Treatment Questions & Answers

Does my Medicare cover oral appliance treatment?
Yes, and we are the only dentist in the Inland Empire (Spokane/Coeur d'Alene/Post Falls) that is a provider that treats Obstructive Sleep Apnea with oral appliance therapy for Medicare patients for the Medicare-approved maximum as full payment.  You won't be billed for more that this Medicare-approved amount.  Medicare pays 80% of this approved amount and your secondary Part B will cover some (many times all) of the remaining 20%.  Go to this link to verify this:  https://www.medicare.gov/physiciancompare/#results&loc=COEUR%20D%20ALENE%2C%20ID%2083815&lat=47.7276369&lng=-116.781196&flow=default&type=specialty&paging=1&keyword=Oral%20surgery%20(Dentist%20only)&dist=15&name=Oral%20surgery%20(Dentist%20only)&id=19&loctype=z.

Does my insurance cover treatment?
It depends on your insurance but our experience is that most insurance companies do cover some of the cost.  We will contact your insurance carrier and pre-verify your coverage.

Does medical insurance or dental insurance cover treatment?
Treatment for Obstructive Sleep Apnea is only covered under medical insurance, never under dental insurance.  It is a medical problem, not a dental problem.

How long does the treatment take?
Treatment time is several weeks to several months depending on the severity of the patient's apnea.

Will I be required to return to the same dental office for follow-up care?
Yes.  Oral appliance therapy must be completed by the same office.  The patient is encouraged to return for annual recalls to determine that maximum medical improvement (MMI) is being maintained.  Once maximum medical improvement is achieved in our office, the patient can seek follow up treatment at any qualified office.

I have full upper and lower dentures. Can I still use an oral appliance?
Probably.  The oral appliance can normally be fitted directly over the dentures.  It takes an examination in the office to determine whether your case can be treated that way.

I have not had dental care in quite some time. Will I be required to complete all dental care prior to the appliance being inserted?
Yes, but a provisional or transitional appliance can be fabricated for use while the dental treatment is being completed. This will allow the you to have an oral appliance throughout this dental care.  


Don’t let a sleep breathing disorder put you at risk

Is it a sleep breathing disorder that is jeopardizing your job stability?   Are you irritable with coworkers or customers?

Do you have difficulty finishing your work tasks because of tiredness and no energy?

Lack of good nightly sleep can make you feel tired all day long – wanting a nap.  There are a number of reasons this can occur, but did you know there are solutions for this issue?

Sleep breathing disorders are common and can prevent you from having refreshing sleep.  There different sleep breathing disorders with varying causes – obstructive sleep apnea is the most common one.  Treatment has helped patients suffering from this condition by opening the airways by adjusting the jaw position at night.

Obstructive sleep apnea (OSA) is a condition tens of millions of people in the US  have.  OSA is not limited to certain older age groups; children also suffer from OSA.  They have difficulty falling and staying asleep because of these breathing difficulties.

OSA occurs when the tongue and throat muscles relax causing your airway to narrow or close as you attempt to breathe in, stopping your from getting enough air (oxygen).  This results in a lower oxygen level in your blood.

When your brain senses this low oxygen level  & high carbon dioxide level, it briefly arouses you from sleep to get your tongue off of your airway. These arousals (dozens to hundreds of times a night) may not be noticed by you.  And the events of blockage may last from 10 seconds to over 1 minute.  We have patients that have events lasting over a minute and a half.   But they impair your ability to reach the deeper stages (stage four & REM) of sleep. The result?  Tiredness during the day as well as other major health complications.

Do you or your bed partner wake up in the middle of the night to the sounds of your partner’s loud snoring?  Snoring does not necessarily disturb the sleep of the person snoring, but can disturb the bed partner.  Now both people have a sleep disorder!!  And the snoring is probably a symptom of OSA as well. And the loudness of the snoring is usually like that of a chain-saw.

Teeth grinding - bruxism - and can cause numerous tooth and health problems.   Not only does it damage teeth, it can be frequent and heavy enough to cause jaw disorders (TMJ/TMD), headaches, and other problems.  The noise made while grinding teeth alone can also prevent a partner from getting sound sleep.

Why treat your sleep disorder?

While snoring can seem to be funny to some, OSA is not trivial.  It comes with dangerous and serious health consequences such as high blood pressure, diabetes, and even death.  Beyond the many serious medical problems, loss of sleep has a big impact on your quality of life.

Many of the most disastrous incidents around the world were caused by sleep deprivation.  The 1979 Three Mile Island nuclear accident, the 1986 Chernobyl nuclear meltdown, and the Exxon Valdez oil spill are examples that lack of sleep has caused major mistakes.  The train wreck in New York a few years ago that killed 4 people had an engineer driving it who had untreated severe obstructive sleep apnea.

Sleep loss is also a public safety hazard; drowsiness causes your reaction time to slow down just as much as driving drunk.  The US National Highway Traffic Administration estimated that 100,000 auto accidents annually are caused by driving while sleepy.  It also contributes to about 1,550 auto accident-related deaths annually!

Lack of restful sleep also causes accidents and injuries on the job; workers who face excessive tiredness are more prone to have work related accidents. Chronic sleep deprivation and sleep disorders increase the risk of many serious health conditions such as heart disease, stroke, cancer, high blood pressure, sudden cardiac death, and many others.

