1

Dental Sleep Therapy

Dr Gy Yatros DMD

Gy Yatros DMD

bull Diplomate ABDSM

bull Faculty USF College of

Medicine

bull Co-Founder of Dental

Sleep Solutionsreg

bull Co-Founder of DS3

Dental Sleep Software

2

Is there anything that works all the time

3

4

Patients come first

5

Two Therapies to Tx OSA

6

Where are we Today

Randomized clinical trials with CPAP vs OAT have yielded comparable outcomes

Inconsistent efficacy of OAT offsets poor compliance of CPAP

7

8

2015 Practice Parameters Notable Findings - Adherence

bull CPAP is superior to oral appliance therapy in improving the apnea-hypopnea index (AHI) and lowering both the arousal index and the oxygen desaturation index (ODI)

bull However data suggest that the efficacy gap between CPAP and oral appliance therapy may be closed when adherence is taken into consideration Even when using a minimal definition of adherencemdashonly 4 hours a nightmdash

bull Data show that up to 83 of patients may be non-adherent to their CPAP treatment

bull Results show that subjective adherence with oral appliance therapy is better overall than objective adherence with CPAP in adult patients with OSA

bull This clinical reality has led researchers to develop the mean disease alleviation calculation which suggests that the overall therapeutic effectiveness of oral appliances may be comparable with CPAP because of the significant difference in adherence rates

9

10

11

12

13

Harefuah 2013 Mar152(3)140-4 184 183[Treatment compliance with continuous positive airway pressure device among adults with obstructive sleep apnea (OSA) how many

adhere to treatment]Sarrell EM1 Chomsky O Shechter D

bull N = 371

bull Year 1bull 13 nightly

bull 13 occasionally

bull 13 never

bull Year 4bull 13 most nights

bull 23 never

Gy Yatros DMD

bull Diplomate ABDSM

bull Faculty USF College of

Medicine

bull Co-Founder of Dental

Sleep Solutionsreg

bull Co-Founder of DS3

Dental Sleep Software

2

Is there anything that works all the time

3

4

Patients come first

5

Two Therapies to Tx OSA

6

Where are we Today

Randomized clinical trials with CPAP vs OAT have yielded comparable outcomes

Inconsistent efficacy of OAT offsets poor compliance of CPAP

7

8

2015 Practice Parameters Notable Findings - Adherence

bull CPAP is superior to oral appliance therapy in improving the apnea-hypopnea index (AHI) and lowering both the arousal index and the oxygen desaturation index (ODI)

bull However data suggest that the efficacy gap between CPAP and oral appliance therapy may be closed when adherence is taken into consideration Even when using a minimal definition of adherencemdashonly 4 hours a nightmdash

bull Data show that up to 83 of patients may be non-adherent to their CPAP treatment

bull Results show that subjective adherence with oral appliance therapy is better overall than objective adherence with CPAP in adult patients with OSA

bull This clinical reality has led researchers to develop the mean disease alleviation calculation which suggests that the overall therapeutic effectiveness of oral appliances may be comparable with CPAP because of the significant difference in adherence rates

9

10

11

12

13

Harefuah 2013 Mar152(3)140-4 184 183[Treatment compliance with continuous positive airway pressure device among adults with obstructive sleep apnea (OSA) how many

adhere to treatment]Sarrell EM1 Chomsky O Shechter D

bull N = 371

bull Year 1bull 13 nightly

bull 13 occasionally

bull 13 never

bull Year 4bull 13 most nights

bull 23 never

Is there anything that works all the time

3

4

Patients come first

5

Two Therapies to Tx OSA

6

Where are we Today

Randomized clinical trials with CPAP vs OAT have yielded comparable outcomes

Inconsistent efficacy of OAT offsets poor compliance of CPAP

7

8

2015 Practice Parameters Notable Findings - Adherence

bull CPAP is superior to oral appliance therapy in improving the apnea-hypopnea index (AHI) and lowering both the arousal index and the oxygen desaturation index (ODI)

bull However data suggest that the efficacy gap between CPAP and oral appliance therapy may be closed when adherence is taken into consideration Even when using a minimal definition of adherencemdashonly 4 hours a nightmdash

bull Data show that up to 83 of patients may be non-adherent to their CPAP treatment

bull Results show that subjective adherence with oral appliance therapy is better overall than objective adherence with CPAP in adult patients with OSA

bull This clinical reality has led researchers to develop the mean disease alleviation calculation which suggests that the overall therapeutic effectiveness of oral appliances may be comparable with CPAP because of the significant difference in adherence rates

9

10

11

12

13

Harefuah 2013 Mar152(3)140-4 184 183[Treatment compliance with continuous positive airway pressure device among adults with obstructive sleep apnea (OSA) how many

adhere to treatment]Sarrell EM1 Chomsky O Shechter D

bull N = 371

bull Year 1bull 13 nightly

bull 13 occasionally

bull 13 never

bull Year 4bull 13 most nights

bull 23 never

4

Patients come first

5

Two Therapies to Tx OSA

6

Where are we Today

Randomized clinical trials with CPAP vs OAT have yielded comparable outcomes

Inconsistent efficacy of OAT offsets poor compliance of CPAP

7

8

2015 Practice Parameters Notable Findings - Adherence

bull CPAP is superior to oral appliance therapy in improving the apnea-hypopnea index (AHI) and lowering both the arousal index and the oxygen desaturation index (ODI)

bull However data suggest that the efficacy gap between CPAP and oral appliance therapy may be closed when adherence is taken into consideration Even when using a minimal definition of adherencemdashonly 4 hours a nightmdash

bull Data show that up to 83 of patients may be non-adherent to their CPAP treatment

bull Results show that subjective adherence with oral appliance therapy is better overall than objective adherence with CPAP in adult patients with OSA

bull This clinical reality has led researchers to develop the mean disease alleviation calculation which suggests that the overall therapeutic effectiveness of oral appliances may be comparable with CPAP because of the significant difference in adherence rates

9

10

11

12

13

Harefuah 2013 Mar152(3)140-4 184 183[Treatment compliance with continuous positive airway pressure device among adults with obstructive sleep apnea (OSA) how many

adhere to treatment]Sarrell EM1 Chomsky O Shechter D

bull N = 371

bull Year 1bull 13 nightly

bull 13 occasionally

bull 13 never

bull Year 4bull 13 most nights

bull 23 never

Patients come first

5

Two Therapies to Tx OSA

6

Where are we Today

Randomized clinical trials with CPAP vs OAT have yielded comparable outcomes

Inconsistent efficacy of OAT offsets poor compliance of CPAP

7

8

2015 Practice Parameters Notable Findings - Adherence

bull CPAP is superior to oral appliance therapy in improving the apnea-hypopnea index (AHI) and lowering both the arousal index and the oxygen desaturation index (ODI)

bull However data suggest that the efficacy gap between CPAP and oral appliance therapy may be closed when adherence is taken into consideration Even when using a minimal definition of adherencemdashonly 4 hours a nightmdash

bull Data show that up to 83 of patients may be non-adherent to their CPAP treatment

bull Results show that subjective adherence with oral appliance therapy is better overall than objective adherence with CPAP in adult patients with OSA

bull This clinical reality has led researchers to develop the mean disease alleviation calculation which suggests that the overall therapeutic effectiveness of oral appliances may be comparable with CPAP because of the significant difference in adherence rates

9

10

11

12

13

Harefuah 2013 Mar152(3)140-4 184 183[Treatment compliance with continuous positive airway pressure device among adults with obstructive sleep apnea (OSA) how many

adhere to treatment]Sarrell EM1 Chomsky O Shechter D

bull N = 371

bull Year 1bull 13 nightly

bull 13 occasionally

bull 13 never

bull Year 4bull 13 most nights

bull 23 never

Two Therapies to Tx OSA

6

Where are we Today

Randomized clinical trials with CPAP vs OAT have yielded comparable outcomes

Inconsistent efficacy of OAT offsets poor compliance of CPAP

7

8

2015 Practice Parameters Notable Findings - Adherence

bull CPAP is superior to oral appliance therapy in improving the apnea-hypopnea index (AHI) and lowering both the arousal index and the oxygen desaturation index (ODI)

bull However data suggest that the efficacy gap between CPAP and oral appliance therapy may be closed when adherence is taken into consideration Even when using a minimal definition of adherencemdashonly 4 hours a nightmdash

bull Data show that up to 83 of patients may be non-adherent to their CPAP treatment

bull Results show that subjective adherence with oral appliance therapy is better overall than objective adherence with CPAP in adult patients with OSA

bull This clinical reality has led researchers to develop the mean disease alleviation calculation which suggests that the overall therapeutic effectiveness of oral appliances may be comparable with CPAP because of the significant difference in adherence rates

9

10

11

12

13

Harefuah 2013 Mar152(3)140-4 184 183[Treatment compliance with continuous positive airway pressure device among adults with obstructive sleep apnea (OSA) how many

adhere to treatment]Sarrell EM1 Chomsky O Shechter D

bull N = 371

bull Year 1bull 13 nightly

bull 13 occasionally

bull 13 never

bull Year 4bull 13 most nights

bull 23 never

Where are we Today

Randomized clinical trials with CPAP vs OAT have yielded comparable outcomes

Inconsistent efficacy of OAT offsets poor compliance of CPAP

7

8

2015 Practice Parameters Notable Findings - Adherence

bull CPAP is superior to oral appliance therapy in improving the apnea-hypopnea index (AHI) and lowering both the arousal index and the oxygen desaturation index (ODI)

bull However data suggest that the efficacy gap between CPAP and oral appliance therapy may be closed when adherence is taken into consideration Even when using a minimal definition of adherencemdashonly 4 hours a nightmdash

bull Data show that up to 83 of patients may be non-adherent to their CPAP treatment

bull Results show that subjective adherence with oral appliance therapy is better overall than objective adherence with CPAP in adult patients with OSA

bull This clinical reality has led researchers to develop the mean disease alleviation calculation which suggests that the overall therapeutic effectiveness of oral appliances may be comparable with CPAP because of the significant difference in adherence rates

9

10

11

12

13

Harefuah 2013 Mar152(3)140-4 184 183[Treatment compliance with continuous positive airway pressure device among adults with obstructive sleep apnea (OSA) how many

adhere to treatment]Sarrell EM1 Chomsky O Shechter D

bull N = 371

bull Year 1bull 13 nightly

bull 13 occasionally

bull 13 never

bull Year 4bull 13 most nights

bull 23 never

8

2015 Practice Parameters Notable Findings - Adherence

bull CPAP is superior to oral appliance therapy in improving the apnea-hypopnea index (AHI) and lowering both the arousal index and the oxygen desaturation index (ODI)

bull However data suggest that the efficacy gap between CPAP and oral appliance therapy may be closed when adherence is taken into consideration Even when using a minimal definition of adherencemdashonly 4 hours a nightmdash

bull Data show that up to 83 of patients may be non-adherent to their CPAP treatment

bull Results show that subjective adherence with oral appliance therapy is better overall than objective adherence with CPAP in adult patients with OSA

bull This clinical reality has led researchers to develop the mean disease alleviation calculation which suggests that the overall therapeutic effectiveness of oral appliances may be comparable with CPAP because of the significant difference in adherence rates

