Everyday Dentistry
Sleep Apnea & Snoring Appliances
For patients diagnosed with obstructive sleep apnea who cannot tolerate a CPAP machine, a custom oral appliance is a well-established alternative — and one many people find far easier to live with.
Treated by
Dr. Jonathan Berkowitz, DMD
Residency-trained Prosthodontist
- University of Michigan prosthodontic residency
- Ten years attending prosthodontist, Northport VA
- Implants placed and restored in-house
What obstructive sleep apnea is
During sleep, the muscles of the throat relax. In obstructive sleep apnea the airway narrows or closes entirely, breathing stops for seconds at a time, and the brain briefly rouses you to reopen it. This can happen dozens or hundreds of times a night without your being aware of any of it.
The consequences are significant. Untreated sleep apnea is associated with high blood pressure, heart disease, stroke, and type 2 diabetes, as well as the daytime exhaustion and impaired concentration that usually prompt people to seek help. Falling asleep during the day, and particularly while driving, is a serious warning sign.
Loud snoring, witnessed pauses in breathing, waking with a dry mouth or headache, and unrefreshing sleep are the common indicators. It becomes more prevalent with age and is substantially underdiagnosed.
How an oral appliance works
A mandibular advancement device is a custom-made appliance, somewhat like a pair of interlocking nightguards, that holds the lower jaw slightly forward during sleep. That position keeps the airway open by preventing the tongue and soft tissues from collapsing back into it.
It is small, has no motor, needs no electricity, and travels easily. For patients who have abandoned a CPAP machine — and a substantial proportion do — an appliance that is actually worn every night is more effective than a machine that sits in a cupboard.
Oral appliances are most effective for mild to moderate sleep apnea and for primary snoring. Severe apnea is generally better treated with CPAP, and where that is the case we will say so rather than fitting an appliance that will not do enough.
You need a diagnosis first
We cannot diagnose sleep apnea, and neither can any dentist. Diagnosis requires a sleep study, interpreted by a physician — either an overnight study in a laboratory or, increasingly, a home study.
If you suspect you have sleep apnea, start with your physician or a sleep specialist. Once you have a diagnosis and a recommendation for oral appliance therapy, we can make and fit the appliance and manage the dental side of your care.
We work alongside your physician rather than in place of them. Follow-up sleep testing while wearing the appliance is how effectiveness is confirmed, and that remains a medical assessment.
Questions
Things people ask
If your question is not here, call the office. Nobody will pressure you into booking.
Call 212-874-1700Will an appliance stop my snoring?
For many patients it substantially reduces or eliminates snoring, since the mechanism causing the snoring is often the same partial airway obstruction the appliance addresses.
Snoring without apnea can also be treated this way, though it is still worth being assessed for apnea first — snoring is the most common symptom of it.
Is it uncomfortable?
There is an adjustment period of a week or two. Some jaw soreness in the morning and increased salivation at first are common and usually settle.
The advancement is adjustable, so we start conservatively and increase gradually, which makes adaptation considerably easier.
Does insurance cover it?
Oral appliance therapy for diagnosed obstructive sleep apnea is often covered under medical insurance rather than dental, since it treats a medical condition.
Coverage requires a documented diagnosis and usually a physician's prescription. We can help with the documentation, though the specifics depend on your plan.
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