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TMD and Sleep Apnea Patient Referral Form

Obstructive Sleep Apnea

Treatment History

TMD Referral

Patient's Chief Complaint(s) (Please Check all that apply:)

Referral for Oral Appliance Therapy Evaluation for:

Signs and Treatment for Obstructive Sleep Apnea:

Snoring is a very common problem that affects millions of us. Did you know that snoring can actually be a sign of a very serious and dangerous condition called Obstructive Sleep Apnea (OSA)?

Snoring occurs when the muscles of your throat relax, your tongue falls backward, and your throat narrows. As you breathe, the walls of the throat begin to vibrate leading to the sound of snoring. The narrower your airway becomes, the more vibration and the louder you snore. Sometimes the walls of the throat completely collapse creating a condition called apnea (cessation of breathing). This is a very serious condition which requires medical attention.

Other Potential Signs of Obstructive Sleep Apnea include:

           • Episodes of waking up gasping or choking (mostly witnessed by another person)

             • Loud snoring

             • Excessive daytime sleepiness or fatigue                             

             • Irritability

             • Difficulty focusing

             • Morning headaches

             • Lack of energy          

Patients who are diagnosed with snoring may be able to be treated with oral appliance therapy. The first line of treatment in the ADA for mild or moderate obstructive sleep apnea is an oral appliance. For those who are diagnosed with severe sleep apnea, combination therapy (using both CPAP and a dental device) may be an option to decrease the air pressure on the CPAP machine and make it easier to wear and sleep. If you are CPAP intolerant, an oral appliance is a possibility as well.

Dr. Emily Stopper offers complimentary consultations for airway assessments to evaluate your collapsibility. When left untreated, sleep apnea can negatively affect your energy levels, productivity, and mental well-being. It can also have long-term, adverse effects on your heart, metabolism, and overall health. Sleep apnea can affect anyone: fit or overweight, old or young, male or female. It can even affect children. Effective treatment of obstructive sleep apnea has been shown to help alleviate these symptoms. You will have less waking during the night, a more restful sleep, and wake up with more energy. Oral appliance treatment helps to keep your airway open throughout the night so that you don’t stop breathing. 

At Sleep & Headache Solutions, we are passionate about our patients and their overall health and well-being. We work closely with our patients’ primary care providers to achieve the best possible health outcomes for our mutual patients. If you or a someone you know snores loudly at night or have other potential symptoms of sleep apnea, please talk to a doctor or a health care professional to rule out this potentially fatal condition.