9

10

11

12

13

Harefuah 2013 Mar152(3)140-4 184 183[Treatment compliance with continuous positive airway pressure device among adults with obstructive sleep apnea (OSA) how many

adhere to treatment]Sarrell EM1 Chomsky O Shechter D

bull N = 371

bull Year 1bull 13 nightly

bull 13 occasionally

bull 13 never

bull Year 4bull 13 most nights

bull 23 never

2015 Practice Parameters Notable Findings - Adherence

bull CPAP is superior to oral appliance therapy in improving the apnea-hypopnea index (AHI) and lowering both the arousal index and the oxygen desaturation index (ODI)

bull However data suggest that the efficacy gap between CPAP and oral appliance therapy may be closed when adherence is taken into consideration Even when using a minimal definition of adherencemdashonly 4 hours a nightmdash

bull Data show that up to 83 of patients may be non-adherent to their CPAP treatment

bull Results show that subjective adherence with oral appliance therapy is better overall than objective adherence with CPAP in adult patients with OSA

bull This clinical reality has led researchers to develop the mean disease alleviation calculation which suggests that the overall therapeutic effectiveness of oral appliances may be comparable with CPAP because of the significant difference in adherence rates

9

10

11

12

13

Harefuah 2013 Mar152(3)140-4 184 183[Treatment compliance with continuous positive airway pressure device among adults with obstructive sleep apnea (OSA) how many

adhere to treatment]Sarrell EM1 Chomsky O Shechter D

bull N = 371

bull Year 1bull 13 nightly

bull 13 occasionally

bull 13 never

bull Year 4bull 13 most nights

bull 23 never

10

11

12

13

Harefuah 2013 Mar152(3)140-4 184 183[Treatment compliance with continuous positive airway pressure device among adults with obstructive sleep apnea (OSA) how many

adhere to treatment]Sarrell EM1 Chomsky O Shechter D

bull N = 371

bull Year 1bull 13 nightly

bull 13 occasionally

bull 13 never

bull Year 4bull 13 most nights

bull 23 never

11

12

13

Harefuah 2013 Mar152(3)140-4 184 183[Treatment compliance with continuous positive airway pressure device among adults with obstructive sleep apnea (OSA) how many

adhere to treatment]Sarrell EM1 Chomsky O Shechter D

bull N = 371

bull Year 1bull 13 nightly

bull 13 occasionally

bull 13 never

bull Year 4bull 13 most nights

bull 23 never

12

13

Harefuah 2013 Mar152(3)140-4 184 183[Treatment compliance with continuous positive airway pressure device among adults with obstructive sleep apnea (OSA) how many

adhere to treatment]Sarrell EM1 Chomsky O Shechter D

bull N = 371

bull Year 1bull 13 nightly

bull 13 occasionally

bull 13 never

bull Year 4bull 13 most nights

bull 23 never

13

Harefuah 2013 Mar152(3)140-4 184 183[Treatment compliance with continuous positive airway pressure device among adults with obstructive sleep apnea (OSA) how many

adhere to treatment]Sarrell EM1 Chomsky O Shechter D

bull N = 371

bull Year 1bull 13 nightly

bull 13 occasionally

bull 13 never

bull Year 4bull 13 most nights

bull 23 never

Harefuah 2013 Mar152(3)140-4 184 183[Treatment compliance with continuous positive airway pressure device among adults with obstructive sleep apnea (OSA) how many

adhere to treatment]Sarrell EM1 Chomsky O Shechter D

bull N = 371

bull Year 1bull 13 nightly

bull 13 occasionally

bull 13 never

bull Year 4bull 13 most nights

bull 23 never

EFFECTIVENESS =

Efficacy X Compliance

15

Effectiveness of Treatment

CPAP

bull Efficacy = 100

bull Compliance = 50

bull Tx Effectiveness = 50

MAD

bull Efficacy = 70

bull Compliance = 100

bull Tx Effectiveness = 70

16

17

Success in Life

bull Getting a sleep patient to sit down and talk with you

bull Getting a patient to accept treatment

bull Improving sleep and health of patient

bull Getting paid by patient

bull Getting paid by Insurance

bull Reducing AHI by half and getting below 10

bull Making at least one device per week

bull Getting a local MD to make just ONE referral

Success in Dental Sleep

Traditional Parameters

bull AHI RDI

bull Reduction by one half and to below 10 and relief of subjective symptoms

Defin

ing Su

ccess

OSA is a SYNDROME

bull Glucose intolerance

bull Insulin resistance

bull Hypertension

bull Weight gain

bull Depression

bull GERD

bull Impotenece

bull Tired

bull Sleepy

bull Snoring

bull Low Energy

bull Wake Unrefreshed

bull Memory problems

21

Whatrsquos your planCOOKING UP SUCCESS

22

2 Goals of Dental Sleep

1 Improve Symptoms (Subjective)

2 Decrease Health Risks (AHI)

23

Prior to ConsultationDiagnosis Obtained

bull Copy of BASELINE sleep study received and reviewed

Patient completes sleep questionnaire via DS3 Web Portal

bull Software or paper forms

Obtain patientrsquos medical insurance

bull Complete Verification of Benefits (VOB) ndash DS3 Instant Eligibility Check

Patients want to know What does it cost What does my insurance

cover

24

Review Baseline Sleep Testbull Verify study is a BaselineDiagnostic

test

bull Important information notedbull Date

bull If over 2 years consider having patient retested

bull Type of test (HSTPSG)

bull PlaceFacility

bull Diagnosis

bull AHIRDI

bull AHIRDI in Supine Position

bull 02 NadirLSAT

bull SPO2 lt 90

25

Epidemiological Data from the Wisconsin Sleep Cohort

bull Random selection of 1000 adult state employees

bull All received an overnight polysomnogram in 1992

bull 3 subsequent polysomnograms of this cohort

26

larr Normal gt95

larr Mild ~91

larr Moderate ~84

larr Severe ~57

Survival Rates

Young T Finn L Peppard PE Szklo-Coxe M Austin D Nieto FJ Stubbs R Hla KM Sleep disordered breathing and mortality eighteen-year follow-up of the wisconsin sleep cohort SLEEP 200831(8)1071-1078

Wisconsin

Sleep Cohort

All Cause

Mortality

27

Detailed Sleep Questionnaire

Obtain a thorough sleep and health history from the patient PRIOR

to consultation

28

Detailed Sleep Questionnaire

bull Subjective (Complaints amp Symptoms)

bull Previous Treatments

bull Health History

29

Detailed Sleep Questionnaire Subjective Complaints

Epworth Sleepiness Score

Thornton Snoring Scale

Chief Complaint

Other Complaints

Sleep Quality

Number of times wake up each night

Morning Headaches

Witnesses Apneas

Bedtime Partner sleep in same room

30

31

32

I want to help youhelliphellip

Agree to treatment speech

bull Together wersquore going to do everything we can to treat your disease with a MRD We will evaluate

bull Top 5 CCrsquos

bull AHIRDI

bull LSAT

bull T below 90

bull Communicate with your physicians

bull Facilitate other treatment options if necessary

3 Goals of Dental Sleep

1 Wear Device

2 Subjective Improvement

3 Objective Success

34

38

39

Device Delivery

40

Titration Sleep Test

Treatment

Titration Sleep Test Protocol

Subjective Success

Wearing device through the

night

Confident it is helping them

Pain free

Subjective tests improving

41

Titration HST

GOOD One night one position

BETTER Two nights two positions

BEST Three nights three positions

42

43

44

bull PROTOCOL

bull Patient to take adjustment key(s) Bands Rods

bull Sleep tech to wake patient but patient adjusts device

bull INSTRUCTIONS TO TECH bull IF AHI ge 10 OR RDI ge 15 ADJUST

APPLIANCE 2 FULL TURNS

bull REPEAT AT 45 MIN INTERVALS UNTIL SUCCESSFUL CONSIDER TITRATING CPAP AFTER 4 TO 5 HOURS IF UNSUCCESSFUL

TITRATING AT SLEEP CENTER

45

TitratePromote Nasal Breathing

ElasticsChin StrapLip ClosureEnsure device doesnrsquot dislodgeNose ConesTape TAP Mouth ShieldManage allergies

EPAPPositional TherapyAdd low flow O2Combination TherapyMedical ReferralChange vertical or devices DNA ApplianceTimeDiscontinueAlternative Tx

What else can we do

46

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

Effectiveness of Treatment

CPAP

bull Efficacy = 100

bull Compliance = 50

bull Tx Effectiveness = 50

MAD

bull Efficacy = 70

bull Compliance = 100

bull Tx Effectiveness = 70

16

17

Success in Life

bull Getting a sleep patient to sit down and talk with you

bull Getting a patient to accept treatment

bull Improving sleep and health of patient

bull Getting paid by patient

bull Getting paid by Insurance

bull Reducing AHI by half and getting below 10

bull Making at least one device per week

bull Getting a local MD to make just ONE referral

Success in Dental Sleep

Traditional Parameters

bull AHI RDI

bull Reduction by one half and to below 10 and relief of subjective symptoms

Defin

ing Su

ccess

OSA is a SYNDROME

bull Glucose intolerance

bull Insulin resistance

bull Hypertension

bull Weight gain

bull Depression

bull GERD

bull Impotenece

bull Tired

bull Sleepy

bull Snoring

bull Low Energy

bull Wake Unrefreshed

bull Memory problems

21

Whatrsquos your planCOOKING UP SUCCESS

22

2 Goals of Dental Sleep

1 Improve Symptoms (Subjective)

2 Decrease Health Risks (AHI)

23

Prior to ConsultationDiagnosis Obtained

bull Copy of BASELINE sleep study received and reviewed

Patient completes sleep questionnaire via DS3 Web Portal

bull Software or paper forms

Obtain patientrsquos medical insurance

bull Complete Verification of Benefits (VOB) ndash DS3 Instant Eligibility Check

Patients want to know What does it cost What does my insurance

cover

24

Review Baseline Sleep Testbull Verify study is a BaselineDiagnostic

test

bull Important information notedbull Date

bull If over 2 years consider having patient retested

bull Type of test (HSTPSG)

bull PlaceFacility

bull Diagnosis

bull AHIRDI

bull AHIRDI in Supine Position

bull 02 NadirLSAT

bull SPO2 lt 90

25

Epidemiological Data from the Wisconsin Sleep Cohort

bull Random selection of 1000 adult state employees

bull All received an overnight polysomnogram in 1992

bull 3 subsequent polysomnograms of this cohort

26

larr Normal gt95

larr Mild ~91

larr Moderate ~84

larr Severe ~57

Survival Rates

Young T Finn L Peppard PE Szklo-Coxe M Austin D Nieto FJ Stubbs R Hla KM Sleep disordered breathing and mortality eighteen-year follow-up of the wisconsin sleep cohort SLEEP 200831(8)1071-1078

