Getting Started
So you want to start making sleep apnea treatment a part of your practice? That’s great, and we’re here to help you all along the way.
Step 1 (Most Important)
Start screening your existing patients today.
The most conservative estimates show that at least 20% of the population suffers from a sleep disorder, and the vast majority (90%) is still undiagnosed. That means that if you only see five patients per day, one of them probably has sleep apnea.
• Educate your staff on the visual indications to look for and questions to ask.
• Use one of our provided screening tools, or one of the many other screening tools available.
• Explain to the patient what you found that puts them at risk, and why you feel it’s important enough to further explore.
Step 2
Order a Sleep Test on the patients who need it.
Medical Insurance will only pay for a sleep apnea oral appliance if the patient has a sleep test which shows they have sleep apnea. Home Sleep Testing (HST) is generally the most convenient and cost effective way to collect the needed data.
• Use the HST referral form to order a Sleep Test for the patient.
• Give the patient the informational brochure and card, and let them know someone will be contacting them to answer questions and coordinate the testing.
Step 3
Determine if Oral Appliance therapy is a viable option for this patient.
It’s very important that you discuss all the treatment options with the patient because not every patient is a good candidate for OAT. If the decision is made to move forward with OAT, be sure to note the reasons why (and the reasons why other treatments were not chosen) in the patient’s chart.
• The decision to treat OSA with an Oral Appliance will likely be based on the severity of the patient’s OSA, their oral health and their insurance benefits.
• Explain the results of the Sleep Test to the patient.
• Discuss all treatment options and why you believe they would benefit from one over another.
• Discuss the risks of choosing not to treat OSA.
• Take impressions and bite registrations for an Oral Appliance if that therapy will be used
Step 4
Order the Oral Appliance.
There are quite a variety of oral appliances available today for that will treat OSA, but there is no single device that is the best option for every patient. Be sure to educate yourself on a variety of appliances and don’t hesitate to contact us for guidance. Professional labs such as Gergen’s Orthodontics, can make a number of different appliances and offer support on which ones to choose as well.
Step 5
Seat the Appliance.
Using a high quality and experienced lab will help to keep the adjustments needed to fit the appliance to a minimum. There are certain appliances that rely on orthodontic clasps, instead of only on the acrylic, to keep a snug fit in the patient’s mouth. These are specifically designed to fit correctly the first time.
The day that you actually seat the appliance is the day that a claim can be submitted to the medical insurance. Just send a superbill along with your chart notes and we’ll get your claim into the insurance company.
Step 6
Follow Up and Titration
Depending on the patient, you may need to titrate the appliance anywhere from four to 10 times to get the optimal benefit. As a general rule of thumb, optimal therapy will occur around 70% of the patient’s maximum protrusion, but there are other factors to keep in mind as well. Vertical spacing also plays a role in opening the airway, and patient comfort is important as well. The patient should be bale to tell you that they feel the benefits from a properly titrated device. Their snoring should be reduced, they should feel more energized in the morning and throughout the day, blood pressure levels may fall from elevated levels, and they may even begin to lose weight. However, the only way to know for sure that the OAT is successful is by having the patient undergo a Sleep Test with the oral appliance in place. A successful appliance should reduce the AHI by 50% or bring it within normal levels (under 5).