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Sleep Apnea


Sleep apnea is a disorder that causes pauses in breathing or periods of very low breathing levels during sleep. Each pause in breathing (apnea) can last from a few seconds to minutes, and may occur up to 30 times an hour! Each time the breathing is abnormally low, it is called a hypopnea.

Sleep apnea can only be diagnosed with an overnight test, or sleep study, called a polysomnogram.

There are three types of sleep apnea, Central Sleep Apnea (CSA), Obstructive Sleep Apnea (OSA), and Complex or Mixed Sleep Apnea.  Central sleep apnea happens when breathing is interrupted by lack of effort to breathe, this is usually only treatable with continuous positive airflow (CPAP) or a breathing machine. In obstructive sleep apnea, the breathing is blocked by something despite respiratory effort.  This is the most common type of sleep apnea and snoring is very common. Obstructive sleep apnea happens because the airway of the throat is composed of soft tissue that sometimes collapses, due to relaxed muscles, obstructing airways during sleep. Complex or mixed sleep apnea is a combination of the two.


Regardless of the type of sleep apnea diagnosed, one who has it rarely knows it. Sleep apnea is usually a problem brought about by someone witnessing the lack of breath or breathing, and the presence of snoring. Symptoms may include daytime sleepiness and sleep disturbance.



EMA Appliance

Tap III Appliance        

Sonomodent Appliance



Pharyngometer and Rhineometer  Computerized Airway Analysis

Depending on each patients medical history, the sleep study findings, patient preferences and life style treatment can vary dramatically.


Dr. Koeppel utilizes oral appliances to keep the airways open and prevent pauses in breathing (apneas) in OSA. There are two kinds of oral appliance, tongue retaining devices (TRDs) and mandibular advancement devices (MADs).


Both appliances result in having the tongue move forward and having the mouth stay open beyond its normal resting position.

Tongue retaining devices (TRDs) use suction to hold the tongue right behind the front teeth, while pulling the lower jaw forward.

This method will not work out well for those patients who primarily breathe out of their mouths because it is centered on suction. Mandibular advancement devices (MADs) are fabricated to go over the teeth so the lower jaw is held slightly farther forward than it normally would be, these are the most common appliances. Thus stopping the tissue in the throat from collapsing. MADs also lower elevator muscle activity, stopping bruxism (grinding), alleviating clenching and increasing nasal airflow.



A pharyngometer is a device used by Dr. Koeppel to quickly and easily measure the stability and size of patients airway. The pharyngometer is used when sleep apnea may be present, because there is a clear relationship between a narrow collapsible airway and OSA (obstructive sleep apnea). This test is minimally invasive and usually takes about 3 minutes to complete.



With this device results of the test are shown graphically by displaying the relationship between the cross- sectional area of the airway and the distance from top to bottom in centimeters on a computer screen. The pharyngometer uses acoustic reflection technology, by projecting sound waves down the airway and recoding them as they reflect back up. Dr. Koeppel is very experienced in using this technology in his office and has helped many patients sleep though the night without worrying about OSA.




Call our office at (631) 318-0000 to arrange a consult with Dr. Koeppel to learn more about OSA and OSA Appliances. You can also use our Consult Request form to arrange an appointment.


Patients seeking specific answers or information related to the material on this page can also choose to contact Dr. Koeppel directly with our Ask The Dentist form Dr Ira Koeppel will reply to you directly with the information you are seeking.