Obstructive Sleep Apnea (OSA), a condition were breathing becomes shallow and often pauses for several seconds while asleep, is becoming increasingly common not only in the United States but all around the world. While being older than 40 and carrying a few extra pounds are often to blame for this condition, this is not always the case as OSA also affects those who are younger than 40 and within a normal weight range.

Current information suggests that over 20 million Americans suffer from OSA while the majority are unaware. In fact, an estimated 82% of men and 92% of women go undiagnosed. What makes this problem even more complicated is the fact that many who are diagnosed with OSA and are issued a CPAP machine fail to comply for a variety of reasons.

In order to properly diagnose (or rule it out) OSA, you are typically asked to fill out a STOP-BANG questionnaire which asks a series of 8 questions to determine your risk of having OSA. If the results show a moderate or high risk of OSA, you may be asked to complete a Polysomnogram (sleep study). From here, you and your doctor can determine which type of sleep study may be best for you. There are currently two types available – “in a lab” and “at home”.

At Home Sleep Study Vs In-Lab Sleep Study

There are basically two different types of tests for sleep apnea. As the names suggest, the lab study is conducted in a sleep lab setting while the home study can be conducted at home, in your bedroom.

Home Sleep Study

When an at home sleep study is prescribed, the patient has issued a small device in which several sensors plug into. This device records breathing activity as well as blood oxygen levels throughout the night as you sleep. This information is then downloaded and interpreted by either your doctor or the provider of the equipment.  At home equipment typically contains the following sensors:

• Nasal cannula used to measure airflow coming from the nose
• Belt is worn around the chest to measure movement which is an indicator of breathing
• Finger clip to measure blood-oxygen levels

The patient is given instruction on how to make all of the connections. The patient connects the equipment prior to going to bed in evening. In the morning, the patient removes the equipment and returns it to the issuing company.

Many patients prefer the “at home” version because they are not forced to sleep in an unfamiliar laboratory with a dozen wires attached to their body. Other prefer the home test because they are not comfortable with allowing someone to monitor them while asleep. Home sleep studies are also attractive to those who have high deductible insurance plans or have no insurance, simply because they are less expensive.

The insurance company, of course, prefer the at home test for one simple reason and that is cost. At home sleep, studies can be conducted for 1/3 or even 1/4 of the cost of a lab sleep study. Home testing typically costs between $200 – $500. Many insurance companies are requiring home testing to be conducted as a primary screening tool for OSA.

An important consideration for home testing is the likelihood that the patient has OSA. A home test is typically offered to those who have a moderate to high risk of OSA simply because a mild case of sleep apnea may be undetectable using at home equipment.

Lab Sleep Study

Unlike the at home sleep study, the in lab study is conducted at a sleep center. Chances are if you live in a suburban area or in a major city, there are several sleep centers in your area.

A sleep center contains resting rooms with advanced monitoring equipment. You typically arrive at a sleep center in the evening and a technician will hook up a number of different sensors to your body. These sensors attach to the skin and include the following:

• Jaw and eyes
• Head for brain activity
• Leg to detect movement
• Microphone to detect snoring
• Chest belt to detect breathing
• EKG to monitor the heart

You are then asked to fall asleep as the technician monitors the equipment.

In the morning, you are disconnected from the machinery and sent on your way home. The results are typically not immediately available as they will need to be read and interpreted by a sleep specialist or your doctor. This process typically takes between 1-2 weeks. Once complete, your doctor will inform you of the results during your follow-up visit.

The total cost for a sleep study ranges from $1,000 – $3,000 or more.

Criticism

Both home testing and lab testing have their fair share of criticism.

As with many healthcare issues, the discussion typically revolves around cost.

Those who support at home sleep studies prefer this method simply because it’s fairly accurate, more comfortable for the patient and cost-effective.

Labs are often criticized for being overprescribed and excessively expensive. The undeniable fact is, sleep labs are a cash cow for those involved in the industry. In fact, it’s a multi-billion dollar a year industry.

As at home testing evolves and becomes increasingly popular, those who have financial ties to the sleep lab industry are obviously not too thrilled about the push for home testing.

On the other hand, proponents of sleep labs often criticize home testing due to the limited amount of data collected, particularly brain wave activity. Nearly all at home sleep apnea tests are unable to measure brain wave activity. Why does this matter? Because at home test can be fooled by someone who simply lays in bed without falling asleep. Since they are awake and the airway is not relaxed creating an obstruction, the machine reads their breathing and oxygen levels as “normal” and a proper diagnosis could be missed.

Another criticism of the at-home study is the inability to detect other sleep disorders. Sleep labs are able to detect other sleep disorders that would otherwise go undetected while conducting an at home sleep study.

Which type of study should I choose?

There are several factors that one should consider when deciding whether to go with a lab study or home study.

Likelihood of OSA

Your physician will conduct an evaluation and will only recommend a home sleep study if it’s highly likely that you have moderate to severe OSA. If the probability is low then a home sleep study should not be recommended.

In addition, a home sleep study will only be recommended if your doctor does not have reason to believe that another condition may exist. Other sleep disorders can be detected in a lab setting whereas a home sleep test can only detect the presence of OSA.

Cost and Coverage

These days, insurance companies are pushing for more home testing because OSA screening is becoming more common and home testing is, of course, less expensive when compared to lab testing.

Those who have a high deductible plan or carry no insurance at all may be more attracted to a home sleep study while those with ample coverage may desire the most accurate equipment which will be sleep lab testing.

