Testing and Treatment of Sleep Apnea

Obstructive Sleep Apnea is a life threatening condition. When left untreated it takes an average of eight years off a person’s life. This is why we ask each and every one of our new patients, no matter what their reason for coming to us, “Has anyone ever said that you snore?” We’ve developed a specific protocol to not only treat our sleep disorder patients but educate them as we follow through all of our diagnostic procedures.

The initial appointment begins with a thorough interview of the patient.

The Interview Basics:

• Obtain a detailed medical history
• Check blood pressure, neck circumference and blood oxygen levels
• Review the patients Epworth Sleepiness Scale
• Has the patient had a recent sleep study?
• Does the patient have a crowded oropharynx?
• Review those findings with the patient
• Discuss types of sleep disorders and their implications

The doctor then begins his examination with external palpations of:

• Muscles of mastication
• Temporomandibular joints
• Cervical musculature
• Ligaments and Tendons
• Greater and Lesser Occipital Nerves

Followed by an intra oral examination:

• Oral cancer screening
• Tongue position, shape, and size
• Swallow Assessment
• Oropharynx evaluation
• Size of the arches
• Palatal vaulting
• Health of the periodontal structures
• Status of the teeth
• Occlusal evaluation

Based on our findings we develop a treatment plan for the patient. Many times it is necessary to refer the patient to a sleep physician for a consultation and possible sleep study. If the results of the sleep study establish that the patient’s sleep apnea is mild to moderate then we know that an oral appliance is the best treatment option. Additional diagnostic studies will be needed to decide which dental orthotic will best treat the patient’s apnea. Airway orthotics (AO) come in varied designs and many are FDA-approved. They are completely non-invasive, totally painless and must only be worn at night.

Our insurance coordinator will discuss medical insurance involvement and financial obligations with the patient as well as schedule all appropriate appointments.

If additional diagnostic studies are needed, the patient then returns for a second appointment. This is yet another very detailed appointment which includes the following:

• Joint Vibration Analysis (Used to measure any unusual activity occurring in the jaw joints)
• Radiographs of the jaw joints, paranasal sinuses, cervical spine and either a panoramic view of the patient’s entire mouth or a full mouth series of individual radiographs of the teeth.
• Pharyngometer and Rhinometer studies (Determines if there are any nasal or pharyngeal obstructions and the volume of air entering the patient’s lungs). The goal is to increase the volume of air entering the lungs by manipulating the patients jaw.
• Once we find the correct position of the jaw or what Dr. Tregaskes calls “The sweet spot”, we take a positional record which is used to accurately create the patients Mandibular Advancement Device. (MAD)
• We’ll then take alginate impressions used to make quality stone casts from which the device will be fabricated.

Last but not least is the day of insertion. This is a much quicker appointment usually about two to three weeks after the patient has completed all of the required diagnostic studies. We insert the patient’s oral sleep device, make any necessary adjustments, review the cleaning and care instructions and send the patient on their way to a good night's sleep.

We like to see our patients back in one week (or sooner if required) to reevaluate and titrate the appliance if needed. Dr. Tregaskes then determines when he would like to see the patient again based on their feedback. A progress report is completed by the patient at each of these reevaluation appointments.

Ares Home Sleep Study

In some cases, rather than sending the patient for an overnight study at a sleep clinic, we are able to use the Ares instead. The Ares (Apnea Risk Evaluation System) is a patient-friendly home-based sleep study used to determine the severity of the patient’s sleep apnea. Once the patient has returned the device after wearing it for 1-2 nights, we then electronically send that information to a sleep specialist who analyzes it and makes his or her recommendation. Mild to moderate sleep apnea is best treated with a dental appliance.

The Ares measures:

• Blood oxygen saturation (amount of oxygen in the blood)
• Airflow
• Pulse rate
• Snoring levels
• Head movement and head position