Sleep apnea might not sound so bad if you don't have it.

Sleepless nights and drowsy days aren't the worst of it, though.

Marked by extreme snoring broken by spells of gasping for breath, sleep apnea often bothers a bed partner as much as the patient.

Over the years, sleep apnea sufferers have complained that treatments are too uncomfortable and impractical to make them worth the trouble.

Now, a new device designed to stem snoring and sleepless nights caused by sleep apnea is getting rave reviews from local patients who say its near-instant relief is nothing short of a cure.

"I love it. It's fantastic," said Julie Cooper, 58, of Mountville, whose mild sleep apnea left her foggy during the day and tossing and turning at night. On trips, she'd have to be paired in hotel rooms with girlfriends who didn't mind her loud snoring.

Two months after dentist Ronald Reinmiller of Landisville fitted her with one of the newest oral appliances on the market, she's a new person.

"Now I don't snore; I don't toss and turn like I did," Cooper said. "Even my husband noticed it. And now I wake up refreshed — that was the main thing that bothered me."

•••

Obstructive sleep apnea occurs during sleep when throat muscles relax, causing them to collapse and block the airway. The result is cyclical periods of stopped breathing that usually last from 10 to 30 seconds but can go on up to a minute or longer. The patient jolts awake gasping for air, but often doesn't remember waking in the morning.

All that starting and stopping is hard on a good night's rest, not to mention a heart.

Sleep apnea patients often suffer crippling daytime fatigue, leaving them vulnerable to traffic accidents, depression, headaches and irritability. Over years, that starting and stopping can cause hypertension, stroke and heart disease, all of which can lead to early death.

Reinmiller, who also found relief for his mild sleep apnea using the device, is specially trained to fit patients with the appliance, which is similar to dental retainers for the lower and upper jaw. The adjustable device pulls the lower jaw slightly forward during sleep, keeping the airway open.

•••

Jason, a 32-year-old Lititz resident who preferred not to have his last name published, had had the device for only a few days when he was interviewed. But his girlfriend said she instantly noticed a difference in his sleep.

"You used to be able to hear my snoring in the street," he said. "Now my girlfriend said she thought I was dead while I was sleeping. I didn't make one sound."

Until now, standard treatment has been the continuous positive airway pressure, or CPAP, device. Introduced in 1981, it sends a steady flow of air into patients' noses and mouths through a mask connected to a CPAP machine.

Even with lighter, quieter machines, CPAP is a hard sell for the claustrophobic and those who find the mask cumbersome. And many complain that the device blows air on bed partners and isn't practical for travel.

Cooper's husband also has sleep apnea. He has a CPAP machine he doesn't use. And she is sensitive to latex, so she couldn't tolerate the CPAP nose mask against her skin.

But Reinmiller's patients have few, if any, complaints about the new oral appliance aside from some mouth pain after the first few nights of wearing it.

"When I first wore it, I had three teeth that hurt," said Reinmiller. "That drove me nuts. They hurt. But after a week, that went away. There is a period of acclimation, but for me, it was easy to decide."

Reinmiller said oral appliances to treat apnea have been around for the past 10 years or more. Of the 90 or so on the market, he said, "about 20 do what they're supposed to do, and about three of them are really great."

•••

What sets apart the SomnoMed model that his patients have worn successfully is that it can be ever-so-slightly adjusted by the patient to compensate for weight fluctuations, allergies or other changes. Many other models can be adjusted only by a dentist.

"It can be adjusted a maximum of 6 millimeters, but that's a huge distance dentally," Reinmiller said. "One-tenth of a millimeter can mean the difference between this thing working and not working."

Frances Jones, 68, of Millersville has been tested for sleep apnea, but hasn't received her results yet.

But she is using a SomnoMed appliance she got from Reinmiller in November to treat excruciating jaw pain from a TMJ disorder.

"It was just unbelievable," Jones said. "It was getting to the point where I wasn't sure I wanted to eat because my jaw was so painful. It just felt like it was going to lock."

Jones tried another oral appliance some years ago and said "it just didn't work," so she was skeptical when Reinmiller suggested she try the SomnoMed appliance.

"What really cinched it for me was when I got up the next morning and didn't have any pain," Jones said. "It's amazing. It's absolutely amazing. If someone had told me it would work, I would have said, 'No way.' But I hope other people give it a try because it really did help."

•••

Giving it a try won't be easy, however, even for those previously diagnosed with sleep apnea — unless they want to foot the entire bill.

Only medical doctors may legally diagnose sleep apnea, and they first have to perform a formal sleep study. And only specially trained dentists may fit someone for the $1,500 device, so physicians may be inclined to steer patients toward other treatment options, such as a CPAP machine. Often insurance companies require patients to first try CPAP because it's the standard treatment. Only if the patient can't tolerate CPAP will some insurers cover other treatments.

Reinmiller said a formal study required to diagnose sleep apnea is expensive, costing patients up to $2,000 unless insurance chips in. A CPAP machine runs about $2,000.

Reinmiller suggests that patients seeking a formal sleep study as a path to sleep apnea treatment make sure it is a "split study," with half the study conducted without any air device and the other half conducted with a CPAP machine. The portion of the study with a CPAP might qualify as enough of a trial to convince an insurance company to let the patient try other treatments, such as oral appliances.

To get their insurance companies to consider covering other treatment options, patients also may need to fill out a "CPAP rejection" form filed through their primary-care physician.

•••

Also complicating the situation is that Reinmiller and other dentists who fit oral appliances aren't familiar with the medical insurance forms that must be submitted to get coverage for the appliance. Plus, getting medical insurers to chip in on the cost of an oral appliance might be tricky.

Reinmiller said he's still getting his office staff acclimated to a whole new raft of medical insurance forms, so he doesn't know how readily insurers will cover the SomnoMed device, but he wants to get out the word that a new option is available.

"People need to know there are more treatments out there than a CPAP machine," Reinmiller said.

And for a handful of those already using the SomnoMed appliance, cost may be no object.

"We haven't crossed the insurance bridge yet," Cooper said. "But I would pay for it no matter what because it's worth it for me. Whether (insurance) pays for it or they don't, I'm happy."

E-mail: slindt@lnpnews.com