About Sleep Apnea

Welcome. Your journey to better sleep and better overall health begins today. I’m Dr Vandervelden from West Michigan CPAP Alternatives. I’m here to talk to you today about custom oral appliance therapy, an effective alternative treatment to CPAP. I suffer from obstructive sleep apnea, and like most people, I was put in a CPAP. I hated my CPAP, but I knew I needed it. I started looking for alternatives and heard about custom oral appliances. I tried it for myself, and I was amazed at how well it worked. Sleep testing showed I didn’t need my CPAP anymore, so I got really excited, and over the next several years, I obtained the highest level of training in this field and currently I provide comprehensive dental sleep therapy utilizing custom oral appliance therapy.

I do this full-time, and recently sold my general dentistry practice because the demand for custom oral appliances has grown so much since word had gotten out in the community that I offer a highly effective and patient-preferred alternative to CPAP. What is sleep apnea? You probably heard it is a serious condition that doctors are worried about, but why? Well, for starters, it is progressive in nature, and there is no cure. In a nutshell, you are not getting enough air at night while you’re sleeping if you suffer from sleep apnea. This is due to your airway getting blocked during sleep, particularly during deep sleep when your airway dilator muscles— the muscles responsible for keeping your airway open— go slack and your airway is more likely to collapse. These episodes, where your airway is either fully or partially collapsed, lead to a lack of air or oxygen being delivered to the entire body and result in heavier, labored breathing. Even if your body can overcome these obstructions and get enough air through increased effort and taking deeper breaths, this labored breathing takes a toll on your body over time. If you suffer from sleep apnea, even mild sleep apnea, it means that you require more effort to breathe, and you will not get the full benefits of healthy, restful sleep.

Sleep apnea is associated with death, stroke, heart attack, cardiac arrhythmias such as AFib, certain cancers, a weakened immune system, worsening diabetes, mood disorders such as depression and anxiety, increased motor vehicle accidents, and weight gain. Erectile dysfunction, being tired throughout the day, morning headaches, memory loss, poor sleep quality, and unfortunately, there is no cure for sleep apnea other than jaw surgery, which is not practical for the majority of the population, and it carries risks. So, if you suffer from sleep apnea or snoring, what are your options? CPAP, custom oral appliance therapy, and hypoglossal nerve stimulation, like Inspire, are considered the top three mainstream treatment options that have been shown to be highly effective in treating obstructive sleep apnea and snoring.

How do they work? CPAP works by blowing air down your throat, and that air pressure keeps the collapsible portion of your airway open.

In theory, this is the most effective treatment, but the catch is that most people hate CPAP and struggle using it enough to get meaningful health benefits. It is well documented that long-term compliance with CPAP is under 50%, and ideal usage is less than 25%. This brings us to custom oral appliance therapy. A custom oral appliance is like a retainer you wear in your mouth. It positions the lower jaw forward, which opens the airway. The lower jaw is stabilized and prevented from falling back, which is what keeps your airway open even when you’re lying on your back. Studies show that when compliance is taken into account, custom oral appliance therapy is just as effective as CPAP. Over 95% of my patients are still using their oral appliance all night every night after one year. Patients love wearing their oral appliance, they tell us it’s comfortable, easy to sleep with, and highly effective.

Studies show that overall, custom oral appliance therapy is more cost-effective compared to CPAP in the long run, and studies show patients strongly prefer custom oral appliance therapy to CPAP.

Lastly, we have hypoglossal nerve stimulation or Inspire. Inspire is like a pacemaker for the tongue. The device is implanted in your chest, and the wires are then attached to the motor nerve of the tongue. When the device detects your airway collapsing, it applies voltage to the motor nerve of the tongue, which then moves the tongue forward, opening the airway. It is highly effective, but like all surgeries, it shouldn’t be a first-line option in most cases. CPAP and custom oral appliance therapy should be tried first. Also, you’ll have to go under general anesthesia twice to get Inspire. Once to see if you’re even a candidate, and then again to implant the device in your body. Also, the battery dies after about 10 years, which will require a follow-up surgical procedure

Costs are up to 40 thousand dollars, and even with insurance coverage, there will likely be high out-of-pocket costs. There are also potential health risks that come with going under general anesthesia and surgeries in general that you should discuss with your doctor before considering this option.

So, you might be thinking to yourself, why don’t sleep doctors make custom oral appliances? Well, you must be a dentist to offer custom oral appliance therapy because the teeth support the appliance. Well, you might be wondering, why don’t I just buy an over-the-counter sleep appliance or snore guard? Don’t confuse custom oral appliance therapy with the inexpensive snore guards found online. Studies show over-the-counter sleep appliances do not work as well as custom oral appliances. Studies show that dental devices bought online that are not being managed by a diplomat dentist like me increase the risk of severe side effects, which include tooth loss, damaged dental work, permanent TMJ jaw pain, and significant bite changes.

