Frequently Asked Questions

Sleep apnea is a serious sleep disorder where breathing repeatedly stops and starts during sleep. The most common type is obstructive sleep apnea (OSA), which occurs when throat muscles relax and block the airway.

Each pause in breathing can last from a few seconds to minutes and may occur 30 times or more per hour. These interruptions prevent you from reaching deep, restorative sleep stages.

Common symptoms include:

• Loud snoring (though not everyone who snores has sleep apnea)
• Gasping or choking during sleep
• Witnessed breathing pauses by a bed partner
• Excessive daytime sleepiness and fatigue
• Morning headaches
• Difficulty concentrating or memory problems
• Irritability or mood changes
• Frequent nighttime urination
• Dry mouth or sore throat upon waking
• Restless sleep or insomnia

Risk factors include:

• Excess weight: Obesity significantly increases risk
• Age: More common in older adults
• Gender: Men are 2-3 times more likely to have sleep apnea
• Neck circumference: Thicker necks may have narrower airways
• Family history: Genetic predisposition
• Nasal congestion: Difficulty breathing through the nose
• Smoking: Increases inflammation and fluid retention in airways
• Alcohol use: Relaxes throat muscles
• Medical conditions: High blood pressure, diabetes, heart disease

Untreated sleep apnea can lead to serious health complications:

• Cardiovascular problems: High blood pressure, heart attack, stroke, atrial fibrillation
• Type 2 diabetes: Increased insulin resistance
• Metabolic syndrome: Weight gain and metabolic dysfunction
• Liver problems: Fatty liver disease
• Cognitive decline: Memory loss, difficulty concentrating
• Depression and anxiety: Mood disorders
• Increased accident risk: Drowsy driving accidents
• Lower quality of life: Chronic fatigue affecting daily activities

No. While snoring is often a symptom of sleep apnea, not all snorers have sleep apnea.

Snoring is caused by vibration of relaxed throat tissues and may be harmless (primary snoring).

Sleep apnea involves actual pauses in breathing where the airway becomes blocked. However, loud, chronic snoring—especially with gasping or choking sounds—is a red flag for sleep apnea and should be evaluated.

Yes. Pediatric sleep apnea affects 1-4% of children, most commonly between ages 2-8. Common causes include enlarged tonsils and adenoids, obesity, or craniofacial abnormalities.

Signs in children include snoring, mouth breathing, bedwetting, poor school performance, hyperactivity, and behavioral problems. Early diagnosis and treatment are crucial for healthy development.

Sleep apnea is very common. An estimated 39 million U.S. adults have obstructive sleep apnea, though many cases remain undiagnosed.

Studies suggest that approximately 26% of adults aged 30-70 have some form of sleep apnea, with prevalence increasing with age and weight.

Weight loss can significantly improve sleep apnea symptoms and, in some cases, resolve it completely. A 10% reduction in body weight can lead to a 26% reduction in AHI (apnea-hypopnea index).

However, not all sleep apnea is caused by excess weight. Anatomical factors like jaw position, tongue size, and airway structure also play roles. Even thin individuals can have sleep apnea. Treatment is still recommended while pursuing weight loss.

The AHI is the number of apneas (complete breathing pauses) and hypopneas (partial breathing reductions) per hour of sleep. It's the primary measure used to diagnose and classify sleep apnea severity:

• Normal: AHI less than 5
• Mild OSA: AHI 5-14
• Moderate OSA: AHI 15-29
• Severe OSA: AHI 30 or higher

Yes, there is a genetic component. If you have a family member with sleep apnea, you're more likely to develop it. Hereditary factors include facial bone structure, tongue size, airway anatomy, and body fat distribution.

However, genetics alone don't determine sleep apnea—lifestyle factors like weight, smoking, and alcohol use also play significant roles.

