Dr. Liza Karamardian, DDS, treats snoring and obstructive sleep apnea with custom oral appliances, including the Vivos system. These appliances suit people who cannot tolerate CPAP, and people whose snoring turns out to be sleep apnea once a sleep study is done. At Los Gatos Dental Group, the first visit is a conversation about how you actually sleep, and adults and children are both welcome.
Sleep apnea means your airway narrows or closes over and over while you sleep. Each pause in breathing pulls your brain out of deep sleep so you can restart it, and you may not remember a single one. What you notice is the aftermath: a second coffee that does nothing and a partner who has quietly moved to the guest room. Untreated obstructive sleep apnea is linked with a higher risk of high blood pressure, heart disease, type 2 diabetes and depression, so a year of pushing through is not a harmless choice.
Sleep apnea is easiest to spot from the outside, so ask whoever shares your bed what they hear. Common signs include:
Snoring by itself does not mean you have sleep apnea. Apnea snoring tends to be loud and interrupted by pauses and gasps, and only a sleep study can confirm the diagnosis. The study counts how many times per hour your breathing stops or slows, called your AHI. An AHI of 5 to 15 is mild, 15 to 30 is moderate, and 30 or more is severe.
CPAP is still where physicians and insurers usually start for severe sleep apnea. An oral appliance is a strong option for milder apnea and for anyone who cannot keep wearing a mask, and Vivos takes a different approach to the same problem. Here is how the three compare.
| Oral appliance (nightly) | CPAP | Vivos | |
|---|---|---|---|
| Who it is for | Mild to moderate apnea, or people who cannot use CPAP | Moderate to severe apnea, and the usual starting point for severe cases | Adults whose sleep study shows apnea, and children through Vivos guides |
| How it works | Holds the lower jaw forward while you wear it | A bedside machine pushes air through a mask to keep the airway open | Gradually reshapes the jaw and airway so they stay more open |
| Comfort | Small and quiet, with temporary jaw soreness common at first | Mask and hose discomfort bother many people, and dry mouth is common | Removable, worn in the evening and overnight, about 12 hours a day in published data |
| Travel | Fits in a small case, no power needed | Needs power and carries more gear | Small and portable while you wear it |
| Nightly or long term | Works only while worn, so use is ongoing | Works only while used, so use is ongoing | Intended to change airway shape, so use is for a set treatment period followed by checkups |
| Typical timeline | A few weeks to make, then adjustments over the following weeks or months | Starts after a prescription and machine setup | About 10 to 15 months on average in published studies |
Some people do best with an appliance and CPAP together, so CPAP can run at a lower pressure. And if your sleep study points to severe apnea, we will tell you what we recommend and work alongside your physician instead of steering you toward a mouthpiece.
Many oral appliances work only while you wear them. The Vivos system, which we use, takes a different approach called Pneumopedics®: gentle, steady pressure that is intended to widen the palate and jaw gradually, so the airway has more room to stay open after active treatment. That is what airway-focused dentistry means in practice: looking at how the shape of your jaw and palate affects your breathing, not only at your teeth.
Vivos reports FDA clearance for its CARE line of removable appliances for adults with moderate to severe obstructive sleep apnea, used alongside CPAP or myofunctional therapy when needed. Which Vivos appliance fits you is decided after your records visit.
In published data, treatment averaged about 10 to 15 months. The data behind the FDA's severe sleep apnea clearance showed a median of 9.7 months, and a 2023 peer-reviewed review of adult cases found an average of 14.8 months, with individual courses ranging from 5 to 36 months. Dr. Karamardian gives you a personal estimate after your records visit. Treatment is nonsurgical, and results vary, so we repeat a sleep test to see whether your numbers have really changed.
An oral appliance or Vivos may suit you if your sleep study shows obstructive sleep apnea and you want an option besides a mask, or if you tried CPAP and could not stay with it. For severe apnea, physicians and insurers usually start with CPAP, and we will talk through whether a Vivos appliance makes sense alone or alongside CPAP or myofunctional therapy. Central sleep apnea is a brain signaling problem rather than a blocked airway, so an appliance does not replace CPAP there, and your physician guides that care. If you snore but have never been tested, start with a sleep study, because snoring alone does not tell us which problem you have.
If Vivos is not the right fit, we can make a simpler sleep appliance in our office, which works well for many people with mild or moderate apnea.
The Vivos program starts at $9,500. It is a comprehensive, data-focused treatment: we measure your airway and your breathing at the start with a cone-beam CT scan and a take-home sleep ring, and we repeat sleep testing so you can see whether your numbers have really changed. Your medical plan may cover part of it, and payment plans can spread the rest, as explained below.
