Sleep Apnea and Snoring


Sleep Apnea and Snoring

Restful sleep is a health issue. It is vital to your overall well being to have a restful night’s sleep. According to the CDC, sleep disorders are now so pervasive that they constitute a public health epidemic. Are you concerned that you or a loved one may suffer from sleep related disorders? Here are 2 things everyone should know but probably are not aware of:

  1. Snoring is not normal or healthy… in anyone! Snoring alone has been linked to an increased risk of cardiovascular disease. Some studies show snoring is a 90% predictive risk factor for Obstructive Sleep Apnea (OSA).
  2. Untreated OSA is linked to development of cancer, heart attack, stroke, diabetes, depression, and obesity.

Sleep Apnea: Health Crisis

Flow Limited Breathing

Treatment Options for Sleep Apnea

Continuous Positive Airway Pressure (CPAP) Machine

First line treatment for sleep apnea is often the Continuous Positive Airway Pressure (CPAP) machine. CPAP therapy involves wearing a mask on your face at night that blows air (positive pressure) through your nose to keep your airway from collapsing at night. This breathing machine is kept on all night and can require adding distilled water to humidify the air you breathe. CPAP machines are not custom made but prefabricated with a number of different mask to attach to the hoses.

Mandibular Advancement Device (MAD)

Most patients believe they will have to wear a noisy and uncomfortable CPAP machine while they sleep, but this is not true. One of the most common treatment options for sleep apnea and snoring is a simple oral appliance. These are custom made to fit your mouth and to push your lower jaw and tongue forward to open your airway and thus allow you to breathe correctly while you sleep. Most patients prefer oral appliances because they are comfortable to wear, easy to bring when traveling and affordable.

Myofunctional Therapy

Myofunctional therapy is training for proper swallowing and breathing mechanics. Most people do not realize the importance of breathing through the nose. The two most important factors for success with CPAP and/or MAD are nasal patency (ability to breathe adequately through nose) and BMI (body mass index). Myofunctional therapy in conjunction with other treatment modalities is the most effective means of treating sleep apnea.

Orthodontic Expansion

Depending on the age of the patient when apnea is diagnosed, orthodontics can be a very effective treatment option. Orthodontic treatment works by widening the roof of the mouth and repositioning the jaw to a point it opens the airway. It is the most effective treatment in younger children who have not finished growing. However, there are new methods of orthodontic treatment that are proving successful in adults.

Surgical Options

Conservative, non-surgical sleep apnea treatment is always our preference. However if these modalities fail there are many surgical interventions available which can correct and sometimes cure sleep apnea. Our team works closely with other providers that offer surgical options for managing OSA. Surgical options include (but are not limited to):


How Do I Find Out if I Have Sleep Apnea?

Sleep Apnea must be diagnosed by a physician from an overnight sleep study. The sleep study can be completed at a facility with trained staff monitoring all facets of sleep or with a home monitor from the comfort of your own bed. Both options can be used by a boarded sleep physician to diagnose your condition. Home sleep studies are much less expensive but also can under diagnose the presence of sleep apnea. In some cases, it is recommended that if you have a negative reading with a home sleep test that you follow up with an in-lab sleep study to verify results.

What is the Difference Between Mild, Moderate, and Severe Sleep Apnea?

The American Academy of Sleep Medicine has 3 classification categories for obstructive sleep apnea (mild, moderate, and severe). The difference between the categories is the number of suffocation events per hour of sleep. Mild is equal to 5-15 events per hour. Moderate is 16-30. Severe is over 30 suffocation events per hours of sleep. Obstructive sleep apnea is progressive in nature and will only get worse over time with no treatment.

Will I Stop Snoring With Treatment?

It depends and there is no guarantee that snoring will be completely stopped. However, we will do everything possible to help you get into the best position. The best position is a combination of minimal snoring noise, restful sleep, and comfort. It often takes time to adjust to your appliance and find this position. We are able to run some simple tests to help us determine this position.

How Will I Know if the Treatment Really Works?

The first way is subjective analysis of how you feel. However, we don’t rely simply on how you feel to determine whether the appliance is working. We will also validate the treatment using a follow-up sleep study to ensure your suffocation events are eliminated. This means we may have to repeat this test until we get the results we want. We also may use technology such as the CBCT X-ray or Cone Beam to evaluate how well the appliance has opened the airway.

What are the Risks of Treatment?

We can assure you that we will take every precaution to prevent possible harm. However, it is possible to have some changes to your occlusion (the way the teeth fit together) as well as your TMJ (jaw joint) with treatment.

What are the Risks of Not Treating Sleep Apnea?

Untreated Obstructive Sleep Apnea is a life threatening condition. Few diseases exist which have more significant consequences to health and longevity than this. Possible risks include but are not limited to: heart attack, stroke, uncontrollable type 2 diabetes, poor work (school) performance, daytime fatigue and sleepiness, automobile accidents, negative social interactions and many more.

Is an Appliance the Only Treatment I Will Need?

CPAP (or continuous positive airway pressure) devices are the gold standard for treating Obstructive Sleep Apnea. The effectiveness of a CPAP should not be undervalued. However, there are many people that do not tolerate wearing a CPAP machine. The main goal for treatment should always be finding the least expensive, least invasive, and most effective treatment for OSA. There are times when neither CPAP or an oral appliance meet these criteria. In these cases, we will work with you physician and other specialists to determine what other option will get you the best possible outcome.

Will My Insurance Pay for This?

Grabill Family Dentisty is not a participating provider with most medical or dental insurance companies. As a courtesy, we are happy to help in filing paperwork, insurance forms, and any documentation to assist in the processing of your claims. Typically, TMJ and sleep treatments are filed under medical insurance. We feel it is important for you to fully understand the policies you have and their payment allowances. Since we are out-of-network providers, your insurance company may be unwilling to provide any information to us other than the basic plan benefits. Therefore, we may ask you to contact your insurance provider to obtain your plan’s specific benefit information.


Dr. Kolkman was awarded his Fellowship in the AGD by amassing over 1,000 hours of continuing education in the areas of cosmetics, sedation, implants, and biological dentistry. Additionally, Dr. Kolkman is a member of the American Academy of Dental Sleep Medicine.


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