On August 3 2009, NPR (www.npr.org) ran 2 pieces on sleep. Once again, I would like to add some nuance to their reporting. First, I must take objection with the statement that CPAP (Continuous Positive Airway Pressure) machines are “loud and cumbersome”. CPAP machines have changed so much in the past few years. They are small, light (usually 3-4 pounds) and quieter than a fan. Secondly, the oral devices (AKA mandibular advancing device) are not an alternative first-line therapy to CPAP if your apnea is at all severe. Thirdly, these appliances are not as benign as people think at first glance. They can cause mandibular joint or muscle pain, headache, TMJ symptoms, changes in the alignment of the teeth or changes in the bite. Lastly, a big consideration for many patients is the cost. As it stands now, CPAP is covered by all major health insurance companies whereas the oral appliance is not or is only partially covered and dentists charge anywhere from $1500-$3000 for these devices.
Sleep Medicine has become a very specialized field and it is best to have a sleep specialist recommend which treatment is the most appropriate for you to start with. Many dentists are aggressively advertising the oral appliance as an alternative to CPAP and I fear that many of them are crossing the line between dental and medical treatment. The best work up begins with the patient or his/her doctor suspecting that the snoring needs to be evaluated. Then the patient has a sleep study and consults with a sleep physician to determine the presence and severity of sleep apnea. If the oral appliance is the approriate starting point, then the sleep physician will have dentists in the area to recommend. Also, if you are to have any hope of getting your insurance company to reimburse for the oral appliance, it is important to have the proper work up by a sleep physician including a sleep study. This way they know that the appliance is for the treatment of a medical problem, not a dental disorder. Keep in mind that if the only indication is snoring, then the insurance is unlikely to pay as they do not consider snoring to be a medical condition even though the latest research shows that it dramatically increases your chance of stroke.
