As dentists, we have very precise routines for pretty much everything we do: scheduling, billing, patient care, and everything else. Creating a routine that appropriately screens patients for sleep testing is one of the easiest ways you can start making dental sleep medicine more available to your patients—and start improving more lives.
Part of the service we provide at Medical Billing for Dentists is a session that trains all members of your staff to be sleep health awareness advocates. It’s natural that your staff will be oral health advocates already, so adding this new dimension to the collective culture at your practice will require the intentional addition of new routines.
It’s really not enough to make your staff aware of the appliances you can offer patients. Rather, there needs to be an office-wide understanding of the full range of sleep health issues your patients may bring through the door. There also needs to be an office-wide implementation of new routines for starting the sleep health conversation with patients.
One of the easiest routines you can add is sleep health questions on the new patient questionnaire. This can be anything from one or two questions to a half a page, depending on what fits into your pre-existing materials. The important thing here is that new patients take notice of the fact that questions about sleep will be coming up at the appointment. Many patients will not have encountered this at the dentist’s office before, and it gives you an excellent opportunity to start a conversation about sleep health when they ask about it. Learn about the questionnaires and other forms we provide here.
You obviously don’t want to ask repeat-care patients to stop their routine appointments to fill out a sleep health questionnaire, so you’ll need a routine second pathway for introducing the subject. We’ve found the best way to do this is by having the hygienist ask the STOP questions during routine visits.
S – Snoring – Do you snore?
T – Tired – Are you often tired, even after getting a full night’s rest?
O – Observed – Has a spouse or someone else observed you choking or gasping in your sleep?
P – Pressure – Have you been diagnosed or treated for high blood pressure?
Training your hygiene staff in the best way to initiate the STOP questions is incredibly crucial to doing this right, and each person may perfect a different approach. Since this will be new territory for many hygienists, provide them with scripts they can use either verbatim or as inspiration for starting the conversation naturally. Role play different patient scenarios with your staff, and brainstorm ways to raise the topic in a way in which it will be heard and received positively. For example, if a patient is yawning and nodding off in the chair—this may remind your hygiene staff member to ask about his or her sleep habits, but it’s certainly not the best time to initiate a conversation about sleep health!
Ultimately, you want sleep health questions to be as routine as asking how frequently patients floss or whether they experience any dental pain. Finally, make it clear to hygiene staff that the STOP questions need to be a part of their routine from now on. Let them know you expect those questions to have been asked before you see each patient.
Your staff may already be enthusiastic about oral appliances, but we want them to be sleep health awareness advocates in a broader sense. What this means is that addressing sleep health is not just checking off boxes.
We see many patients who may have already done a sleep study and been recommended treatment, but, for whatever reason, are not adhering to the doctor’s recommendations. You may not get this information out of a patient by simply asking the STOP questions. By understanding the greater issues related to all sleep breathing disorders, we have the ability to make a genuine connection with patients in this situation and they may be open to new treatments as a result.
The truth is that many patients who have been recommended a CPAP machine do not use them, and are unaware there are alternatives. These patients always require a light touch, as no one wants to confess to their dentist that they are a “bad patient” for their doctor. Patients often face challenges adhering to medical advice, and a knowledgeable sympathetic ear can make them comfortable enough to seek treatment with a dental provider.
When you discover a patient has already done a sleep study there are three questions you need to ask:
These questions should always be asked conversationally, and patients who are complying should be congratulated for taking steps to correct their sleep breathing issues. For the patients who are not complying with a doctor’s recommended treatment, usually a CPAP machine, we suggest getting a copy of the sleep study—no matter how old it may be—so we can have a follow-up appointment to share other treatment options available to them. Many times, they are unaware that other treatment options even exist. If the patient is amenable, have him or her sign a medical release form then and there, so you can obtain a copy of their study (rather than asking the patient to dig it up on his own).
For patients who may have undiagnosed sleep breathing disorders, it’s critical we have options to offer them for testing. We also need to have information on hand, pre-printed and ready, to offer them before they walk out the door. This material should include local sleep clinics/facilities, as well as guidance on home sleep testing. Being a helpful source of information is the best way to establish your practice as resource for patients with sleep breathing disorders.
For more ways to screen patients for sleep testing and improve your dental sleep medicine practice, call me, Dr. Marty Lipsey, at 209-527-1995. By offering sleep apnea treatment to patients, you are in the business of improving and saving lives. That is a noble calling, and I’m here to help you succeed!