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How Acupressure Rings Stop Snoring

As we all know, or possibly don’t know, snoring is caused by muscles in your airway relaxing a bit too much. When you sleep, these relaxed muscles vibrate, thus creating noise when you breathe in and out. Acupressure, similar to acupuncture can activate the nerves around these relaxed muscles and stimulate them to once again be supportive, ultimately resulting in normal breathing functions and no more snoring. The Acupressure ring utilizes the network of the Central Nervous System to stop you from snoring.

The Antisnor Acupressure Ring was originally designed and developed by an Australian couple, John and Marcia Woodley, along with their son John Woodley Junior in 1999. Oddly enough, the family does not have any historical connection to medicine, but rather a family legacy in the jewelry business. Who knew?! The Woodley family had an interest in natural remedies, which initially sparked the concept of an acupressure device that also served the purpose as a natural remedy. Upon inception, the family formed Atqol, a company dedicated to natural healing solutions. Atqol Limited is the primary manufacturer and distributor of this anti-snore ring. The company holds three separate patents for this product in Canada, Australia, and the US.

Design

So you may be wondering how this beautiful ring actual stops you from snoring, right? Well, interestingly enough, the actual design of the ring itself triggers nerves that network throughout the body and lead directly to the cause of the problem – your airway. This unique ring design is actually beautifully engineered. As you can see, the sides of the ring itself look like some sort of puzzle piece. This is because the indented and raised surfaces are actually applying pressure to the underside of the small finger when being worn. Nerves located on your little finger on the left hand right in the middle of the joint and knuckle are targeted specifically in an attempt to relieve snoring. This is acupressure at work, my friends. The ring should be firmly worn – slight pressure to the ring on both sides should give you a comfortable and effective fit. The side of the ring with the gap in it also doubles as an added safety benefit – it will never get stuck on your finger!

Clinical Trials

Atqol conducted their first clinical trial of the Antisnor Ring in 2012. The trial was spearheaded by a pulmonologist doctor (one who specializes in diseases of the respiratory tract) from Eurosafe, a scientific research firm out of Saint Gregoire, France. The test subjects in the study were all volunteers who suffered from snoring on a daily basis. Also included, were the affected partners of the test subjects. In total, there were 30 couples participating. The researchers not only wanted to see how the acupressure ring impacted the snorer themselves, but also the partners who had to deal with hearing the snoring each and every night.

The Study

On a daily basis, the test couples answered a series of questions about their previous night’s sleep. The questions ranged from what the quality of sleep was for the snorer, to the reaction and sleep quality of the partner. Some nights, the snorer was told to wear the ring, and others not. That way, the snorer, and partner could compare night to night during the clinical trial and get the most meaningful results. The couples also used the Epworth Sleepiness Scale and Visual Analogue Scale to measure their levels of sleepiness during the day. These scales are well known in the industry and have become a world standard in measuring the level of daytime sleepiness. The tests are self-administered and consist of several questions and a rating point scale.

The Results

The scientific conclusions were that 80% of the test couples reported that the acupressure ring did indeed improve the quality of sleep for both partners. Reports showed that participants experienced a better quality of sleep, increased ease of movement first thing after awakening, an increase in airflow while breathing at night, and less of a dry throat when using the ring. An astonishing 50% decrease in the severity of the snoring, in general, was seen during this trial. The participants also gave feedback on the ring as far as comfort and usability go. Nearly all of the subjects claimed the ring was comfortable, easy to use, non-invasive, and would most likely continue to use the product for an extended period of time.

Price, Sizing & Shipping

This acupressure ring is available in three simple sizes: Small, Medium and Large. The Small size fits little fingers ranging in size from 16mm-19mm or ring sizes 5-9. The medium ring size will fit little fingers that measure 18mm-21mm in sizes or ring sizes 10-14. The large size will fit little fingers measuring 20mm-23mm in diameter or ring sizes 13-18.

Product Guarantee

The manufacturer completely backs this product and if you are not satisfied with the results, you can return the item for a full refund within 45 days of the purchase date. All they require for the return is the ring in its original packaging, the receipt for the item (proof of purchase) and your mailing address for which they can send you your refund. Processing time for the return can take anywhere from 7 to 28 days.
Since the ring is made of sterling silver, it should last a lifetime. Atqol markets that some customers have been using the ring every night for over 6 years and that it will never wear out to the point that it would need a replacement. In the event it ever would, I’m sure the company would send a replacement to such a great customer anyway.

The Antisnor ring is listed at $39.95 and can often be ordered with free standard shipping included. Since the manufacturer is an Australian-based company, delivery times within the country usually take anywhere from 3 to 9 days. International orders shipping to the US or Canada may take 2 – 3 weeks. Plan accordingly.

Customers

I have seen nothing but rave reviews from recent customers who purchased this product. One customer claimed they have been wearing the ring for more than two years, on a daily basis, and not only did it help them sleep well, but also helped with their breathing. Another user commented on how effective the ring was for both parties – the snorer himself and also his wife. He mentioned that the ring ultimately positively impacted some sinus issues that have always been a problem for him as well.

Antisnor Amazon Reviews

The manufacturer does have the item listed for sale on Amazon. It is unclear if all sizes are available there at the moment, though. There are a few customer comments regarding the product. One customer recently purchased the acupressure ring in mid-January, 2015 and claimed that he had to perfectly position the ring in order to trigger the nerve. Once he found the sweet spot of positioning it, his snoring turned into a quiet sleep, for both him and his wife. This comment makes sense because your nerves aren’t necessarily everywhere on your little finger, but with a little bit of experimenting on the actual position of the ring, it sounds like the ring is a home run. Another Amazon customer stated simply that it worked “magically”. Very good.

