Category: Dr. Avi Weisfogel

Positive Airway Pressure Devices vs Oral Appliances

Sleep apnea can be managed using various treatment approach and two of the commonly used methods are positive airway pressure devices and oral appliances. Let us discuss each one of them to find out which is one is better for sleep apnea.

Positive Airway Pressure Devices

Sleep Apnea sufferer

A positive airway pressure machine is used together with a breathing mask. It is one of the commonly used treatment methods for moderate to severe sleep apnea. The mask is worn over the nose and sometimes over the mouth during sleep and it will deliver pressurized air to prevent the patient’s airway from collapsing during sleep.

Dentists are now involved in the treatment of sleep apnea. There are now dentists who are specially trained to treat and manage sleep apnea. They are called dental sleep professionals. What they do is they create a custom-fitted dental appliance which the patient needs to wear during sleep to keep the airway open and prevent the tongue and muscles from blocking the airway. The use of the oral appliance for the treatment of patients with mild to moderate sleep apnea has been approved by the American Academy of Sleep Medicine. In fact, they also recommend oral appliance for patients with severe sleep apnea, especially those who cannot tolerate positive airway pressure devices.

The air comes from the machine and delivered to the system via a flexible tube. There are different types of machines used such as:

  • CPAP – Continuous Positive Airway Pressure
  • BiPAP – Bilevel Positive Airway Pressure
  • VPAP – Variable Positive Airway Pressure

Is CPAP Effective

The efficacy of a positive airway pressure device primarily depends on the patient’s adherence. Those who consistently use the machine feel better. They noticed a significant reduction of hypopnea and apnea episodes during sleep. There is also a significant reduction in snoring. However, some sleep apnea patients don’t like using positive airway pressure devices as they are not that comfortable to wear. They also produce annoying sounds. Those who started using it stop in the middle while others don’t even start using it.

Oral/Dental Appliances

obstructive sleep apnea

Many sleep apnea patients prefer oral appliance over a positive airway pressure device because it is comfortable and easy to wear, portable, and does not produce annoying sounds. There are oral devices that can be readily purchased over the counter. They are cheaper than custom made oral devices, but they do not guarantee a proper fit. Fitting is important as a poorly fit oral device can cause the tooth to move as well as the possibility of developing jaw-related problems. If you wish to use an oral appliance for sleep apnea treatment, then you should see a dentist specializing in sleep medicine. The dentist will thoroughly assess your condition, create a custom-fitted oral appliance, and will do the necessary adjustments.

For people with severe sleep apnea, a combination of oral appliance and positive airway pressure is helpful. Just make sure you see a sleep specialist to thoroughly assess the severity of your condition and come up with the best treatment and management plan.

Treatment Options for Sleep Apnea

Sleep apnea needs to be addressed as it may lead to other serious health conditions when left unmanaged. Fortunately, sleep apnea patients have a vast choice for managing their condition and we are going to tackle some of them. We will start with the basic and most common of all; the CPAP or continuous positive airflow pressure.

Sleep Medicine

CPAP – Continuous Positive Airflow Pressure

For moderate to severe sleep apnea, sleep experts recommend the use of a CPAP device; a mask-like machine that covers the mouth and nose. The patient should wear the mask during sleep as it provides a constant stream of air keeping your breathing passages open while you sleep. Although it is effective, many sleep apnea patients don’t like to use it because of the annoying sound and discomfort. As time passes by, CPAP makers did some update to significantly improve the design and function of the machine. Today, you can find a lighter, quieter, and more comfortable CPAP machines.

Discover all the different sleep apnea treatment options with the teachings from Dr. Avi Weisfogel.  You can contact Dr. Avi Weisfogel here

Tips when using CPAP:

  1. See to it that the device fits you perfectly.
  2. When starting to use the machine, use it for just a short period of time and gradually increase the air pressure as you go on.
  3. Always visit your sleep doctor to check the fit and evaluate your progress.
  4. There are ways to minimize discomfort such as using soft pads to reduce skin irritation.
  5. Use nasal pillows if you are experiencing nose discomfort.
  6. You might want to consider using chinstraps to help keep the mouth closed and reduce the possibility of throat irritation.
  7. Make sure that your mask, tubing, and headgear are clean.

