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FAQs

Many of our patients often have the same questions when they come to us. Get the answers to those common questions below.

Locate the answer to your question by choosing a topic:

SLEEP APNEA

Who gets Sleep Apnea?

Anyone can have sleep apnea. You don’t have to be obese to get it, either. One in four people who has sleep apnea is skinny! It occurs in all age groups but is more common as a person ages. Men get it more often than women, until women quit menstruating, and then they catch up with men. At least 4% of middle-aged men and 2% of middle-aged women have sleep apnea with excessive daytime sleepiness. Common signs and symptoms of sleep apnea include:

  • Excessive Daytime Sleepiness
  • Increased risk of cardiovascular problems (heart attack, hypertension, congestive heart failure)
  • Increased risk of stroke
  • Increased risk of motor vehicle accidents
  • Weight gain from increased insulin resistance and glucose intolerance
  • Decreased mentation
  • Impotence
  • Mood swings and irritability
  • Morning headaches
  • Decreased life expectancy if untreated
What should I do if I think I have sleep apnea?

You can call us at 210-541-9001 and we are happy to schedule a free consultation to talk about how to help you get a sleep study. However, it is a good idea for you to see your Primary Care Provider and discuss with them why you think you may have it. Likely, they will tell you that you need a sleep study.

What is a sleep study?

The ONLY way to know whether or not you have sleep apnea is to have a sleep study done. Your insurance company will very likely pay for a sleep study IF they feel the test is justified. How would they determine that? If you snore, and you’re sleepy, and you’re tired, and you have some of the co-morbidities of sleep apnea, then you’re more likely than not to have sleep apnea. Sleep studies can be done in a brick and mortar type lab; this is called a polysomogram or PSG. Sometimes, you can do a Home Sleep Test, or HST. Talk with your PCP or Dr. Drake to help get you headed in the right direction. We have relationships with nearly every sleep lab and sleep MD in town.

What are the health consequences of not treating sleep apnea?

Not sleeping well and not oxygenating well while you’re sleeping is a BAD combination. We know that people who have sleep apnea and don’t treat it are much more likely to DIE! Sleep apnea is a serious disease. It makes everything worse, from hangnails to relationships to…yes, even cancer! Patients with OSA are more likely to have high blood pressure, glucose intolerance, car crashes, strokes, and impotence.

What are the benefits of treating Sleep Apnea?

I think we treat sleep apnea for two main reasons. First and foremost, I think we do it for Quality of Life (QOL) reasons. We sleep better; we feel better; we think better; we perform better. The second reason we should treat sleep apnea is to mitigate health risks. Very simply, we live longer lives with fewer problems. Oh, yeah, and your spouse doesn’t have to sleep on the couch either.

Is technology affecting my sleep?

Our cell phones, tablets, computers and other electronic devices have become such a huge part of our daily lives that it’s often hard to put them down—even at bedtime. Keeping your phone on your nightstand may not seem like a big deal, but it is affecting your sleep in more ways than you realize.

Could depression be linked to sleep apnea?

Sleep deprivation or sleep apnea does not cause depression. Not getting enough sleep, however, contributes to your depression. Depression is exacerbated when you don’t sleep, or when you don’t sleep well; it upsets your normal, daily routine.

Insurance

Is oral appliance therapy covered by my medical insurance?

Many times the cost for your dental sleep therapy is covered or supplemented by medical insurance. Dr. Drake’s office is trained and experienced to help you obtain your maximum medical benefits at minimal cost to you. We typically need a diagnosis from a sleep study and a Letter of Medical Necessity in order to get your claim paid. Most payors insist on pre authorization as well.

Are you in network with my insurance company?

Dr. Drake is IN NETWORK with Medicare, TriCare, Humana, and UHC. Often, we are able to get GAP exceptions even when we are not in network, allowing you to use in network benefits. Please call us at 210-541-9001 if you have any questions about insurance.

What is a GAP exception?

Don’t fret, however, if you don’t see your insurance company listed above. Many times, we can get a GAP exception for other insurers, (BC/BS, UHC, Cigna, Anthem, among others) that allows you to receive out-of-network benefits at in-network levels. Through our vast network and years of experience treating obstructive sleep apnea, Dr. Drake’s Sleep Solutions has become a leader in the industry for maximizing your insurance benefits. Our team is dedicated to minimizing cost and maximizing patient benefit.

Is oral appliance therapy covered by my dental insurance?

The short answer is No. The long answer is No way.

Oral Appliance Therapy

Why can't I just order a device off the TV or get one from Walmart?

You can, of course, but our response to that has always been “We fix $6 haircuts.” Over the counter devices are usually the “boil and bite” type, similar to what you may have used in 8th grade football. The “one size fits all” usually means it doesn’t fit at all. So they don’t stay attached to your teeth as well, and your jaw falls out and open and back (and closes your airway!); additionally, they are not “titratable” or adjustable.

Do I need a custom dental device?