My Personal Opinion

Although I have not tried the Atqol snoring ring, I have tried a similar antisnoring ring and the results were not nearly as impressive as what I had experienced using a snoring mouthpiece. Mouthpieces work incredibly well by targeting the area in which snoring occurs, the airway.

You can compare over 30 different mouthpieces that I have tried here.Share This Post:

Morning sickness, fatigue, and unusual food cravings are all common and often anticipated side effects of pregnancy. However, the occurrence of snoring, on the other hand, leaves most pregnant women confused and usually concerned.

If you are pregnant and have recently started snoring, you may find comfort knowing that over 25% of women begin to snore at some time during their pregnancy. This percentage increases after entering the third trimester of pregnancy.

Snoring during pregnancy not only has the potential to keep your bed partner awake at night, but it may also be a sign that an underlying medical condition may exist.  This could be obstructive sleep apnea, a sleep-related breathing disorder in which your breathing becomes shallow or often ceases several times during the night. Due to the potential of such a condition existing, it’s especially important to discuss the onset of snoring during pregnancy with your doctor to rule out the possibility of a more serious condition.

What are some common causes of snoring during pregnancy and how can you reduce or prevent the snoring?

Common Causes

Weight gain

A likely culprit of this bedroom nuisance is simply weight gain. It’s not uncommon for women to gain an excessive amount of weight during pregnancy. In fact, nearly 50% of American women who become pregnant are considered overweight while pregnant.

In general, those who are overweight tend to accumulate excess fat and tissue in the neck area. As a result of this excessive material in the neck area, the airway can become constricted and tissues in the airway begin to collide with each other which causes the sound of snoring that we are familiar with.

This may leave you wondering how much weight gain is too much? According to the United States Institute of Medicine, this will vary depending on your normal weight prior to pregnancy. Women who are of normal weight should aim for a gain of between 25 lbs to 35lbs while overweight women should gain between 15lbs to 25lbs. Those who are typically obese should consider gaining only 11 lbs to 20 lbs. In other words, the more you weigh prior to becoming pregnant, the less you should gain during pregnancy.

Inflammation of the nasal passages

Swollen and inflamed nasal passages may be the cause of snoring during pregnancy. Excessive mucus production and nasal passage swelling are common during pregnancy due to an increase in estrogen. Blood vessels in the nose tend to swell which causes inflammation in the nasal passage. Swollen nasal passages restrict airflow and sometimes completely stop airflow through the nose. As a result, snoring will occur as air passes through the narrow opening. Aside from weight gain, nasal passage inflammation is one of the most common causes of snoring in pregnant women.

Physiological

As your baby grows it will inevitably place pressure on your diaphragm which will make breathing more of a challenge. This pressure will cause restricted breathing which may ultimately cause snoring that did not exist prior to pregnancy.

With each passing day, the fetus grows larger, resulting in more pressure against the diaphragm. This is perhaps why snoring is most common in the third trimester as the baby has grown to a considerably large size.

Stress

Stress can cause a number of different symptoms regardless of your pregnancy status. Stress is often an overlooked factor when it comes to many different conditions including snoring.

Unfortunately, pregnancy can be a stressful period of time due to all of the unforeseen events that can occur within the nine-month period. Combine this with the anxiety of anticipated childbirth and you have several factors that can lead to high levels of stress.

So how does stress cause snoring? It’s well known that stress can affect the rate at which we breathe. An increased rate of breathing along with other factors (such as inflamed nasal passages or relaxed excessive tissue in the throat) can ultimately lead to snoring.

Alcohol, tobacco or sedatives 

You may not know this but alcohol, tobacco, and sedatives such as sleeping pills can all cause snoring as they relax the throat muscles.

Being that we are in the 21st century, we all should be well aware of the problems associated with the use of these products and issues with childbirth. Just in case, avoid all three as they not only cause snoring but also greatly increase the risk of your child being born with a birth defect.

How can I stop the snoring?

Now that we have addressed some of the common causes of snoring, let’s consider some possible solutions to prevent the snoring.  While you may not be able to completely stop the snoring, you may be able to greatly reduce the severity and frequency of it so that you and your partner can get a full night of rest.

Let’s start by addressing the most common cause of snoring during pregnancy – weight gain. I know what you are thinking “but I’m eating for two, of course, I’m going to gain weight”. While this may be true, you should still attempt to stay within the recommended weight range for your body type. As previously mentioned, this should be between 25 lbs and 35 lbs. This amount should be even less if you were overweight or obese prior to becoming pregnant.

Before changing your diet, be sure to speak with your doctor and perhaps a dietitian to determine the best course of action to help you to achieve optimal weight while ensuring that your baby is getting proper nutrients that it needs to develop. It’s fairly safe to say that you should eat less processed foods including doughnuts, ice cream, potato chips, cheesecake, and brownies and eat more wholesome fruits and vegetables.

Inflamed nasal passages are going to occur regardless. One solution may be to use nasal strips such as those made by Breathe Right. These flexible strips adhere to each nostril and use the bridge of the nose to create a “spring” action which pulls the nasal passages open. As a result, the nasal passages open up and air flows freely.  It’s important to remember that these will only be effective if the snoring originates in the nasal passage area. A 10 pack of these can be purchased for around $5 at your local Walmart, Walgreens, or CVS. If they work, large packages can be purchased at a lower cost per unit.

