Sleep Apnea

If you're exhausted no matter how many hours you spend in bed— or if a partner has told you that you snore, gasp, or stop breathing at night—it's worth taking seriously. Sleep apnea doesn't just leave you tired; left unaddressed, it can affect your heart, your mood, and your long-term health. The good news: it's a treatable condition, and diagnosis is the first step.

Sleep apnea is a disorder marked by repeated pauses in breathing during sleep—sometimes dozens of times a night— that fragment sleep even when you don't fully wake up. It often goes undiagnosed for years simply because the person experiencing it is asleep when it happens; it's frequently a partner who notices first.

Obstructive Sleep Apnea (OSA), the most common form, occurs when the upper airway becomes partially or fully blocked during sleep. Central Sleep Apnea (CSA) is different—it results from the brain not sending proper signals to the muscles that control breathing, rather than a physical blockage. A note on treatment: oral appliance therapy, the approach we offer, is effective for OSA; CSA generally requires a different kind of medical management, and we'll help direct you appropriately if that's what an evaluation points to.

Signs to watch for

• Loud, regular snoring—especially with pauses, gasping, or choking sounds
• Excessive daytime sleepiness
• Frequent morning headaches
• Dry or sore throat on waking
• Trouble falling or staying asleep
• Fatigue, low energy, or difficulty concentrating during the day
• Mood swings or irritability
• Waking frequently to urinate

Not everyone experiences every symptom, and some—like snoring—can happen without sleep apnea at all. But if a combination of these is persistently affecting your quality of life, it's worth having evaluated.

What contributes to sleep apnea

Risk factors include excess weight, a larger neck circumference, a naturally narrow airway (from tongue, tonsil, or adenoid size), being male or over 40, family history, and certain conditions like hypertension, type 2 diabetes, or cardiovascular disease. Some medications— particularly sedatives and opioids—can contribute as well.

Why it's worth treating

Beyond disrupted sleep, untreated sleep apnea is linked to higher long-term risk of cardiovascular problems, type 2 diabetes, mood disorders, weight gain, and cognitive changes over time—which is part of why we recommend evaluation sooner rather than living with it indefinitely.

Snoring happens when tissue in the throat and nasal passages vibrates during sleep. It becomes worth addressing when it's disruptive—to your sleep, a partner's, or your daytime energy—or when it comes with other symptoms that suggest sleep apnea rather than simple snoring.

If lifestyle changes (sleep position, weight management) and over-the-counter approaches haven't helped, a custom oral appliance can often reduce or eliminate snoring.

Sleep apnea and TMJ disorder frequently overlap—nighttime teeth grinding is now understood to often be the brain's response to a partially blocked airway, which means jaw pain and sleep-disordered breathing can be two symptoms of the same underlying problem. As a board-certified orofacial pain specialist trained in dental sleep medicine, Dr. Kruman can evaluate both together, and offers custom oral appliance therapy as an alternative for patients who can't tolerate CPAP. If teeth grinding is part of your picture, it's worth reviewing our page on bruxism as well.

Custom oral appliance therapy uses a small, custom-fitted device worn during sleep that gently repositions the jaw to keep the airway open—a well-established alternative for patients who've tried CPAP and found it uncomfortable, disruptive to a partner's sleep, or difficult to stick with long-term.

Who's a good candidate for oral appliance therapy

Oral appliance therapy tends to work best for mild to moderate obstructive sleep apnea, and for patients with more severe OSA who genuinely can't tolerate CPAP. A sleep study—either in-lab or at-home—is typically needed first to confirm the diagnosis and its severity; Dr. Kruman can help coordinate this if you don't already have one.

Mild vs. moderate sleep apnea—does treatment differ?

Mild and moderate OSA usually respond well to oral appliance therapy on its own. More severe cases may still benefit from an appliance, often alongside other approaches coordinated with your sleep physician—weight management, positional therapy, or in some cases a surgical evaluation. Treatment starts with understanding where your case falls on that spectrum, not a one-size-fits-all prescription.

If CPAP hasn't worked for you

CPAP is effective when it's tolerated, but a large share of patients stop using it within the first year—mask discomfort, dry mouth, a feeling of claustrophobia, and travel inconvenience are the most common reasons. If that's been your experience, you're not out of options: oral appliance therapy is an evidence-backed alternative, not a fallback plan.

The first visit is a full evaluation, not just a fitting. Dr. Kruman will review your sleep history and symptoms, examine your airway and jaw structure, and go over any prior sleep study results if you have them. If you don't yet have a sleep study, he'll help arrange one—diagnosis has to come before treatment.

From there, you'll leave with a working assessment of whether oral appliance therapy is a good fit, what the process looks like (typically impressions or a digital scan, a custom fabrication period, then fitting and adjustment visits), and a realistic sense of timeline. Questions about cost and insurance are welcome at this visit too—see our Fees & Insurance page for how we handle billing as an out-of-network practice.

Is oral appliance therapy as effective as CPAP?

For many patients with mild to moderate OSA, yes—appliance therapy can be comparably effective, and for some patients it's more effective in practice simply because they actually wear it consistently, unlike a CPAP mask they couldn't tolerate. Severity matters here, which is why an evaluation comes first.

Will insurance cover this?

The OPS Group is an out-of-network, self-pay practice. Many patients use out-of-network benefits or HSA/FSA funds toward treatment. Visit the Fees & Insurance page for details, or ask during your first visit.

How long does it take to get a custom appliance?

After your evaluation and impressions or scan, fabrication typically takes a few weeks, followed by a fitting visit and short adjustment period to get the fit right.