Sleep Apnea Evaluation

Your Path to Better Sleep Starts With a Comprehensive Evaluation

If you suspect you have sleep apnea, have been diagnosed but struggle with treatment, or are concerned about your snoring and its effects on your health, a comprehensive evaluation is the essential first step toward finding relief and protecting your long-term health.

At Aloha Sleep Apnea & Airway Center, we specialize exclusively in dental sleep medicine and oral appliance therapy. Our detailed evaluation process is designed to thoroughly understand your sleep concerns, assess your anatomy, review your medical history, and determine the most appropriate treatment path forward.

Why a Proper Evaluation Matters

Sleep apnea is a serious medical condition that affects an estimated 25 million Americans, with many more cases remaining undiagnosed. The consequences of untreated sleep apnea extend far beyond poor sleep quality:

• Cardiovascular risks: 3-4x increased risk of stroke, 2-3x increased risk of heart attack
• Metabolic effects: Strong association with type 2 diabetes, weight gain, and metabolic syndrome
• Cognitive impacts: Memory problems, difficulty concentrating, and increased dementia risk
• Safety concerns: 2-3x increased risk of motor vehicle accidents
• Quality of life: Chronic fatigue, mood changes, depression, and relationship strain

A thorough evaluation ensures that you receive an accurate understanding of your condition and appropriate treatment recommendations—not a one-size-fits-all approach.

What to Expect During Your Evaluation

Our evaluation process is comprehensive, taking 45-60 minutes to ensure we gather all the information needed to make the best treatment recommendations for your unique situation.

Part 1: Comprehensive History Review

We begin by understanding your complete picture through detailed discussion:

Sleep History Assessment

Understanding your sleep patterns and symptoms is crucial:

• Sleep quality and patterns: How long you sleep, how often you wake, how rested you feel
• Snoring characteristics: Frequency, loudness, positional patterns, partner observations
• Witnessed breathing pauses: Has anyone observed you stop breathing during sleep?
• Gasping or choking episodes: Do you wake suddenly feeling short of breath?
• Morning symptoms: Headaches, dry mouth, sore throat upon waking
• Daytime sleepiness levels: Using validated tools like the Epworth Sleepiness Scale
• Sleep position preferences: Back, side, or stomach sleeping
• Nocturia: Frequency of nighttime urination (often improved with sleep apnea treatment)

Medical History Review

Your overall health affects both sleep apnea severity and treatment options:

• Prior sleep studies and diagnoses: Reviewing any existing polysomnography or home sleep test results
• Current and past sleep treatments: CPAP use, surgical interventions, previous oral appliances
• CPAP experience: If applicable, detailed discussion of what you’ve tried and what challenges you’ve faced
• Cardiovascular conditions: High blood pressure, heart disease, arrhythmias, stroke history
• Metabolic conditions: Diabetes, obesity, thyroid disorders
• Respiratory conditions: Asthma, COPD, nasal obstruction
• Medications: Some medications affect sleep quality and airway muscle tone
• Family history: Sleep apnea has genetic components
• Surgical history: Previous throat, nose, or jaw surgeries

Lifestyle and Behavioral Factors

Lifestyle significantly impacts sleep apnea:

• Work schedule: Shift work, irregular hours, job demands
• Sleep habits: Bedtime routines, sleep environment, consistency
• Caffeine and alcohol consumption: Timing and amounts
• Tobacco use: Current or former smoking
• Exercise patterns: Activity level and timing
• Weight history: Recent changes, weight fluctuations
• Stress levels: Emotional health and coping mechanisms

Part 2: Oral and Airway Examination

Our specialized dental sleep medicine examination assesses multiple factors that determine oral appliance candidacy:

Comprehensive Dental Assessment

Your teeth must be able to support an oral appliance:

• Number of teeth: Minimum requirements for appliance retention (typically 8-10 teeth per arch)
• Tooth condition: Stability, decay, need for restorations
• Existing dental work: Crowns, bridges, implants, partial dentures
• Periodontal health: Gum condition, bone support, tooth mobility
• Bite alignment: How upper and lower teeth fit together
• Dental restorations needed: Any work that should be done before or after appliance therapy

TMJ and Jaw Function Evaluation

Your jaw joints must tolerate mandibular advancement:

• Range of motion: How far your jaw can move forward, side to side, and open
• TMJ joint assessment: Clicking, popping, crepitus, pain on movement
• Muscle palpation: Tenderness in jaw muscles, signs of bruxism (teeth grinding)
• Jaw protrusion capability: Maximum comfortable forward movement
• History of TMJ disorders: Previous problems, treatments, current symptoms
• Jaw locking or limitation: Any restricted movement

Airway Visualization and Classification

We evaluate the physical structures of your airway:

• Mallampati classification: Visibility of throat structures with mouth open (Class I-IV)
• Tongue size and position: Macroglossia (enlarged tongue) assessment
• Soft palate and uvula: Length, width, position
• Tonsil size: If present, graded 0-4
• Pharyngeal airway space: Visible posterior airway
• Lateral pharyngeal narrowing: Width of side walls
• Neck circumference: Measured at thyroid cartilage (larger circumference correlates with OSA severity)
• Facial structure: Retrognathia (recessed jaw), micrognathia (small jaw)
• Nasal assessment: Visible obstruction, deviated septum, turbinate hypertrophy

Part 3: Review of Sleep Study Results

If you have existing sleep study results, we carefully analyze all components:

Key Metrics We Evaluate

• Apnea-Hypopnea Index (AHI): The primary measure of sleep apnea severity

  • Normal: AHI < 5 events/hour
  • Mild OSA: AHI 5-15 events/hour
  • Moderate OSA: AHI 15-30 events/hour
  • Severe OSA: AHI > 30 events/hour

• Respiratory Disturbance Index (RDI): Similar to AHI but includes additional breathing events

• Oxygen Desaturation:

  • Lowest oxygen saturation (nadir SpO2)
  • Time spent below 90% saturation
  • Oxygen desaturation index (ODI)

• Sleep Architecture: How apnea affects your sleep stages

  • REM vs. non-REM distribution
  • Sleep efficiency
  • Arousal index

• Positional Data:

  • Supine (back) vs. non-supine AHI
  • Positional vs. non-positional OSA

• Central vs. Obstructive Events: Critical for treatment selection (oral appliances treat obstructive, not central apnea)

Determining Candidacy for Oral Appliance Therapy

Based on our comprehensive evaluation, we assess whether oral appliance therapy is appropriate for your specific situation.

Ideal Candidates for Oral Appliance Therapy

You’re likely a good candidate if you have:

Sleep Apnea Characteristics:

• Mild to moderate obstructive sleep apnea (AHI 5-30)—oral appliances are considered first-line treatment at these levels
• Positional sleep apnea (worse on back)—often responds well to oral appliances
• Primary snoring without significant apnea events
• CPAP intolerance with documented compliance challenges

Dental and Oral Health:

• Sufficient healthy teeth (typically 8-10 per arch) for appliance retention
• Good periodontal health without severe gum disease or tooth mobility
• Stable dental restorations or ability to complete needed dental work
• No planned extensive dental work that would affect appliance fit

Jaw Function:

• Adequate protrusive range (ability to move jaw forward 6-10mm)
• No severe TMJ disorders that would be worsened by mandibular advancement
• Acceptable jaw muscle function without significant myofascial pain
• History of good tolerance to dental appliances (night guards, retainers)

When Oral Appliances May Not Be Appropriate

Certain conditions may make oral appliance therapy less suitable:

• Severe obstructive sleep apnea (AHI > 30) as primary treatment—though oral appliances may be tried if CPAP fails or used in combination therapy
• Central or complex sleep apnea—oral appliances treat obstructive apnea only
• Insufficient teeth for appliance retention (full dentures, extensive tooth loss)
• Severe periodontal disease with loose teeth
• Active TMJ disorders with significant pain or dysfunction
• Severe bruxism that may damage appliances or teeth
• Certain jaw skeletal abnormalities that limit protrusion

If You’re Not a Candidate

If our evaluation determines that oral appliance therapy isn’t the optimal choice for you, we provide:

• Clear explanation of why another treatment approach may be more effective
• Referrals to appropriate specialists: ENT physicians, sleep medicine doctors, oral surgeons, or orthodontists
• Guidance on alternative options: CPAP optimization, positional therapy, surgical evaluation
• Continued coordination with your existing healthcare team
• Reassessment option if circumstances change (dental work completed, weight loss, etc.)

Understanding Your Evaluation Results

Interpretation of Findings

After completing your evaluation, we discuss our findings in detail:

Airway Assessment Results:

• Your Mallampati score and what it means
• Tongue and soft tissue contributions to airway obstruction
• Jaw structure considerations
• Overall airway anatomy evaluation

Dental Assessment Results:

• Teeth that will anchor the appliance
• Any dental concerns to address
• Periodontal status
• Recommendations for dental work if needed

Candidacy Determination:

• Clear yes/no/conditional recommendation for oral appliance therapy
• Explanation of factors influencing the recommendation
• Expected outcomes based on similar cases
• Alternative recommendations if not a candidate

Questions We Commonly Answer

During the evaluation, we address questions including:

• Is oral appliance therapy appropriate for my severity level?
• What type of appliance would you recommend for me specifically?
• What results can I realistically expect?
• What is the expected timeline from evaluation to treatment completion?
• How much will treatment cost and what does my insurance cover?
• What follow-up care is included with treatment?
• How will you coordinate care with my other doctors?
• What are the potential side effects and how are they managed?