A change in sleeping position may be all that it takes to stop the snoring. Try sleeping on your left side with your head slightly elevated. Sleeping on your back will actually increase the intensity of snoring as gravity causes the tongue and tissues to fall back into the airway. Sleeping on your side prevents this from happening.

You may also want to try sleeping with a specialized pillow which will help to elevate your head and make sleeping on your side more comfortable.

It goes without saying that you should not consume alcohol, use tobacco or sedatives while pregnant. There are of course several reasons for this, snoring being one.

Finally, you may want to consider a snoring mouthpiece. These simple devices are usually custom fitted and can be placed in your mouth before going to bed. They work by holding the lower jaw slightly forward which helps to keep your airway clear of obstruction. A variety of manufacturers make this product but almost all work by using the same principle.  One product, in particular, is the Joy mouthpiece.  The Joy helps to prevent pregnancy snoring and can also be additionally used as a birthing mouthpiece which can actually shorten your delivery time while giving birth.  Learn more about the Joy Mouthpiece and how it can benefit you.

Whichever solution you choose, ensure that you first speak with your doctor, especially if you wake up tired and with frequent headaches as this may be a sign of a more serious condition such as obstructive sleep apnea.

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Snoring mouthpieces harbor bacteria and quickly begin to smell

Anyone who has ever owned a snoring mouthpiece for even a short period of time will tell you that they can get a bit funky after wearing a few nights.

A while back we discussed cleaning specific mouthpieces using a store purchased products such as toothpaste, mouthwash, dish soap, and effervescent tablets. When it comes to cleaning, most mouth guard manufacturers offer their own guidelines which typically include these cleaning agents.

Cleaning is however only half of the battle. Using some of the above-mentioned products will often remove physical debris, leaving behind odor-causing bacteria, fungus, and viruses. These little critters are invisible to the naked eye but are still present, even after a thorough scrubbing. Since conditions inside of the mouth provide a perfect breeding ground for such critters, any colonies that were washed away during “cleaning” will quickly repopulate and within a day or two the rancid smell returns.

Until recently, I haven’t been able to find a cleaning and sterilizing product for snoring mouthpieces. The best product that I could find was effervescent tablets which kill just that bacteria and often discolor the plastic of some oral appliances.

After using Polident tablets for several years, I came across a new product called “Z CLEAN” which claims to clean and kill 99.9% of virus, fungus, and bacteria. The directions say that it can be used to “sterilize your snoring and sleep apnea devices”.  Okay, so an all-in-one product that cleans and completely sterilizes and made specifically for mouthpieces? Tell me more!

About Z Clean

Z- Clean is a product that has been developed by the oral appliance manufacturer Zyppah who has teamed up with an Orthodontic Appliance Plastics, (O.A.P.) a Hewlett, NY company that specializes in cleaning and disinfecting products for everything from aligners to dentures and mouthguards.

According to the product label, Z CLEAN is made in the USA and has been cleared by the FDA. When shopping for any such product, it’s extremely important to ensure that the product has been examined and cleared by the US Food and Drug Administration (or equivalent safety regulation agency in your country). Otherwise, you will never know if the product is safe to use for its intended purpose.

If you were to take a look at the advertisement on their website, the exact type of product that they are selling isn’t quite clear. Is it a large roll of effervescent tablets? Perhaps a canister of cleaning powder? As it turns out, it’s actually a 1.5oz bottle filled with a mint-scented gel-like foaming cleaner. The advertisement states that one bottle should last for thirty days.

The product packaging offers the following directions for use:

1. Wet the device with water
2. Spray device with Z Clean foam
3. Wait 45 seconds as foam activates
4. Brush any heavy stains with toothbrush
5. Rinse the device with water and let dry

Overall, the cleaning process seems easy and straightforward.

How much does it cost?

Zyppah is currently selling one bottle for $19.95 plus $9.95 shipping and handling, bringing the overall cost to $30. However, if you are purchasing this as an add-on item while buying the Zyppah, shipping is combined and there are no additional shipping and handling charges.

$20 for a bottle of cleaner and disinfectant? Sounds a bit expensive but does it actually work and how long does it last?  I was interested so I grabbed a bottle and put it to the test.

Product Review

Wet the device

Spray one pump and spread around entire mouthpiece with finger

Allow to sit for 45 seconds and brush with toothbrush

Rinse clean and allow to air dry

Putting Z Clean to the test

Being one who owns several snoring mouthpieces, I was curious to find out how well the Z cleaner worked. Up until this point I have always used effervescent tablets or a mild dish detergent such as Dawn to clean my oral appliances. While effervescent tablets seem to get the job done, I have always been left wondering what kind of bacteria, fungus, and virus are left behind in the cracks and crevices. Even after cleaning using the effervescent tablets, my mouthpieces still seems to have a slight odor once cleaned and dried, signaling the presence of bacterial growth.

So it was out with the old and in with the new. According to the product label, Z Clean can be used with all snoring and sleep apnea devices as well as CPAP accessories. I, however, decided to start by testing it on the Zyppah simply because this product was made specifically for this device. I later tested it on the Good Morning Snore as well as the SleepTight. All three products are distinctively different.

