The Do’s & Don’ts During Your Patients’ First Sleep Apnea Consultation

Successful Sleep Dentistry Article #2

The Do’s & Don’ts During Your Patients’ First Sleep Apnea Consultation

Once you’ve identified a potential sleep apnea patient the next step is a consultation (for more information on identifying patients with sleep apnea in your dental practice please read this). At the first consultation, the dentist should educate the patient about their possible condition and touch upon their treatment options. A great sleep dentist will go one-step further and elicit enthusiasm from the patient to begin and continue their treatment.

A sleep dentist’s initial consultation with a patient exhibiting the symptoms of sleep apnea will be crucial in getting the sufferer to take action. It will likely be the first time that the patient learns about their possible condition in detail and understands the impact it’s having on their life and, for some, that of their partner’s. This consultation should convince them to undertake a sleep study and ultimately seek treatment to improve their health and long-term wellbeing.

Dentists can use the following techniques to encourage patients to acknowledge their symptoms and take action.

Elicit Symptoms and Accept Likely Prognosis

Some patients can be hesitant in accepting they have health problems, such as sleep apnea. If patients have been told they snore in the past from others, they may not realize it could be a potential sign of a serious medical condition. To counter this effect a good sleep dentist will use open-ended questions as well as their medical knowledge to probe and allow the patient to come to the conclusion themselves that they may suffer from sleep apnea and that getting treatment would positively impact their quality of life.

Leading questions that will help build the case in the patient’s mind for treatment include:

Quality of life questions

How often do you feel tired during the day?
What is the quality of your sleep like?
How does your snoring impact your relationship?
How would better sleep impact your waking life?

Medical condition questions

Do you know how a bad night’s sleep impacts your body?
Did you know poor sleep is associated with high blood pressure, weight gain and memory loss[1]?

To support the consultation view visual aids from Whole You™, that can be used as educational resources in your practice.

Focus on Hope for a Better Life

Patients suffering from sleep apnea may have normalized their symptoms and consider them a usual part of their day-to-day life. The sleep dentist needs to explain that the symptoms they are experiencing aren’t common in people not suffering from sleep apnea, and can be successfully treated. This should encourage the patient to realize the positive impact treatment would have on their life.

During the first consultation the sleep dentist should connect the loss of oxygen with its potential negative affects on the heart, brain and other organs and systems of the body. Patients will also quickly realize that the loss of oxygen leads to poor sleep, fragmented and disturbed sleep, sleep deprivation, and reduced restorative and dream sleep (sleep staging is altered). Crucially it’s important for the patient to understand how much better their life could be if their sleep apnea is successfully treated and their symptoms are alleviated.

Ultimately, the patients need to come to the conclusion by themselves, that they may suffer from sleep apnea and that getting treatment would positively affect their quality of life.

Secure Spousal Support

One of the keys to a successful first consultation can be asking the patient to bring their spouse or partner. The partner’s interest in getting their spouse to take a sleep study and look at treatment options will be twofold – firstly they will want to see their spouse enjoy improved health and wellbeing; secondly sleep apnea impacts the sufferer’s partner directly. A study by Beninati et al. reported a sleep apnea patient’s snoring was associated with their bed partner’s arousals from sleep, which adversely affected the partner’s sleep quality.[2] On top of that, snoring alone was found to be a risk factor for sexual dysfunction[3].

Be the Educated Guide they need

The majority of sleep apnea patients are undiagnosed[4] and many people are simply uneducated on the condition, its symptoms and the impact it’s having on their lives. A sleep dentist may be the first to identify the condition in the patient and so has a duty to accurately inform them and answer any questions they may have.

Therefore before raising the topic to a patient, a dentist who is considering a move into sleep dentistry must be as informed as possible and aware of the latest developments in the field as they would for dentistry.

Advice from a Veteran Sleep Dentist

The Whole You™ provides solutions for people with sensory and mobility challenges, works with Dr. Barry Chase, an expert sleep dentist with over 10 years’ experience in the field. Below Dr. Chase offers his advice on how to achieve a successful first consultation.

What makes great consultation different from good consultation?

Dr. Chase: I know I have done a great consultation when the patient says I should stop talking and asks for the impressions so they can get the dental device as soon as possible. What I have done is connected the patients symptoms and medical co-morbidities to their sleep apnea and the loss of oxygen.

