps keep them moist and comfortable. Another solution offered by Metrohealth is to purchase a saline nasal solution, which is essentially a mixture of salt and water. Saline nasal solution can be purchased for a low price at a local drug store. A final option would be to use a nasal decongestant, although you will want to consult with a physician before taking a decongestant for an extended period of time.

The third most common problem with CPAP machines is adjusting to the continuous pressure. The Hopedale Medical Complex recommends using the CPAP’s machine “ramp” setting. The “ramp” setting allows users start out with very little pressure with the machine gradually increasing it until the optimal pressure level is achieved. Consult with your physician about what ramp setting is right for you. The method of adjusting the ramp setting varies between CPAP machines; consult the owner’s manual or manufacturer for more information.

There are a few other things you can do to avoid CPAP problems. The most important thing is to clean the tubing, headgear and mask regularly. Bacteria grows in the tubing over time, especially when used with a heated humidifier, which can cause respiratory problems. Unclean headgear and masks can also accumulate bacteria and cause infections. Another important tip is to stay consistent and committed to the CPAP treatment. If you don’t stay consistent with treatment, it will be more difficult to continue because you have not gotten accustomed to mask and continuous pressure. Finally, if you still have trouble, consult your physician and get help from CPAP support forums, such as Apneasupport.org or CPAP Talk.

Is my CPAP machine covered by my insurance company or Medicare/Medicaid?

CPAP Machine coverage varies by plan, but many insurance companies do cover the cost of the machine and necessary parts such as CPAP masks and tubing. Usually the insurance companies will require some proof of need, so it may be necessary to take a polysomnogram or some other sleep test to determine whether you have a sleep disorder. Resmed, a CPAP machine manufacturer, states that Medicare requires an AHI of 15 or more per hour. A patient may also qualify with an AHI of 5 if there is documented symptoms of excessive daytime sleepiness, impaired cognition, mood disorders, insomnia, hypertension, ischemic heart disease or history of stroke. For more information, consult your insurance/Medicare/Medicaid representative.

I have been told that I need a surgical procedure to correct my problem.

Prior to surgical procedures being done, the American Academy of Sleep Medicine recommends a trial period of usage of an oral appliance to see if the severity of the apnea can be reduced.

What is UPPP Surgery?

The most common surgery for sleep apnea is the uvulopalatopharyngoplasty, or UPPP procedure, which is intended to enlarge the airway by removing or shortening the uvula and removing the tonsils and adenoids, if present, as well as part of the soft palate or roof of the mouth. (The uvula is the tissue that hangs from the middle of the back of the roof of the mouth; the word comes from the Latin “uva” meaning “grapes.”) According to the “Practice Parameters for the Treatment of Obstructive Sleep Apnea: Surgical Modifications of the Upper Airway,” issued in 1996 by the American Academy of Sleep Medicine, the overall efficacy is 40.7%. A more recent surgery using a laser (laser-assisted uvulopalatoplasty or LAUP, a modification of the UPPP where the surgeon cuts the uvula with a laser) is performed for snoring. There is not yet enough information to say whether LAUP is effective for OSA.

What is the Pillar® Procedure?

The Pillar procedure is a solution for both snoring and mild to moderate sleep apnea originating from the soft palate. This breakthrough procedure is office-based, requiring only a local anesthetic or more commonly a conscious sedation. Four to five small, flexible implants are placed into the upper soft palate to add support during sleep. Within three months of implantation, the palate flutters less and snoring is improved.

Pillar implantation takes about twenty minutes to perform. This procedure is associated with minimal discomfort with most patients returning to work the following day.

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Why would a doctor put in up to five implants when most other doctors put in three?

The Pillar Procedure was originally performed with three implants and the majority of studies regarding its efficacy were carried out using three implants.

Based on personal experience over the years, better snoring control occurs for more patients with four to five implants. The width of the soft palate will determine whether four or five implants will be placed.

How much pain is expected and what is the recovery time?

Most patients will experience a sore throat for one to two days which is typically relieved with the use of throat lozenges and over the counter pain medications. The majority of patients return to work by the day after implantation.

When will I start to notice an improvement in snoring?

The majority of patients notice an effect within four to six weeks after implantation, although 10-20% will notice an immediate snoring reduction.

