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Obstructive sleep apnea affects around 20 million Americans and can lead to hypertension, heart attack, stroke, depression, muscle pain, fibromyalgia, morning headaches, and excessive daytime sleepiness.

Friday, January 29, 2010

ARE YOU SICK AND TIRED OF BEING SICK AND TIRED?

PATIENTS WITH UNTREATED SLEEP APNEA ARE PRONE TO MANY NUMEROUS MEDICAL PROBLEMS FROM HEART ATTACKS,STROKES, SHORT TERM MEMORY LOSS, INCREASED MOTOR VEHICLE ACCIDENTS, WORSENING OF DIABETES, CORONARY ARTERY DISEASE, STRESS DISORDERS INCLUDING DEPRESSION AND MANY OTHER PSYCHIATRIC PROBLEMS.

THE MAJORITY OF PATIETS GIVEN CPAP ARE UNABLE TO TOLERATE IT OR ONLY WEAR IT FOR A FEW HOURS A DAY. CPAP IS THE GOLD STANDARD OF TREATMENT AND IS VERY EFFECTIVE WHEN USED ALL NIGHT/ EVERY NIGHT.

STROKES AND HEART ATTACKS USUALLY OCCUR IN THE EARLY MORNING HOURS 3-5 AM. PATIENTS WHO WEAR CPAP FOR ONLY A FEW HOURS HAVE USUALLY STOPPED USING THEIR CPAP BEFORE THEY REACH THIS HOUR WITH PEAK RISK FOR CARDIOVASCULAR EVENTS. IT IS CRITICAL FOR CPAP USERS TO WEAR THEIR CPAP FOR 7-7 1/2 HOURS A NIGHT.

PATIENTS WHO ARE INADEQUATELY TREATED OFTEN ARE TIRED AND MORE PRONE TO ILLNESS. IF YOU CANNOT TOLERATE CPAP TREATMENT OF YOUR SLEEP APNEA THAN AN ORAL APPLIANCE IS THE MOST SUCCESSFUL ALTERNATIVE TO CPAP. THERE ARE ALSO SURGICAL AND BEHAVIORAL METHODS OF TREATING OBSTRUCTIVE SLEEP APNEA INCLUDING POSITIONAL THERAPY AND WEIGHT LOSS.

IF YOU ARE SICK AND TIRED OF BEING SICK AND TIRED YOUR ANSWER IS TO TREAT YOUR SLEEP APNEA THOROUGHLY. IF YOU HATE CPAP COMFORTABLE ORAL APPLIANCES MAY BE A SOLUTION THAT WILL DRAMATICALLY IMPROVE YOUR QUALITY OF LIFE AS WELL AS PROTECT YOUR HEALTH.

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posted by Dr Shapira at 8:54 PM

Thursday, January 28, 2010

Morning Headacahes and Sleep Apnea

The two major causes of morning headaches are sleep apnea and night-time clenching and grinding. As much of 80% of grinding and clenching is secondary to sleep apnea. Patients who routinely wake with morning headaches need to be evaluated and treated if they have sleep apnea. Headaches that occur at waking but continue throughout the day are more likely related to TMJ disorders.

Oral appliances can treat sleep apnea at night but a different type of appliance can treat headaches, facial pain, migraines and jaw problems. Patients suffering from chronic headaches will find the I HATE HEADACHES site a valuable resource. The site focuses on how neuromuscular dentistry can relieve migraines andtension-type headaches, chronic daily headaches and sinus pain.

http://www.ihateheadaches.org

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posted by Dr Shapira at 6:45 PM

Wednesday, January 27, 2010

Dentures and oral appliances for treating sleep apnea

Do you have a CPAP device/snore preventer that can be used by a patient who is totally edentulous?

Yes there are appliances that treat apnea. The first class is TRD or tongue retaining devices. They are not my favorite but are an easy option for denture patients.

I prefer to stabilize dentures with implants which allows the use of any oral apppliance.

I make a custom appliance that is spring loaded to push the upper and lower denture in place while advancing the mandible. It is a custom appliance and has not been approved by the FDA so it cannot be marketed.

An interesting fact is some patients with sleep apnea sleep with their dentures out. In some patients, I just had one recently, just wearing your dentures while sleeping can cure apnea.

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posted by Dr Shapira at 6:42 PM

Monday, January 25, 2010

Bite Change with TAP 3 Oral Appliance Cures Sleep Apnea But Changes Your Bite. What comes next?

JIM:
I have a TAP3 appliance for OSA and I found that using it every night for 2 years changed my bite to where I could not get it back into alignment even using the little blue tabs every day. I am back on CPAP, but if you have any suggestions, I would love to hear them.

