The Sleep Better Process
Our process is simple and painless with easy to follow steps. We work with Board Certified Sleep Physicians and Primary Care Physicians to diagnose, discuss and offer treatment options best suited for your lifestyle. We will help you determine the Medical Insurance Benefits available to you for treatment. Our goal is to educate you on your condition, set up a sleep test (if one has not been recently completed), and coordinate with your Sleep Physician or Primary Care Doctor. If it is determined that a custom made oral appliance is the appropriate treatment for your condition, we will take all the necessary records to make one for you. We will guide you through each step along the way so you better understand the process and what we are trying to accomplish to benefit your sleep health.
Step 1
Consultation
A sleep health consultation is the very important first step to determine what might be the cause of you sleeping disorder. During the consultation we will review your health history, sleep health questionnaire and do a clinical examination to assess the possible contributing factors that may be contributing to your poor sleep health. Every patient and situation are unique so this time is very important to evaluate an appropriate plan of action.
At the time of your screening consultation we may recommend testing of your nasal and upper airway breathing with acoustic rhinometry and pharyngometry. These devices can provide an indication as to whether there are nasal obstructions or soft tissue collapse during breathing cycles. The testing is simple, quick, noninvasive and painless! We may also recommend a three dimensional imaging of you airway with our in office Cone Beam Technology.
Take our sleep questionnaire by downloading the form, filling in the fields and either email it to us at: SleepApneaSD@gmail.com or bring it with you to your consultation.
Step 2
Evaluation
Together we can review our findings from the acoustic testing and determine whether it is necessary to do further testing. At this point we will make recommendations on how to pursue treatment of your condition. Based on our discussion we may suggest you do a simple overnight pulse oximeter testing.
With the overnight pulse oximeter testing we can gain insight into the blood oxygen levels you maintain while you are asleep. This simple test will allow us to determine whether more extensive sleep testing should be done. Additionally we are one of the few offices in San Diego that utilize multiple methods of evaluating the function and anatomy of your airway. We utilize 3-Dimensional Cone Beam technology which will map your airway anatomy. We also utilize Acoustic Oral Pharangometry and Acoustic Rhinometry to evaluate how your airway may collapse and how easily you breath through your nose.
Step 3
Testing
Polysomnography (PSG) is the medical term for an overnight sleep test. These tests may be preformed in a sleep lab under the supervision of a highly trained medical technician or at home utilizing sophisticated medical devices which can measure breathing, pulse, heart rate, oxygenation, snoring levels and how they relate to sleep position, and brain activity while you sleep. We can refer you to the appropriate board certified sleep physician to initiate the evaluation process. We can also refer you to a medically approved Home Sleep Test provider. These home sleep testing services will come to your home to deliver and demonstrate the proper use of a testing unit and personally assist you with the test itself and medical insurance billing. In our practice we also have Level 3 Ares Sleep units (accepted by almost all medical insurance carriers for comprehensive home sleep testing) and take home pulse oximetry devices and both of these methods can be utilized to evaluate the best way to manage the most effective of treatment for you.
The most accurate form of testing is in a sleep lab where you are evaluated by a sleep technician during your nights sleep. Often times in sleep labs, after initial testing has been evaluated, interventional therapy allows the sleep technician to try treatment protocols while the patient is sleeping. The sleep technician can titrate (adjust) the CPAP machine or oral appliance therapy to try and find the most favorable settings to benefit the patient. These adjustments can find the best settings to reduce their arousals, interruptions and the fragmentation of their sleep.
Step 4
Prescription
Once comprehensive testing has been completed a Board Certified Sleep physician can do a complete evaluation of the test results and prescribe appropriate therapy. With OSA, depending on the severity of the sleep disorder, the usual initial recommendation is CPAP therapy. However in circumstances where the patient does not feel they will tolerate the use of the machine, or if they have a home trial and feel they cannot accept this form of treatment, the prescribing physician will often suggest an alternative form of treatment with Oral Appliance Therapy.
If Oral Appliance Therapy is prescribed as the preferred form of treatment, this prescription will be passed on to our office. From here we can take the steps to make a properly designed oral appliance to try and achieve the maximum patient health benefit. We will discuss the options for the most appropriate appliance to use and determine the correct positioning of the lower jaw. We will evaluate various other measures that can make the treatment more effective. In our practice we often use the sound wave testing of a pharyngometer to try and give the best predictive outcome for the most advantageous lower jaw position.
Step 5
Treatment & Fitting
In our practice we use sound wave testing of a pharyngometer to try and give the best predictive outcome of the most advantageous position of the lower jaw position to facilitate breathing during sleep. Properly positioning of the lower jaw to open the airway may be fine tuned to find the most optimal position. Research has shown that it is not always a case where more advancement of the lower jaw provides the most optimal treatment. It is a matter of finding the "sweet spot" where the lower jaw is moved forward just enough and the bite is opened just enough to provide maximum benefit to the patient. Too much movement forward or excessive opening may prove to be uncomfortable, unnatural and not provide the maximum benefit.
After a determination is made as to what may be the most optimal position of the lower jaw for the appliance, a digital computer scan impression is taken of the teeth and an index is used to determine the starting lower jaw position from our evaluation and testing.
Once an appliance is made it is delivered to the patient to use at home. After it has been utilized for a few weeks, the patient is scheduled to come back in for a follow up visit. An assessment is made to see how they are doing with the appliance, if their feeling of well being and daytime sleepiness has improved and if their bed partner has noticed a difference in their breathing patterns and snoring during sleep. Snoring should be reduced as should the episodes of gasping or choking. At this time adjustments can be made to the appliance if it is determined that they may facilitate the treatment. After the appliance has been used for several more weeks, an overnight sleep test may be ordered to determine the efficacy of the appliance. There should be regular follow up visits to ensure that the device is in the correct position for optimal efficiency.
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Testimonials
“...I had been diagnosed with severe to moderate sleep apnea and was using a CPAP ... [Dr. Danney] recommended an oral appliance to me, and did some testing, and they figured out, [with] his testing, [they] were able to open up my airway by 80% more... and believe me I am very happy that I did ... I no longer have to check my CPAP in when I travel, my husband is not complaining about my snoring, and I am not having sleepless nights like I was, fighting my CPAP machine. It’s been a lifesaver.”
“Through a simple test, Dr. Danney was able to make an appliance for me, which was much more comfortable, convenient, and easy to use... Within a few days I noticed I was much more alert during the course of my workday, I slept more soundly, and I was no longer snoring.”
”Garry’s sleep was so quiet that I actually had to start checking him at night to make sure he was breathing. There’s no question that there’s a major improvement in him.”
“Dr. Danney has been my dentist for quite some time and after a consultation recommended I see a sleep physician for my snoring issues. ... (My Sleep Physician) recommended a CPAP machine which I have been using for about three, four years...and can’t sleep to my side, there’s a variety of reasons why I went back to see Dr. Danney who recommended this oral appliance. It’s been amazing. It’s been actually a Godsend for us because I sleep better, I wake up much more fresh ... It’s actually helping me in getting much longer sleep so I don’t wake up during the evening .... I love this and you’re the best!”
“I have had a much better sleep because I’m not awakened quite often during the night with loud noises ... and I feel that both of our sleep has been enhanced and is much better since Michael has been using the appliance provided by Dr. Danney ... so thank you Dr. Danney because I am sleeping through the night”