Custom-made oral appliances

Sleep Apnea

Many sleep patients prefer to use oral appliances over other sleep apnea treatment methods. Why? Oral or also known as dental appliances are more comfortable and convenient to use. They do not produce annoying sounds too.

Custom-made oral appliances approved for sleep apnea treatment are usually made from acrylic and they are worn inside the mouth just like a mouth guard. They can also be worn around the head and chin to reposition the lower jaw. Some of the commonly used oral appliances are mandibular advancement device and tongue retaining device. They open the airway and bring the lower jaw forward and keep the tongue from blocking the airway.

Should you wish to try using oral appliances for your sleep apnea, all you have to do is to visit a dentist that specializes in dental sleep medicine. The dentist will thoroughly assess your sleep apnea and will create a custom-fitted oral appliance to address your needs. Getting the right fit is a must to prevent potential side effects such as soreness and permanent change in position of the inside structure of the mouth.

Sleep apnea implants

A pacemaker system is inserted which stimulates the muscles to keep the airway open so that you can breathe effortlessly while you sleep. It is perfect for people with moderate to severe sleep apnea, especially in people with central sleep apnea. It is a relatively new treatment approach approved by the United States Food and Drug Administration. However, sleep apnea implants are expensive.


If you have tried all other sleep apnea treatment methods and nothing seemed to work, then the last resort is surgery. As you know, surgery carries risk of complications and infections.

Oral appliances – A treatment for sleep apnea

Sleep Apnea Disorder

Moderate and severe sleep apnea is treated using positive airway pressure machines such as CPAP. A CPAP mask is worn over the nose and mouth during sleep, which supplies pressurized air that flow into the patient’s throat.

The air pressure prevents the patient’s airway from collapsing. Aside from CPAP or continuous positive airway pressure, there are other machines that deliver the same effect such as BiPAP or bilevel positive airway pressure and VPAP or variable positive airway pressure.

Although they are helpful in the management of sleep apnea, a large number of sleep apnea patients are not comfortable using them. Fortunately, there are other methods of treating sleep apnea and one of them is wearing an oral/dental appliance. The Food and Drug Administration has approved over 100 oral appliances for the treatment of snoring and obstructive sleep apnea.

Oral appliances are worn in the mouth while you sleep. They hold the lower jaw forward to keep the airway open and prevent the tongue and muscles from obstructing the airway. The use of the oral appliance for the treatment and management of sleep apnea was approved by the American Academy of Sleep Medicine. The organization recommends the use of the oral appliance in patients with mild, moderate, and severe sleep apnea particularly in patients who cannot tolerate CPAP devices.

Why choose oral appliances over CPAP?

Sleep Apnea

They are comfortable and easy to wear.
They do not produce annoying sounds, which is one of the major concerns when using CPAP.
They are portable and convenient for travel.
They are easy to clean and maintain.

Should you go for over-the-counter oral appliance or custom made oral appliance?

There are readily available over-the-counter oral appliances at the leading drug stores and online stores. They are more affordable too when compared to the custom-fitted oral appliance. However, you have to keep in mind that an oral appliance that is not fitted properly may cause unwanted side effects. It may cause the teeth to move or might create jaw-related problems.

To get the most of what oral appliance has to offer, you should go for a custom-fitted oral appliance. Your primary care physician will schedule a sleep study to determine if you have a sleep apnea as well as its level of severity. After which, the dentist who is trained in dental sleep medicine will create the oral appliance and will also do the fitting.

Make sure that you choose the best dentist in town. Only a trained dental professional has the ability to help address your sleep apnea problem. The dentist will conduct a thorough evaluation of your teeth, mouth, as well as the temporomandibular joint.