Dr Shapira Response: Bite changes often happen after long term year especially if patients do not do 2 minutes of exercise daily. I have a few thousand patients with oral appliances and rarely do they quit because of bite changes. Not wearing the appliance will often let bite settle back to its original position or possibly settle back incompletely.

I explain to my patients up-front about the changes because I hate surprises. The reasons that your bite changes is that it was pathological to begin with. The reason you had sleep apnea was due to a jaw relation that predisposed you to the problem. When you wore the appliance at night you corrected the 24/7 pathology eight hours a day. Your bite change is actually healing of the underlying pathology of your jaw position. Your apnea actually becomes less severe even when you are not wearing your CPAP. Therefore when they titrate you on CPAP it may be wrong in a few months. As your jaw returns to old position the apnea will worsen again. An advantage to a bite change is lower CPAP pressure initially.

Patients sometimes switch between oral appliances and CPAP to prevent bite changes (very effective) but in general dentists seem more upset by the bite changes than patients.

I have had many patients who report relief of neck pain, headaches, back pain, sinus pain and other problems and that pushing the bite back causes recurrence of symptom so they chose to ignore the exercises and let the bite changes happen.

When we treat patients with TMJ disorders or headaches we have them wear an appliance 24/7 and want the bite change an then if tx is successful make the new jaw position permanent with crowns, ortho or occlusal adjustment.

You did not say wether you are now wearing your CPAP all night - every night. Dying in your sleep or having a stroke is a big deal, a bite change is manageable.

The key to preventing bite changes is to do the exercises regularly from the beginning and continue. If bite changes begin discuss it with your dentist promptly.

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posted by Dr Shapira at 6:42 PM

Circadian Rhythm and How we Fall Asleep

When writing for a sleep apnea blog, it's impossible to not write about sleep, itself, and the mechanics of how we come to sleep and what happens while we sleep. If you are a sleep apnea sufferer, you may not even know you have this dangerous disorder, but your partner may notice that your breathing is stopping several times a night and you are gasping for air while you sleep. If this is the case, you should contact a sleep apnea specialist such as Dr. Ira Shapira in Gurnee, Illinois immediately, as sleep apnea can be a life-threatening condition but is treatable.

So, let's get back to sleep (or the topic of sleep that is). All humans have what is called a circadian rhythm, which is like an internal clock that tells us when we should be awake and when we should be asleep. The term "circadian" comes from the Latin "circa" which means "around" and "diem" or "dies" which means "day," so it literally means "approximately one day." Our Circadian rhythm is linked to the cycle of light and dark.

There are many health problems associated with disturbances in our circadian rhythm including seasonal affective disorder (SAD, ironically, is the acronym for this disorder) and delayed sleep phase syndrome (DSPS). Disruption to our circadian rhythm will most likely have a negative impact on us both mentally and physically.

During the day, a chemical messenger known as "adenosine" builds up as our bodies use energy, and the more adenosine that builds up, the sleepier we will feel around bedtime. Adenosine, working in combination with your natural circadian rhythm sends the message to your brain and body that it's time to sleep.

If you have difficulty sleeping, feel fatigued during the day, have anxiety and other health problems, or your partner states you gasp for air while you sleep, you may suffer from sleep apnea. Please contact Dr. Shapira today to schedule a thorough evaluation.

posted by Lynn at 11:48 AM

Sunday, January 24, 2010

ACNE from CPAP MASK

Question: I use the full face mask with cpap. It seems that where the mask contacts my face, acne breaks out. What causes this and what is best to treat the acne with?

Response: William, Acne from a CPAP mask is not uncommon. While most of my patients eventually switch to oral appliance I can offer a few suggestions.

1. Keep the mask and hoses scrupulously clean

2. A thin layer of Lanolin can be place on the ares where the mask contacts the face 1/2 hour before putting the mask on. The skin should be thoroughly washed and dried first.

Dr Shapira

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posted by Dr Shapira at 11:52 AM

I Can't Lose Weight? That common complaint may may mean you have a sleep disorder.

Control of metabolism is closely tied to the quality of sleep. Patients who find it very difficult to lose weight should consider being evaluated for sleep disorders. Poor sleep can cause weight gain and make weight loss all but impossible.

There are many mechanisms for these metabolic changes. Growth Hormone is produced primarily during our first period of Delta Sleep. If our sleep is disturbed from snoring, apnea or other causes at this crucial time production of Growth Hormone (GH) can be decreased of eliminated. In adults GH is responsible for converting fat to muscle.