Wisconsin

Sleep Cohort

All Cause

Mortality

27

Detailed Sleep Questionnaire

Obtain a thorough sleep and health history from the patient PRIOR

to consultation

28

Detailed Sleep Questionnaire

bull Subjective (Complaints amp Symptoms)

bull Previous Treatments

bull Health History

29

Detailed Sleep Questionnaire Subjective Complaints

Epworth Sleepiness Score

Thornton Snoring Scale

Chief Complaint

Other Complaints

Sleep Quality

Number of times wake up each night

Morning Headaches

Witnesses Apneas

Bedtime Partner sleep in same room

30

31

32

I want to help youhelliphellip

Agree to treatment speech

bull Together wersquore going to do everything we can to treat your disease with a MRD We will evaluate

bull Top 5 CCrsquos

bull AHIRDI

bull LSAT

bull T below 90

bull Communicate with your physicians

bull Facilitate other treatment options if necessary

3 Goals of Dental Sleep

1 Wear Device

2 Subjective Improvement

3 Objective Success

34

38

39

Device Delivery

40

Titration Sleep Test

Treatment

Titration Sleep Test Protocol

Subjective Success

Wearing device through the

night

Confident it is helping them

Pain free

Subjective tests improving

41

Titration HST

GOOD One night one position

BETTER Two nights two positions

BEST Three nights three positions

42

43

44

bull PROTOCOL

bull Patient to take adjustment key(s) Bands Rods

bull Sleep tech to wake patient but patient adjusts device

bull INSTRUCTIONS TO TECH bull IF AHI ge 10 OR RDI ge 15 ADJUST

APPLIANCE 2 FULL TURNS

bull REPEAT AT 45 MIN INTERVALS UNTIL SUCCESSFUL CONSIDER TITRATING CPAP AFTER 4 TO 5 HOURS IF UNSUCCESSFUL

TITRATING AT SLEEP CENTER

45

TitratePromote Nasal Breathing

ElasticsChin StrapLip ClosureEnsure device doesnrsquot dislodgeNose ConesTape TAP Mouth ShieldManage allergies

EPAPPositional TherapyAdd low flow O2Combination TherapyMedical ReferralChange vertical or devices DNA ApplianceTimeDiscontinueAlternative Tx

What else can we do

46

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

17

Success in Life

bull Getting a sleep patient to sit down and talk with you

bull Getting a patient to accept treatment

bull Improving sleep and health of patient

bull Getting paid by patient

bull Getting paid by Insurance

bull Reducing AHI by half and getting below 10

bull Making at least one device per week

bull Getting a local MD to make just ONE referral

Success in Dental Sleep

Traditional Parameters

bull AHI RDI

bull Reduction by one half and to below 10 and relief of subjective symptoms

Defin

ing Su

ccess

OSA is a SYNDROME

bull Glucose intolerance

bull Insulin resistance

bull Hypertension

bull Weight gain

bull Depression

bull GERD

bull Impotenece

bull Tired

bull Sleepy

bull Snoring

bull Low Energy

bull Wake Unrefreshed

bull Memory problems

21

Whatrsquos your planCOOKING UP SUCCESS

22

2 Goals of Dental Sleep

1 Improve Symptoms (Subjective)

2 Decrease Health Risks (AHI)

23

Prior to ConsultationDiagnosis Obtained

bull Copy of BASELINE sleep study received and reviewed

Patient completes sleep questionnaire via DS3 Web Portal

bull Software or paper forms

Obtain patientrsquos medical insurance

bull Complete Verification of Benefits (VOB) ndash DS3 Instant Eligibility Check

Patients want to know What does it cost What does my insurance

cover

24

Review Baseline Sleep Testbull Verify study is a BaselineDiagnostic

test

bull Important information notedbull Date

bull If over 2 years consider having patient retested

bull Type of test (HSTPSG)

bull PlaceFacility

bull Diagnosis

bull AHIRDI

bull AHIRDI in Supine Position

bull 02 NadirLSAT

bull SPO2 lt 90

25

Epidemiological Data from the Wisconsin Sleep Cohort

bull Random selection of 1000 adult state employees

bull All received an overnight polysomnogram in 1992

bull 3 subsequent polysomnograms of this cohort

26

larr Normal gt95

larr Mild ~91

larr Moderate ~84

larr Severe ~57

Survival Rates

Young T Finn L Peppard PE Szklo-Coxe M Austin D Nieto FJ Stubbs R Hla KM Sleep disordered breathing and mortality eighteen-year follow-up of the wisconsin sleep cohort SLEEP 200831(8)1071-1078

Wisconsin

Sleep Cohort

All Cause

Mortality

27

Detailed Sleep Questionnaire

Obtain a thorough sleep and health history from the patient PRIOR

to consultation

28

Detailed Sleep Questionnaire

bull Subjective (Complaints amp Symptoms)

bull Previous Treatments

bull Health History

29

Detailed Sleep Questionnaire Subjective Complaints

Epworth Sleepiness Score

Thornton Snoring Scale

Chief Complaint

Other Complaints

Sleep Quality

Number of times wake up each night

Morning Headaches

Witnesses Apneas

Bedtime Partner sleep in same room

30

31

32

I want to help youhelliphellip

Agree to treatment speech

bull Together wersquore going to do everything we can to treat your disease with a MRD We will evaluate

bull Top 5 CCrsquos

bull AHIRDI

bull LSAT

bull T below 90

bull Communicate with your physicians

bull Facilitate other treatment options if necessary

3 Goals of Dental Sleep

1 Wear Device

2 Subjective Improvement

3 Objective Success

34

38

39

Device Delivery

40

Titration Sleep Test

Treatment

Titration Sleep Test Protocol

Subjective Success

Wearing device through the

night

Confident it is helping them

Pain free

Subjective tests improving

41

Titration HST

GOOD One night one position

BETTER Two nights two positions

BEST Three nights three positions

42

43

44

bull PROTOCOL

bull Patient to take adjustment key(s) Bands Rods

bull Sleep tech to wake patient but patient adjusts device

bull INSTRUCTIONS TO TECH bull IF AHI ge 10 OR RDI ge 15 ADJUST

APPLIANCE 2 FULL TURNS

bull REPEAT AT 45 MIN INTERVALS UNTIL SUCCESSFUL CONSIDER TITRATING CPAP AFTER 4 TO 5 HOURS IF UNSUCCESSFUL

TITRATING AT SLEEP CENTER

45

TitratePromote Nasal Breathing

ElasticsChin StrapLip ClosureEnsure device doesnrsquot dislodgeNose ConesTape TAP Mouth ShieldManage allergies

EPAPPositional TherapyAdd low flow O2Combination TherapyMedical ReferralChange vertical or devices DNA ApplianceTimeDiscontinueAlternative Tx

What else can we do

46

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

bull Getting a sleep patient to sit down and talk with you

bull Getting a patient to accept treatment

bull Improving sleep and health of patient

bull Getting paid by patient

bull Getting paid by Insurance

bull Reducing AHI by half and getting below 10

bull Making at least one device per week

bull Getting a local MD to make just ONE referral

Success in Dental Sleep

Traditional Parameters

bull AHI RDI

bull Reduction by one half and to below 10 and relief of subjective symptoms

Defin

ing Su

ccess

OSA is a SYNDROME

bull Glucose intolerance

bull Insulin resistance

bull Hypertension

bull Weight gain

bull Depression

bull GERD

bull Impotenece

bull Tired

bull Sleepy

bull Snoring

bull Low Energy

bull Wake Unrefreshed

bull Memory problems

21

Whatrsquos your planCOOKING UP SUCCESS

22

2 Goals of Dental Sleep

1 Improve Symptoms (Subjective)

2 Decrease Health Risks (AHI)

23

Prior to ConsultationDiagnosis Obtained

bull Copy of BASELINE sleep study received and reviewed

Patient completes sleep questionnaire via DS3 Web Portal

bull Software or paper forms

Obtain patientrsquos medical insurance

bull Complete Verification of Benefits (VOB) ndash DS3 Instant Eligibility Check

Patients want to know What does it cost What does my insurance

cover

24

Review Baseline Sleep Testbull Verify study is a BaselineDiagnostic

test

bull Important information notedbull Date

bull If over 2 years consider having patient retested

bull Type of test (HSTPSG)

bull PlaceFacility

bull Diagnosis

bull AHIRDI

bull AHIRDI in Supine Position

bull 02 NadirLSAT

bull SPO2 lt 90

25

Epidemiological Data from the Wisconsin Sleep Cohort

bull Random selection of 1000 adult state employees

bull All received an overnight polysomnogram in 1992

bull 3 subsequent polysomnograms of this cohort

26

larr Normal gt95

larr Mild ~91

larr Moderate ~84

larr Severe ~57

Survival Rates

Young T Finn L Peppard PE Szklo-Coxe M Austin D Nieto FJ Stubbs R Hla KM Sleep disordered breathing and mortality eighteen-year follow-up of the wisconsin sleep cohort SLEEP 200831(8)1071-1078

Wisconsin

Sleep Cohort

All Cause

Mortality

27

Detailed Sleep Questionnaire

Obtain a thorough sleep and health history from the patient PRIOR

to consultation

28

Detailed Sleep Questionnaire

bull Subjective (Complaints amp Symptoms)

bull Previous Treatments

bull Health History

29

Detailed Sleep Questionnaire Subjective Complaints

Epworth Sleepiness Score

Thornton Snoring Scale

Chief Complaint

Other Complaints

Sleep Quality

Number of times wake up each night

Morning Headaches

Witnesses Apneas

Bedtime Partner sleep in same room

30

31

32

I want to help youhelliphellip

Agree to treatment speech

bull Together wersquore going to do everything we can to treat your disease with a MRD We will evaluate

bull Top 5 CCrsquos

bull AHIRDI

bull LSAT

bull T below 90

bull Communicate with your physicians

bull Facilitate other treatment options if necessary

3 Goals of Dental Sleep

1 Wear Device

2 Subjective Improvement

3 Objective Success

34

38

39

Device Delivery

40

Titration Sleep Test

Treatment

Titration Sleep Test Protocol

Subjective Success

Wearing device through the

night

Confident it is helping them

Pain free

Subjective tests improving

41

Titration HST

GOOD One night one position

BETTER Two nights two positions

BEST Three nights three positions

42

43

44

bull PROTOCOL

bull Patient to take adjustment key(s) Bands Rods

bull Sleep tech to wake patient but patient adjusts device

bull INSTRUCTIONS TO TECH bull IF AHI ge 10 OR RDI ge 15 ADJUST

APPLIANCE 2 FULL TURNS

bull REPEAT AT 45 MIN INTERVALS UNTIL SUCCESSFUL CONSIDER TITRATING CPAP AFTER 4 TO 5 HOURS IF UNSUCCESSFUL

TITRATING AT SLEEP CENTER

45

TitratePromote Nasal Breathing

ElasticsChin StrapLip ClosureEnsure device doesnrsquot dislodgeNose ConesTape TAP Mouth ShieldManage allergies

