The Snoring Bear: Part 6

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Before we get back to the story, I need to tell the golfers what OSA has to do with their golf score.

What happens to your golf score if you have sleep apnea? A recent study of 12 golfers with moderate to severe OSA was done. These OSA golfers who had their sleep apnea treated dropped their handicaps from 9.2 to 6.3 on average. It would appear that golf requires skills that treatment of OSA improves!

But more on insurance companies. You can read prior episodes of this story online at Just search on “Snoring Bear.” Insurance companies know more about obstructive sleep apnea (OSA) and its health risks than most people know. Believe it or not, they know that if a sufferer doesn’t get treatment, these health risks are very high and can include death.

So, our patient has now gone without treatment for his OSA and without insurance for a year. One night, he looked down in the crib at his daughter (not Johnny) sound asleep. He wanted to see her grow up, become a beautiful young lady, and walk down the aisle during her wedding with him at her side. The next day, he made an appointment with the sleep doc.

In the office, he saw a small thing that looked like a mouth guard on the doctor’s desk. Well, in came the sleep doctor and he told him the story, the long story. He started with the diagnosis all the way to CPAP failure and finished with the insurance refusal. He shared that he knew how dangerous OSA was. He told the sleep doc that he would give treatment another chance if there was anything else besides CPAP.

The doctor’s answer was, “No other options exist for you because your OSA is too severe!”

Our patient did not know that most sleep docs (including his) were trained to be pulmonologists. These are doctors who are specialists who deal with diseases of the lungs. Their training is focused on (and in many cases was limited to) CPAP for treatment of OSA.

If your only tool is a hammer, all you are looking for is a nail!

Our patient asked about the mouth guard thing on his desk, “What’s this?”

“An oral appliance, a mandibular advancement device (MAD) which pulls your tongue forward off of the airway to prevent OSA. But it would never work for you because your OSA is too severe — you are much too sick!”

Our patient asked if he could just try it out. The doctor just echoed, “It will not work for you!” The patient asked, “What would I have to do to allow you to let me try one?” After a brief moment, the doctor answered, “Lose 40 pounds and then I will let you try one”

Side note: all sleep doctors have a governing body known as the American Academy of Sleep Medicine (AASM). They must be certified as a Diplomate in that organization to be qualified to diagnose OSA. The guidelines put out by that organization for treatment of OSA (published in 2015) are summarized below.

Oral appliance therapy (OAT) should be used for adults with OSA, instead of no treatment at all.

OAT should also be offered to patients who want an alternative treatment type instead of CPAP. It should also be offered to patients who cannot tolerate CPAP.

Patients should consult a qualified dentist who uses a custom MAD device which can be adjusted rather that a non custom one such as the ones over the counter in stores or online.

Dentists trained to treat OSA should be able to provide management of dental side effects of OAT.

Follow up by a sleep doctor is recommended once OAT is completed and maximum medical improvement is reached. Periodic evaluation is recommended with both the sleep physician and the dentist.

Next week we will see if he really loses the weight!

• • •

Dr. Donald Johnson founded Northwest Treatment Center for Snoring & Sleep Apnea in Coeur d’Alene to help patients stop their snoring and live free with no limits! Obstructive sleep apnea is usually able to be treated with a small oral appliance. Dr. Johnson’s office is at 114 W. Neider Ave., near Costco. The website for more information is and the office phone is (208) 667-4551. Schedule a free consultation appointment today!

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