Upon arising in the morning I rinsed off my Zyppah, gave it a pump of Z Clean and used my finger to distribute the solution. Forty-five seconds later I used a fresh toothbrush to give it a good scrub followed by a rinse. I then allowed it to air dry until later in the evening.

As bedtime approached I grabbed the Zyppah and gave it the sniff test. Surprisingly, it still had a minty fresh smell!

In the morning there were no noticeable odors on the mouthguard so I cleaned and stored it. Once again, it remained fresh smelling after spending several hours drying.

For the next few nights, I tried Z Clean with both the GMSS as well as the SleepTight with identical results.

Because I’m not a scientist and do not own a microscope, I can not attest that this product killed 99.9% of virus, fungus, and bacteria. What I can confirm is that it keeps oral appliances smelling fresh which is an issue that I have always dealt with, until now.

How long will it last?

One bottle = 75 pumps =75 cleanings

Right about now you are probably wondering how long will a bottle last? If it lasts for several weeks then it could still be a great value.

While putting the Z Clean Clean to the test, I found that just one pump provided just enough foam to cover the surface of a mouthpiece and clean it. Since most of us will clean our mouthpiece once per day, typically in the morning, it’s safe to assume that 1 pump equals 1 day. Now, how many pumps are in this 1.5 oz bottle?

With a brand new bottle in hand, I was determined to found out the answer to this question so I pumped the bottle until empty while counting. As it turns out, one bottle produced about 75 pumps or 75 days of use.  Does this mean that it will only last for 75 number of days? Not necessarily.

Because it’s not completely necessary to sanitize daily, you can use a less expensive alternative such as Polident for most days of the week and use Z Clean every other day for a deep cleaning and to completely sanitize. If used only three times a week with one pump per cleaning, a bottle should last for up to six months. This will reduce the monthly cost while keeping your oral appliance fresh.

Recommendation

Z Clean is an effective cleaner and sterilizer that solves the issue of smelly mouthpieces. While it’s a bit on the expensive side, a little bit really goes a long way. If used sparingly, a bottle will last for several weeks. In my opinion, $20 is a small price to pay for a product that cleans and sterilizes, leaving only a fresh mint scent behind. The Z Clean is by far the best oral appliance cleaning solution currently available on the market.

Here are a few pros and cons to consider:

Pros

• Only product that kills 99% of bacteria, fungus, and viruses while cleaning
• No soaking overnight cleans and sterilizes in about a minute
• Mild ph and gentle cleaning agent prevents discoloration
• Safe to use on any mouthpiece
• Can be used for other purposes such as CPAP accessories

Cons

• A bit pricey but can last up to 6 months

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Oral Appliance Therapy – The CPAP Alternative

You have spent countless nights trying to become accustomed to wearing your CPAP mask and have grown tired and feel defeated. Frustration sets in and you are actually considering surgery as a solution to your sleep apnea. If this sounds familiar, you may want to take another look at your options prior to undergoing an often painful and risky surgical procedure that still do not guarantee results.

While surgical procedures such as the uvulopalatopharyngoplasty and soft palate implants (pillar procedure) are necessary in certain cases, doctors often view surgery as an aggressive approach to treating OSA. Before considering surgery, understand that there is one non-invasive solution that your doctor may not have mentioned. This solution does not require any surgery and has proven to be quite effective in treating mild to moderate sleep apnea. So what exactly are we talking about here? It’s called a dental appliance or oral appliance and it’s been in use for over three decades.

You may be wondering why you have never heard of this device. After all, it’s been available for several years and many people have found success with it. While there are several reasons why these are not as popular as CPAP machines, perhaps the most cited reason is that most doctors are not well-versed when it comes to oral appliance therapy. For years, they have been told that the CPAP is the “gold standard” when it comes to treating OSA and have accepted this as the only answer. While the CPAP along with weight loss and avoidance of sedatives is still the best and most effective treatment option, patient compliance plays a huge roll in whether or not treatment is successful.

Often times, a few simple modifications will make a huge difference when it comes to CPAP compliance. For example, adding a humidifier to your machine or trying out a different style of mask may be all that it takes to make your experience more comfortable.

But what about those who are not able to tolerate the CPAP? Those who have tried to work with their CPAP and simply can not tolerate it despite all efforts may want to speak with their doctor about oral appliance therapy.

Limitations

This type of treatment does have its limitations.

First, it’s usually only prescribed to those with mild to moderate obstructive sleep apnea who are CPAP intolerant. Those with severe OSA or central sleep apnea are very unlikely to be prescribed one of these devices.

Another limitation is its effectiveness. While oral appliances are effective, they are still not quite as effective as the tried-and-true CPAP. This is of course why in most cases the CPAP is always the first tool that physicians recommend for the treatment of OSA.

As with any other piece of equipment, dental appliances will occasionally need to be adjusted or repaired. After several months of use, they will eventually wear out and need to be replaced.

Those who have issues such as Temporomandibular Joint Dysfunction (TMJ) may not be able to use a dental appliance

After taking the above limitations into consideration you may still find yourself interested in oral appliance therapy. If so, continue reading to learn more about this treatment option.

More on dental appliances for sleep apnea

After many failed attempts with the CPAP, you have decided to further explore dental appliances. What exactly is a dental appliance, how are they used, and how much do they cost? These are a few questions that I hope to answer.

If you have ever seen an athletic mouthguard, you probably already have an idea of what a dental appliance for sleep apnea looks like.

While their appearance may be similar, they serve two entirely different purposes and should not be confused with each other.