Yes. Women often present with different symptoms than men. While men typically have loud snoring and witnessed apneas, women more often report:

• Insomnia or difficulty staying asleep
• Morning headaches
• Fatigue and depression
• Less obvious snoring

As a result, sleep apnea in women is often underdiagnosed. Post-menopausal women have increased risk as hormonal changes affect airway muscle tone.

Sleep apnea is diagnosed through a sleep study (polysomnography). There are two types:

1. In-Lab Sleep Study (Polysomnography): Overnight stay at a sleep center with comprehensive monitoring of brain waves, oxygen levels, heart rate, breathing, and body movements.
2. Home Sleep Apnea Test (HSAT): Portable device used at home to monitor breathing, oxygen levels, and heart rate. More convenient and cost-effective for diagnosing obstructive sleep apnea in patients without other medical conditions.

Yes, a physician's order is required for a sleep study. This can come from your primary care doctor, a sleep specialist, or another healthcare provider.

We work closely with referring physicians and can help coordinate the sleep study process, including working with your doctor to obtain the necessary referral.

Home Sleep Apnea Test (HSAT):

• Done in your own bed
• Fewer sensors (4-7 channels)
• Self-applied
• More convenient and less expensive
• Good for diagnosing moderate to severe OSA

In-Lab Polysomnography:

• Overnight stay at sleep center
• Comprehensive monitoring (20+ channels)
• Technician-supervised
• More expensive
• Detects all sleep disorders, not just OSA
• Required for complex cases or suspected central sleep apnea

Results typically take 3-10 business days:

• Home sleep tests: Usually 3-7 days
• In-lab studies: Typically 7-10 days

A board-certified sleep physician reviews the data and provides a detailed report with diagnosis and treatment recommendations.

For diagnosing obstructive sleep apnea in patients without other major medical conditions, home sleep tests are highly accurate and FDA-approved. They correctly identify OSA in about 90% of cases.

However, HSATs only measure breathing and oxygen levels—not brain activity or sleep stages. If your HSAT is negative but symptoms persist, an in-lab study may be recommended to rule out other sleep disorders.

The process is simple:

1. Pick up or receive the device by mail with detailed instructions
2. Before bed, attach sensors (finger probe for oxygen, nasal cannula for airflow, chest belt for breathing effort)
3. Sleep normally in your own bed
4. Remove sensors in the morning
5. Return the device to our office or by mail

Most people find the process comfortable and sleep reasonably well despite the sensors. See our HSAT guide for more details.

Yes, absolutely. You should sleep in whatever position is normal for you. The sleep study needs to capture your typical sleep patterns to provide an accurate diagnosis.

In fact, the study will track your sleeping position because some people have "positional sleep apnea" that occurs mainly when sleeping on their back.

Sleep studies typically require at least 4 hours of recorded sleep data for valid results. If you sleep poorly or don't get enough recorded data, you may need to repeat the test.

Home sleep tests have an advantage here since you're in your own comfortable environment. If the first night doesn't yield enough data, you can often repeat it the next night with the same device.

Generally, no. You should continue taking your regular medications unless specifically instructed otherwise by your doctor. The goal is to capture your typical sleep patterns.

However, avoid alcohol and caffeine on the day of your test, as these can significantly affect sleep quality and test accuracy.

Most medical insurance plans, including Medicare and Medicaid, cover sleep studies when medically necessary and ordered by a physician. Home sleep tests are generally well-covered as a cost-effective diagnostic tool.

We verify your insurance benefits before scheduling the test and provide you with an estimate of any out-of-pocket costs. See our Insurance Guide for detailed coverage information.

An oral appliance (also called a mandibular advancement device or MAD) is a custom-fitted device worn during sleep to treat obstructive sleep apnea and snoring. It resembles a sports mouthguard or orthodontic retainer.

The appliance works by gently repositioning the lower jaw forward, which opens the airway and prevents the tongue and soft tissues from collapsing and blocking breathing during sleep.