Custom made, titratable dental devices are the ONLY way to go. Unequivocal research shows that they work the best. In the hands of a qualified dentist, they work even better. Custom devices fit you and no one else. They occupy less space in your mouth and leave more room for soft tissue and air. As Ferris Buehler said about the Ferrarri, “I highly recommend one, if you have the means.”

Is oral appliance therapy comfortable?

There is definitely a learning curve to wearing a dental device, but it is usually short lived. Over 90% of OUR patients can wear their device through the night, without pain, and can tell that it is helping them, after about ten days.

How do I know if I am a candidate for dental device sleep therapy?

You need at least six or so teeth in each arch; you need to be able to move your lower jaw forward; you gums should be in good shape; and you should have had a sleep study. There are exceptions that we can sometimes work around.

How do I know which oral appliance is best for me?

We don’t expect you to know; that’s why we evaluate multiple parameters to determine which device would be best for you.

How long does an oral appliance last?

Most insurance companies will pay to replace a dental device after about two and a half years or so. And that’s about how long they last. Like anything that is put into your mouth, it varies. We’ve had patients wear their device every night for several years and it’s still doing well; others are very hard on them and they wear out after just a couple of years. Most device manufacturers warranty their device for time frames from one to three years.

How successful is oral appliance therapy at reducing snoring?

Studies show a 95% success rate at treating snoring. How do they define successful treatment? By moving six points better on a 0-10 scale. So if your hubby is at an 8 now, it’s very likely we can get him from a roar to a purr. By the way, oral appliance therapy reduces snoring as good as or better than CPAP.

How successful is oral appliance therapy at treating my sleep apnea?

This is a loaded question, to be sure, and depends on how you define “success”. The industry standard is to reduce the RDI (Respiratory Disturbance Index) by ½ and to get it below 15, along with improvement of subjective symptoms. Success rates for oral appliance therapy vary from 30% to 90%. OUR experience here is that we meet these numbers at least 75% of the time. You can see, from the chart below, how dental devices compare to CPAP:

  • Snoring: As GOOD as or BETTER
  • AHI: PAP better by 6 events (Hoekema same)
  • LSAT: PAP better by 3% (Hoekema same)
  • Arousal Index: PAP slightly better
  • ODI: PAP slightly better
  • Sleep architecture: As GOOD as
  • Sleep Efficiency: As GOOD as
  • Daytime sleepiness: As GOOD as
  • QOL: PAP slightly better
  • HTSN: PAP slightly better but NEITHER sig
  • Adherence: BETTER
  • Side Effects: BETTER
Can I keep seeing my existing dentist?

Yes! We encourage you to continue to see your existing dentist for routine and preventative dental care. Dr. Drake’s goal is to successfully treat your snoring or Obstructive Sleep Apnea (OSA) and to collaborate with your dentist and other medical caregivers to provide a comprehensive approach to your treatment needs. Dr. Drake will evaluate your teeth, gums, and TM Joint to ensure that they are stable enough for dental sleep therapy and that you are a candidate. He will work closely with your existing dentist and other medical providers to ensure comprehensive care, and we forward copies of any pertinent records or X-rays that were completed during your visit to help in future treatment. We work hard to provide the best possible treatment to you by providing coordinated patient care.

What are the common side effects of oral appliance therapy?

Dental device therapy is non-invasive and reversible. We hold your jaw forward during the night, and for most people, it goes back to “normal” soon after in the morning. We provide you with an AM Aligner and exercises to help you reposition your bite back to normal. Dental device therapy does put pressure and forces on your teeth and jaws, however, and you may have temporary bite changes, jaw and muscle soreness, and a dry mouth.

Can I use oral appliance therapy if I wear dentures?

If you have NO teeth, then you cannot wear a custom made Mandibular Advancement Device. You can wear a Tongue Stabilizing Device. If you have some lower teeth but no upper teeth, then you CAN wear a Mandibular Advancement Device. This requires a little more time and effort but it can be very successful.

Can my physician make my dental device?

The short answer is yes, because it lies within the Scope of Practice for what a physician can do. The better question you can ask is “Should a physician make you a dental device?” Physicians know a whole lot about a lot of things, but the intricacies of teeth and bites is usually not a part of that. Not many have knowledge or experience of how to manage the processes of taking impressions, getting the device to fit well, making the necessary adjustments, or managing the potential side effects from dental device therapy. The American Academy of Sleep Medicine (AASM) Guidelines, updated in July of 2015, regarding the use of dental devices, recommends that a device be made and managed by a “Qualified” dentist. They go on to define a Qualified Dentist as someone who has 25 or more hours of Continuing Dental Education specifically related to dental sleep medicine in the last two years as well as experience in treating patients. Dr. Drake is presently the only dentist in San Antonio who is credentialed by the American Board of Dental Sleep Medicine.