Other hormones affected by sleep include insulin, cortisol, leptin and grehlin.

Insulin determines sugsr metabolism and poor control can cause weight gain and excessive hunger. Cortisol is a stress hormone and eating is freuently used to control stress when cortisol is not maintained at proper levels. Leptin and Grehli control hunger and satiet, both the desire to eat and the relief of hunger.

Patients with sleep apnea have less oxygen and metabolism is disturbed by oxygen desaturation.

Sleep apnea, Insomnia and insufficient sleep can all contribute to weight gain and make weight loss difficult or impossible.

Sleep apnea is dangerous not just because of cardiovascular consequences but also due to hormonal disturbances that frequently are caused by sleep disordered breathing.

Patient Response: The word Insomnia originated from the Latin word Insomis meaning sleepless. To put it in a better way it is a condition where one is unable to obtain sufficient sleep. For me Insomnia meant feeling stressed, lost, sad and feeling worthless.

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posted by Dr Shapira at 11:20 AM

Why Don't Sleep Doctors, Sleep Centers, Sleep Techs and DME's tell patients that CPAP fails most patients?

A Recent John Hopkins University study published in August 2009 in PloS Medicine has indicated that snoring with severe obstructive sleep apnea doubles the chance of premature deaths in men aged 40 to 70 years. PloS Medicine is a peer-reviewed open-access journal published by the Public Library of Science.

This is not new information but just another study showing the severe risks associated with untreated sleep apnea. Other facts are that patients with untreated sleep apnea have a six fold increase in motor vehicle accidents and they are more likely to die in their sleep that while exercising.

I see so many patients who are not being treated for sleep apnea because they hate CPAP or could not deal with problems associated with CPAP use. The Sleep Centers, Doctors , Sleep Techs and DME companies that fail to refer patients for alternative therapies must bear the brunt of responsibility. 60 % of patients abandon CPAP use but there is no concerted effort to refer them for oral appliances.

The real question is why aren't more patients referred for appliance therapy.

I think ignorance is the primary cause, many sleep professionals are unaware of the high success rates of oral appliances, and some just do not know much at all. There is a subgroup that has vested interests in CPAP prescriptions. The sleep centers are often own DME companies, Sometimes the doctor's wife or children own the DME company. I do not find this to be a problem as long as patients who do not tolerate CPAP are then referred for oral appliances or surgical intervention.

I have patients tell me that they are made to feel like it is their failure when they can't tolerate CPAP. They are not told the the majority of patients are CPAP intolerant and/or fail CPAP. CPAP is a excellent treatment for a significant number of patients with very high eficacy, unfortunately more patients fail with CPAP then succeed.

It is the makers or CPAP, Distributors and DME companies and all sleep professionals to honestly explain to patients that the majority of patients never learn to tolerate CPAP and to help them find alternative treatments.

Insurance companies are probably most at fault because they share a common interest with patients. Finding alternative treatments for patients who fail CPAP will save insurance companies enormous amounts of future medical expenses. Insurance companies are aware that oral appliances are more expensive than CPAP in the short run but pale compared to costs for treating heart attacks or strokes. Insurance companies should review their files and identify patients prescribed CPAP who do not order additional supplies. In all likely-hood these patients are not using CPAP and therefore are at a greatly increased risk not just of cardiovascular events but also faced increased risks related to diabetes, motor vehicle accidents, and other serious medical problems.

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posted by Dr Shapira at 8:48 AM

Friday, January 22, 2010

DEVELOPMENTAL CHANGES IN CHILDREN WITH SLEEP APNEA MUST BE ADDRESSED AFTER REMOVAL OF TONSILS AND ADENOIDS

A recent study in the International Journal of Pediatric Otorhinolaryngology looked at arch Maxillary (upper jaw) development in children with snoring and sleep apnea and evaluated changes after adenotonsillar surgery. The physical changes did not correct after surgery and these children were left with residual problems that could plague the for their entire life. The authors concluded " Dento-facial development in snoring children is not changed by adenotonsillar surgery regardless of symptom relief. If snoring persists or relapses orthodontic maxillar widening and/or functional training should be considered. Collaboration between otorhinolaryngologist, orthodontists and speech and language pathologists is strongly recommended."

It is essential that the pediatric and dental communities recognize that children do not grow and eliminate the problems of enlarged tonsils and adenoids but rather they experience distorted growth that must be corrected. Early diagnosis and treatment of airway is essential for proper dento-facial growth. The NHLBI considers sleep apnea to be a TMJ Disorder. Sleep Apnea, Snoring, Migraines, Tension Headaches, Chronic Daily Headaches and TMJ disorders all begin in a common developmental pathway.

