Less Calculus – More Sleep: A Day in the Life of a Sleep Hygienist

by Gina Pepitone-Mattiello, RDH 

A day in my life as a dental sleep medicine hygienist makes my heart happy and helps me sleep better at night. For starters, I am not picking up a scaler or explorer anymore. Instead, my instruments are a pulse oximeter and sphygmomanometer. Days are filled following up with referrals from sleep centers, physicians, and the occasional internet surfer who discovers our practice online. No matter how they come to us, they are always seeking the same things – hope and a better night’s sleep.

I am working in a dental sleep medicine practice that manages , commonly known as oral appliances. Long story short (no, it really will be), this simply complex oral appliance saved my husband’s life and turned me into an airway advocate.

I call the night before a workday my “evening prep.” Prior to a patient visiting our practice, our sleep administrator obtains any pertinent medical records, sleep study results, clinical notes, and health insurance information. Each night I spend around an hour reviewing my patient records and explore their story. As I familiarize myself with my patient’s symptoms and medical history, I begin to understand why they are seeking help. Sometimes they just want refreshing sleep, occasionally they have nightmares of drowning, and in other instances they simply aim to make their partners happy; no one is exactly the same.

Mornings begin with a team huddle. We discuss details of each patient including preferences of the referring physician, their sleep breathing disorder diagnosis, and their applicable medical benefits. Our administrative team is notified about any fees or additional records needed beforehand. Some are new patients already diagnosed with OSA while others suspect they may have sleep apnea.

When I meet a new patient for the first time, I mostly just listen. After we chat about their chief complaints and their goals for treatment, I explain the mechanism of Oral Appliance Therapy and how it may help them. I’ve found the Airhead Obstructive Sleep Apnea Demonstration Model (TMJ Technologies) to be wildly useful for this purpose. His mandible moves, the airway collapses, and it shows how an oral appliance maintains an open airway. This is always an eye-opener for patients – it’s almost like DSM show and tell!

We discuss their symptoms and I help them connect the dots regarding how those symptoms are related to their sleep breathing disorder. Dedicating the time to explain how the body functions and what the toll of poor sleep is on their physical and mental well-being frequently leads to an “aha” moment. This is usually the first time anyone has really carved out the time to listen to them and explain this information in relatable terms.

I have several MAD samples that I use to further explain how oral appliances work. After that, I begin the dental sleep clinical exam. At this point, I put my “dental hat” back on and chart the teeth, perform a TMJ evaluation, document anatomical features including tongue size, Mallampati classification, and other general features present in the oral cavity. It’s very important that we identify any dental concerns precluding the patient from wearing an oral appliance. Additionally, a thorough oral exam can help guide the decision-making process about which appliance is best indicated for the patient. Many insurance payors also require this documentation.

Once all of the information is gathered, it is time for the sleep dentist to see the patient. They will confirm that the patient is a candidate for oral appliance therapy and the style of oral appliance is determined. Next I review medical insurance benefits with the patient and map the financial arrangements. Then we take impressions. I take most of the impressions using a digital scanner although we occasionally take PVS impressions.

The bulk of my day is filled with appliance delivery appointments. During these blocks, I insert the MAD, review what the patient should expect regarding fit and feel, and lastly, but crucially important, we discuss home care instructions. After that, we talk about the importance of maintaining a sleep diary. I always ask my patients to keep track of their sleep schedule and subjective symptoms. This is important because it helps me to determine when the device should be adjusted and when it is time for the follow-up sleep test.

During the dreary days of COVID, I’ve been able to maintain our schedule and continue seeing patients due to an ingenious piece of technology called Doxy.me (Doxy.me, LLC). Despite physical distancing, Doxy.me allows me to virtually see my patients. Most oral appliances can be adjusted by the patient though clinician guidance. This software is far more personal than phone calls and enables me to stay connected with my patients and be sure they get the care they deserve. Plus, we can see each other’s expressions and smiles.

I also allocate time for patients that have contacted us or been referred to us but have yet to be diagnosed. I connect these patients with SleepTest.com for virtual evaluations and home sleep testing. For a certain percentage of our patient population, this has been a wildly beneficial adjunctive service.

Being a dental sleep hygienist has been such a rewarding transition in my career. The physical wear and tear is dramatically less than when I was hunkering over patients all day long scaling and root planing. This path is not without its challenges though. It can be difficult to remain present and focused with each patient. So much of my role now involves listening and counseling. That requires full attention and empathy. It can also be heartbreaking to experience so many people suffering with sleep breathing disorders, the difficulty it causes in their lives, and realize how little help there is for them in our current healthcare landscape. I want to do everything I can to help them, but I can’t fix everything. However, I diligently strive to locate resources and cultivate a network of specialists who are wonderful team players and share our singular goal – to give our patients better quality of life through healthy sleep.

All of this culminates in the most rewarding gifts I receive. The gifts of patients coming in to say, “thank you for giving me my life back” or “my wife back.” This means I have helped them, their loved ones, and I played a part in making a real difference in their lives. So, I wonder sometimes – do I do this for me or is it for them? Does it even matter? Either way, my patients are breathing better, sleeping better, and enjoying healthier lives. That is my blessing. One of my mentors said, “On a good day, we can save a smile, but on a great day, we can save a life.” I want every day to be a great day.