Oral appliances are highly effective, especially for mild to moderate sleep apnea:

• 70-80% of patients see clinically significant improvement in AHI
• 85-95% reduction in snoring
• 85% patient satisfaction and compliance rate
• Improvement in daytime sleepiness and quality of life

They're also effective for many patients with severe OSA who cannot tolerate CPAP. Success depends on proper fitting, adjustment, and consistent nightly use.

Good candidates include:

• Patients with mild to moderate OSA
• Those who cannot tolerate CPAP therapy
• People who prefer a portable, travel-friendly solution
• Patients with severe OSA and CPAP intolerance (with physician approval)
• Primary snorers without apnea
• Those with adequate healthy teeth to support the appliance
• Patients without severe TMJ disorders

The complete process typically takes 4-6 weeks from start to finish:

• Week 1: Initial consultation and evaluation
• Week 2: Impressions and measurements taken
• Weeks 3-4: Custom fabrication at dental laboratory (2-3 weeks)
• Week 5: Delivery and fitting appointment
• Weeks 6-12: Adjustment and titration period

See our complete treatment guide for details.

Most patients adjust within 1-3 weeks. Initial side effects are normal and typically include:

• Excessive saliva (resolves within 1-2 weeks)
• Mild jaw soreness or tenderness (improves within 2-4 weeks)
• Tooth sensitivity (usually temporary)
• Minor gum irritation

Custom-fitted appliances are designed for maximum comfort. We make adjustments as needed during the titration period to ensure the appliance is both effective and comfortable.

Yes, there are over 100 FDA-cleared oral appliances. The main types are:

We'll recommend the best appliance type based on your anatomy, severity of sleep apnea, dental health, and personal preferences.

Daily care is simple:

• Rinse with cool water every morning
• Brush gently with soft toothbrush and mild soap or non-abrasive toothpaste
• Rinse thoroughly and air dry in protective case
• Never use hot water (can warp the appliance)

Weekly deep cleaning:

• Soak in denture cleaner or specialized appliance cleaner
• Rinse thoroughly before use

With proper care, most oral appliances last 3-5 years. Lifespan depends on:

• Appliance material and quality
• Teeth grinding habits
• How well you maintain it
• Normal wear and tear

We monitor wear at your regular follow-up visits and recommend replacement when needed. Insurance often covers replacement every 3-5 years.

Some adjustable appliances allow for small home adjustments following our specific instructions. However, all significant adjustments should be made by our office to ensure:

• Optimal treatment effectiveness
• Proper jaw positioning
• Avoiding damage to teeth or TMJ
• Maintaining appliance integrity

Never force or over-adjust your appliance. Contact us if you're experiencing discomfort or feel adjustments are needed.

Minor, temporary bite changes upon waking are normal and typically resolve within minutes. With proper appliance design, titration, and monitoring, permanent bite changes are rare.

We minimize risks by:

• Custom-fitting appliances precisely
• Gradual jaw advancement during titration
• Regular monitoring of bite alignment
• Teaching morning jaw exercises
• Making adjustments as needed

Yes, you can drink water while wearing your appliance. However, avoid other beverages (especially sugary or acidic drinks) as they can promote tooth decay. If you need to eat or drink something other than water during the night, remove the appliance, rinse your mouth, and reinsert it.

Contact our office immediately. Depending on the situation:

• Minor damage: May be repairable in our office or by the lab
• Major damage or loss: Will require a new appliance

We keep your dental impressions on file for several years, which can expedite replacement. Check your homeowner's or renter's insurance, as they sometimes cover lost or damaged medical devices. Some dental insurance plans cover appliance replacement.

Yes, regular follow-up is essential for treatment success:

• First 2-3 months: Multiple visits for adjustment and titration
• 8-12 weeks: Follow-up sleep study to verify effectiveness
• Every 6 months: Routine check-ups in year one
• Annually: Comprehensive evaluations thereafter

These appointments ensure your appliance remains effective, comfortable, and doesn't cause dental or jaw problems.