Low oxygen levels due to OSA can increase your blood pressure and put a heavy strain your heart.  The more severe your OSA, the greater the risk.  If you already suffer from heart disease, these episodes of low oxygen in the blood can lead to a heart attack.  OSA can also increase the risk of atrial fibrillation, congestive heart failure, and other vascular diseases.  Patients with OSA are also more likely to have impaired liver function.

Diminished sex drive is also a consequence of OSA.   If you have problems in your relationship because of your lack of libido, it may be solved by treating your sleep breathing disorder.  Sleep deprived people have lower interest in sex when compared to non-sleep deprived people.  This can be because of low energy, increased sleepiness, and heightened levels of tension caused by sleep loss.  The Journal of Clinical Endocrinology and Metabolism published a 2002 study, suggesting that men suffering loss of libido have a lower testosterone level when compared to other men.  The study found that almost 50% of the men suffering from severe OSA had abnormally low levels of testosterone secretion during the night.

Do you feel foggy and slow after a sleepless night?  Have you made a critical errors at work because of sleepiness?  Sleep is critical for effective thinking and learning.  Sleep loss has a negative impact on these cognitive processes.

Sleep loss first affects your attention span, and then it makes you dull and less alert. You may have difficulty concentrating.  Sleep loss also impairs problem solving and reasoning abilities meaning you are less able to process information and make sound decisions.

During sleep, memories are consolidated during the various sleep cycles.  Without enough sleep, it is more difficult for to remember what you learned or experienced the previous day.  Students that do all-nighters before exams will not do as well as students that get a good night's sleep.

Impaired mental health is harmful for everyone – no matter what age or lifestyle they follow.  Chronic sleep loss may cause you to start developing symptoms of depression.  If you are not in stages 3 and 4 of the sleep cycle long enough, you will not get enough serotonin and therefore have some level of depression.  A 2005 poll showed that sleep loss was more common in patients with clinically-diagnosed depression and/or anxiety.  Sleep loss aggravates depression and depression aggravates sleep. If OSA is causing your sleep deprivation, treating the OSA problem could reduce the symptoms of depression.

Chronic loss of sleep can result in fine lines in the skin, dull looking skin, puffy eyes, dark circles under the eyes, and a lifeless look on the face.  Droopy eyelid syndrome is caused by untreated OSA.  This is because sleep loss causes an increase in the level of the stress hormone, cortisol, damaging the collagen in your skin. It can also damage the protein responsible for smooth, firm skin.  Using up your cortisol levels because of OSA doesn't leave enough cortisol for the events it is supposed to be there for.

Chronic sleep loss can also reduce the levels of HGH (human growth hormone) in the body.  During our formative years, this hormone is essential for growth and development.  As we age, it is still essential to the overall health and well-being one experiences. HGH helps increase muscle mass, bone strength, and skin. It also helps tissue repair.

Impaired memory is also a result of sleep loss.  Do you find yourself forgetting small details or critical information?  This can be a big problem, especially for your professional life.   Sleep deprivation could be a reason for the inability to retain information. French and US researchers found in 2009 that sharp wave ripples are brain events responsible for memory consolidation.  They usually occur during the deepest stages of sleep and impact an area of the brain where our long-term memories are stored.  Therefore, lack of sleep can prevent the brain from consolidating information and storing memories properly.

Also, when we don’t sleep enough, we lose the ability to interpret events correctly.  This creates difficulty making correct judgments. This can also mean that patients who don’t get enough sleep are prone to making incorrect judgments with respect to how much the sleep loss is really affecting them.  It is impossible for a normal person to function properly on inadequate sleep. This is a big problem in a profession where it is crucial to be able to judge your functioning level accurately.

Experts agree that people who sleep for about six hours nightly may feel that they have become adjusted to this sleeping habit and may also feel that they function perfectly.  But the effects of sleep deprivation actually show very clearly on mental alertness and performance tests.

A 2004 study suggested that people who sleep only 6 hours or less had nearly a 30% higher rate of obesity compared to those who sleep for 7-9 hours daily.  Appetite-regulating peptides and sleep duration are linked.  Ghrelin, a peptide that stimulates hunger and improves appetite, is increased, and leptin, a peptide that signals the brain that we are full, is decreased when our body lacks sleep.  Sleep deprivation does not stop at just increasing our appetite.  We also crave for foods higher in fat and carbohydrates.

The “Whitehall II Study”, conducted by British researchers for over 20 years, studied the effects of sleep deprivation on the mortality of over 10,000 individuals.  In 2007, they published the results that suggested that the risk of death from any cause was almost doubled when sleep time reduced from seven hours to five hours a night.

Sleep apnea and snoring can be treated!!!

Good news --  obstructive sleep apnea can’t be cured because it is a structural problem, but it can be treated effectively.  It's like a person with 20/100 vision.  Glasses compensate for the shape of the eye and the lense to make an in-focus image.

The first step is to determine if OSA is the cause of your sleep disorder.  Once diagnosed, we will work  to help you find the most effective treatment for you.  If you live in Spokane, Coeur d'Alene, or Post Falls, call our office at (844) 847-6673 for a free consultation.

In many cases, a simple oral appliance can be all you need to keep your airway open during sleep and get the healthy sleep you need to thrive.