EPAPPositional TherapyAdd low flow O2Combination TherapyMedical ReferralChange vertical or devices DNA ApplianceTimeDiscontinueAlternative Tx

What else can we do

46

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

Traditional Parameters

bull AHI RDI

bull Reduction by one half and to below 10 and relief of subjective symptoms

Defin

ing Su

ccess

OSA is a SYNDROME

bull Glucose intolerance

bull Insulin resistance

bull Hypertension

bull Weight gain

bull Depression

bull GERD

bull Impotenece

bull Tired

bull Sleepy

bull Snoring

bull Low Energy

bull Wake Unrefreshed

bull Memory problems

21

Whatrsquos your planCOOKING UP SUCCESS

22

2 Goals of Dental Sleep

1 Improve Symptoms (Subjective)

2 Decrease Health Risks (AHI)

23

Prior to ConsultationDiagnosis Obtained

bull Copy of BASELINE sleep study received and reviewed

Patient completes sleep questionnaire via DS3 Web Portal

bull Software or paper forms

Obtain patientrsquos medical insurance

bull Complete Verification of Benefits (VOB) ndash DS3 Instant Eligibility Check

Patients want to know What does it cost What does my insurance

cover

24

Review Baseline Sleep Testbull Verify study is a BaselineDiagnostic

test

bull Important information notedbull Date

bull If over 2 years consider having patient retested

bull Type of test (HSTPSG)

bull PlaceFacility

bull Diagnosis

bull AHIRDI

bull AHIRDI in Supine Position

bull 02 NadirLSAT

bull SPO2 lt 90

25

Epidemiological Data from the Wisconsin Sleep Cohort

bull Random selection of 1000 adult state employees

bull All received an overnight polysomnogram in 1992

bull 3 subsequent polysomnograms of this cohort

26

larr Normal gt95

larr Mild ~91

larr Moderate ~84

larr Severe ~57

Survival Rates

Young T Finn L Peppard PE Szklo-Coxe M Austin D Nieto FJ Stubbs R Hla KM Sleep disordered breathing and mortality eighteen-year follow-up of the wisconsin sleep cohort SLEEP 200831(8)1071-1078

Wisconsin

Sleep Cohort

All Cause

Mortality

27

Detailed Sleep Questionnaire

Obtain a thorough sleep and health history from the patient PRIOR

to consultation

28

Detailed Sleep Questionnaire

bull Subjective (Complaints amp Symptoms)

bull Previous Treatments

bull Health History

29

Detailed Sleep Questionnaire Subjective Complaints

Epworth Sleepiness Score

Thornton Snoring Scale

Chief Complaint

Other Complaints

Sleep Quality

Number of times wake up each night

Morning Headaches

Witnesses Apneas

Bedtime Partner sleep in same room

30

31

32

I want to help youhelliphellip

Agree to treatment speech

bull Together wersquore going to do everything we can to treat your disease with a MRD We will evaluate

bull Top 5 CCrsquos

bull AHIRDI

bull LSAT

bull T below 90

bull Communicate with your physicians

bull Facilitate other treatment options if necessary

3 Goals of Dental Sleep

1 Wear Device

2 Subjective Improvement

3 Objective Success

34

38

39

Device Delivery

40

Titration Sleep Test

Treatment

Titration Sleep Test Protocol

Subjective Success

Wearing device through the

night

Confident it is helping them

Pain free

Subjective tests improving

41

Titration HST

GOOD One night one position

BETTER Two nights two positions

BEST Three nights three positions

42

43

44

bull PROTOCOL

bull Patient to take adjustment key(s) Bands Rods

bull Sleep tech to wake patient but patient adjusts device

bull INSTRUCTIONS TO TECH bull IF AHI ge 10 OR RDI ge 15 ADJUST

APPLIANCE 2 FULL TURNS

bull REPEAT AT 45 MIN INTERVALS UNTIL SUCCESSFUL CONSIDER TITRATING CPAP AFTER 4 TO 5 HOURS IF UNSUCCESSFUL

TITRATING AT SLEEP CENTER

45

TitratePromote Nasal Breathing

ElasticsChin StrapLip ClosureEnsure device doesnrsquot dislodgeNose ConesTape TAP Mouth ShieldManage allergies

EPAPPositional TherapyAdd low flow O2Combination TherapyMedical ReferralChange vertical or devices DNA ApplianceTimeDiscontinueAlternative Tx

What else can we do

46

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

OSA is a SYNDROME

bull Glucose intolerance

bull Insulin resistance

bull Hypertension

bull Weight gain

bull Depression

bull GERD

bull Impotenece

bull Tired

bull Sleepy

bull Snoring

bull Low Energy

bull Wake Unrefreshed

bull Memory problems

21

Whatrsquos your planCOOKING UP SUCCESS

22

2 Goals of Dental Sleep

1 Improve Symptoms (Subjective)

2 Decrease Health Risks (AHI)

23

Prior to ConsultationDiagnosis Obtained

bull Copy of BASELINE sleep study received and reviewed

Patient completes sleep questionnaire via DS3 Web Portal

bull Software or paper forms

Obtain patientrsquos medical insurance

bull Complete Verification of Benefits (VOB) ndash DS3 Instant Eligibility Check

Patients want to know What does it cost What does my insurance

cover

24

Review Baseline Sleep Testbull Verify study is a BaselineDiagnostic

test

bull Important information notedbull Date

bull If over 2 years consider having patient retested

bull Type of test (HSTPSG)

bull PlaceFacility

bull Diagnosis

bull AHIRDI

bull AHIRDI in Supine Position

bull 02 NadirLSAT

bull SPO2 lt 90

25

Epidemiological Data from the Wisconsin Sleep Cohort

bull Random selection of 1000 adult state employees

bull All received an overnight polysomnogram in 1992

bull 3 subsequent polysomnograms of this cohort

26

larr Normal gt95

larr Mild ~91

larr Moderate ~84

larr Severe ~57

Survival Rates

Young T Finn L Peppard PE Szklo-Coxe M Austin D Nieto FJ Stubbs R Hla KM Sleep disordered breathing and mortality eighteen-year follow-up of the wisconsin sleep cohort SLEEP 200831(8)1071-1078

Wisconsin

Sleep Cohort

All Cause

Mortality

27

Detailed Sleep Questionnaire

Obtain a thorough sleep and health history from the patient PRIOR

to consultation

28

Detailed Sleep Questionnaire

bull Subjective (Complaints amp Symptoms)

bull Previous Treatments

bull Health History

29

Detailed Sleep Questionnaire Subjective Complaints

Epworth Sleepiness Score

Thornton Snoring Scale

Chief Complaint

Other Complaints

Sleep Quality

Number of times wake up each night

Morning Headaches

Witnesses Apneas

Bedtime Partner sleep in same room

30

31

32

I want to help youhelliphellip

Agree to treatment speech

bull Together wersquore going to do everything we can to treat your disease with a MRD We will evaluate

bull Top 5 CCrsquos

bull AHIRDI

bull LSAT

bull T below 90

bull Communicate with your physicians

bull Facilitate other treatment options if necessary

3 Goals of Dental Sleep

1 Wear Device

2 Subjective Improvement

3 Objective Success

34

38

39

Device Delivery

40

Titration Sleep Test

Treatment

Titration Sleep Test Protocol

Subjective Success

Wearing device through the

night

Confident it is helping them

Pain free

Subjective tests improving

41

Titration HST

GOOD One night one position

BETTER Two nights two positions

BEST Three nights three positions

42

43

44

bull PROTOCOL

bull Patient to take adjustment key(s) Bands Rods

bull Sleep tech to wake patient but patient adjusts device

bull INSTRUCTIONS TO TECH bull IF AHI ge 10 OR RDI ge 15 ADJUST

APPLIANCE 2 FULL TURNS

bull REPEAT AT 45 MIN INTERVALS UNTIL SUCCESSFUL CONSIDER TITRATING CPAP AFTER 4 TO 5 HOURS IF UNSUCCESSFUL

TITRATING AT SLEEP CENTER

45

TitratePromote Nasal Breathing

ElasticsChin StrapLip ClosureEnsure device doesnrsquot dislodgeNose ConesTape TAP Mouth ShieldManage allergies

EPAPPositional TherapyAdd low flow O2Combination TherapyMedical ReferralChange vertical or devices DNA ApplianceTimeDiscontinueAlternative Tx

What else can we do

46

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

21

Whatrsquos your planCOOKING UP SUCCESS

22

2 Goals of Dental Sleep

1 Improve Symptoms (Subjective)

2 Decrease Health Risks (AHI)

23

Prior to ConsultationDiagnosis Obtained

bull Copy of BASELINE sleep study received and reviewed

Patient completes sleep questionnaire via DS3 Web Portal

bull Software or paper forms

Obtain patientrsquos medical insurance

bull Complete Verification of Benefits (VOB) ndash DS3 Instant Eligibility Check

Patients want to know What does it cost What does my insurance

cover

24

Review Baseline Sleep Testbull Verify study is a BaselineDiagnostic

test

bull Important information notedbull Date

bull If over 2 years consider having patient retested

bull Type of test (HSTPSG)

bull PlaceFacility

bull Diagnosis

bull AHIRDI

bull AHIRDI in Supine Position

bull 02 NadirLSAT

bull SPO2 lt 90

25

Epidemiological Data from the Wisconsin Sleep Cohort

bull Random selection of 1000 adult state employees

bull All received an overnight polysomnogram in 1992

bull 3 subsequent polysomnograms of this cohort

26

larr Normal gt95

larr Mild ~91

larr Moderate ~84

larr Severe ~57

Survival Rates

Young T Finn L Peppard PE Szklo-Coxe M Austin D Nieto FJ Stubbs R Hla KM Sleep disordered breathing and mortality eighteen-year follow-up of the wisconsin sleep cohort SLEEP 200831(8)1071-1078