The natural tissue response to the implants will progressively support the soft palate over the 3-12 months after implantation to further minimize the sound of snoring.

Are the implants permanent?

Pillar® implants are made of a strong woven material that lasts a lifetime. Designed to be permanent, the implants are capable of being removed although there is rarely a reason to do so.

Is the Pillar Procedure covered by my insurance?

Procedures for the treatment of snoring, including the Pillar Procedure, are considered to be ‘cosmetic’ or ‘lifestyle related’ and are not covered by insurance.

Some insurance companies will cover the consultation visit for evaluation of snoring, since snoring can be a sign of sleep apnea a serious medical condition.

I have sleep apnea. Will the Pillar Procedure be covered by my insurance?

The Pillar® Procedure can be very successful in reducing mild to moderate sleep apnea arising from collapse of the soft palate. However, the policies of all the insurance companies our practice is contracted with specifically exclude the Pillar Procedure as a covered benefit for the treatment of sleep apnea.

Insurance companies see CPAP as the first-line treatment for sleep apnea. And in place of that, an oral appliance would be the next best option. If you wish to have the Pillar® Procedure as an alternative to an insurance covered benefit like CPAP for the treatment of your sleep apnea, please understand that our practice cannot bill your insurance company for the Pillar procedure, nor can we contact them to request authorization to perform the Pillar® procedure as a covered benefit.

What is Somnoplasty®?

Somnoplasty is an effective, minimally-invasive choice for the treatment of obstructive sleep apnea syndrome. Delivering radiofrequency energy submucosally to the base of tongue, Somnoplasty creates limited zones of coagulation beneath the tissue surface. As lesions resorb, they stiffen and reduce the tissue in the base of tongue. A study published for OSAS/UARS reported a 55% reduction in the mean respiratory disturbance index (RDI) from baseline for all subjects – with an overall mean reduction in tongue volume of 17%.

How effective is Somnoplasty in the treatment of obstructive sleep apnea?

Initial clinical results showed that Somnoplasty effectively treated obstructive sleep apnea by shrinking the base of tongue (the most difficult source of obstruction to treat) in moderately and severely affected patients. These results were presented at the Annual Meeting of the American Academy of Otolaryngology-Head and Neck Surgery Foundation in September 1998, with data. Sophisticated testing and analysis following treatment with Somnoplasty indicated that patients experienced an average of 17% and as much as a 35% reduction in tongue tissue volume, a range that is comparable to conventional surgical techniques.

Who is a candidate for Somnoplasty for obstructive sleep apnea?

All potential candidates should be evaluated by a physician to confirm the presence of obstructive sleep apnea (including an overnight sleep study) and identify the possible sites of airway obstruction.

What other conditions can be treated with Somnoplasty?

Somnoplasty has been cleared by the FDA for use in the treatment of 3 conditions: habitual snoring (soft palate and uvula), chronic nasal obstruction (enlarged inferior turbinates), and Obstructive Sleep Apnea. As of June 1999, more than 20,000 patients have been treated with Somnoplasty Procedures.

Is there a glossary of terms? I am not familiar with the medical and dental jargon.

Apnea

A cessation of breathing/airflow lasting greater than 10 seconds.

Apnea Hypopnea Index (AHI)

A measure of one’s severity of sleep apnea, as determined by the number of apneas plus hypopneas, on average, in an hour of sleep; <5 events /hour = ("normal"); 5-15 events/hour = (mild sleep apnea); 15-30 events/hour = (moderate sleep apnea); >30 events/hour = (severe sleep apnea).

Arousal

An interruption of sleep of a duration greater than 3 seconds.

ASV

Adaptive Servo Ventilation machines: essentially operates as would a bilevel machine, but with the added ability to adjust IPAP (inhalation pressure) upward very rapidly (within one breath) if the sleeper looks like they won’t reach the target volume or flow that the machine has been tracking.

Bilevel

This device regulates airway pressure at prescribed levels, alternating between inhalation (IPAP) and exhalation (EPAP) pressures. Usually, the inspiratory pressure is higher than the expiratory pressure. Bilevel therapy is helpful to those with sleep apnea combined with other respiratory conditions.