A great consultation not only motivates the patient but also injects a sense of urgency. One of the most powerful tools is to ask open ended questions which will allow the patient to self-realize as the patients answer: Do you get uninterrupted quality sleep? Do you wake up unrefreshed perhaps with headaches, unable to spring out of bed energized to face the day? Are you sleepy during the day, feeling like you can nap at any time? Do you awaken during the night, gasping for breath, heart racing, sweaty? The main idea is to allow the patient to realize these symptoms are not normal and therapy can help those affected feel better.

How do you first broach the topic of sleep apnea with your patient?

Dr. Chase: First, you will be surprised how many patients have already had sleep studies and have tried other therapies such as CPAP. You just have to ask and you have now opened the door that you as the sleep dentist are the solution to their sleep apnea problem.

Sleep apnea presents with visual intra-oral signs such as scalloped tongue, narrow arches with vaulted palates, and long soft palates that extend inferiorly behind the posterior aspect of the tongue (these are just a few of many other anatomic signs of sleep apnea, read more here). Discovery of these signs will allow you or your hygienist to ask about snoring and sleep apnea symptoms. Using a mirror to demonstrate the visuals signs as well as having posters and other visual products (such as the Whole You toolkit) demonstrated in the office makes it easy to discuss dental sleep medicine with your patient.

Why are some patients resistant to learning about obstructive sleep apnea (OSA) and how can this be resolved?

Dr. Chase: To my surprise I struggled getting case acceptance when I set up a private practice primarily dedicated to dental sleep medicine. The patient flow was good, but after presenting what I thought was a good explanation of dental sleep medicine, I heard, “sounds good Doc, but I’ll think about it and get back to you”, or “OK, I’ll check with my wife”. And these responses were from patients who just had to pay the deductibles of the patient responsibility as I was an insurance based sleep practice.

I eventually realized it was the consultation; the language and message I was using to explain the mechanics of Oral Appliance Therapy (OAT). While I was explaining, the patient became a disinterested listener as what I was talking about was a device, a piece of plastic, which nobody really wanted to wear, especially to sleep.

Our practice completely revised the way in which we presented dental sleep medicine and as a result, our case acceptance is now 93 percent.

What did we change and how did it become so effective?

To begin with, we stopped “telling” the patient and reversed the process to where the patient is now “telling” us. We start by asking questions and let the patient self-realize the problem leading them to ask for the solution. There is a big difference between me telling the patient “you need this” and the patient asking “Doc, can I have that?”. When the patient says, “Doc, please stop talking, I now know I need the appliance. Please let me know where can I go for a sleep study?”, it’s the sign of successful consultation.

How do patients make the decision on whether to proceed with a sleep study?

Dr. Chase: What I have learned in 40 years of private practice is that patients make decisions as a result of the interplay between their head and their heart – between the logic and rationality of what they perceive is best, and the emotional intensity of how they feel about the treatment and its effect on them. Between the two, I have discovered that how a patient feels is often the more powerful factor in decision making. Therefore, I focus on the emotional value of how OSA is affecting their lives and the benefits of therapy to address those concerns, rather than the logical considerations of “it’s the right thing to do”.

So I have a target, a place where I want to land with the patient. It is the place where the patient says, “Oh my goodness, I can now see how my sleep apnea is negatively affecting my quality of life and jeopardizing my medical wellbeing”.

How do you close your consultation that your patient is fully motivated to precede to treatment conversation?

Dr. Chase: Let’s divide our patients who we screened into two categories. The first ones are those patients who have already tired other therapies such as CPAP, they usually know the seriousness of sleep apnea. Your job is to relate the danger of untreated sleep apnea and allow the patient to realize that you are their best hope for treatment success. The second category is those patients who are newly screened in your dental office. They need a sense of urgency to get a sleep study. Those patients are motivated by a new understanding of the loss of oxygen as the paramount factor during apnea events and the resultant sleep dysfunctions, disturbances, concomitant with certain medical co-morbidities.

If you are a dentist who is interested in oral appliance therapy to add as a treatment option for your patients, please call Whole You™ at 718-643-7326 or visit www.wholeyou.com.

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Successful Sleep Dentistry Article #2