Over-the-counter "boil-and-bite" devices are not recommended for treating diagnosed sleep apnea. Here's why:

• Not custom-fitted to your anatomy
• Cannot be precisely adjusted for optimal effectiveness
• May cause dental or TMJ damage
• Not monitored by a qualified professional
• Typically not covered by insurance
• Less effective than custom appliances

Sleep apnea is a serious medical condition requiring proper diagnosis and professionally supervised treatment.

Yes, most medical insurance plans (not dental insurance) cover oral appliance therapy when:

• You have a diagnosed sleep apnea (based on sleep study)
• Treatment is prescribed by a physician
• The appliance is custom-fabricated by a qualified dentist

Coverage typically includes 50-80% of costs after deductible. Medicare Part B also covers oral appliances under specific conditions. See our Insurance Guide for details.

Total cost typically ranges from $2,000-$3,500, which includes:

• Initial consultation and examination
• Custom impressions and bite registration
• Custom appliance fabrication
• Delivery and fitting
• Follow-up adjustments (first 90 days typically included)

With insurance: Most patients pay $300-$800 out-of-pocket after insurance coverage.

Without insurance: We offer payment plans and financing options to make treatment affordable.

Medical insurance is used for oral appliance therapy because sleep apnea is a medical condition. This includes plans like:

• Commercial health insurance (Aetna, United Healthcare, Blue Cross, etc.)
• Medicare Part B
• Medicaid (varies by state)
• Tricare

Dental insurance typically does not cover sleep apnea treatment, though it may cover any necessary dental work to prepare for the appliance (like fillings).

Yes! We handle the entire insurance process:

• Verify your insurance benefits before treatment
• Provide cost estimates of your out-of-pocket expenses
• Submit prior authorization requests
• File all insurance claims on your behalf
• Follow up on claim processing
• Answer any insurance-related questions

Our goal is to make the insurance process as smooth and stress-free as possible.

Yes! Oral appliance therapy for diagnosed sleep apnea is an eligible expense for both Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA). This includes the appliance itself, consultations, fittings, and follow-up appointments. Using tax-advantaged funds can reduce your out-of-pocket costs by 20-30%.

Yes, we offer flexible payment options:

• In-house payment plans with no interest
• Third-party financing through CareCredit and other providers
• Extended payment terms available
• Low or no-interest financing options (subject to credit approval)

We believe cost shouldn't be a barrier to treating sleep apnea. We'll work with you to find a payment solution that fits your budget.

Insurance denials can often be appealed successfully. We will:

• Review the denial reason with you
• Help you file an appeal with additional documentation
• Work with your physician to provide medical necessity letters
• Guide you through the appeals process

If the denial stands, we offer self-pay discounts and payment plans to make treatment affordable.

Yes, Medicare Part B covers oral appliances for obstructive sleep apnea when:

• You have a diagnosis of OSA from a sleep study
• A physician prescribes the oral appliance
• You cannot tolerate CPAP therapy or CPAP was ineffective
• The appliance is custom-fabricated

Medicare typically covers 80% of the approved amount after you meet your Part B deductible. You're responsible for the remaining 20% plus any deductible.

CPAP (Continuous Positive Airway Pressure): A machine that delivers pressurized air through a mask to keep airways open. Considered the gold standard for severe sleep apnea.

Oral Appliance: A custom-fitted dental device worn during sleep that repositions the jaw to keep airways open mechanically.

Both are effective treatments; the best choice depends on apnea severity, personal preferences, and ability to tolerate each option.

Reasons to choose an oral appliance:

• Convenience: No machine, no electricity, no noise
• Travel-friendly: Small and portable
• Comfort: Many find it more comfortable than a mask
• Better compliance: 85% use rate vs. 50-60% for CPAP
• CPAP intolerance: If you've tried CPAP and couldn't tolerate it
• Lifestyle: Easier for active lifestyles, camping, travel
• Bed partner preference: Silent operation

Absolutely. CPAP intolerance is one of the most common reasons for choosing oral appliance therapy. Common CPAP issues include:

• Claustrophobia or mask discomfort
• Air pressure intolerance
• Dry mouth or nasal congestion
• Machine noise disturbing sleep
• Difficulty traveling with equipment
• Skin irritation from mask

Most insurance companies, including Medicare, cover oral appliances for patients who cannot tolerate or refuse CPAP therapy.

