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You have come to our office because your referring physician feels you might benefit from an intra-oral appliance which is designed to improve your breathing during sleep by advancing your lower jaw or holding your tongue forward. This movement helps to open the airway space which can reduce snoring and sleep apnea in many cases. We cannot guarantee that this device will be successful for all patients because there are many factors involved in sleep apnea.

Patients who have been diagnosed as having sleep apnea should have routine visits to their physician or sleep disorders center. Moderate or severe obstructive sleep apnea is a potentially life threatening disease, and periodic monitoring of the disease is important. The intra-oral sleep apnea appliance does not cure snoring or sleep apnea, but it is designed to reduce snoring and apneic episodes while it is being worn. If your physician has suggested a change in sleeping position or weight loss, these actions are important and are to be accomplished in addition to using the intra-oral device. It is best to avoid alcohol, hypnotic or sedative drugs within three to four hours of going to bed.

Prior to the fabrication of any intra-oral device, you must have a consultation appointment to evaluate your oral condition as well as to discuss possible choices of treatment. If you require new fillings, crowns (caps), implant placement, or periodontal therapy, these procedures should be completed before the appliance is made. Any change in your dentition may require construction of a new device. If you do not have a general dentist, I can recommend someone in your local area for all the services you may require. The first step may require you to have cephalometric x-ray pictures taken to determine the size of various oral structures. These films and a clinical examination will help determine if you can expect to be helped by an intra-oral sleep apnea device.

Normally, three to four appointments are required to fabricate the appliance, followed by appointments to adjust the fit of the device and evaluate its degree of effectiveness. The fit, wear and comfort of the appliance will be evaluated as the patient deems necessary.

Prior to your first appointment, please obtain any authorization forms your medical insurer may require for coverage, along with recent x-ray pictures from your dentist's office. You will be contacted if a copy of your sleep study report and the doctor's referral letter or prescription is needed. If you wear a mouth piece of any sort (orthodontic retainer, night guard, etc.), please bring it with you to your appointment.

Most insurance companies will pay for oral appliances to treat obstructive sleep apnea, but may be very strict in their definition of 'sleep apnea.' You may wish to check with your insurer prior to your appointment. The billing code for a custom fabricated oral device is E0486. In addition to the above, you will need to bring various forms to the first visit. Please print out these forms in the section called "Pre-Appointment Forms." Sign, fill them out and bring them with you to your appointment. Any questions you may have can be answered during your appointment.

We look forward to helping you feel more awake!

The Doctors and Staff at Harmony Dental Sleep Therapy

• • •

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``` PHYSICIAN REFERRAL FORM
SLEEP APNEA SELF TEST
SLEEP JOURNAL

MARIA SOKOLINA D.D.S.
1066 Clifton Ave. Clifton, NJ 07013-3616 315 W57th Str, Ste 209, NYC, NY 10019 (973) 777-2731 (212) 960-8919
OFFICE HOURS:

Mon: 8:00am - 5:00pm | Tue: 8:00am - 7:00pm

Wed: 8:00am - 4:00pm | Thu: 8:00am -7:00pm

Fri: 8:00am - 3:00pm | Sat: 8:00am - 2:00pm
AADSM Hackensack UMC Mountainside
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