Frequently Asked Questions
1. My husband snores. Where can I find an oral appliance?
Oral appliance therapy to treat snoring and obstructive sleep apnea should
be provided by an experienced dentist. A list of dentists who are members
of the American Academy of Dental Sleep Medicine can be found at this
web site by clicking on Find-A-Dentist. 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, the dentist can work closely with the physician to treat the problem
in the most effective way. An overnight polysomnogram can be arranged
through the family doctor.
2. Are oral appliances effective? Where can I obtain studies demonstrating
Oral appliances were first utilized in the 1930's to help people breathe
properly during sleep. By the 1980's, physicians and dentists began
to seriously study the effectiveness of oral appliances to treat snoring
and obstructive sleep apnea and found them to be effective in many, but
not all cases. Recent 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.
3. I was diagnosed with sleep apnea. How do I know if I have mild, moderate
or severe apnea?
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 the hospital 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 and
should be thoroughly discussed with you by your physician. Properly trained
dentists work closely with physicians and understand the details of the
sleep study and they effect the therapy.
4. What does RDI stand for?
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 10 is normal while an RDI over 40 may indicate severe disease.
5. What's the difference between snoring and obstructive sleep apnea?
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.
6. How does oral appliance therapy compare with CPAP. Are there studies
that explain this?
When it became apparent that Oral Appliance Therapy was legitimate and
desirable part of the treatment mix, questions naturally arose regarding
its comparative effectiveness with positive airway pressure modalities.
Recently, four studies have focused on Oral Appliance Therapy going head
to head with nasal CPAP. Three of them used a cross-over design and the
fourth a parallel group design. All of the investigations were randomized,
controlled treatment trials. Each of the studies focused on effectiveness
as a product of the treatment efficacy in combination with acceptance
and adherence to treatment. Treatment efficacy was similar in all the
trials and did not deviate significantly from past investigations. It
was shown that Oral Appliance Therapy often, but not always decreased
the apnea-hypopnea index whereas CPAP nearly always resolved sleep disordered
breathing entirely. Acceptance and adherence to treatment with CPAP was
limited while that of Oral Appliance Therapy was less so resulting in
the proportion of successfully treated patients being about the same in
each study. In all three cross-over trials where patients were asked to
choose a preferred treatment, the majority chose oral appliance therapy.
7. Will my appliance be covered by medical insurance? Will Medicare cover
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
8. Does the American Academy of Dental Sleep Medicine work directly with
patients to obtain insurance coverage?
The AADSM is a non-profit professional membership organization. We teach
dentists and physicians how to use oral appliance therapy to treat sleep
disordered breathing. However, we do not work directly with patients in
relation to their insurance companies. You must work with your AADSM trained
dentist, physician and insurance carrier.
9. What is the price range for oral appliances?
There are presently over 40 different oral appliances available. Fees are
determined by the individual dentist and differ according to the cost
of the appliance itself along with the time and skill necessary to achieve
a long-term therapeutic end result. Patients are cautioned to understand
that effective therapy rendered by a properly trained dentist using a
durable, adjustable appliance will not fall into the inexpensive end of
the fee scale.
10. 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 and require
personal communications from the dentist to find these codes that may
be of value.
11. Does the American Academy of Dental Sleep Medicine recommend a specific
appliance over another?
The AADSM does not endorse specific appliances. Recent studies however,
are showing that custom-made adjustable appliances that move the lower
jaw forward are very effective. In addition, tongue-retaining devices
have been shown to be effective.
12. How can I find a dentist who works with a specific appliance?
The AADSM does not identify dentists who utilize specific appliances. It
is recommended, however, that patients seek out a properly trained dentist
who works closely with a sleep physician and understands the use of several