We’ll start by having a conversation. I want you to share with me the scope of your problem. By the time you get here, you will have received a questionnaire or two to help me understand much about how your life and physical status is impacting you. It is important that you be completely honest. All your information will be held in the strictest confidence. Remember, my goal is to not only improve your sleep disordered breathing, but to make your life better overall. If you have already had a sleep study, please be sure to bring a copy with you. If you haven’t had one, you will be asked to get one. The reason is that the sleep study will quantify the level of the disturbance. In that way follow-ups can be compared to original values. I understand your concerns about giving up a night sleep to be in a sleep center, but it is the only way to get such complete information. The cost of our initial consultation is $250 which will be payable at your visit. We accept all major credit cards as well as your check and cash.

What happens next?

We are going to gather some additional info. One of the tests we are going to do is known as a heart rate variability test. It’s a very simple test. A belt with a couple of electrode pickups built into it is placed just below your chest. It is a measure of cardiac efficiency, overall health and also provides us with a picture autonomic nervous system function, both sympathetic and parasympathetic. You will start by lying comfortably in our dental chair. No snickering there, I know some of you are not comfortable in the dental chair, but remember, we’re not doing any of that stuff. Then you will be asked to stand.

Now, that’s not too difficult, right?

So what’s this autonomic stuff?

Allow me to explain. Our bodies function to a large extent without our knowing or need to control. For instance, we don’t have to tell our heart to beat, nor do we have to instruct our stomach and intestines to move food along toward it’s final exit. That’s what I mean by autonomic. There are two types of control in the autonomic system. The first is the sympathetic nervous system. This provides us with the ability to respond instantaneously to a threat. The second, the parasympathetic nervous system provides an opposite effect, to return us to a lower level of vigilance. If a patient has an elevated sympathetic tone, he or she is more likely to experience a greater effect from the release of adrenalin aka epinephrine that results from the decrease in blood oxygen, a result of your breathing disorder. Of course, this is a rather simplistic explanation. However, you can see that if a person is not in balance, the body’s ability to survive is compromised. If you are interested in finding out more, the good ‘ol web is rich with information on this topic.

A lateral head x-ray, known as a cephalometric radiograph is taken to assist in the selection of appliances. It shows the position of the tongue and it’s relation to the airway opening. It also shows me the position and elevation of the hyoid bone. It is this bone which clues me into the muscle activity of the tongue and what can be done to use it to improve the size of the airway diameter, which will ultimately allow more air to pass to the lungs. Remember that this is the goal.

Impressions of your upper and lower teeth. Don’t worry if you feel you are a gagger. We have ways of getting you through that. I’ve been taking impressions for over 30 years. Your appliances will be designed for your comfort as well as the needed effect.

Is there an additional charge for this visit?

Yes, this part of treatment is $800. However, when you go ahead with your appliance therapy, this amount will be credited toward that cost. Yes, the full amount, so it’s like getting the diagnostic tests for free. We have to do this because of the time involved to acquire diagnostic information which is critical for us to make the proper evaluation. Additional impressions may be taken depending on the range of appliance therapy needed.