Many primary care providers, when they suspect obstructive sleep apnea (OSA), refer patients to a sleep specialist for evaluation and at most will maintain existing CPAP prescriptions with annual refills. This leaves patients navigating months-long wait times for sleep studies, struggling with poorly tolerated therapy, or simply going untreated. We take a more comprehensive and proactive approach to both diagnosis and treatment.

Diagnostics – We offer convenient, mail-order home sleep studies that allow you to complete testing in your own bed rather than spending a night in an unfamiliar sleep lab. Our testing device meets AASM Type 1A criteria with 3% recording accuracy, placing it among the highest sensitivity home sleep tests available—as close as possible to in-lab polysomnography for detecting OSA. These FDA-approved devices provide accurate diagnosis of OSA severity and can be completed within days rather than waiting months for an in-lab study. For most patients with suspected OSA (without complex comorbidities like central sleep apnea or significant cardiac/pulmonary disease), home sleep testing is reasonably effective and far more accessible.

Medical Management – Weight Loss Therapies – For many patients, OSA is directly related to excess weight, particularly around the neck and upper airway. Even modest weight loss (10-15% of body weight) can significantly improve or even resolve OSA in overweight patients. We actively incorporate medical weight loss strategies into OSA management:

GLP-1 receptor agonists (semaglutide/Wegovy, tirzepatide/Zepbound) – These medications produce substantial, sustained weight loss (15-25% of body weight on average) and have been shown in clinical studies to significantly improve OSA severity. As patients lose weight on GLP-1 therapy, AHI (apnea-hypopnea index) often drops dramatically, sometimes to the point where CPAP is no longer necessary. For overweight patients with OSA, GLP-1s address both the metabolic dysfunction and the mechanical airway obstruction simultaneously.

Combination pharmacotherapy – For patients who need more aggressive weight loss, we can combine GLP-1s with other agents like bupropion, topiramate, metformin, orlistat, or naltrexone to maximize weight reduction and OSA improvement. These can also be used without a GLP-1 in case of insurance issues individually providing 3-4% weight loss.

Metabolic optimization – Weight loss not only reduces airway obstruction but also decreases systemic inflammation, improves insulin sensitivity, and reduces cardiovascular risk—all of which compound the benefits for OSA patients who frequently have metabolic syndrome.

For appropriate patients, medical weight loss can transform OSA from a chronic condition requiring lifelong CPAP into a resolved issue, or at minimum reduce severity enough to make PAP therapy far more tolerable at lower pressures.

Advanced PAP Therapy – BiPAP with ASV (Adaptive Servo-Ventilation) – While CPAP (continuous positive airway pressure) remains the standard first-line therapy, many patients find it poorly tolerated or experience inadequate symptom resolution despite technically “adequate” treatment. We offer BiPAP with ASV, a more sophisticated form of positive airway pressure therapy that has been shown to be superior to CPAP in both tolerability and symptom management.

Unlike CPAP, which delivers constant pressure, BiPAP ASV dynamically adjusts pressure breath-by-breath, providing different pressures for inhalation and exhalation while automatically adapting to your breathing patterns throughout the night. A randomized controlled trial by Barry Krakow and colleagues demonstrated that BiPAP ASV achieved significantly higher rates of symptom improvement compared to CPAP, with better resolution of insomnia, fatigue, and daytime dysfunction. The study showed that patients who had failed or struggled with CPAP often experienced dramatic improvement when switched to ASV technology. In particular for patients with insomnia, ASV lead to remission of 68% of cases compared to 24% on CPAP.

BiPAP ASV can be particularly valuable for patients with:

• CPAP intolerance or failure
• Residual daytime sleepiness despite “compliant” CPAP use
• Central or complex sleep apnea patterns
• Comorbid insomnia alongside OSA
• Difficulty tolerating high CPAP pressures

Surgical Options – Curative Approaches – For patients seeking long-term solutions rather than nightly device dependence, we provide detailed discussions of modern surgical treatments that can actually be curative, unlike older procedures (uvulopalatopharyngoplasty/UPPP, tongue reduction) that had poor success rates and significant morbidity.

Maxillomandibular Advancement (MMA) – The gold standard surgical treatment for OSA, with cure rates exceeding 85-90% in appropriately selected patients. This procedure advances both the upper jaw (maxilla) and lower jaw (mandible) forward, expanding the entire airway from the nose through the throat. Beyond curing sleep apnea, MMA often significantly improves facial aesthetics by enhancing jaw projection, improving facial balance, and creating a more youthful appearance. Unlike UPPP, which destroys tissue, MMA creates space—addressing the root anatomical problem.

Nasomaxillary Expansion (MSE/MARPE/FME/EASE) – As discussed in our allergies section, this procedure expands the upper jaw, widening the nasal passages and improving nasal breathing. For patients with OSA who also have nasal obstruction or midface deficiency, this can be combined with MMA or used as a standalone treatment. Like MMA, it may improve facial aesthetics while addressing the underlying skeletal restriction causing airway collapse. It is often used in combination with MMA as part of a two phase treatment.

We’re happy to discuss specific surgeons and orthodontists with expertise in these procedures and help you determine if you’re a surgical candidate. For many patients—particularly younger individuals tired of nightly devices, those with anatomical skeletal deficiency, or people who’ve failed conservative therapy—these surgical options represent a genuine cure rather than lifelong management.

Our approach is comprehensive: accurate and convenient diagnosis using the highest-sensitivity home testing available, medical management through weight loss when appropriate, optimization of PAP therapy (including advanced technologies that go beyond basic CPAP), and informed discussion of surgical options that can permanently resolve OSA while potentially improving facial structure and aesthetics.