CPAP is generally more effective at reducing AHI numbers, especially for severe sleep apnea. However, effectiveness is meaningless if you don't use it.

The key factor is compliance:

• CPAP compliance: 50-60% of patients use it regularly
• Oral appliance compliance: 85% of patients use it consistently

A treatment only works if you actually use it. For many patients, an oral appliance provides better real-world outcomes because they're more likely to wear it every night.

Yes, combination therapy is sometimes used for severe sleep apnea. Benefits include:

• CPAP can often be used at lower, more tolerable pressure
• Better overall treatment effectiveness
• Improved comfort and compliance

This approach requires coordination between your sleep physician and our office. Some patients also use an oral appliance for travel or backup when not using CPAP.

Initial costs are similar, but long-term costs differ:

Over time, oral appliances may be slightly more cost-effective, with the added benefit of better compliance rates.

It depends on your insurance and apnea severity:

• Mild to moderate OSA: Oral appliances are considered first-line treatment. No CPAP trial required.
• Severe OSA: Some insurance companies require a CPAP trial first, though this varies.
• Medicare: Typically requires documented CPAP intolerance or failure.

We'll review your specific insurance requirements during your consultation and work with your physician to determine the best treatment path.

While not a cure, these lifestyle modifications can improve sleep apnea:

• Weight loss: Even 10% body weight reduction can significantly improve symptoms
• Avoid alcohol: Especially 3-4 hours before bedtime
• Quit smoking: Reduces airway inflammation
• Sleep position: Side sleeping often reduces apnea events
• Regular exercise: Improves overall health and sleep quality
• Avoid sedatives: They relax throat muscles
• Treat nasal congestion: Use saline rinses or allergy medications
• Maintain sleep schedule: Consistent sleep-wake times

Yes! This is one of the biggest advantages of oral appliances. They're:

• Small enough to fit in your pocket or purse
• No electricity required
• No TSA issues at airport security
• Perfect for camping, hotels, or anywhere you sleep

Travel tips: Always keep your appliance in its protective case, bring cleaning supplies, and consider a backup storage case.

Side sleeping is generally best for sleep apnea. Gravity helps keep airways open when you're on your side.

Back sleeping often worsens apnea as the tongue and soft tissues fall backward, blocking the airway.

Tips to stay on your side: Use a body pillow, wear a sleep position device, or try the "tennis ball trick" (tape a tennis ball to the back of your pajamas to discourage back sleeping).

Yes, significantly. Alcohol:

• Relaxes throat muscles, increasing airway collapse
• Reduces arousal responses, causing longer apnea events
• Worsens sleep quality and oxygen desaturation
• Can turn simple snoring into sleep apnea

Recommendation: Avoid alcohol for at least 3-4 hours before bedtime, even when using treatment.

Yes! Regular exercise can:

• Help with weight loss, reducing apnea severity
• Improve sleep quality and sleep architecture
• Strengthen airway muscles
• Reduce daytime fatigue
• Improve cardiovascular health

Studies show that exercise can reduce AHI by 25-30%, even without significant weight loss. Aim for 150 minutes of moderate exercise per week. However, exercise alone is rarely sufficient—treatment is still necessary for most patients.

Absolutely. Sleep apnea affects many aspects of health, and your healthcare providers need to know. It's especially important to inform:

• Anesthesiologists: Before any surgery (apnea affects anesthesia risk)
• Cardiologists: Sleep apnea increases cardiovascular risks
• Dentists: For routine dental care
• Primary care physician: For overall health management
• Specialists: For diabetes, high blood pressure, etc.

You'll notice improvements in several ways:

We'll conduct a follow-up sleep study after 8-12 weeks to objectively measure treatment effectiveness.