Coordinating Your Care

If You Already Have a Sleep Apnea Diagnosis

If you’ve been diagnosed with obstructive sleep apnea by a physician (through polysomnography or home sleep testing), we can often proceed directly to treatment planning after your evaluation. We communicate with your sleep physician to:

• Share our evaluation findings
• Obtain necessary prescriptions and authorizations
• Coordinate treatment planning
• Arrange follow-up efficacy testing

If You Need a Diagnosis

If you haven’t had a sleep study and our clinical evaluation suggests sleep apnea, we help coordinate diagnostic testing:

Important Understanding: Sleep apnea must be diagnosed by a licensed physician through objective sleep testing. As dental sleep medicine specialists, we do not diagnose sleep apnea. However, we work closely with sleep physicians who can order and interpret:

• Home Sleep Apnea Testing (HSAT): Convenient in-home testing for most patients
• In-laboratory Polysomnography (PSG): Comprehensive overnight testing when indicated

We coordinate the testing process, help with scheduling and insurance authorization, and schedule follow-up to review results and proceed with treatment planning.

Learn more about HSAT coordination →

Preparing for Your Evaluation Appointment

What to Bring

Essential Documents:

• Sleep study results (if you have them)—bring the full report, not just the summary
• List of current medications with dosages
• Medical insurance card
• Referral from your physician (if required by your insurance)
• CPAP compliance report (if you’re a CPAP user)—we can pull data from most machines

Helpful Information:

• List of questions you’d like answered
• Sleep diary if you’ve been keeping one
• Your partner (if possible)—they often provide valuable observations about your sleep

Sleep Diary Recommendation

Consider keeping a sleep diary for 1-2 weeks before your appointment, tracking:

• Bedtime and wake time each day
• Sleep quality rating (1-10 scale)
• Number of awakenings during the night
• Snoring reports from your bed partner
• Daytime energy levels and sleepiness episodes
• Naps taken and their duration
• Caffeine, alcohol, and medications consumed

This information provides valuable context for your evaluation.

What Happens After Your Evaluation

If You’re a Good Candidate

If our evaluation confirms you’re appropriate for oral appliance therapy:

1. Treatment Discussion: We explain appliance options, expected outcomes, and the treatment process
2. Insurance Verification: We confirm coverage and provide cost estimates
3. Impressions: Digital or physical impressions can often be taken the same day or at your next visit
4. Treatment Planning: We coordinate with your sleep physician and schedule follow-up appointments
5. Device Fabrication: Custom appliance creation (typically 2-3 weeks)
6. Delivery and Titration: Appliance fitting and gradual optimization

If Additional Testing Is Needed

If diagnostic sleep testing is required:

1. HSAT Coordination: We help arrange home sleep testing through a qualified physician
2. Insurance Authorization: We assist with prior authorization as needed
3. Testing Completion: You complete the overnight sleep test at home
4. Results Review: We schedule a follow-up appointment to review results and proceed with treatment planning

Why Choose Aloha Sleep Apnea & Airway Center

Specialized Expertise

Our practice focuses exclusively on dental sleep medicine:

• Advanced training in oral appliance therapy
• Comprehensive understanding of sleep medicine and sleep-disordered breathing
• Access to all FDA-approved oral appliance designs
• Experience with complex cases including CPAP failures and challenging anatomy
• Continuing education commitment staying current with latest research and techniques

Thorough Evaluation Process

Our evaluation is designed for accuracy and completeness:

• 45-60 minutes of dedicated assessment time—never rushed
• Multi-factor candidacy assessment considering all relevant variables
• Honest recommendations based on evidence, not sales goals
• Clear communication about options, expectations, and limitations

Coordinated Care Approach

We work as part of your healthcare team:

• Direct communication with your sleep physician
• Collaboration with your primary care provider and specialists
• Insurance coordination and benefits verification
• Long-term follow-up and monitoring

Schedule Your Evaluation Today

Take the first step toward understanding your sleep concerns and exploring effective treatment options. Whether you’ve been diagnosed with sleep apnea, suspect you might have it, or are simply concerned about snoring, our comprehensive evaluation provides the answers you need.

Our evaluation is thorough, informative, and focused on finding the right solution for your unique situation. We serve patients throughout Aloha, Hillsboro, Beaverton, Portland, and the greater Oregon metro area.

Contact us today to schedule your sleep apnea evaluation and begin your journey toward better sleep and better health.

Note: Home sleep apnea testing (HSAT) is ordered and interpreted by a physician. We coordinate testing and provide oral appliance therapy in collaboration with the patient’s sleep physician, ensuring comprehensive, medically-supervised care for your sleep-disordered breathing.