How is Dr. Drake's Sleep Solutions different from your ''regular'' dentist?
  • UNDERSTANDING THE DISEASE: We explain your sleep study and the co morbidities associated with sleep apnea and WHY it is important to treat it. NOT treating sleep apnea is NOT an option! You can’t stick your head in the sand and make it go away.
  • FDA APPROVED DENTAL DEVICE: You receive a custom fitted, state of the art, FDA approved Mandibular Repositioning Device; you also receive a custom fitted AM Aligner to help you recapture your bite and minimize side effects.
  • FOCUSED ON SLEEP: DSS of San Antonio is singularly focused on keeping your airway open so that you can breathe better, sleep better, live healthier, and live longer! Sleep is ALL we do; all day; every day. We work with you to provide solutions to sleep problems other than sleep apnea. We work with you to provide solutions for tiredness and fatigue issues.
  • SUPPORT and GUIDANCE: We are here to help ensure that your device fits well, is comfortable, and is adjusted to the best possible position to maximize your airway space. Having treated thousands of patients, we know what “normal” is and isn’t. We have many “tricks” up our sleeves, so to speak, to help minimize side effects and make your device work better.
  • INSURANCE: We are in network with most providers; if not in network, we work hard to get you a GAP exception and in network benefits. We make every attempt to keep your out of pocket as low as possible.
  • COLLABORATE with YOUR PHYSICIANS: We collaborate and communicate at multiple points in your treatment with your physician(s) and dentist(s) to ensure a comprehensive, team oriented approach to your overall health. Increasingly, it is more important that your doctors know what each of the others is doing.

Sleep

What is good sleep hygiene?

Good sleep hygiene doesn’t mean always going to bed clean! A short guide is here. As a rule, spend some time winding down before bed. Do things that help you relax. Don’t do things that arouse you (outside of intimacy, of course). Keeping a regular schedule helps. Cool, dark rooms, comfortable beds, good pillows, quiet (white noise OK), no pets or computers or TV’s or phones.

Does it make a difference if I sleep on my side?

Some patients will be diagnosed with positional sleep apnea. Usually, sleep apnea and snoring are at their worst when we are on our backs. Worse when you are extremely tired. Worse when you have alcohol or sedatives on board For some people, they don’t have sleep apnea when they sleep on their side but they do have sleep apnea when they sleep on their back. If this is you, you may benefit from a sleep aid that will keep you from sleeping on your back. I’ve heard of patients putting three tennis balls into a sock and then sewing that onto the back of a T shirt. There are commercial products available as well, belts and pillows, that help you to keep from sleeping on your back.

Is sleep apnea different from insomnia?

Yes. Sleep apnea and insomnia are two completely different beasts. Sleep apnea disrupts your sleep continuity and oxygen levels while you are sleeping. Insomnia keeps you from sleeping. Both can make you tired ad sleepy tomorrow, but each is treated quite differently. It’s a real bummer if you suffer from both!

Is technology affecting my sleep?

Our cell phones, tablets, computers and other electronic devices have become such a huge part of our daily lives that it’s often hard to put them down—even at bedtime. Keeping your phone on your nightstand may not seem like a big deal, but it is affecting your sleep in more ways than you realize.

Could depression be linked to sleep apnea?

Sleep deprivation or sleep apnea does not cause depression. Not getting enough sleep, however, contributes to your depression. Depression is exacerbated when you don’t sleep, or when you don’t sleep well; it upsets your normal, daily routine.

TMJ/TMD

What is TMJ/TMD?

TMJ is short for Temporomandibular Joint. We all have one. Well, two actually. It is our lower jaw joint and allows us to open and close and chew and all that good stuff. It has a lot of muscles attached to it, and sometimes the joint or the muscles around and attached to the jaw joint can hurt. When it hurts, many doctors refer to the associated pain in the TMJ as TMD, or Temporomandibular Disorder or Temporomandibular Dysfunction. So the next time you hear a friend say, “Oh, I have TMJ.” You can respond with, “So do I! Actually, I have two!” semantics.

If I have TMJ problems, can I still wear a dental sleep device?

The answer to this question is almost always. Recent studies have shown a very strong correlation between bruxing and sleep apnea. And we all know that bruxing or clenching your teeth together very hard for long periods of time can cause damage to your teeth and pain in your muscles and joints. Don’t make the mistake of thinking you are not a candidate for dental device therapy just because your jaw joint hurts. More often than not, treatment with a Mandibular Repositioning Device make your TMJ better! Ask Dr. Drake to evaluate your condition to determine if you are a candidate for dental device therapy. For the cases where there are TMJ/jaw concerns, dental sleep devices are available that don’t move the jaw forward and have little effect on the TMJ. Dr. Drake or an associate dentist will be happy to discuss your TMJ concerns and to help decide if you are a good candidate for dental sleep therapy.

Does Sleep Device therapy help or hurt my TMJ?

The short answer is more often than not it helps with TM Joint pain or dysfunction. But not always. It’s more important that we breathe at night than whether or not we have jaw pain, but jaw pain can be debilitating, as you may very well know. We proceed, with caution, on patients who have jaw pain or a history of jaw problems, but we usually proceed. Often, it may dictate which device we choose or sometimes require modification of a sleep device to make it also act like a TMJ splint. ALL good reasons for why you should work with someone who has a lot of experience in dental sleep medicine.

Our Dental Solution Will Help You

Get Some Rest.

Our Custom Dental Sleep Devices Have a 96% Success Rate!