Wisconsin

Sleep Cohort

All Cause

Mortality

27

Detailed Sleep Questionnaire

Obtain a thorough sleep and health history from the patient PRIOR

to consultation

28

Detailed Sleep Questionnaire

bull Subjective (Complaints amp Symptoms)

bull Previous Treatments

bull Health History

29

Detailed Sleep Questionnaire Subjective Complaints

Epworth Sleepiness Score

Thornton Snoring Scale

Chief Complaint

Other Complaints

Sleep Quality

Number of times wake up each night

Morning Headaches

Witnesses Apneas

Bedtime Partner sleep in same room

30

31

32

I want to help youhelliphellip

Agree to treatment speech

bull Together wersquore going to do everything we can to treat your disease with a MRD We will evaluate

bull Top 5 CCrsquos

bull AHIRDI

bull LSAT

bull T below 90

bull Communicate with your physicians

bull Facilitate other treatment options if necessary

3 Goals of Dental Sleep

1 Wear Device

2 Subjective Improvement

3 Objective Success

34

38

39

Device Delivery

40

Titration Sleep Test

Treatment

Titration Sleep Test Protocol

Subjective Success

Wearing device through the

night

Confident it is helping them

Pain free

Subjective tests improving

41

Titration HST

GOOD One night one position

BETTER Two nights two positions

BEST Three nights three positions

42

43

44

bull PROTOCOL

bull Patient to take adjustment key(s) Bands Rods

bull Sleep tech to wake patient but patient adjusts device

bull INSTRUCTIONS TO TECH bull IF AHI ge 10 OR RDI ge 15 ADJUST

APPLIANCE 2 FULL TURNS

bull REPEAT AT 45 MIN INTERVALS UNTIL SUCCESSFUL CONSIDER TITRATING CPAP AFTER 4 TO 5 HOURS IF UNSUCCESSFUL

TITRATING AT SLEEP CENTER

45

TitratePromote Nasal Breathing

ElasticsChin StrapLip ClosureEnsure device doesnrsquot dislodgeNose ConesTape TAP Mouth ShieldManage allergies

EPAPPositional TherapyAdd low flow O2Combination TherapyMedical ReferralChange vertical or devices DNA ApplianceTimeDiscontinueAlternative Tx

What else can we do

46

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

Whatrsquos your planCOOKING UP SUCCESS

22

2 Goals of Dental Sleep

1 Improve Symptoms (Subjective)

2 Decrease Health Risks (AHI)

23

Prior to ConsultationDiagnosis Obtained

bull Copy of BASELINE sleep study received and reviewed

Patient completes sleep questionnaire via DS3 Web Portal

bull Software or paper forms

Obtain patientrsquos medical insurance

bull Complete Verification of Benefits (VOB) ndash DS3 Instant Eligibility Check

Patients want to know What does it cost What does my insurance

cover

24

Review Baseline Sleep Testbull Verify study is a BaselineDiagnostic

test

bull Important information notedbull Date

bull If over 2 years consider having patient retested

bull Type of test (HSTPSG)

bull PlaceFacility

bull Diagnosis

bull AHIRDI

bull AHIRDI in Supine Position

bull 02 NadirLSAT

bull SPO2 lt 90

25

Epidemiological Data from the Wisconsin Sleep Cohort

bull Random selection of 1000 adult state employees

bull All received an overnight polysomnogram in 1992

bull 3 subsequent polysomnograms of this cohort

26

larr Normal gt95

larr Mild ~91

larr Moderate ~84

larr Severe ~57

Survival Rates

Young T Finn L Peppard PE Szklo-Coxe M Austin D Nieto FJ Stubbs R Hla KM Sleep disordered breathing and mortality eighteen-year follow-up of the wisconsin sleep cohort SLEEP 200831(8)1071-1078

Wisconsin

Sleep Cohort

All Cause

Mortality

27

Detailed Sleep Questionnaire

Obtain a thorough sleep and health history from the patient PRIOR

to consultation

28

Detailed Sleep Questionnaire

bull Subjective (Complaints amp Symptoms)

bull Previous Treatments

bull Health History

29

Detailed Sleep Questionnaire Subjective Complaints

Epworth Sleepiness Score

Thornton Snoring Scale

Chief Complaint

Other Complaints

Sleep Quality

Number of times wake up each night

Morning Headaches

Witnesses Apneas

Bedtime Partner sleep in same room

30

31

32

I want to help youhelliphellip

Agree to treatment speech

bull Together wersquore going to do everything we can to treat your disease with a MRD We will evaluate

bull Top 5 CCrsquos

bull AHIRDI

bull LSAT

bull T below 90

bull Communicate with your physicians

bull Facilitate other treatment options if necessary

3 Goals of Dental Sleep

1 Wear Device

2 Subjective Improvement

3 Objective Success

34

38

39

Device Delivery

40

Titration Sleep Test

Treatment

Titration Sleep Test Protocol

Subjective Success

Wearing device through the

night

Confident it is helping them

Pain free

Subjective tests improving

41

Titration HST

GOOD One night one position

BETTER Two nights two positions

BEST Three nights three positions

42

43

44

bull PROTOCOL

bull Patient to take adjustment key(s) Bands Rods

bull Sleep tech to wake patient but patient adjusts device

bull INSTRUCTIONS TO TECH bull IF AHI ge 10 OR RDI ge 15 ADJUST

APPLIANCE 2 FULL TURNS

bull REPEAT AT 45 MIN INTERVALS UNTIL SUCCESSFUL CONSIDER TITRATING CPAP AFTER 4 TO 5 HOURS IF UNSUCCESSFUL

TITRATING AT SLEEP CENTER

45

TitratePromote Nasal Breathing

ElasticsChin StrapLip ClosureEnsure device doesnrsquot dislodgeNose ConesTape TAP Mouth ShieldManage allergies

EPAPPositional TherapyAdd low flow O2Combination TherapyMedical ReferralChange vertical or devices DNA ApplianceTimeDiscontinueAlternative Tx

What else can we do

46

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

2 Goals of Dental Sleep

1 Improve Symptoms (Subjective)

2 Decrease Health Risks (AHI)

23

Prior to ConsultationDiagnosis Obtained

bull Copy of BASELINE sleep study received and reviewed

Patient completes sleep questionnaire via DS3 Web Portal

bull Software or paper forms

Obtain patientrsquos medical insurance

bull Complete Verification of Benefits (VOB) ndash DS3 Instant Eligibility Check

Patients want to know What does it cost What does my insurance

cover

24

Review Baseline Sleep Testbull Verify study is a BaselineDiagnostic

test

bull Important information notedbull Date

bull If over 2 years consider having patient retested

bull Type of test (HSTPSG)

bull PlaceFacility

bull Diagnosis

bull AHIRDI

bull AHIRDI in Supine Position

bull 02 NadirLSAT

bull SPO2 lt 90

25

Epidemiological Data from the Wisconsin Sleep Cohort

bull Random selection of 1000 adult state employees

bull All received an overnight polysomnogram in 1992

bull 3 subsequent polysomnograms of this cohort

26

larr Normal gt95

larr Mild ~91

larr Moderate ~84

larr Severe ~57

Survival Rates

Young T Finn L Peppard PE Szklo-Coxe M Austin D Nieto FJ Stubbs R Hla KM Sleep disordered breathing and mortality eighteen-year follow-up of the wisconsin sleep cohort SLEEP 200831(8)1071-1078

Wisconsin

Sleep Cohort

All Cause

Mortality

27

Detailed Sleep Questionnaire

Obtain a thorough sleep and health history from the patient PRIOR

to consultation

28

Detailed Sleep Questionnaire

bull Subjective (Complaints amp Symptoms)

bull Previous Treatments

bull Health History

29

Detailed Sleep Questionnaire Subjective Complaints

Epworth Sleepiness Score

Thornton Snoring Scale

Chief Complaint

Other Complaints

Sleep Quality

Number of times wake up each night

Morning Headaches

Witnesses Apneas

Bedtime Partner sleep in same room

30

31

32

I want to help youhelliphellip

Agree to treatment speech

bull Together wersquore going to do everything we can to treat your disease with a MRD We will evaluate

bull Top 5 CCrsquos

bull AHIRDI

bull LSAT

bull T below 90

bull Communicate with your physicians

bull Facilitate other treatment options if necessary

3 Goals of Dental Sleep

1 Wear Device

2 Subjective Improvement

3 Objective Success

34

38

39

Device Delivery

40

Titration Sleep Test

Treatment

Titration Sleep Test Protocol

Subjective Success

Wearing device through the

night

Confident it is helping them

Pain free

Subjective tests improving

41

Titration HST

GOOD One night one position

BETTER Two nights two positions

BEST Three nights three positions

42

43

44

bull PROTOCOL

bull Patient to take adjustment key(s) Bands Rods

bull Sleep tech to wake patient but patient adjusts device

bull INSTRUCTIONS TO TECH bull IF AHI ge 10 OR RDI ge 15 ADJUST

APPLIANCE 2 FULL TURNS

bull REPEAT AT 45 MIN INTERVALS UNTIL SUCCESSFUL CONSIDER TITRATING CPAP AFTER 4 TO 5 HOURS IF UNSUCCESSFUL

TITRATING AT SLEEP CENTER

45

TitratePromote Nasal Breathing

ElasticsChin StrapLip ClosureEnsure device doesnrsquot dislodgeNose ConesTape TAP Mouth ShieldManage allergies

EPAPPositional TherapyAdd low flow O2Combination TherapyMedical ReferralChange vertical or devices DNA ApplianceTimeDiscontinueAlternative Tx

What else can we do

46

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

Prior to ConsultationDiagnosis Obtained

bull Copy of BASELINE sleep study received and reviewed

Patient completes sleep questionnaire via DS3 Web Portal

bull Software or paper forms

Obtain patientrsquos medical insurance

bull Complete Verification of Benefits (VOB) ndash DS3 Instant Eligibility Check

Patients want to know What does it cost What does my insurance

cover

24

Review Baseline Sleep Testbull Verify study is a BaselineDiagnostic

test

bull Important information notedbull Date

bull If over 2 years consider having patient retested

bull Type of test (HSTPSG)

bull PlaceFacility

bull Diagnosis

bull AHIRDI

bull AHIRDI in Supine Position

bull 02 NadirLSAT

bull SPO2 lt 90

25

Epidemiological Data from the Wisconsin Sleep Cohort

bull Random selection of 1000 adult state employees

bull All received an overnight polysomnogram in 1992

bull 3 subsequent polysomnograms of this cohort

26

larr Normal gt95

larr Mild ~91

larr Moderate ~84

larr Severe ~57

Survival Rates

Young T Finn L Peppard PE Szklo-Coxe M Austin D Nieto FJ Stubbs R Hla KM Sleep disordered breathing and mortality eighteen-year follow-up of the wisconsin sleep cohort SLEEP 200831(8)1071-1078