This is to make sure that your teeth and jaw structure are fit to wear the appliance. Check with the American Academy of Dental Sleep Medicine the list of dentist who is trained to perform sleep apnea treatment using oral appliance. Oral appliances are generally covered by your health insurance plan. To be sure, you should contact your health insurance for an estimate of insurance coverage.

Dr. Avi Weisfogel – Expert

Dr. Avi Weisfogel is an expert in Dental Sleep Medicine and offers continuing education for dentists, the Dental Sleep MBA.  Contact Dr. Avi Weisfogel for more information here

The Signs Of Obstructive Sleep Apnea To Look For

If you have lost count of how many times you’ve suffered from sleepless nights, interrupted sleep, or poor-quality sleep, then you’re certainly not alone.

Some of the common symptoms of sleep disorders include: lack of energy, difficulty concentrating, memory loss and forgetfulness, diminished productivity and performance at school or work, depression, lack of energy, mood disturbances (e.g. irritability, anger, impulsive actions, etc.), irregular breathing, fatigued driving, and a general decreased quality of life.

Avi Weisfogel smiling dentist

Common Sleep Disorders

Based on Dr. Avi Weisfogel, the creator and owner of the International Academy of Sleep (IAOS), there are over 70 recognized forms of sleep ailments , and one of the most common are sleep apnea, insomnia and restless leg syndrome, respectively.


About 10% of adults in the U.S. suffer from chronic insomnia, which can be a debilitating condition that is characterized by: difficulty falling asleep at night, often waking up in the middle of the night and with problems falling asleep, and frequently waking up considerably earlier than planned or desired. Generally, chronic insomnia refers to situations where insomnia continues for at least three weeks, and acute insomnia refers to shorter durations. Dr. Avi Weisfogel notes that a lot of men and women switch between bouts of acute and chronic insomnia. He also adds that the illness may temporarily relieve for weeks or months at a stretch before returning.

Sleep Apnea

Sleep apnea (formally referred to as obstructive sleep apnea or OSA) affects about 20 million people in the U.S. However, Dr. Avi Weisfogel notes that as many as 90 percent of these individuals are living with undiagnosed and therefore untreated sleep apnea, either because they do not know they have this debilitating and potentially fatal condition, or they do not realize it is a serious problem that needs to be evaluated by a health care professional.

Sleep apnea occurs when the soft tissues in the throat relax during sleep and block the upper respiratory system. A partial blockage typically causes snoring, even though a complete blockage causes an individual to stop breathing for several seconds during the night. This forced the brain to wake up and triggers violent gasping and hacking, to be able to clear the airway and allow oxygen to enter the lungs.

As noted above, a lot of men and women who undergo this process on a regular basis — and it can happen several times a night — are unaware it is happening. As such, upon awakening they typically feel tired and irritable, but do not understand why (or they attribute it to the wrong root cause, like something they ate or an argument, they had the night before). In addition, the burden placed on the respiratory system puts a strain on the heart, which may result in heart attack, heart arrhythmia, heart failure, and other serious and possibly fatal cardiological problems.

Restless Leg Syndrome

Restless leg syndrome (RLS) is a common neurological disorder that compels individuals to constantly move their legs, feet, and possibly other body parts during sleep. The compulsion is triggered by sensations like itching, aching, burning, throbbing and pulsing. Understandably, the constant need to shift position wreaks havoc on sleep quality. Just like sleep apnea, many folks who suffer from restless leg syndrome are unaware that they have a clinical condition for which treatment and drugs are available. Dietary and lifestyle changes may also alleviate or eliminate symptoms.

Getting Help

If you know or believe that you’re suffering from one of them or any other sleep disorders, then talk with your primary care physician. A growing number of dentists are also offering their patients sleep apnea evaluations. Adds Dr. Avi Weisfogel: it is a mistake for people to assume that sleep disorders correct themselves over time, or that poor quality sleep is something which they need to learn how to live together and accept. Neither of them are true. The issue is serious, and help is available.