Sleep Apnea

People with obstructive sleep apnea (OSA) have disrupted sleep and low blood oxygen levels. When obstructive sleep apnea occurs, the tongue is sucked against the back of the throat. This blocks the upper airway and airflow stops. When the oxygen level in the brain becomes low enough, the sleeper partially awakens, the obstruction in the throat clears, and the flow of air starts again, usually with a loud gasp.

Repeated cycles of decreased oxygenation lead to very serious cardiovascular problems. Additionally, these individuals suffer from excessive daytime sleepiness, depression, and loss of concentration.

Some patients have obstructions that are less severe called Upper Airway Resistance Syndrome (UARS). In either case, the individuals suffer many of the same symptoms.

The first step in treatment resides in recognition of the symptoms and seeking appropriate consultation.  A thorough head and neck exam are performed to look for deficiencies.

In addition to a detailed history, the doctor will assess the anatomic relationships in the maxillofacial region. With cephalometric (skull x-ray) analysis, the doctors can ascertain the level of obstruction. To confirm the amount of cardiovascular compromise and decreased oxygenation levels, a sleep study may be recommended to monitor an individual overnight.

There are several treatment options available. An initial treatment may consist of using a nasal CPAP machine that delivers pressurized oxygen through a nasal mask to limit obstruction at night. One of the surgical options is an uvulo-palato-pharyngo-plasty (UPPP), which is performed in the back of the soft palate and throat. A similar procedure is sometimes done with the assistance of a laser and is called a laser assisted uvulo-palato-plasty (LAUPP). In other cases, a radio-frequency probe is utilized to tighten the soft palate. These procedures usually performed under light IV sedation in the office.

In more complex cases, the bones of the upper and lower jaw may be repositioned to increase the size of the airway (orthognathic surgery). This procedure is done in the hospital under general anesthesia and requires a one to two day overnight stay in the hospital.

A safe and non-surgical treatment is now available to correct the structure of the airway using a DNA Appliance (Daytime Nighttime Appliance).

   As a Certified Provider of the DNA Appliance ® (Daytime Nighttime Appliance) system, we can treat the teeth, jaws, temporomandibular joints (TMJ), face and airway for optimal growth and development by engaging the patient’s underlying genetics without the use of surgery.  Using the principles of Epigenetic Orthodontics, this technique activates one’s naturally occurring genes to correct underdevelopment in the craniofacial region with removable appliances worn during the evening and nighttime – during the body’s natural circadian rhythm. The bones in the craniofacial region are remodeled over time, non-surgically making a foundational correction to the structure of the airway. It is a pain-free, minimally invasive process which uses no drugs, medication, or injections.

  • Straightening and aesthetically developing the healthy alignment of the teeth and dental arches
  • Treating TMJ disorders
  • Non-surgically treating the airway space
  • Reducing and eliminating snoring and obstructive sleep apnea

How does the DNA Appliance work?


The DNA Appliance gently expands the upper arch space in three dimensions, which in turn increases the size of the nasal cavity. As the upper arch is widened, the lower jaw is able to move forward into a more natural position. As the jaw moves forward, it pulls the tongue and soft tissues, thus increasing the size of the airway. The result is a dramatic improvement in the patient’s ability to breathe.

The CT imaging shown above compares the width of the airway (in red) “Before” treatment with the DNA Appliance and “After”, clinically documenting the expansion in the airway in an adult patient.

This unique appliance, based upon a patented design, is worn like a dental or orthodontic retainer; however, it is worn only in the evening/night and gently guides the teeth, jaws, facial bones and airway into more optimal spatial positioning aiding sleep and breathing patterns. In contrast to other appliances that rely on continuous force only – which damages sensitive tissue – the DNA appliance applies intermittent force, providing a resting period for the tissues between nightly use.

Additional Benefits for Patients

The DNA Appliance system is unique because it was not only developed to lessen sleep apnea, but it also straightens teeth, develops the upper and lower arch, and improves the upper airway. By improving the upper airway through an increase in facial volume, a cosmetic benefit of facial feature balancing occurs. This can give a lifting result similar to that found with an injectable or filler such as Juvederm or Radiesse, but is a natural and permanent solution. Some patients have even reported this is much like a “non-surgical facelift”.

With the use of DNA Appliances, our body has the ability to self correct—to enhance the teeth, jaws, TMJ, face, and airway into more optimal relations for functions, such as sleep and breathing. Dr. Julie Fagundes is a Certified Provider of the DNA Appliance system. Call to schedule an appointment today!  

OSA is a very serious condition that needs careful attention and treatment. Most major medical plans offer coverage for diagnosis and treatment.