Frequently Asked Questions: Dental Sleep Medicine

      Note: Always consult a qualified physician to determine if you are a good candidate for oral appliance therapy.
Q: What is the sleep cycle and why is it important?
A: Sleep is a physical and mental resting state in which a person becomes relatively inactive and unaware of the environment. Sleep is characterized by two distinct states: Non-REM sleep and REM sleep. These alternate in 90 to 110 minute cycles. Normal sleep pattern has 4-5 sleep cycles throughout the night. Sleep has been determined to be biologically necessary for life due to the healing and repair that occurs.
 Q: What is obstructive sleep apnea (OSA)?
A: OSA is a chronic condition that occurs when your muscles relax during sleep, allowing soft tissue to collapse and block the airway. This can cause you to stop breathing hundreds of times per night for anywhere from a few seconds to more than a minute.  Repeated breathing pauses may result in reduced oxygen levels and disturbances in sleep.
Q: How prevalent is obstructive sleep apnea (OSA) in the United States?
A: Approximately 54 million adults in the US have OSA.
Q: What are the common signs and risk factors of obstructive sleep apnea (OSA)?
A: OSA is more common in men, but it can occur in women too. Having excess body weight, a narrow airway, or misaligned jaw can increase the risk of OSA. Snoring, choking sounds while sleeping, intermittent snoring with pauses, excessive daytime sleepiness, awakenings with gasping, poor memory, irritability, and morning headaches may be signs of OSA. You should schedule a visit with your physician to discuss these symptoms.Q: How do I know if I have obstructive sleep apnea (OSA)?
A: After discussing your symptoms, your physician or a board-certified sleep medicine physician will complete a sleep evaluation and may schedule an overnight sleep study at a sleep facility or a home sleep apnea test. The physician will interpret the data from your sleep study to make a diagnosis.Q: Is treating obstructive sleep apnea (OSA) important?
A: Treating OSA is incredibly important. When left untreated, OSA can cause excessive daytime fatigue, morning headaches, and memory loss. In addition, studies suggest that untreated OSA increases the risk of numerous health issues, such as hypertension, congestive heart failure, atrial fibrillation, coronary artery disease, stroke and type 2 diabetes.Q: How is snoring distinguished from obstructive sleep apnea (OSA)?
A: Snoring is a major symptom of OSA, so all cases of snoring should be evaluated by a physician to determine whether or not you have OSA.
Q: What is an oral appliance?
A: An oral appliance is a custom-fit, mouth-guard-like device worn only while you sleep. It keeps your airway open and unobstructed by supporting your jaw in a forward position to keep the upper airway from collapsing and blocking the airway.
 Q: What is the difference between continuous positive airway pressure (CPAP) therapy and oral appliance therapy?
A: CPAP therapy involves wearing a mask that covers the nose and mouth and is connected to a tube that allows air pressure to keep the airway open during sleep. Oral appliance therapy consists of wearing a custom-fit mouth-guard during sleep to support the jaw in a forward position to help maintain an open airway.Q: Are oral appliances comfortable to wear?
A: Many patients consider an oral appliance to be more comfortable to wear than a CPAP mask. Oral appliances are custom-made to fit your mouth and made of lightweight material. To enhance the effectiveness of your oral appliance, follow-up visits with your dentist will be needed to ensure the optimal fit of the oral appliance. The oral appliance will be adjusted over time to ensure maximum comfort and effectiveness.Q: What are the benefits of oral appliance therapy over other treatment methods?
A: Oral appliance therapy is an effective, non-invasive treatment that fits easily into your lifestyle. Oral appliances are comfortable, quiet, portable, easy to wear, convenient for travel and easy to care for. Additionally, oral appliances do not restrict movements while sleeping, work with any patient sleeping positions, can be used for patients that are CPAP intolerant, do not require electricity, and require no consumable parts to replace. Q: Are oral appliances safe to use?
A: More than 100 oral appliances have received FDA clearance, meaning they have undergone and passed a rigorous safety and effectiveness assessment process.  Your dentist will recommend the appliance that is best for you.
Q: After I have decided with my physician that an oral appliance is the best treatment for me, how do I obtain one?
A: Your physician will write a prescription for you to receive a custom-made oral appliance. A dentist, qualified in dental sleep medicine, will take impressions of your teeth to build a model. This model will be sent to a dental lab where the oral appliance is made. Q: Does insurance cover oral appliance therapy?
A: Oral appliance therapy is covered by Medicare. Most private insurance plans cover oral appliance therapy, but you should check with your insurance provider and review your plan details to ensure coverage. 
Under Medicare, as well as the policies of most private insurers, the oral appliance must be custom-fabricated to be covered. Medicare and other insurers also have specific documentation requirements, so you will need to work with both your physician and dentist to ensure that you have everything you need to ensure coverage.

It is essential to note that oral appliance therapy is covered by medical insurance, not dental insurance, as obstructive sleep apnea is a medical condition that is treated collaboratively by dentists and physicians. As such, when reviewing insurance coverage policies, make sure to ask your provider about their medical coverage policies and requirements for oral appliance therapy.

Q: Can any dentist provide oral appliance therapy/practice dental sleep medicine?
A: Education in dental sleep medicine is required for dentists to provide safe, quality care to patients using oral appliance therapy for sleep-related breathing disorders. At minimum, dentists should meet the educational requirements defined by the AADSM to be a “Qualified Dentist” in dental sleep medicine.  To find a qualified dentist near you, visit the AADSM’s website.
Q: What is the role of the dentist in the treatment of obstructive sleep apnea (OSA)?
A: Dentists should screen patients for OSA using questionnaires and evaluating the airway and then refer the patient to a physician for an evaluation. Since OSA is a medical condition, dentists should not diagnose sleep disorders. If oral appliance therapy is determined by the physician and patient to be the most appropriate treatment option, the physician will write a prescription for an oral appliance and refer the patient to a qualified dentist who will provide and monitor oral appliance therapy as part of a treatment team with the physician. The qualified dentist will monitor and treat potential side effects of oral appliance therapy and provide follow-up to ensure the optimal fit of the oral appliance. Patients should return to their physician to confirm the treatment efficacy of oral appliance.
Q: How are oral appliances made and fitted?
A: Oral appliances are customized using digital or physical impressions and models of your teeth. These models are sent to a dental lab where the oral appliances are made. Once the oral appliance is ready, you will return to your dentist's office for a fitting. Your dentist will adjust the appliance to maximize its comfort and effectiveness. Your dentist will then teach you how to clean and maintain the oral appliance. A sleep study may then be scheduled by your physician to verify treatment success.
Q: How will your lifestyle change with oral appliance therapy?
A: Treating snoring or OSA with oral appliance therapy can help you feel like a new person. You will find that your symptoms and your quality of life can improve dramatically when you remain committed and use your appliance each night. You will likely sleep better, have more energy, and feel sharper throughout the day.
Q: Where can I find a qualified dentist?
A: The directory for qualified dentists is located here. 
Works Cited