These online appliances typically don’t last and are usually uncomfortable. Plus, there’s no sleep testing used to optimize the device settings and to confirm effectiveness.

Now, you might be thinking, ” Wait, those severe side effects listed above sound awful. Is that going to happen to me? Don’t worry; custom oral appliance therapy is totally different than an over-the-counter snore guard or mandibular advancement device (MAD for short). Studies show that in the hands of a diplomat dentist like myself, most side effects are minor and can be mitigated. This includes temporary jaw discomfort, temporary tooth soreness, minor insignificant bite changes, a little dry mouth, and very rarely TMJ symptoms. It is extremely rare for my patients to stop wearing their appliance due to a side effect.

Is this legit? Yes, custom oral appliance therapy is approved by the American Academy of Sleep Medicine as a first-line option to treat mild and moderate obstructive sleep apnea. It’s also approved by the American Academy of Sleep Medicine for severe sleep apnea if you’re non-compliant with CPAP or just flat out refuse CPAP

Can any dentist do this? Technically, yes, but it’s not recommended. Diplomat dentists like me receive the highest level of training in this field. Studies show that patients have significantly better long-term outcomes when managed by a diplomate dentist compared to other dentists who primarily focus on making appliances but do not provide comprehensive management of sleep apnea long term. Remember, sleep apnea is a progressive condition and requires close monitoring for best results. Changes in your jaw position may be necessary in the future to keep this therapy working at its best.

Do you know of a family member who could benefit from this therapy, but they’re from out of state? We have many patients who have come from far away, and they tell us it was worth the drive to get the best result. But if the commute is a major barrier, then find a diplomat sleep dentist at dentalsleep.org. Make sure you ask if this Dentist provides comprehensive care. Some Diplomate Dentist are primarily focused on making appliances, while others provide closer follow-up and long-term management of your sleep apnea. The process matters; it’s not just about the appliance. There are diplomats in every state. Again, dentalsleep.org. So what’s next? If you have already scheduled your free 30-minute consultation or are watching this in our office, congratulations on making the first step. Let me explain a little bit about our process

During your complimentary consult appointment, I will scan your mouth and complete a full workup to determine if you’re a candidate for custom oral appliance therapy. I’ll be honest if I feel this therapy will achieve your goals. This is important. I use the latest intraoral imaging technology which allows my partnering labs to make precision-fit, high-quality oral appliances that are smaller and work better than cheaper alternatives. My team will then set you up with multiple nights of home sleep testing using cutting edge sleep testing technology that the Cleveland Clinic has shown to be highly accurate. It is a ring that you wear on your finger. In the morning, you place the ring on your docking station until the next night. The docking station downloads the data from your ring and stores it.

When you’ve completed all your nights with your ring, you simply return the ring and docking station to our team at the determined time and complete the face-to-face telehealth visit with my partnering board-certified sleep physicians. They’ll review all your treatment options again and provide the prescription for your oral appliance, which I require before we schedule the next appointment, where your appliance is fitted in your mouth to confirm a good fit, along with further care instructions. These short, 15-minute visits are done via telehealth at your convenience. You don’t have to go to a sleep center to be set up with home sleep testing. Our office will help you feel confident about how to use this. Even if you have completed recent sleep testing, I still require every patient to undergo testing throughout therapy and complete all included telehealth visits with my partnering board-certified sleep physicians because this leads to the best long-term outcomes and is just the best care. Due to my thorough process, my patients are more effectively treated, have minimal side effects, and have better long-term results than other dentists who primarily focus on making appliances.

I will have you undergo multiple nights using the ring at multiple lower jaw positions toyou’re your jaw set just right. Forward enough for the appliance to be effective, but not so far forward that it causes major side effects. I also continue to check the status of your sleep apnea every 2 years, allowing me to continue to slowly move your jaw forward, when needed, to keep this therapy working well for you. This is why it is crucial to set your lower jaw in the least forward position from the start. Other dentists do not do this. I provide comprehensive, high-quality custom oral appliance therapy and offer long-lasting results. When it comes to your sleep and overall health, you deserve the best.

All this sounds great, but will it cost a fortune? This may come as a surprise, but studies show that not treating your sleep apnea costs you more than treating it. Plus, think of all the potential health issues you can avoid by treating your sleep apnea, not to mention the better-quality sleep, higher energy, and higher clarity you will experience after a night of healthy sleep. You will feel a whole lot better after a night of using your appliance vs. not using it. Custom oral appliance therapy, when done successfully, is likely a great investment in your health and for your bank account.

Thank you for taking the time to watch this informational video on custom oral appliance therapy. The team at West Michigan CPAP Alternatives is excited to see if we can help you meet your sleep goals, and we hope you are a candidate for this life-changing therapy.