Our Process
SCREENING-We believe in unbiased SCREENING for everyone regardless of age, gender, ethnicity or body type for early detection of potential Sleep Apnea which could be lifesaving!
By having you answer a few simple questions, Dr. Krishnamurthy can accurately predict whether or not you suffer from Sleep Apnea. If she thinks you have a high likelihood of having sleep apnea, then she will arrange for you to be accurately tested in the privacy and comfort of your own bedroom or be referred out to do an in lab sleep study based on your condition.
The first part of the questionnaire measures the degree of “tiredness” that you experience during the daytime, compared to the average individual. This is commonly known as the Epworth Sleepiness Scale (ESS), a universally accepted screening tool. The rest of the questionnaire asks about your other medical conditions, many of which are being exacerbated by or even caused by your sleep apnea.
At Norcal Snore and Sleep Solutions, we invite you all to come in for a complimentary Sleep Apnea/Snoring screening. Let’s see if you are simply a “primary snorer”, who can easily and quickly be “cured” with an Oral Appliance, or are you a much more serious Sleep Apnea who usually can also be successfully treated with an Oral Appliance.
TESTING-We believe in facilitating immediate TESTING for all the positively screened patients.
Sleep Apnea is diagnosed by an interpretation of the data of your Home Sleep Test by a Board certified sleep physician. Your overnight Home Sleep Test records your breathing and blood oxygen levels all night long while you are asleep in the privacy and comfort of your own bedroom. This test is covered by most medical insurance companies.
If your Home Sleep Test (HST) shows that you suffer from SEVERE Sleep Apnea or some aberrations in your sleep report indicating other potential Sleep Disorders, and you have other comorbidities such as heart disease, hypertension, history of stroke, diabetes, etc., you will then most likely be directed by Board certified sleep physician to have a Polysomnography Test (PSG) conducted in a nearby Sleep Lab where you would spend the night in a private hotel-like room, and your breathing would be monitored and recorded by a Respiratory Technician. This test is also covered by most medical insurance companies.
TREATMENT
PAP Therapy:
Currently, the three most effective methods of treatment for sleep apnea are:
Use of a continuous positive airway pressure device (CPAP). This is an apparatus with a nose mask connected by a thick tube to an air compressor that pushes air into the nose continuously throughout the night. The constant air pressure successfully keeps the airway open. However, the device is difficult to adapt to & research reveals that 50% of people on CPAP are non-compliant after three months. One CPAP user describes his experience like trying to sleep while having your head out the window driving 50mph.
Oral Appliance Therapy:
Dental Treatment For Snoring And Sleep Apnea
Dental appliance referred to as Oral Appliance Therapy (OAT) or Mandibular Advancement Device(MAD) needs as little as 2-3 visits to the Sleep Dentist to be fitted for a laboratory created, custom-fitted appliance that is worn by the person at night. This device brings the lower jaw and tongue forward . This is the same principle used to open the airway when giving CPR to an unconscious victim.
While they come in many different shapes and sizes and materials, they all are discreetly hidden within your mouth at bedtime, and they function by bringing your lower jaw slightly forward, thereby opening your airway and stopping your snoring, and eliminating your sleep apnea. While your sleep apnea must be diagnosed by a medical doctor, these Oral Appliances can only be made by a licensed dentist that has been thoroughly trained in Sleep Medicine.
Dr. Krishnamurthy is Boarded in Sleep Medicine by the American Sleep and Breathing Academy (ASBA), and has been practicing sleep medicine for well over 6 years. Most mild and moderate Sleep Apnea patients are treated with an Oral Appliance as their 1st treatment choice. Severe patients are urged to try a CPAP, but if they cannot, or simply do not want to try it, they are also treated with an Oral Appliance. The compliance rate of patients on Oral Appliance Therapy is so high, that even though the efficacy rate of CPAP is slightly higher, the Mean Disease Alleviation (MDA) of Oral Appliance Therapy is much better.
Some users complain that their jaw muscles are tight or sore the following morning. The soreness, if occurring at all, usually goes away after a few minutes of recommended exercises and use of Morning Repositioner and this complication tends to improve as the person’s jaw adapts to a new position.
Surgery:
The goal of most surgical procedures is to remove the excess tissue from the nose and/or throat and palate in order to open the upper air passages to facilitate breathing. Some common surgeries include removal of Tonsils and Adenoids, UPPP (Uvulopalatopharyngoplasty), Septoplasty ,Turbinate surgery, Genioglossus and Hyoid Advancement, Tori removal and finally, the most drastic MMA (Maxillomandibular Advancement).
All the above, except MMA are usually temporary fixes that require repeat surgeries. MMA, while extremely debilitating at first, usually works permanently. Dr.Krishnamurthy only believes in surgery as a last resort, or occasionally in conjunction with Oral Appliance Therapy.
A new promising surgical approach called Inspire is now surfacing. It is currently limited to patients that have tried and failed with CPAP and Oral Appliance. It involves implanting a “pacemaker-like device” in your chest which sends signals to your tongue in rhythm with your chest movements during breathing. Those signals cause your tongue to jut forward out of the way of blocking your airway, There isn’t enough long term data yet to evaluate its long term efficacy.
Combination Therapy:
Sometimes based on your medical condition Dr. Krishnamurthy might recommend Combination therapy with PAP, surgery, Oral Appliance, Positional therapy, weight loss, Nasal Dilators/strips and good Sleep Hygiene Habits.
To successfully treat bruxism, snoring & sleep apnea, a thorough examination should be performed. The course of treatment depends on the information gathered while making the diagnosis. Options should be considered, & discussed, evaluating the possible benefit & risk with each individual case. Dental appliances are frequently effective, less invasive, & less expensive than other options of therapy available.
For more information or questions regarding Sleep Apnea, please call our office @ (916) 542-7996 today!
