Sleep Apnea

Do you have sleep apnea?

Are you drowsy during the day with no explanation? Do you snore loudly or wake up breathless in the middle of the night? If you’re experiencing any of these symptoms, you may be one of more than 40 million Americans who are affected by sleep apnea.

What is sleep apnea?

Sleep apnea is a condition in which your breathing stops periodically during sleep, for 10 seconds or more, as many as 60-80 times per hour! Each time you stop breathing in your sleep, the resulting lack of oxygen alerts your brain, which temporarily wakes you up to restart proper breathing. Since the time spent awake is so brief, most people with sleep apnea don’t remember it, and many feel like they are getting a good night’s sleep when, in fact, they are not. The constant wake-sleep, wake-sleep cycle prevents those with sleep apnea from achieving deep sleep, resulting in a constant drowsy feeling during the day, and greatly increases your risk for having a heart attack or stroke.

What are the signs of sleep apnea?

The following symptoms can indicate the presence of sleep apnea. If you notice one or more of these, contact our practice.

  • Insomnia or difficulty sleeping
  • Loud snoring at night
  • Waking up at night short of breath
  • Snorting or choking sounds during the night (indicating a restart of breathing)
  • Waking up with a sweaty head and neck
  • Waking up several times per night to urinate
  • Headaches upon waking in the morning
  • Erectile Dysfunction
  • Irregular heartbeat
  • Poorly controlled blood pressure, even on multiple medications
  • Falling asleep unintentionally during the day
  • Extreme drowsiness throughout the day

Are there different types of sleep apnea?

There are three categories of sleep apnea. The most common is called obstructive sleep apnea (OSA), and occurs due to a physical blockage, usually the collapsing of the soft tissue in the back of the throat. Less common is central sleep apnea (CSA), in which breathing stops because the muscles involved don’t receive the proper signal from the brain. And some people suffer from “mixed” or “complex” sleep apnea, which is a combination of obstructive and central.

Is sleep apnea dangerous?

Sleep apnea is considered a serious medical problem and if left untreated it can lead to high blood pressure, increasing the risk of heart failure and stroke. The ongoing state of fatigue caused by sleep apnea can lead to problems at work or school, as well as danger when driving or operating heavy machinery. Sleep apnea can also cause complications with medication or surgery; sedation by anesthesia can be risky, as can lying flat in bed after an operation. If you know or suspect you suffer from sleep apnea, let your family doctor know before taking prescribed medication or having surgery.

How is sleep apnea treated?

Treatments for sleep apnea depend on the severity of each individual case, and the type of apnea. The diagnosis of sleep apnea can only be made by an MD after you have undergone a sleep study. Basic treatment for mild sleep apnea may be behavioral — for instance, patients are instructed to lose weight, stop smoking, or sleep on their sides instead of on their backs. Beyond that, oral devices similar to orthodontic retainers can be used to position the lower jaw forward slightly in such a way that opens up the airway. In more advanced cases, a CPAP machine (constant positive airway pressure) is typically used with a mask that fits over your nose and mouth. It assures an open airway by assisting each breath you take with pressurized air. The pressure is adjusted to match each patient’s needs. Some patients are simply not able to use a CPAP due to claustrophobia issues or active lifestyles like back country hunting and camping. Even in these more advanced cases of sleep apnea, an oral appliance may be prescribed if the patient is unwilling or unable to use a CPAP. In mild to moderate cases, an oral appliance is often the first choice in treating sleep apnea. Dr. Rich is specially trained to evaluate and treat sleep apnea with oral appliances, in coordination with your medical doctor.

Is a custom made Oral Appliance covered by my medical insurance?

Most likely yes, even if you have already tried a CPAP machine. Our office sleep coordinator would be happy to discuss with you how your insurance might help you to receive an oral appliance to treat your sleep apnea. After collecting some information about your specific plan, she can submit a pre-authorization to see what coverage you have. Most medical insurance plans do cover oral appliance therapy. Give us a call at 253-939-6900 or email for more information.

What should I do if I suspect that someone in my family suffers from sleep apnea?

Contact our practice, and we can assist you in the best course of action for you. Please do NOT buy a “snoring appliance” on the internet or from TV ads. They are more bulky and less comfortable than a custom made device. More importantly, it is impossible to tell the difference between simple snoring and sleep apnea without a formal sleep study. You may resolve the snoring and NOT solve the sleep apnea, an even more dangerous situation, since you have simply turned off the body’s “warning alarm” that something serious is wrong. Morning sleepiness is not a reliable indicator. You are increasing your risk of serious health issues like a fatal heart attack or stroke if you leave this critical health issue unresolved or inadequately treated. We can guide you through the process of appropriate diagnosis by a qualified MD and participate in determining the best treatment, which often involves us making a custom oral appliance instead of you having to deal with the hoses and cords of a CPAP. Don’t wait. Call today.

Here is how we are keeping you safe, particularly during the COVID-19 viral outbreak.


Pre and day-of appointment screening questions to determine infection risk.

Hand sanitizing gel and masks for all patients immediately upon entering.

“No touch” infrared forehead thermometer check before treatment.

Social distancing protocol and ‘sneeze guard’ shields at the reception desk.

Medical-grade HEPA filtration units for sanitation of the air we breathe in the office.

• PPE for clinical staff includes a gown, gloves, mask, eye protection and a face shield.

Disposable sterile single-use clinical instruments are utilized wherever possible.

Reusable instruments are packaged and sterilized in an autoclave before being returned to service. Delicate reusables are soaked overnight in a hospital-grade sterilant solution.

Our autoclave is tested AT LEAST weekly by an independent microbiology lab to confirm that our autoclave is working properly.

All exposed patient chair and work surfaces are sprayed and wiped down with a hospital-grade disinfecting solution that kills viruses and bacteria between patients.

High-touch areas like computer keyboards, mice, headrests and chair arms are covered with single-use disposable barriers that are replaced after each patient.

• New Mandibular Advancement Devices are disinfected twice: by the lab after fabrication and again in our office before delivery to a patient.


Thank you for entrusting us to keep you safe while we help you get a more restful night’s sleep. After all, getting quality sleep is one of the most important things you need to stay healthy!