Frequently Asked Questions about Sleep Apnea & Snoring

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My husband snores. Where can I find an oral appliance?

Dr. Nancy Nehawandian provides oral appliance therapy to treat snoring and obstructive sleep apnea. However, prior to beginning treatment, an overnight sleep study (polysomnogram) should be performed by a medical doctor to objectively identify the problem and its severity. Following this, Dr. Nehawandian can work closely with the physician to treat the problem in the most effective way.

Oral appliances have been utilized since the 1930's to help people breathe properly during sleep. Studies show oral appliances to be most effective in treating snoring and mild to moderate obstructive sleep apnea. However, some appliances have been shown to effectively treat severe apnea in some cases. While oral appliances are often effective, it is important to know that they are not adequate for everyone and to date, it is not possible to predict the successes from the failures prior to treatment.

The best way to diagnose sleep apnea is with an overnight sleep study. Depending on the physician's preference, this study can be performed in a sleep clinic or at home. It will objectively measure many parameters throughout the night that will aid the physician in determining the severity of the problem. Some of the important measurements include: how often breathing is interrupted; the quality of sleep; the oxygen level in the blood; the heart rate; and excessive bodily movements. The severity of the sleep apnea is determined by the assessment of these parameters. Dr. Nehawandian works closely with sleep physicians and understands the details of the sleep study and how they effect your therapy.

The term RDI stands for Respiratory Disturbance Index and is one very important measure of the severity of the sleep disorder. The RDI is a number that represents how many times per hour breathing stops or becomes very shallow. This index is important because it is often associated with disruption of sleep and dangerous drops in blood oxygen levels. Most physicians agree that an RDI below 5 is normal while an RDI over 40 may indicate severe disease.

The term Sleep Disordered Breathing describes a number of sleep breathing disorders that includes snoring, upper airway resistance syndrome and obstructive sleep apnea. Sleep Disordered Breathing is viewed as a continuum where simple snoring represents a mild disorder during which breathing during sleep is very loud due to the near collapse of the upper airway. When the snoring becomes worse due to further airway collapse (to the point where sleep is interrupted) the term upper airway resistance syndrome is used. Most serious, is the complete collapse of the airway that is termed obstructive sleep apnea. During an apnea, breathing cannot occur and the sleeper is forced to awaken to resume normal breathing.

Who is a good candidate for Oral appliances?

• Patients with moderate to severe OSA who are intolerant of or refuse treatment with nasal CPAP.
• Patients with primary snoring or mild OSA who do not respond to, or are not appropriate candidates for treatment with behavioral measures such as weight loss or sleep-position change.

Oral appliances are sometimes covered by insurance. They are often not covered by commercial insurance carriers, HMO's and Medicare for a variety of reasons including: lack of knowledge and understanding by insurance companies of the recent advances in oral appliance therapy in the treatment of sleep apnea; snoring (only) is not a recognized medical condition by the medical field; and lack of CPT or medical reimbursement code for oral appliance therapy.

What is the price range for oral appliances?

There are presently over 40 different oral appliances available. Fees differ according to the cost of the appliance itself along with the time and skill necessary to achieve a long-term therapeutic end result. Is there an insurance code for my appliance? To date, there is no formal CPT or medical reimbursement code for oral appliances. However, some insurance companies have codes that may be utilized to attain benefits. These codes vary from company to company.