The athletic mouthguard serves as a protective barrier between your teeth that prevents tooth injury while playing contact sports. In contrast, the dental appliance also fits between the teeth but functions as a device that holds the jaw slightly forward while asleep. It’s simply two trays – an upper and lower, that are bound together to form a mouthpiece. While there are over 80 different models to choose from, the Tap 3 Elite seems to be one of the more popular ones.

What makes this product unique and effective when it comes to treating OSA is the fact that the lower tray rests slightly in front of the upper which when worn, causes the jaw to maintain the forward position. The degree in which the advancement is set will vary from one person to another.

Why is it important to position the jaw forward? By doing so, you are pulling tight all of the muscles and tissue that surrounds the airway. This creates a clear opening for air to travel and prevents airway vibration and collapse. A restrictive airway is, of course, the cause of OSA.

Dental appliances are typically fitted and adjusted by your dentist. When choosing a dentist to create your custom appliance, be sure to find one who has extensive experience in dental sleep medicine. You will likely undergo a sleep study after receiving your new appliance to ensure that it’s working properly. Adjustments may be necessary to achieve a properly functioning device and a comfortable fit.

How much do they cost?

One of the most commonly asked questions that I hear is “How much will an oral appliance cost?” or “Will my insurance cover one?”. The short answer is somewhere around $3,000 however, this amount will vary depending on which device you choose and how much your dentist charges to fit one.

As for insurance coverage, many insurance companies cover a large portion or in some cases all of the expense associated with acquiring an oral appliance if it’s deemed to be a medical necessity.

Unfortunately, not all insurance companies operate by the same rules. What makes it even more complicated is the fact that most doctors can only give you a rough estimate of the expense because even they are uncertain of how much your insurance is willing to cover until they begin working with your insurance company. In short, your health insurance will likely foot most of the bill but be prepared to pay out up to $1,000 or more if they decide not to.

When is surgery appropriate?

Most doctors will tell you that invasive surgery should be last on your list when it comes to treating OSA. Depending on the type of surgery that you are considering, the recovery period could last for several days to several weeks or even months. Even after undergoing surgery, some patients still have issues with sleep apnea.

For these reasons, the CPAP or oral appliance (along with weight loss if necessary) are the ideal treatment choice. There are however some instances where surgery is necessary such those who have very large tonsils or airway obstructions. It’s always recommended that you speak with your doctor concerning the best treatment options for your particular situation.Share This Post:

Several years ago when I first looked into buying an anti-snoring mouthguard, I remember wondering exactly what it would feel like to wear one of these devices. Some of the products that were available appeared large in size and intimidating. I simply couldn’t imagine the idea of falling asleep with such a monstrous piece of plastic in my mouth. Fortunately, I was able to overcome this fear and order my first mouthpiece.

My experience with the one-piece mouthguard

The first product that I had tried was a simple one-piece boil and bite device with two medium size breather holes at the front. When it arrived, it appeared to be about the size that I had envisioned based on the online photos. Before starting the fitting process, I placed it into my mouth to get a feel for its actual size. As I expected, it was pretty bulky and left about a half inch of space between my upper and lower teeth. At this point, I began to question whether or not I would be able to tolerate such a gargantuan piece of plastic stuffed inside of my oral cavity.

Nonetheless, I continued forward with the fitting process by heating a few cups of water on the stove until it began to boil. After submerging the mouthpiece into the hot water for several seconds, it emerged from the water as translucent and very pliable. I allowed it to cool for a couple seconds and then placed it into my mouth, bit down firmly, and slightly pushed out on my jaw. As I was biting down, I could feel my teeth slowly sinking into the hot molten plastic. This position was held for several seconds as I worked the plastic around the outer edges of my teeth with my finger and inner edges with my tongue.

Once the fitting process was complete, I noticed a reduction in the gap between my upper and lower teeth as well as a much better fit. Instead of half of an inch of space, there was only about 1/4″. While the fit was much closer after going through the fitting process, it was still noticeable inside of my mouth.

From here I gave it a try, to see if it actually worked. The first night was rather awkward. I woke up in the morning next to a large pile of drool and felt a bit of soreness in my jaw. While I was not exactly thrilled with my first night experience, I was pleasantly surprised when my wife told me that I did not snore one bit throughout the night. This confirmation provided a glimmer of hope that I may have found a snoring solution that actually works. After contacting the manufacturer’s customer support, I learned that drooling and soreness are typical side effects that usually disappear after a few days.

Moving on, I used my mouthguard for the next four nights with continued success. The drooling stopped after the second night and morning soreness was completely eliminated after the fourth night.

While it did take a few days to become accustomed to wearing it, doing so was well worth the effort and I were thrilled with the results. It felt great to wake up in the morning refreshed and ready to tackle another day.

Encouraged by my success, I set out to find a product that was more compact and just as effective as the simple one-piece device.

Finding a more compact solution

The “zQuiet”

After testing out several different one-piece mouthguards, (all featured similar designs) I decided to venture into testing out a few products that were engineered differently. The first product that I tried out was the zQuiet followed by the GMSS. In comparison to the standard boil and bite units that I had previously tried, each was completely unique.

The zQuiet featured a thin upper and lower tray that is hinged together at the rear of the mouth near the molars. I found this product to be particularly interesting because it could be used straight out of the box and appeared to have a much lower profile, meaning that I should be able to close my mouth so that it rests in more of a natural state.