BiPAP

Philips Respironics trademark for its bilevel machine

Bruxism

Grinding of the teeth. Often associated with sleep apnea.

Central Sleep Apnea

Sleep Apnea characterized by episodes where there is no airflow and no effort to breathe lasting greater than 10 seconds. Different from an obstructive sleep apnea because the cause of the cessation of breathing is not a physical obstruction.

Cheyne-Stokes Respiration

A form of Central Sleep Apnea where one’s breath becomes progressively shorter and shallower, pauses completely, and then after a period starts the cycle over. Could be a sign of a problem with the heart.

Chinstraps

A chinstrap is worn to keep the mouth closed to prevent leak from the mouth.

Complex Sleep Apnea

When central sleep apneas are triggered by the application of positive airway pressure. Contrast with Mixed Sleep Apnea, Obstructive Sleep Apnea and Central Sleep Apnea.

CPAP

Continuous Positive Airway Pressure. Filtered room air is delivered to a mask that fits over the nose to prevent upper airway tissues from collapsing. The prescribed pressure acts as a splint to maintain the airway. This pressure is continuous during both inhalation and exhalation. CPAP is used to treat Obstructive Sleep Apnea (OSA) as well as Upper Airway Resistance Syndrome (UARS). CPAP is a corrective therapy that should be used on a nightly basis to be beneficial.

Desaturation

Drop in O2 oximetry distribution saturation by 3% below average saturation.

DME

Durable Medical Equipment provider, home health care provider or any other person or entity that sells CPAP supplies and equipment. Equipment is prescribed by a physician, and supplied by the DME. CPAP supplies can be rented on a month-to-month basis or purchased, depending on insurance requirements.

ENT

Ear Nose Throat physician

Epworth Sleepiness Scale

<10=(does not indicate EDS (Excessive Daytime Somnolence));10-15=(indicates daytime somnolence-not excessive);>16 (indicates EDS).

Filters

Filters attach to pressure devices to improve the quality of air inhaled. There are two types of filters available: reusable and disposable.

GERD

Gastroesophageal reflux disease

Humidifier for Breathing Device

Humidification is provided by passing air across a tray of water to prevent nasal dryness. There are two types of humidifiers: heated or non-heated. A humidifier can increase the comfort and tolerance while using a positive pressure device. Some insurance companies do not cover humidification.

Hypopnea

>50% decrease in airflow for 10 seconds or greater with a decrease in oxygen saturation of >3%.

Mask

There are several interfaces for positive pressure devices, most involving a mask with headgear, worn over the nose. A properly fitted mask creates a good seal around the nose, while maintaining comfort. Air leaking into the eyes should be avoided. The user’s mouth must be closed during therapy while using a nasal mask or pillows or a leak will occur.

Mixed Sleep Apnea

Sleep Apnea characterized by episodes of both central and obstructive apnea events (the centrals not being triggered by the CPAP therapy). Contrast with Central Sleep Apnea, Complex Sleep Apnea and Obstructive Sleep Apnea.

MMA

Maxillo-mandibular advancement, a type of surgery

Nasal Pillows

An alternative to the standard mask, small silicone “pillows” fit into the nostrils and deliver air directly to the nasal passages.

Nocturia

Frequent nighttime urination, often associated with untreated sleep apnea.

Non-supine

Sleeping in any position other than on the back.

Normal Sleep Architecture

Stage 1: 5%
Stage 2: 50%
Stage 3: 10%
Stage 4: 10%
Stage REM: 25%

NPSG

Nocturnal Polysomnogram, or sleep study.

OAT

Oral Appliance Therapy – custom oral jaw and tongue positioning devices which have proven to be remarkably effective at reducing and eliminating snoring and obstructive sleep apnea episodes.

Obstructive apnea

A respiratory episode where there is no airflow lasting greater than 10 seconds, and the cause of the airflow limitation is a physical obstruction.

Obstructive Sleep Apnea (OSA)

Obstructive Sleep Apnea is the partial or complete collapse of the upper airway which is caused by the relaxation of excessive tissue during sleep. This may result in frequent arousals associated with decreases in blood oxygen levels. This constant interruption of sleep results in a loss of restful, healthy sleep. This lack of sleep generally causes daytime sleepiness and poses a serious threat to physical health and mental well-being.

