Snoring is that loud low frequency sound that bothers the bed partners and other people in the house who can hear it across the hallway. Snoring indicates a partial obstruction to the airway in sleep.
The most important question with snoring is: Is this in reality sleep apnea?
Once that question has been resolved with a clinical history are a sleep study the treatment is usually CPAP, Oral Appliance or clinic based procedures to relieve the site of obstruction.
Obstructive sleep apnea is a disorder resulting from periodic collapse of the upper airway during sleep.This manifests in snoring and choking episodes that is recognized by family and friends. Partial or complete closure of the airway causes decrease in oxygen supply, struggle to breathe and results in unrefreshed sleep and daytime sleepiness.
Obstructive sleep apnea is reliably diagnosed using a lab based study (PSG or polysomnogram) or a home cased study (HST).
Apnea Hypopnea Index (AHI) is used to quantify the severity of OSA. AHI if less than 5 in an adult is considered normal as we all stop breathing once in awhile during sleep. AHI between 5-15 is mild OSA,, 15-30 is moderate OSA and greater than 30 is considered severe OSA.
The first line treatment of sleep apnea is CPAP for all severity of sleep apnea. Oral Appliance may be considered in mild to moderate sleep apnea,
Only upon failing these two treatments, other treatments are considered.
I perform a detailed exam and identify the cause and site of obstruction in snoring and sleep apnea.
I have a detailed discussion about the causes of sleep apnea and the increased risk for adverse health effects from untreated or poorly controlled sleep apnea.
Oral appliance is also considered first line treatment of OSA. Custom fitted appliances is offered by my practice and has the same effectiveness as CPAP for mild to moderate OSA.
I identify the specific site of obstruction in snoring and sleep apnea and address obstruction in clinic. The procedures are in the nose, back of the throat (palate) and tongue. These are done under local anesthesia, well tolerated and covered by most insurances.
Specific sites of obstruction identified in clinic can be relieved in the operating room. Deviated nasal septum, turbinate hypertrophy, tongue based procedures and palate based procedures (UPPP, uvulopalatopharyngoplasty) and jaw surgery (Maxillo Mandibular Advancement) are tailored specific to each patient. Inspire Hypoglossal nerve stimulator is the latest proven method of treating sleep apnea.
Most treatment options are covered by your insurance. However, we check your insurance benefits prior to starting treatment. Please allow us up to 30 days to verify benefits.
Sleep apnea is a serious medical condition. It's not a dental condition. Board Certified Sleep MD are best suited to diagnose and treat Sleep apnea.
Custom-made Oral Appliances are proven to treat mild to moderate sleep apnea. Most medical insurances pay for this treatment. We offer FDA approved custom fit Oral Appliances. Most patients with good dentition, absent TMJ issues are candidates for the Oral Appliance. We offer the sleep study after the appliance is fitted demonstrate the resolution of sleep apnea.
CPAP is a golden standard of treatment of sleep apnea. It's high failure rate can be helped by relieving nasal obstruction or getting the patient acclimated to the CPAP. I also provide custom made strapless nasal pillows to help tolerate the CPAP better.
"Pacemaker for the tongue", Inspire Upper Airway Stimulation System is a new FDA-approved treatment. Studies published in major scientific journals, including the New England Journal of Medicine, showed majority of patients achieved a resolution of their sleep apnea.
There are only two official centers for Inspire Hypoglossal Nerve Stimulator in DFW, Dallas Fort Worth metroplex. My Center is one of them. We offer comprehensive diagnosis, treatment and follow-up of Inspire Hypoglossal Nerve Stimulator patients.
Allergy evaluation and treatment: This may not cure sleep apnea but will make CPAP and Oral Appliance tolerable.
Weight Loss: This is perhaps the most underestimated and underutilized treatment of sleep apnea. Conventional wisdom suggests that, in absence of anatomical abnormalities, 10% reduction of body weight will significantly reduce snoring and sleep apnea. 20% reduction of body weight is likely to cure snoring and sleep apnea.
However, weight loss is difficult when one is suffering from sleep apnea. the tiredness and drowsiness associated with sleep apnea makes a person crave sugary and fatty food to keep up the energy levels. Patients also tend to drink sweetened caffeinated beverages to keep themselves alert. This further worsens the weight gain and sleep apnea.
Tracheostomy: The last option for sleep apnea is the first one that was discovered; Tracheostomy bypasses the upper airway completely and is final option for life threatening apnea if all else fails.