Often, yes, but through your medical plan rather than your dental plan, because sleep apnea is a medical diagnosis. Ask your plan whether it covers oral appliances for sleep apnea and whether it requires prior authorization. Many plans also ask for a physician's diagnosis from a sleep study, a prescription for the appliance, and a record that CPAP did not work for you or is not recommended. Coverage varies by plan, and we cannot promise it.
We are a fee-for-service practice. Our team at Los Gatos, CA verifies your benefits and files claims for you, and you get a clear estimate before treatment begins, so you know your out-of-pocket cost up front. For the part insurance does not cover, we work with CareCredit and LendingClub, and sleep apnea therapy is one of the treatments those payment plans are used for. You can read more on our financing and insurance page, or ask the front desk about cost and benefits.
A sleep physician diagnoses sleep apnea, usually from a sleep study. If your doctor already referred you for an oral appliance, bring the referral and your results to the consultation. If you have not been tested, your physician can order a study, often as a home test. Insurance generally needs a physician's prescription for the appliance, and we repeat testing during treatment to see whether your numbers are improving, then share the results with your physician.
Children can have sleep-disordered breathing too, and it often looks like a behavior problem instead of tiredness. Signs include snoring, restless sleep, bedwetting, mouth breathing, swollen tonsils or adenoids, trouble focusing at school and slowed growth. Because a child's jaws are still developing, the Vivos guides can steer growth toward a wider airway when started early, in some cases as young as age 4. The guides are FDA-registered orthodontic devices worn mostly at night. Enlarged tonsils and allergies cause many cases of childhood snoring, so we recommend that your pediatrician or an ENT specialist weigh in as well. This short video from the nonprofit Right to Grow explains how a child's airway develops.
Dr. Karamardian leads sleep apnea care here and prepares your personalized report after the records visit. Because sleep care happens inside a full-service dental practice, the same team that knows your teeth and your bite also checks how an appliance is changing them. Adults and children can be treated under one roof, so a household that sleeps badly can get help together. Read Dr. Karamardian's full biography and watch the video below where she explains how she looks into your oral structures to identify signs of sleep apnea.
Picture waking before the alarm without dreading the day, and a partner who sleeps beside you instead of down the hall. Every year of broken sleep can add strain to your heart and your mood, so start by scheduling a sleep apnea consultation or call (408) 402-0900.
Call Us Now (408) 402 0900 Book an AppointmentIt depends on how severe your apnea is and what you will actually use. CPAP is usually the first choice for severe sleep apnea. An oral appliance suits milder apnea and people who cannot tolerate a mask, and it is quiet and easy to travel with. Your sleep study and your physician help decide, and some people use both.
Most mouthpieces move the lower jaw slightly forward, which keeps tissue at the back of the throat from collapsing and vibrating. Vivos appliances work on the shape of the palate and jaw over time instead. Either way, the appliance should be custom made and monitored by a dentist trained in sleep medicine. Boil-and-bite guards from a drugstore are generally not recommended for treating sleep apnea.
Often, yes. Sleep apnea is a medical diagnosis, so oral appliances are usually billed to your medical plan rather than your dental plan. Plans commonly ask for a physician's diagnosis from a sleep study, a prescription, and sometimes proof that CPAP did not work for you. Coverage varies, so ask your plan about prior authorization before you start.
The Vivos program starts at $9,500 and covers comprehensive, data-focused treatment. Some medical plans cover part of the cost, and CareCredit and LendingClub payment plans can spread the rest. We verify your benefits and give you a clear estimate before treatment begins, so you know your out-of-pocket cost up front.
In published studies, Vivos treatment averaged about 10 to 15 months. The data behind the FDA's severe sleep apnea clearance showed a median of 9.7 months, and a 2023 peer-reviewed review of adults found an average of 14.8 months, with courses ranging from 5 to 36 months. Dr. Karamardian gives you a personal estimate after your records visit.
Vivos reports FDA clearance for its CARE line of removable appliances for adults with moderate to severe obstructive sleep apnea, used alongside CPAP or myofunctional therapy when needed. Whether Vivos is right for you depends on your sleep study and your physician's advice.
A sleep study is how obstructive sleep apnea is diagnosed, and insurers usually require a physician's diagnosis. Many studies are now done at home with a small device. Home tests are slightly less sensitive than studies done in a sleep lab, so your physician may suggest a lab study if the results are unclear.
No. A standard night guard protects teeth from grinding but is not designed to keep your airway open. A sleep appliance is built to move or reshape the jaw position, and some can also protect against grinding. If you grind your teeth, tell us at your consultation, and see our TMJ and jaw pain care for related treatment.
No. Sleep dentistry usually means dental sedation, which helps anxious patients relax during a procedure. Sleep apnea treatment addresses breathing while you sleep, using a custom oral appliance worn overnight. We offer both, and you can read about our sedation dentistry separately.