OMFS

Oral & Maxillofacial Surgeon, who is a doctor that specializes in problems with the mouth and face, including airway issues involved in the diagnosis and non-surgical and surgical treatment of sleep apnea.

Outgassing

Process by which plastic component parts of CPAP masks and other CPAP supplies give off a chemical odor after being manufactured until they have been exposed to the air for a sufficiently long period of time.

PLM arousal index

The number of periodic limb movements that cause arousals multiplied by the number of hours of sleep.

PLMs

Periodic limb movements.

Polysomnogram study (PSGS)

Sleep study consisting of a test of sleep cycles and stages through the use of continuous recordings of brain waves (EEG), electrical activity of muscles, eye movement (electrooculogram), breathing rate, blood pressure, blood oxygen saturation, and heart rhythm and direct observation of the person during sleep

Polysomnographic technologist

Technician, typically registered, who administers a sleep study.

PSGT

Polysomnographic technologist.

Rain out

Term for the condensation that can build up inside a CPAP hose when warm, humidified air flows through a CPAP tube exposed to cold air.

Ramp

A feature of most units, allows for a gradual increase of pressure as the user falls asleep. The ramp time is usually measured in 5-minute intervals, ranging between 5 and 45 minutes to reach prescribed pressure settings.

RDI

Respiratory Disturbance Index. An index used to assess the severity of sleep apnea based on the total number of complete cessations (apnea) and partial obstructions (hypopnea) of breathing occurring per hour of sleep. These pauses in breathing must last for 10 seconds and are associated with a decrease in oxygenation of the blood. In general, the RDI can be used to classify the severity of disease (mild 5-15, moderate 15-30, and severe greater than 30).

REM latency

Time it takes to achieve REM (dreaming) sleep from sleep onset.

REM Sleep

Short for Rapid Eye Movement sleep, which is the dreaming stage of sleep; Normally occurs every 60-90 minutes.

RERAs

Respiratory effort related arousals. Episodes that are not apneas or hypopneas, often related to loud snoring, that generally do not cause a decrease in oxygen saturation.

Respiratory Arousal Index (RAI)

(AHI + snoring related EEG arousals)/hour of sleep.

Respiratory Effort Related Arousals (RERAs)

Sleep Arousals due to respiratory events characterized by pressure flow limitations in the airflow indicator channel without significant O2 desaturations.

Respiratory related sleep fragmentation

Sleep arousals due to respiratory events or snoring.

RT

Respiratory therapist.

RRT

Registered respiratory therapist (i.e., a respiratory therapist who has passed a board exam for certification).

RPSGT

Registered polysomnographic technologist (i.e., a polysomnographic technologist who has passed a board exam for certification).

SaO2 scale

a measure of oxygen desaturation in the body brought about by sleep disordered breathing; >89%=(“normal”); 85-89%=(mild desaturation);80-84%=(moderate desaturation); <80% (severe desaturation).

Sleep Efficiency

Normal is >80%

Stage 1 Sleep

The lightest stage of sleep. Transitional stage from wake.

Stage 2 Sleep

The first true stage of sleep.

Stages 3/4 Sleep

The deepest, most restorative sleep; aka “Deep Sleep” — Deep Sleep, along with REM sleep, decrease as we age

Supine

Sleeping on back. Without positive airway pressure, often associated with more severe obstructed sleep apnea than sleeping on one’s side.

TMJ

Temporo-mandibular joint, quite often used to refer to a symptomatic problem with the joint or disease state.

Tracheostomy

A tracheostomy is a surgical procedure to create an opening through the neck into the trachea (windpipe). A tube is usually placed through this opening to provide an airway into the upper trachea. This tube is called a tracheostomy tube or trach tube. This airway bypasses the entire upper airway and therefore is 100% successful in curing sleep apnea.

UARS

Upper Airway Resistance Syndrome. UARS is a narrowing of the upper airway during sleep associated with frequent arousals due to difficulty breathing.

UPPP

Uvulopalatopharyngoplasty, a type of surgery

VPAP

Trade name for its bilevel machine.

XPAP

Generic term to refer to any positive airway pressure machine: CPAP, bilevel, etc.

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