Our treatment protocol.
Effective sleep apnea care is never a one-appointment process. Our seven-phase protocol ensures every patient receives a precise diagnosis, optimal treatment, and verified outcomes.
Why protocol matters in sleep medicine
Dental sleep medicine exists at the intersection of dentistry, sleep medicine, and craniofacial biology. Getting it right requires more than prescribing an appliance — it requires a systematic approach that begins with accurate diagnosis, selects treatment based on individual anatomy, and verifies that treatment is actually working.
Our protocol reflects the clinical standards established by the American Sleep and Breathing Academy (ASBA), updated with the latest evidence from sleep science and airway medicine research. The number of appointments at each phase will vary based on individual patient needs — every step has a purpose, and no step is skipped.
Seven phases. No step skipped.
- 01Phase 1
Comprehensive airway & sleep evaluation
Every patient begins with a thorough evaluation that goes far beyond a dental exam. We assess the complete airway — from the nasal passages to the lower pharynx — using both clinical examination and advanced imaging.
- Medical history review with emphasis on sleep, airway, and craniofacial symptoms
- Cone-beam CT (CBCT) imaging of the head and neck for 3D airway visualization
- Cutting-edge diagnostic technology to assess airway dimensions and collapsibility
- Dental and TMJ assessment including jaw range of motion
- Photographic and radiographic documentation of facial growth patterns
- Screening questionnaires: Epworth Sleepiness Scale, STOP-BANG
- 02Phase 2
Sleep study coordination & diagnosis
Objective diagnosis is essential before prescribing treatment. We work with board-certified sleep physicians to ensure every patient receives a medically valid diagnosis.
- Review of any existing sleep studies (PSG or HSAT)
- Arrangement of home sleep apnea testing (HSAT) for appropriate candidates
- Referral to a sleep medicine physician for complex cases or PAP trial requirements
- Sleep study result interpretation in the context of airway anatomy findings
- All procedure codes provided for you to file directly with your insurance carrier
- 03Phase 3
Individualized treatment planning
Results from the evaluation and sleep study are integrated into a personalized treatment plan. We review all findings with you, explain the rationale for each recommendation, and discuss alternatives.
- Presentation of all imaging, sleep study data, and clinical findings
- Discussion of all applicable treatment options with supporting evidence
- Selection of the optimal oral appliance type based on anatomy and clinical needs
- Identification of adjunct therapies (myofunctional therapy, positional therapy, ENT referral)
- We do not bill insurance directly — all procedure codes are provided so you can file with your carrier
- 04Phase 4
Appliance fabrication & delivery
Your custom oral appliance is fabricated by a specialized dental sleep laboratory using precise digital impressions and your bite registration. At delivery, we fit, adjust, and instruct you in the care of your device.
- Digital intraoral scanning — no impression trays
- Custom fabrication at an FDA-registered dental sleep laboratory
- Device delivery with fit verification
- Initial jaw position setting at or near maximum comfortable protrusion
- Home care and maintenance instructions
- Complete itemized procedure codes provided for patient-direct insurance filing
- 05Phase 5
Titration & optimization
Oral appliance therapy is not a set-and-forget treatment. Titration — the gradual advancement of treatment — is essential to achieving therapeutic benefit while maintaining patient comfort. Adjustments are made at monthly intervals and may involve changes to jaw position, vertical dimension, or appliance tension depending on each patient's response.
- Incremental treatment adjustments at monthly intervals
- Assessment of symptom response and side effect monitoring
- Jaw and bite equilibration as needed
- Patient-reported outcome tracking
- Determination of the optimal titration position for the follow-up sleep study
- 06Phase 6
Objective outcome verification
Treatment success must be verified objectively. Once titration is complete, we conduct a follow-up sleep study with the device in place to confirm that the AHI has been reduced to acceptable levels.
- Home sleep apnea test (HSAT) with the device at the titrated position
- Full polysomnogram if clinical complexity warrants
- Comparison of pre- and post-treatment AHI and oxygen saturation data
- Treatment modification if the response is suboptimal
- Documentation of the outcome for your treating sleep physician
- 07Phase 7
Long-term monitoring & care
Sleep apnea treatment is a lifelong commitment. We monitor not only the efficacy of your appliance but also the health of your teeth, bite, and jaw joints — ensuring treatment remains both safe and effective.
- Annual occlusal equilibration and bite assessment
- Device inspection and replacement planning (typically every 3–5 years)
- Re-evaluation if symptoms recur or weight changes significantly
- Coordination with your sleep physician for ongoing medical management
- Periodic repeat sleep testing as clinically indicated
The protocol is the product. So is the doctor.
Dr. Deal has practiced dental sleep medicine and craniofacial pain since 2003 — depth of practice that directly shapes the precision and individualization of every treatment plan.
Dr. Deal is the only double board-certified craniofacial pain and dental sleep medicine practitioner in Arkansas — Diplomate of the American Board of Craniofacial Pain (DABCP) and of the American Board of Sleep and Breathing (DABSB).
We confirm treatment outcomes with sleep studies — not just symptom questionnaires.
We communicate directly with your sleep physician and primary care provider.
We do not accept or bill insurance directly. We provide all procedure codes so you can file with your insurance carrier and seek reimbursement on your own terms.
Sleep apnea is a chronic condition. We are here for annual monitoring and long-term care.