Wisconsin

Sleep Cohort

All Cause

Mortality

27

Detailed Sleep Questionnaire

Obtain a thorough sleep and health history from the patient PRIOR

to consultation

28

Detailed Sleep Questionnaire

bull Subjective (Complaints amp Symptoms)

bull Previous Treatments

bull Health History

29

Detailed Sleep Questionnaire Subjective Complaints

Epworth Sleepiness Score

Thornton Snoring Scale

Chief Complaint

Other Complaints

Sleep Quality

Number of times wake up each night

Morning Headaches

Witnesses Apneas

Bedtime Partner sleep in same room

30

31

32

I want to help youhelliphellip

Agree to treatment speech

bull Together wersquore going to do everything we can to treat your disease with a MRD We will evaluate

bull Top 5 CCrsquos

bull AHIRDI

bull LSAT

bull T below 90

bull Communicate with your physicians

bull Facilitate other treatment options if necessary

3 Goals of Dental Sleep

1 Wear Device

2 Subjective Improvement

3 Objective Success

34

38

39

Device Delivery

40

Titration Sleep Test

Treatment

Titration Sleep Test Protocol

Subjective Success

Wearing device through the

night

Confident it is helping them

Pain free

Subjective tests improving

41

Titration HST

GOOD One night one position

BETTER Two nights two positions

BEST Three nights three positions

42

43

44

bull PROTOCOL

bull Patient to take adjustment key(s) Bands Rods

bull Sleep tech to wake patient but patient adjusts device

bull INSTRUCTIONS TO TECH bull IF AHI ge 10 OR RDI ge 15 ADJUST

APPLIANCE 2 FULL TURNS

bull REPEAT AT 45 MIN INTERVALS UNTIL SUCCESSFUL CONSIDER TITRATING CPAP AFTER 4 TO 5 HOURS IF UNSUCCESSFUL

TITRATING AT SLEEP CENTER

45

TitratePromote Nasal Breathing

ElasticsChin StrapLip ClosureEnsure device doesnrsquot dislodgeNose ConesTape TAP Mouth ShieldManage allergies

EPAPPositional TherapyAdd low flow O2Combination TherapyMedical ReferralChange vertical or devices DNA ApplianceTimeDiscontinueAlternative Tx

What else can we do

46

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

Review Baseline Sleep Testbull Verify study is a BaselineDiagnostic

test

bull Important information notedbull Date

bull If over 2 years consider having patient retested

bull Type of test (HSTPSG)

bull PlaceFacility

bull Diagnosis

bull AHIRDI

bull AHIRDI in Supine Position

bull 02 NadirLSAT

bull SPO2 lt 90

25

Epidemiological Data from the Wisconsin Sleep Cohort

bull Random selection of 1000 adult state employees

bull All received an overnight polysomnogram in 1992

bull 3 subsequent polysomnograms of this cohort

26

larr Normal gt95

larr Mild ~91

larr Moderate ~84

larr Severe ~57

Survival Rates

Young T Finn L Peppard PE Szklo-Coxe M Austin D Nieto FJ Stubbs R Hla KM Sleep disordered breathing and mortality eighteen-year follow-up of the wisconsin sleep cohort SLEEP 200831(8)1071-1078

Wisconsin

Sleep Cohort

All Cause

Mortality

27

Detailed Sleep Questionnaire

Obtain a thorough sleep and health history from the patient PRIOR

to consultation

28

Detailed Sleep Questionnaire

bull Subjective (Complaints amp Symptoms)

bull Previous Treatments

bull Health History

29

Detailed Sleep Questionnaire Subjective Complaints

Epworth Sleepiness Score

Thornton Snoring Scale

Chief Complaint

Other Complaints

Sleep Quality

Number of times wake up each night

Morning Headaches

Witnesses Apneas

Bedtime Partner sleep in same room

30

31

32

I want to help youhelliphellip

Agree to treatment speech

bull Together wersquore going to do everything we can to treat your disease with a MRD We will evaluate

bull Top 5 CCrsquos

bull AHIRDI

bull LSAT

bull T below 90

bull Communicate with your physicians

bull Facilitate other treatment options if necessary

3 Goals of Dental Sleep

1 Wear Device

2 Subjective Improvement

3 Objective Success

34

38

39

Device Delivery

40

Titration Sleep Test

Treatment

Titration Sleep Test Protocol

Subjective Success

Wearing device through the

night

Confident it is helping them

Pain free

Subjective tests improving

41

Titration HST

GOOD One night one position

BETTER Two nights two positions

BEST Three nights three positions

42

43

44

bull PROTOCOL

bull Patient to take adjustment key(s) Bands Rods

bull Sleep tech to wake patient but patient adjusts device

bull INSTRUCTIONS TO TECH bull IF AHI ge 10 OR RDI ge 15 ADJUST

APPLIANCE 2 FULL TURNS

bull REPEAT AT 45 MIN INTERVALS UNTIL SUCCESSFUL CONSIDER TITRATING CPAP AFTER 4 TO 5 HOURS IF UNSUCCESSFUL

TITRATING AT SLEEP CENTER

45

TitratePromote Nasal Breathing

ElasticsChin StrapLip ClosureEnsure device doesnrsquot dislodgeNose ConesTape TAP Mouth ShieldManage allergies

EPAPPositional TherapyAdd low flow O2Combination TherapyMedical ReferralChange vertical or devices DNA ApplianceTimeDiscontinueAlternative Tx

What else can we do

46

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

Epidemiological Data from the Wisconsin Sleep Cohort

bull Random selection of 1000 adult state employees

bull All received an overnight polysomnogram in 1992

bull 3 subsequent polysomnograms of this cohort

26

larr Normal gt95

larr Mild ~91

larr Moderate ~84

larr Severe ~57

Survival Rates

Young T Finn L Peppard PE Szklo-Coxe M Austin D Nieto FJ Stubbs R Hla KM Sleep disordered breathing and mortality eighteen-year follow-up of the wisconsin sleep cohort SLEEP 200831(8)1071-1078

Wisconsin

Sleep Cohort

All Cause

Mortality

27

Detailed Sleep Questionnaire

Obtain a thorough sleep and health history from the patient PRIOR

to consultation

28

Detailed Sleep Questionnaire

bull Subjective (Complaints amp Symptoms)

bull Previous Treatments

bull Health History

29

Detailed Sleep Questionnaire Subjective Complaints

Epworth Sleepiness Score

Thornton Snoring Scale

Chief Complaint

Other Complaints

Sleep Quality

Number of times wake up each night

Morning Headaches

Witnesses Apneas

Bedtime Partner sleep in same room

30

31

32

I want to help youhelliphellip

Agree to treatment speech

bull Together wersquore going to do everything we can to treat your disease with a MRD We will evaluate

bull Top 5 CCrsquos

bull AHIRDI

bull LSAT

bull T below 90

bull Communicate with your physicians

bull Facilitate other treatment options if necessary

3 Goals of Dental Sleep

1 Wear Device

2 Subjective Improvement

3 Objective Success

34

38

39

Device Delivery

40

Titration Sleep Test

Treatment

Titration Sleep Test Protocol

Subjective Success

Wearing device through the

night

Confident it is helping them

Pain free

Subjective tests improving

41

Titration HST

GOOD One night one position

BETTER Two nights two positions

BEST Three nights three positions

42

43

44

bull PROTOCOL

bull Patient to take adjustment key(s) Bands Rods

bull Sleep tech to wake patient but patient adjusts device

bull INSTRUCTIONS TO TECH bull IF AHI ge 10 OR RDI ge 15 ADJUST

APPLIANCE 2 FULL TURNS

bull REPEAT AT 45 MIN INTERVALS UNTIL SUCCESSFUL CONSIDER TITRATING CPAP AFTER 4 TO 5 HOURS IF UNSUCCESSFUL

TITRATING AT SLEEP CENTER

45

TitratePromote Nasal Breathing

ElasticsChin StrapLip ClosureEnsure device doesnrsquot dislodgeNose ConesTape TAP Mouth ShieldManage allergies

EPAPPositional TherapyAdd low flow O2Combination TherapyMedical ReferralChange vertical or devices DNA ApplianceTimeDiscontinueAlternative Tx

What else can we do

46

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

larr Normal gt95

larr Mild ~91

larr Moderate ~84

larr Severe ~57

Survival Rates

Young T Finn L Peppard PE Szklo-Coxe M Austin D Nieto FJ Stubbs R Hla KM Sleep disordered breathing and mortality eighteen-year follow-up of the wisconsin sleep cohort SLEEP 200831(8)1071-1078

Wisconsin

Sleep Cohort

All Cause

Mortality

27

Detailed Sleep Questionnaire

Obtain a thorough sleep and health history from the patient PRIOR

to consultation

28

Detailed Sleep Questionnaire

bull Subjective (Complaints amp Symptoms)

bull Previous Treatments

bull Health History

29

Detailed Sleep Questionnaire Subjective Complaints

Epworth Sleepiness Score

Thornton Snoring Scale

Chief Complaint

Other Complaints

Sleep Quality

Number of times wake up each night

Morning Headaches

Witnesses Apneas

Bedtime Partner sleep in same room

30

31

32

I want to help youhelliphellip

Agree to treatment speech

bull Together wersquore going to do everything we can to treat your disease with a MRD We will evaluate

bull Top 5 CCrsquos

bull AHIRDI

bull LSAT

bull T below 90

bull Communicate with your physicians

bull Facilitate other treatment options if necessary

3 Goals of Dental Sleep

1 Wear Device

2 Subjective Improvement

3 Objective Success

34

38

39

Device Delivery

40

Titration Sleep Test

Treatment

Titration Sleep Test Protocol

Subjective Success

Wearing device through the

night

Confident it is helping them

Pain free

Subjective tests improving

41

Titration HST

GOOD One night one position

BETTER Two nights two positions

BEST Three nights three positions

42

43

44

bull PROTOCOL

bull Patient to take adjustment key(s) Bands Rods

bull Sleep tech to wake patient but patient adjusts device

bull INSTRUCTIONS TO TECH bull IF AHI ge 10 OR RDI ge 15 ADJUST

APPLIANCE 2 FULL TURNS

bull REPEAT AT 45 MIN INTERVALS UNTIL SUCCESSFUL CONSIDER TITRATING CPAP AFTER 4 TO 5 HOURS IF UNSUCCESSFUL

TITRATING AT SLEEP CENTER

45

TitratePromote Nasal Breathing

ElasticsChin StrapLip ClosureEnsure device doesnrsquot dislodgeNose ConesTape TAP Mouth ShieldManage allergies

EPAPPositional TherapyAdd low flow O2Combination TherapyMedical ReferralChange vertical or devices DNA ApplianceTimeDiscontinueAlternative Tx