Upon arrival, I gave the zQuiet a quick rinse under warm water and put it to the test. There was a noticeable difference in thickness. The feel was a bit more natural and less bulky. Due to the inability to custom mold, the fit was a bit looser in comparison to the standard mouthpieces that I have tried. While it was noticeably more comfortable in comparison, I had still experienced a couple days of drooling along with a few days of soreness. As with the other mouthpieces that I have tried, this disappeared after a few days. I was soon left with a more comfortable and compact device that still effectively controlled my snoring.

Soon after, I had tested out a completely different product called the Good Morning Snore Solution or GMSS. Instead of placing between the teeth, this device attached to the tip of the tongue using suction.

Trying the GMSS for the first time was fairly odd. It resembles a pacifier and holds your tongue forward, just passed your front teeth. Imagine about 1/2″ of your tongue sticking out. The sensation is a bit strange but like the other products that I have tried, it was easy to become accustomed to after a few days of use. The tip of your tongue will become tender the first few nights that you use it. This product was also incredibly effective and comfortable after a few days.

How noticeable are they?

After several different trials with various products, I must say that each takes a few days to adjust. After passing the adjustment period, wearing a snoring mouthguard is comfortable and fairly easy to tolerate. While I still prefer a more compact version of this product, such as the zQuiet, I always eventually became accustomed to wearing any product that I have tried.

So, how noticeable are they? No matter what product you choose, each one will be noticeable for a few days until you become accustomed to wearing one. After the initial break-in period, it becomes much easier. There will be a period where it feels unnatural, cumbersome, and you will probably drool a little. Hang in there and you will be well on your way to a comfortable, snore-free night.Share This Post:

A common question asked by those who are interested in a Mandibular Advancement Device is “Will my insurance cover one and how much will I have to pay?”. There are actually several different factors that will determine if and how much your health insurance will cover.

Determining insurance coverage

Dental appliances for Obstructive Sleep Apnea

Before getting too far ahead, it’s important to understand that in most cases, health insurance companies are not going to cover an appliance that is used for the sole purpose of controlling snoring.

That being said, most health insurance companies will cover a portion (about half) or in some cases all of the cost of an oral appliance if it has been determined to be a “medical necessity“.  Appliances that are custom made by the dentist for the purpose of controlling obstructive sleep apnea are considered a medical necessity and are often covered by private insurance as well as Medicare, Medicaid, and obamacare when certain conditions are met.

Which insurance is responsible for covering this expense? Despite the fact that these devices fit inside of the mouth, they are covered under your health insurance, not dental insurance because they are used to treat a medical condition such as sleep apnea.

Unfortunately, with so many insurance companies out there, it’s impossible to make a blanket statement concerning all insurance coverage. Since the insurance companies do not publish the amount that they will cover, not even your doctor can give you an exact out of pocket amount until several weeks after getting the insurance process rolling.

The entire process can take up to six weeks to complete and even then, you will only be given an estimate and not an exact amount. During this time period, you will be working with an insurance billing expert who will submit your information to the insurance company.

An affidavit of intolerance to CPAP explaining why you are unable to use a CPAP to control your sleep apnea as well as a copy of your sleep study is often submitted to your insurance company for review. From here, your insurance will determine the amount that they are willing to pay.

How about a rough estimate?

As a general rule, it’s a good idea not to depend on your insurance company to cover 100% of the cost of your oral appliance. Although better insurance companies will pick up all of the costs associated with obtaining an oral appliance, others will only cover about half.

The cost will also depend upon the brand of oral appliance that you choose. There are well over a hundred manufacturers, some are more expensive than others. Expenses typically include the initial consultation followed by a mouthpiece fitting and then follow up visits for adjustments. Oral appliances alone cost somewhere around $2,000 plus your doctors fees. Overall, you should expect the total cost to add up to somewhere in the ballpark of $3,000 on the low end. As mentioned, it is likely that your insurance will cover around half or more so you should anticipate an out of pocket expense of somewhere around $1,500. If they pick up more than half the cost, consider it a bonus. You will, of course, want to plan to pay the higher amount and not expect your insurance to pick up the entire cost.

Mouthguards for snoring

What if you are interested in obtaining a dental appliance for the sole purpose of controlling snoring that is not related to OSA?

Unfortunately, for those who have simple benign snoring that does not involve sleep apnea, most insurance companies are not willing to pay out in such cases.  If this is the case, you may be left wondering what options are available aside from paying the full $3,000 plus.

While the bad news is, as mentioned, your insurance will likely not cover the expense of an oral appliance, the good news is that there are several do-it-yourself products that can be purchased online that will help to stop the sound of snoring. These DIY products look and function very similarly to professionally fitted oral appliances yet sell for $60-$80 and can be fitted at home in as little as 5 minutes using a pot of hot water.

What started with one manufacturer in the early 1990’s has grown into a much larger industry with several manufacturers who offer their own version of the at-home mouthguard style dental appliance. Take a look at the comparison chart on the homepage to get an idea of what’s available and the overall cost that you should expect to pay.

Concluding thoughts

In recent years, there has been quite a bit of confusion regarding oral appliance therapy and insurance coverage. Unfortunately, many people have been led to believe that oral appliances are expensive and most insurance companies do not cover them. While this may have been true in years past, this no longer seems to be the case.

If you have been diagnosed with OSA and would like to try an oral appliance, your best option is to work with a dentist who is familiar with fitting oral appliances and has a billing team that understands the insurance process. Doing so will be a tremendous help when it comes to getting your insurance company to pay for your dental appliance.

