We offer a variety of treatment options for all sleep disorders at our facility. Obstructive Sleep Apnea (OSA) can be treated with a variety of different therapies, depending on the severity of the apnea. The gold standard for treating Sleep Apnea effectively is CPAP Therapy. We provide several different treatment therapies for Obstructive Sleep Apnea here at NorthStar Medical Specialists, including:

  • CPAP Therapy
  • Provent Therapy
  • Assessment and Referral for Oral Appliance

For patients suffering with insomnia, we offer Cognitive Behavioral Therapy for Insomnia.

PAP (Positive Airway Pressure) therapy is the gold standard for the treatment of sleep apnea. This treatment involves wearing a mask or nasal pillows system connected to a small portable airflow generator that delivers air at positive pressure. The PAP machine sucks in room air and pushes it through the tubing and mask. The air passes through the nose and into the throat, where the slight pressure keeps the upper airway open and prevents it from collapsing.

There are different types of PAP device that may be prescribed by a physician depending on the circumstances:

CPAP is the most common type of PAP device. These devices are generally prescribed for patients who have been diagnosed with Obstructive Sleep Apnea that is anywhere between the mild to severe range. CPAP stands for Continuous Positive Airway Pressure. These machines are also known as “set-pressure” devices since they are set at the minimal pressure needed to prevent apneas from occurring.

APAP, or Auto CPAP devices, are devices that change pressure to match the airflow needed to treat apneas throughout the night. These devices are often used temporarily if a patient is lieu of a CPAP titration sleep study in order for the sleep specialist to determine effective set pressure for the patient. These are not always recommended as long term solution, as the variability of the pressure throughout the night may be too much or too little at times.

BiLevel PAP devices provide higher pressure while breathing in, and lower pressure while breathing out. These devices are mainly used for patients who have obstructive sleep apnea, but are unable to tolerate a traditional CPAP due to difficulty exhaling on a continuous pressure.

ASV (Adapto Servo Ventilation) is the PAP device of choice for patients who have been diagnosed with Central Sleep Apnea or have a combination of both Central and Obstructive Sleep Apnea. This device can be thought of as a CPAP that can be switched to a ventilator mode as needed and can change instantly (on a breath by breath basis). During periods of central apneas, the machine decides how much pressure support is needed during each breath to match the patient’s average breathing pattern over the past three minutes of use. As the patient resumes their normal breathing pattern, the ASV machine will switch back to a traditional CPAP mode.

There are currently three basic types of PAP masks available for use with the PAP device:

NasalPillowNasal Pillows
are the smallest available mask option, which makes them a popular option for patients. The headgear needed for the mask is minimal and patients can sleep in a variety of positions easily. This mask consists of a small “pillow” which fits inside of the nostrils. Because the air is pushed straight into the nostrils, it is not well suited for higher pressures and can make the pressure feel more intense. Some people find it is more difficult to exhale using this type of mask or that it makes their nostrils feel sore. Some simply don’t like the feeling of something in their nostrils. (Mask shown is the Airfit P10)

NasalMaskNasal Masks
are a bit bigger than the pillows and consists of a cushion that goes over the nose and headgear. It is a good universal mask that can be used with any pressure. The pressure won’t feel as intense as with the nasal pillows and this option does not irritate the nostrils. (Mask shown is the Swift Nano Fx)

FullFaceMaskFull Face Masks
are a must for people who breath through their mouths at night. They are helpful when a patient has a cold, allergies, or otherwise can’t breath through their nose. This is the biggest/bulkiest of the mask options. It can also be challenging to get a good fit due to variations in face size and shape. There is also a higher chance of leaks while sleeping during a change in sleep position. (Mask shown is the Simplus)


Our CPAP Coordinator works with each patient to determine their options and preferences and find a mask with a good combination of comfort and fit.

If you are interested in getting started with CPAP therapy or learning if this treatment is right for you, please contact our office at 360-676-1696. You will start by having an initial consultation with one of our sleep specialists.

CPAP Options
NorthStar Medical works with several different CPAP vendors to provide a wide variety of options and for our patients. We currently offer the newest devices offered from ResMed, Fisher & Paykel, and Philips Respironics.

NorthStar Medical works with several different CPAP vendors to provide a wide variety of options and for our patients.  We currently offer the newest devices offered from ResMed, Fisher & Paykel, and Philips Respironics.

Oral Appliance

Oral appliances are an alternate method which may be used to treat obstructive sleep apnea.  These devices are primarily intended for patients who have the milder forms of sleep apnea, however, moderate and severe sleep apnea patients who have failed or refuse CPAP therapy may be candidates to use an oral appliance.   It also may be used in combination with other treatments for sleep apnea, such as CPAP, positional therapy or weight loss efforts.

oral-applianceAn oral appliance is a removable dental apparatus used at night, which fits similarly to a mouth guard or retainer.  The most common type of oral appliance is the mandibular device which moves and then holds the lower jaw in a protruded position during sleep, holding the airway open.

In order to receive an oral appliance, a patient must first be evaluated by a board certified sleep physician, who would determine if an oral appliance is an appropriate treatment.  If so, the patient would be referred to a dentist with specialized training in the manufacture and use of these devices, generally a dental sleep specialist.

A follow up sleep study may be recommended after the patient has been provided the appliance.  This study is used to test the effectiveness of the device in treating the patient’s sleep apnea.  Unfortunately, about one third of patients show no improvement of their sleep apnea while using the oral appliance.  CPAP therapy remains the gold standard in treatment of obstructive sleep apnea.

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Provent Therapy

provent_main1Provent therapy is a newer alternative treatment for patients who have been diagnosed with obstructive sleep apnea. Provent is simple to use but is not the right choice for everyone with obstructive sleep apnea. Although the most effective treatment is CPAP, other treatments such as Provent may be appropriate in certain circumstances. Variables such as the severity of the sleep apnea, the patient’s anatomy, the patient’s treatment preferences, insurance coverage, and the patient’s other medical problems all play a role in determining the if Provent would be an appropriate treatment.

The Provent device looks similar to a round Band-Aid. At bed time, the person with sleep apnea applies the one time use Provent device to each nostril. The Provent device acts as a one-way valve, allowing free flow of air during inhalation but partial restriction of airflow during exhalation. This causes an increase in pressure in the throat during exhalation, preventing collapse of the floppy part of the airway during sleep.

After a 7 to 10 day trial of Provent, a sleep study is performed with the Provent device in place to determine if it is controlling the sleep apnea. If it is reducing the sleep apnea severity to acceptable levels, the individual will then be given a long-term prescription for Provent.

We are excited to have this product available for our patients. If you are interested in hearing more about Provent, please contact our office and speak with one of our specialists at (360) 676-1696.


Insomnia can be a very frustrating, long-term condition, leaving some patients feeling like there is no relief in sight. Cognitive Behavior Therapy for Insomnia (commonly abbreviated as CBTi) is a safe, effective method for treating chronic insomnia without medication which has recently come into focus by the medical community. The National Institute of Health has endorsed this therapy. CBTi focuses on working to change the mental and behavioral factors which perpetuate insomnia and its effects.

Patients who undergo CBTi can expect to meet with their sleep specialist on a weekly basis. During that time your provider will conduct a series of assessments with you and then work with you to change the patterns which create your insomnia. Many patients experience relief in as few as four to six sessions, and the impact of the therapy has been found to continue to improve sleep months and years after the treatment has been completed.

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