What else can we do

46

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

Detailed Sleep Questionnaire

Obtain a thorough sleep and health history from the patient PRIOR

to consultation

28

Detailed Sleep Questionnaire

bull Subjective (Complaints amp Symptoms)

bull Previous Treatments

bull Health History

29

Detailed Sleep Questionnaire Subjective Complaints

Epworth Sleepiness Score

Thornton Snoring Scale

Chief Complaint

Other Complaints

Sleep Quality

Number of times wake up each night

Morning Headaches

Witnesses Apneas

Bedtime Partner sleep in same room

30

31

32

I want to help youhelliphellip

Agree to treatment speech

bull Together wersquore going to do everything we can to treat your disease with a MRD We will evaluate

bull Top 5 CCrsquos

bull AHIRDI

bull LSAT

bull T below 90

bull Communicate with your physicians

bull Facilitate other treatment options if necessary

3 Goals of Dental Sleep

1 Wear Device

2 Subjective Improvement

3 Objective Success

34

38

39

Device Delivery

40

Titration Sleep Test

Treatment

Titration Sleep Test Protocol

Subjective Success

Wearing device through the

night

Confident it is helping them

Pain free

Subjective tests improving

41

Titration HST

GOOD One night one position

BETTER Two nights two positions

BEST Three nights three positions

42

43

44

bull PROTOCOL

bull Patient to take adjustment key(s) Bands Rods

bull Sleep tech to wake patient but patient adjusts device

bull INSTRUCTIONS TO TECH bull IF AHI ge 10 OR RDI ge 15 ADJUST

APPLIANCE 2 FULL TURNS

bull REPEAT AT 45 MIN INTERVALS UNTIL SUCCESSFUL CONSIDER TITRATING CPAP AFTER 4 TO 5 HOURS IF UNSUCCESSFUL

TITRATING AT SLEEP CENTER

45

TitratePromote Nasal Breathing

ElasticsChin StrapLip ClosureEnsure device doesnrsquot dislodgeNose ConesTape TAP Mouth ShieldManage allergies

EPAPPositional TherapyAdd low flow O2Combination TherapyMedical ReferralChange vertical or devices DNA ApplianceTimeDiscontinueAlternative Tx

What else can we do

46

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

Detailed Sleep Questionnaire

bull Subjective (Complaints amp Symptoms)

bull Previous Treatments

bull Health History

29

Detailed Sleep Questionnaire Subjective Complaints

Epworth Sleepiness Score

Thornton Snoring Scale

Chief Complaint

Other Complaints

Sleep Quality

Number of times wake up each night

Morning Headaches

Witnesses Apneas

Bedtime Partner sleep in same room

30

31

32

I want to help youhelliphellip

Agree to treatment speech

bull Together wersquore going to do everything we can to treat your disease with a MRD We will evaluate

bull Top 5 CCrsquos

bull AHIRDI

bull LSAT

bull T below 90

bull Communicate with your physicians

bull Facilitate other treatment options if necessary

3 Goals of Dental Sleep

1 Wear Device

2 Subjective Improvement

3 Objective Success

34

38

39

Device Delivery

40

Titration Sleep Test

Treatment

Titration Sleep Test Protocol

Subjective Success

Wearing device through the

night

Confident it is helping them

Pain free

Subjective tests improving

41

Titration HST

GOOD One night one position

BETTER Two nights two positions

BEST Three nights three positions

42

43

44

bull PROTOCOL

bull Patient to take adjustment key(s) Bands Rods

bull Sleep tech to wake patient but patient adjusts device

bull INSTRUCTIONS TO TECH bull IF AHI ge 10 OR RDI ge 15 ADJUST

APPLIANCE 2 FULL TURNS

bull REPEAT AT 45 MIN INTERVALS UNTIL SUCCESSFUL CONSIDER TITRATING CPAP AFTER 4 TO 5 HOURS IF UNSUCCESSFUL

TITRATING AT SLEEP CENTER

45

TitratePromote Nasal Breathing

ElasticsChin StrapLip ClosureEnsure device doesnrsquot dislodgeNose ConesTape TAP Mouth ShieldManage allergies

EPAPPositional TherapyAdd low flow O2Combination TherapyMedical ReferralChange vertical or devices DNA ApplianceTimeDiscontinueAlternative Tx

What else can we do

46

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

Detailed Sleep Questionnaire Subjective Complaints

Epworth Sleepiness Score

Thornton Snoring Scale

Chief Complaint

Other Complaints

Sleep Quality

Number of times wake up each night

Morning Headaches

Witnesses Apneas

Bedtime Partner sleep in same room

30

31

32

I want to help youhelliphellip

Agree to treatment speech

bull Together wersquore going to do everything we can to treat your disease with a MRD We will evaluate

bull Top 5 CCrsquos

bull AHIRDI

bull LSAT

bull T below 90

bull Communicate with your physicians

bull Facilitate other treatment options if necessary

3 Goals of Dental Sleep

1 Wear Device

2 Subjective Improvement

3 Objective Success

34

38

39

Device Delivery

40

Titration Sleep Test

Treatment

Titration Sleep Test Protocol

Subjective Success

Wearing device through the

night

Confident it is helping them

Pain free

Subjective tests improving

41

Titration HST

GOOD One night one position

BETTER Two nights two positions

BEST Three nights three positions

42

43

44

bull PROTOCOL

bull Patient to take adjustment key(s) Bands Rods

bull Sleep tech to wake patient but patient adjusts device

bull INSTRUCTIONS TO TECH bull IF AHI ge 10 OR RDI ge 15 ADJUST

APPLIANCE 2 FULL TURNS

bull REPEAT AT 45 MIN INTERVALS UNTIL SUCCESSFUL CONSIDER TITRATING CPAP AFTER 4 TO 5 HOURS IF UNSUCCESSFUL

TITRATING AT SLEEP CENTER

45

TitratePromote Nasal Breathing

ElasticsChin StrapLip ClosureEnsure device doesnrsquot dislodgeNose ConesTape TAP Mouth ShieldManage allergies

EPAPPositional TherapyAdd low flow O2Combination TherapyMedical ReferralChange vertical or devices DNA ApplianceTimeDiscontinueAlternative Tx

What else can we do

46

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

31

32

I want to help youhelliphellip

Agree to treatment speech

bull Together wersquore going to do everything we can to treat your disease with a MRD We will evaluate

bull Top 5 CCrsquos

bull AHIRDI

bull LSAT

bull T below 90

bull Communicate with your physicians

bull Facilitate other treatment options if necessary

3 Goals of Dental Sleep

1 Wear Device

2 Subjective Improvement

3 Objective Success

34

38

39

Device Delivery

40

Titration Sleep Test

Treatment

Titration Sleep Test Protocol

Subjective Success

Wearing device through the

night

Confident it is helping them

Pain free

Subjective tests improving

41

Titration HST

GOOD One night one position

BETTER Two nights two positions

BEST Three nights three positions

42

43

44

bull PROTOCOL

bull Patient to take adjustment key(s) Bands Rods

bull Sleep tech to wake patient but patient adjusts device

bull INSTRUCTIONS TO TECH bull IF AHI ge 10 OR RDI ge 15 ADJUST

APPLIANCE 2 FULL TURNS

bull REPEAT AT 45 MIN INTERVALS UNTIL SUCCESSFUL CONSIDER TITRATING CPAP AFTER 4 TO 5 HOURS IF UNSUCCESSFUL

TITRATING AT SLEEP CENTER

45

TitratePromote Nasal Breathing

ElasticsChin StrapLip ClosureEnsure device doesnrsquot dislodgeNose ConesTape TAP Mouth ShieldManage allergies

EPAPPositional TherapyAdd low flow O2Combination TherapyMedical ReferralChange vertical or devices DNA ApplianceTimeDiscontinueAlternative Tx

What else can we do

46

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

32

I want to help youhelliphellip

Agree to treatment speech

bull Together wersquore going to do everything we can to treat your disease with a MRD We will evaluate

bull Top 5 CCrsquos

bull AHIRDI

bull LSAT

bull T below 90

bull Communicate with your physicians

bull Facilitate other treatment options if necessary

3 Goals of Dental Sleep

1 Wear Device

2 Subjective Improvement

3 Objective Success

34

38

39

Device Delivery

40

Titration Sleep Test

Treatment

Titration Sleep Test Protocol

Subjective Success

Wearing device through the

night

Confident it is helping them

Pain free

Subjective tests improving

41

Titration HST

GOOD One night one position

BETTER Two nights two positions

BEST Three nights three positions

42

43

44

bull PROTOCOL

bull Patient to take adjustment key(s) Bands Rods

bull Sleep tech to wake patient but patient adjusts device

bull INSTRUCTIONS TO TECH bull IF AHI ge 10 OR RDI ge 15 ADJUST

APPLIANCE 2 FULL TURNS

bull REPEAT AT 45 MIN INTERVALS UNTIL SUCCESSFUL CONSIDER TITRATING CPAP AFTER 4 TO 5 HOURS IF UNSUCCESSFUL

TITRATING AT SLEEP CENTER

45

TitratePromote Nasal Breathing

ElasticsChin StrapLip ClosureEnsure device doesnrsquot dislodgeNose ConesTape TAP Mouth ShieldManage allergies

EPAPPositional TherapyAdd low flow O2Combination TherapyMedical ReferralChange vertical or devices DNA ApplianceTimeDiscontinueAlternative Tx

What else can we do

46

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

Agree to treatment speech

bull Together wersquore going to do everything we can to treat your disease with a MRD We will evaluate

bull Top 5 CCrsquos

bull AHIRDI

bull LSAT

bull T below 90

bull Communicate with your physicians

bull Facilitate other treatment options if necessary

3 Goals of Dental Sleep

1 Wear Device

2 Subjective Improvement

3 Objective Success

34

38

39

Device Delivery

40

Titration Sleep Test

Treatment

Titration Sleep Test Protocol

Subjective Success

Wearing device through the

night

Confident it is helping them

Pain free

Subjective tests improving

41

Titration HST

GOOD One night one position

BETTER Two nights two positions

BEST Three nights three positions

42

43

44

bull PROTOCOL

bull Patient to take adjustment key(s) Bands Rods

bull Sleep tech to wake patient but patient adjusts device

bull INSTRUCTIONS TO TECH bull IF AHI ge 10 OR RDI ge 15 ADJUST

APPLIANCE 2 FULL TURNS

bull REPEAT AT 45 MIN INTERVALS UNTIL SUCCESSFUL CONSIDER TITRATING CPAP AFTER 4 TO 5 HOURS IF UNSUCCESSFUL

TITRATING AT SLEEP CENTER

45

TitratePromote Nasal Breathing

ElasticsChin StrapLip ClosureEnsure device doesnrsquot dislodgeNose ConesTape TAP Mouth ShieldManage allergies

EPAPPositional TherapyAdd low flow O2Combination TherapyMedical ReferralChange vertical or devices DNA ApplianceTimeDiscontinueAlternative Tx