Since individual circumstances vary, there is no single resource online that will show the exact amount that your insurance company will cover. The only way to determine the amount that you can expect to pay is to visit your dentist. Even after your initial visit, you will likely not have an exact amount until several weeks later when the insurance process starts to go through.

If you have not been diagnosed with sleep apnea (and have spoken with your doctor and are certain that your snoring is not related to OSA), you may want to consider the less expensive alternative which is a plastic DIY mouthguard that often sells for a very reasonable price.

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How safe are snoring mouthpieces?

According to the American Academy of Dental Sleep Medicine, about 24% of women and 40% of men have a snoring problem. Currently (as of 2015) the population in the United States is approximately 319 million. Assuming that half of the population are men and half women, that’s 38 million snoring women and 64 million snoring men or a combined snoring population of 102 million.  In other words, A LOT of people snore.

Snoring has become so common that living with a snoring partner is often accepted as a part of life and jokingly dismissed. Unfortunately, living with a snorer can actually lead to serious relationship issues as sleeping together in the same room can eventually become a problem.

Those who have to deal with a snoring partner usually end up searching for a solution and quickly become overwhelmed with all of the available products from nasal strips, throat sprays, herbal remedies, nasal dilators, mouthpieces, rings, as well as a number of other snoring solutions.  In fact, there are more than 300 snoring products currently registered with the US patent and trademark office.

As a snorer, I have tried several of the mentioned products and above all, have found the Mandibular Advancement Device (MAD), or mouthpiece to be the most effective. For most who are trying to decide upon a solution, product safety always seems to be a concern. That being said, let’s examine some of the safety concerns that one may have when it comes to using one of these devices.

Before getting started, here’s a brief explanation of how these devices work.

In a nutshell, a traditional a MAD resembles an athletic mouthguard and is placed into the mouth at night before going to bed. The device fits around your teeth and holds the lower jaw forward. Doing so opens a restricted airway which is the most common area where snoring occurs. A more in-depth explanation of how these devices work can be found here.

Those who have an interest in treating a snoring problem with such a product usually question the safety of a snoring mouthpiece.

For about three decades now, mouthpieces have been used to treat snoring and in some cases, mild to moderate OSA. They have been issued by dentists for a number of years and when used as prescribed and under the right circumstances, these are generally considered to be safe.

As with any other medical device, there is always an exception when it comes to safe use. Below are a few potential safety issues that you may want to consider.

Sleep apnea

One of the greatest safety concerns when it comes to using a mouthpiece to prevent snoring is whether or not there is a presence of what is known as sleep apnea. Sleep apnea occurs when there is a momentary pause in breathing while asleep that can often last for several seconds. It just so happens that snoring may be a sign of sleep apnea.

Sleep apnea may lead to a number of other health issues such as high blood pressure, heart disease, and stroke.

How do you know if you have sleep apnea? The only way to know whether or not your snoring is related to OSA is to visit your doctor where he or she will help you to determine if further testing is required. Those with known sleep apnea should seek professional medical assistance to treat this condition. This page contains a questionnaire that can help your doctor determine the probability that sleep apnea is present.

While a MAD can be used to treat OSA, this should only be attempted while under the supervision of a doctor. You should not use a MAD if you suspect that your snoring is a symptom of sleep apnea.

Loose/ missing teeth

For the sake of safety, those with loose or a number of missing teeth should not use a mouthpiece to prevent snoring. Two trays, an upper and lower, fit snugly around the teeth and use leverage points to hold the jaw in the forward position. Since a strong set of teeth are needed for proper functioning, such devices should not be used if you are experiencing any such dental issues.

More recently, the Tongue Stabilizing Device (TSD) has been recognized as an effective means to treat snoring. Products such as the GMSS may be a good alternative for those with loose/missing teeth or dentures. Be sure to check with the manufacturer concerning your individual condition before use.

Jaw issues

For those who have jaw issues such as Temporomandibular Joint Dysfunction (TMJ), a jaw that pops, locks, or dislocates or any other problems with their jaw should not use a mouthpiece for snoring. Doing so is not safe and can cause further issues.

A mouthpiece will hold your jaw forward and stretch the muscles in the surrounding area. If an underlying problem currently exists, the use of such products could irritate or worsen the condition.

Food and Drug Administration Involvement

Choosing a product that has been cleared by the Food and Drug Administration (United States) is an important safety consideration that should be examined prior to using a mouthpiece. The FDA examines the safety of such medical devices and issues clearance prior to the product being sold.

Between dentist prescribed products and internet sold DIY mouthguards, there are several dozens to choose from. Unfortunately, there are some manufacturers who did not go through the proper channels to obtain FDA clearance. Simply put, non-FDA cleared products may not be safe and should be avoided altogether. Check here to see if the product that you are interested in has been cleared.

Overall thoughts on safety

When it comes to safety, be sure to review the above safety considerations before deciding to use any such product to stop your snoring.

It’s a good idea to consult with your doctor who can address any additional concerns that you may have as well as help you determine if sleep apnea may be a possibility. If you have loose or missing teeth or issues with your jaw, such devices may not be a good fit for you.

As always, be sure to use a product that has been cleared by the FDA as these are going to be your safest bet.

Follow all of the manufacturer’s instructions and use only as directed.

Speak with your doctor about oral appliances and take a look at some of these DIY products which can be ordered online at a fraction of the cost of professionally fitted devices.

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