What else can we do

46

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

3 Goals of Dental Sleep

1 Wear Device

2 Subjective Improvement

3 Objective Success

34

38

39

Device Delivery

40

Titration Sleep Test

Treatment

Titration Sleep Test Protocol

Subjective Success

Wearing device through the

night

Confident it is helping them

Pain free

Subjective tests improving

41

Titration HST

GOOD One night one position

BETTER Two nights two positions

BEST Three nights three positions

42

43

44

bull PROTOCOL

bull Patient to take adjustment key(s) Bands Rods

bull Sleep tech to wake patient but patient adjusts device

bull INSTRUCTIONS TO TECH bull IF AHI ge 10 OR RDI ge 15 ADJUST

APPLIANCE 2 FULL TURNS

bull REPEAT AT 45 MIN INTERVALS UNTIL SUCCESSFUL CONSIDER TITRATING CPAP AFTER 4 TO 5 HOURS IF UNSUCCESSFUL

TITRATING AT SLEEP CENTER

45

TitratePromote Nasal Breathing

ElasticsChin StrapLip ClosureEnsure device doesnrsquot dislodgeNose ConesTape TAP Mouth ShieldManage allergies

EPAPPositional TherapyAdd low flow O2Combination TherapyMedical ReferralChange vertical or devices DNA ApplianceTimeDiscontinueAlternative Tx

What else can we do

46

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

38

39

Device Delivery

40

Titration Sleep Test

Treatment

Titration Sleep Test Protocol

Subjective Success

Wearing device through the

night

Confident it is helping them

Pain free

Subjective tests improving

41

Titration HST

GOOD One night one position

BETTER Two nights two positions

BEST Three nights three positions

42

43

44

bull PROTOCOL

bull Patient to take adjustment key(s) Bands Rods

bull Sleep tech to wake patient but patient adjusts device

bull INSTRUCTIONS TO TECH bull IF AHI ge 10 OR RDI ge 15 ADJUST

APPLIANCE 2 FULL TURNS

bull REPEAT AT 45 MIN INTERVALS UNTIL SUCCESSFUL CONSIDER TITRATING CPAP AFTER 4 TO 5 HOURS IF UNSUCCESSFUL

TITRATING AT SLEEP CENTER

45

TitratePromote Nasal Breathing

ElasticsChin StrapLip ClosureEnsure device doesnrsquot dislodgeNose ConesTape TAP Mouth ShieldManage allergies

EPAPPositional TherapyAdd low flow O2Combination TherapyMedical ReferralChange vertical or devices DNA ApplianceTimeDiscontinueAlternative Tx

What else can we do

46

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

39

Device Delivery

40

Titration Sleep Test

Treatment

Titration Sleep Test Protocol

Subjective Success

Wearing device through the

night

Confident it is helping them

Pain free

Subjective tests improving

41

Titration HST

GOOD One night one position

BETTER Two nights two positions

BEST Three nights three positions

42

43

44

bull PROTOCOL

bull Patient to take adjustment key(s) Bands Rods

bull Sleep tech to wake patient but patient adjusts device

bull INSTRUCTIONS TO TECH bull IF AHI ge 10 OR RDI ge 15 ADJUST

APPLIANCE 2 FULL TURNS

bull REPEAT AT 45 MIN INTERVALS UNTIL SUCCESSFUL CONSIDER TITRATING CPAP AFTER 4 TO 5 HOURS IF UNSUCCESSFUL

TITRATING AT SLEEP CENTER

45

TitratePromote Nasal Breathing

ElasticsChin StrapLip ClosureEnsure device doesnrsquot dislodgeNose ConesTape TAP Mouth ShieldManage allergies

EPAPPositional TherapyAdd low flow O2Combination TherapyMedical ReferralChange vertical or devices DNA ApplianceTimeDiscontinueAlternative Tx

What else can we do

46

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

Device Delivery

40

Titration Sleep Test

Treatment

Titration Sleep Test Protocol

Subjective Success

Wearing device through the

night

Confident it is helping them

Pain free

Subjective tests improving

41

Titration HST

GOOD One night one position

BETTER Two nights two positions

BEST Three nights three positions

42

43

44

bull PROTOCOL

bull Patient to take adjustment key(s) Bands Rods

bull Sleep tech to wake patient but patient adjusts device

bull INSTRUCTIONS TO TECH bull IF AHI ge 10 OR RDI ge 15 ADJUST

APPLIANCE 2 FULL TURNS

bull REPEAT AT 45 MIN INTERVALS UNTIL SUCCESSFUL CONSIDER TITRATING CPAP AFTER 4 TO 5 HOURS IF UNSUCCESSFUL

TITRATING AT SLEEP CENTER

45

TitratePromote Nasal Breathing

ElasticsChin StrapLip ClosureEnsure device doesnrsquot dislodgeNose ConesTape TAP Mouth ShieldManage allergies

EPAPPositional TherapyAdd low flow O2Combination TherapyMedical ReferralChange vertical or devices DNA ApplianceTimeDiscontinueAlternative Tx

What else can we do

46

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

Titration Sleep Test Protocol

Subjective Success

Wearing device through the

night

Confident it is helping them

Pain free

Subjective tests improving

41

Titration HST

GOOD One night one position

BETTER Two nights two positions

BEST Three nights three positions

42

43

44

bull PROTOCOL

bull Patient to take adjustment key(s) Bands Rods

bull Sleep tech to wake patient but patient adjusts device

bull INSTRUCTIONS TO TECH bull IF AHI ge 10 OR RDI ge 15 ADJUST

APPLIANCE 2 FULL TURNS

bull REPEAT AT 45 MIN INTERVALS UNTIL SUCCESSFUL CONSIDER TITRATING CPAP AFTER 4 TO 5 HOURS IF UNSUCCESSFUL

TITRATING AT SLEEP CENTER

45

TitratePromote Nasal Breathing

ElasticsChin StrapLip ClosureEnsure device doesnrsquot dislodgeNose ConesTape TAP Mouth ShieldManage allergies

EPAPPositional TherapyAdd low flow O2Combination TherapyMedical ReferralChange vertical or devices DNA ApplianceTimeDiscontinueAlternative Tx

What else can we do

46

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

Titration HST

GOOD One night one position

BETTER Two nights two positions

BEST Three nights three positions

42

43

44

bull PROTOCOL

bull Patient to take adjustment key(s) Bands Rods

bull Sleep tech to wake patient but patient adjusts device

bull INSTRUCTIONS TO TECH bull IF AHI ge 10 OR RDI ge 15 ADJUST

APPLIANCE 2 FULL TURNS

bull REPEAT AT 45 MIN INTERVALS UNTIL SUCCESSFUL CONSIDER TITRATING CPAP AFTER 4 TO 5 HOURS IF UNSUCCESSFUL

TITRATING AT SLEEP CENTER

45

TitratePromote Nasal Breathing

ElasticsChin StrapLip ClosureEnsure device doesnrsquot dislodgeNose ConesTape TAP Mouth ShieldManage allergies

EPAPPositional TherapyAdd low flow O2Combination TherapyMedical ReferralChange vertical or devices DNA ApplianceTimeDiscontinueAlternative Tx

What else can we do

46

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

43

44

bull PROTOCOL

bull Patient to take adjustment key(s) Bands Rods

bull Sleep tech to wake patient but patient adjusts device

bull INSTRUCTIONS TO TECH bull IF AHI ge 10 OR RDI ge 15 ADJUST

APPLIANCE 2 FULL TURNS

bull REPEAT AT 45 MIN INTERVALS UNTIL SUCCESSFUL CONSIDER TITRATING CPAP AFTER 4 TO 5 HOURS IF UNSUCCESSFUL

TITRATING AT SLEEP CENTER

45

TitratePromote Nasal Breathing

ElasticsChin StrapLip ClosureEnsure device doesnrsquot dislodgeNose ConesTape TAP Mouth ShieldManage allergies

EPAPPositional TherapyAdd low flow O2Combination TherapyMedical ReferralChange vertical or devices DNA ApplianceTimeDiscontinueAlternative Tx

What else can we do

46

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

44

bull PROTOCOL

bull Patient to take adjustment key(s) Bands Rods

bull Sleep tech to wake patient but patient adjusts device

bull INSTRUCTIONS TO TECH bull IF AHI ge 10 OR RDI ge 15 ADJUST

APPLIANCE 2 FULL TURNS

bull REPEAT AT 45 MIN INTERVALS UNTIL SUCCESSFUL CONSIDER TITRATING CPAP AFTER 4 TO 5 HOURS IF UNSUCCESSFUL

TITRATING AT SLEEP CENTER

45

TitratePromote Nasal Breathing

ElasticsChin StrapLip ClosureEnsure device doesnrsquot dislodgeNose ConesTape TAP Mouth ShieldManage allergies

EPAPPositional TherapyAdd low flow O2Combination TherapyMedical ReferralChange vertical or devices DNA ApplianceTimeDiscontinueAlternative Tx

What else can we do

46

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

45

TitratePromote Nasal Breathing

ElasticsChin StrapLip ClosureEnsure device doesnrsquot dislodgeNose ConesTape TAP Mouth ShieldManage allergies

EPAPPositional TherapyAdd low flow O2Combination TherapyMedical ReferralChange vertical or devices DNA ApplianceTimeDiscontinueAlternative Tx

What else can we do

46

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

46

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

47

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

48

Nose Cones

Nose Cones

Clear

Softer

Sinus Cones

White

Firmer

48

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

49

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

51

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

Chinstrap

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

54

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

55

EPAP - (Provent)

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

56

Positional TherapybullMost peoplehelliphellip

bull OSA worse on backbull Review SS

56

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

57

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

58

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

59

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

60

Medical Referrals

UPPPMMAENTAllergist

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

61

Different Device Change Vertical

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

62

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

63

Time DiscontinueAlternative Tx

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

AHI is gt 5bull Apples to Apples

bull HST vs PSG

bull Date of Baseline

bull Weight gain

bull Per night variance

bull Body position

bull Sleepiness

bull Alcohol

bull Nose

bull Sleeping conditions

bull OSA May be Worse

bull NOT An EXACT Science

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

Communication is the Key

bull After treatment decision

bull Begin Delay not candidate etc

bull At Delivery

bull 1st check

bull Sleep Test

bull Treatment Complete

bull Every 4 to 6 weeks

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

Confidence

70

ldquoConfidence is contagious and so is lack of confidence

and a customer will recognize bothrdquo

Vince Lombardi

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Take Home Messages

bull Define Success PRIOR to beginning treatment

bull Achieve Subjective Successbull You are half way therebull More mild cases this is the primary reason for treating

bull Objective successbull Consider AHIbull Consider SPO2bull Consider per night and sleep testing variancesbull Donrsquot split hairs

bull Donrsquot forget the nose

bull Relax and enjoy your success

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

Dental Sleep MedicineNo shots no extractions no root canalshelliphelliphellip

72

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73

Dr Gy Yatros DMD

Gydentalsleepsolutionscom

infoDentalSleepSolutionscom

wwwdentalsleepsolutionscom

1-877-95-SNORE

73