Dental Sleep Meicine and Neuromuscular Dentistry are key in improving the quality of live of these patients as adults. Early intervention may greatly reduce the number of patients who develop these problems.

nt J Pediatr Otorhinolaryngol. 2009 Nov 23. [Epub ahead of print]
Development of craniofacial and dental arch morphology in relation to sleep disordered breathing from 4 to 12 years. Effects of adenotonsillar surgery.
Löfstrand-Tideström B, Hultcrantz E.

Department of Surgical Sciences, Division of Otorhinolaryngology, University of Uppsala, SE - 751 85 Uppsala, Sweden.
OBJECTIVES: To study the development of craniofacial and dental arch morphology in children with sleep disordered breathing in relation to adenotonsillar surgery. SUBJECTS AND METHODS: From a community-based cohort of 644 children, 393 answered questionnaires at age 4, 6 and 12 years. Out of this group, 25 children who were snoring regularly at age 4 could be followed up to age 12 together with 24 controls not snoring at age 4, 6 and 12 years. Study casts were obtained from cases and controls and lateral cephalograms from the cases. Analysis regarding facial features and dento-alveolar development was performed. RESULTS: Children snoring regularly at age 4 showed reduced transversal width of the maxilla and more frequently had anterior open bite and lateral cross-bite than the controls. These conditions persisted for most cases at age 6, by which time 18/25 had been operated for snoring. In most of the cases, surgery cured the snoring temporarily, but their width of the maxilla was still smaller by age 12-even when nasal breathing was attained. At age 12, the frequency of lateral cross-bite was much reduced and anterior open bite was resolved, both in cases and controls. The children who snored regularly at age 12 operated or not operated, showed a long face anatomy and were oral breathers (this applied even to those who were operated). The seven cases who were not operated and the five who were still snoring in spite of surgery at age 12, did not have reduced maxillary width as compared to the controls. CONCLUSION: Dento-facial development in snoring children is not changed by adenotonsillar surgery regardless of symptom relief. If snoring persists or relapses orthodontic maxillar widening and/or functional training should be considered. Collaboration between otorhinolaryngologist, orthodontists and speech and language pathologists is strongly recommended.

PMID: 19939470 [PubMed - as supplied by publisher]

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posted by Dr Shapira at 4:05 AM

SUDDEN ONSET HEADACHE WITH VOMITING AND DIZZINESS

I RECENTLY RECEIVED THIS POST FROM A PATIENT.

comments : i need a doctor who can help me what is wrong with my head for the last 3 weeks now. half of my head hurting and the pain in my head moves around. like my back head, everywhere part of my head. everyday day my heads hurt. and i vomet, feel dizzy. but right now i dont have a health insurance.

THIS IS IMPORTANT, IF A NEW HEADACHE UNLIKE ANY IN THE PAST SUDDENLY PRESENTS WITH SYMPTOMS SUCH AS DIZZINESS AND/OR VOMITING OR OTHER NEUROLOGICAL SYMPTOMS MEDICAL EVALUATION SHOULD BE DONE IMMEDIATELY.

MY RESPONSE
If this is a new type of headache that you have never had before you should have an immediate medical evaluation. It is important to establish that there are no serious organic problems. I would suggest having a neurologist evaluate you first.

IF THE HEADACHE IS NOT ORGANIC IN NATURE AND YOU RULE OUT SERIOUS CONDITIONS THE NEUROMUSCULAR DENTISTRY IS AN EXCELLENT MEANS TO PREVENT, ELIMINATE AND/OR ALLEVIATE MIGRAINES, TENSION HEADACHES, ETTH, CDH AND OTHER CHRONIC PROBLEMS. THE NEUROMUSCULAR DENTIST IS THE IDEAL PRIMARY CARETAKER FOR MOST CHRONIC HEADACHE PATIENTS. THE NEUROLOGIST IS ESSENTIAL IN EVALUATING UNDERLYING CAUSES. DRUG TREATMENT, PHYSICAL THERAPY, CHIROPRACTIC TREATMENT AND NEUROMUSCULAR DENTISTRY CAN ALL BE EFFECTIVE IN TREATING AND ARE DONE BY DIFFERENT PRACTITIONERS. NEUROMUSCULAR DENTISTRY (NMD)CORRECTS THE UNDERLYING PRIMARY CAUSE IN PATIENTS WHOSE HEADACHES ARE POSTURE RELATED TO THE HEAD, NECK AND JAW. THE NMD FREQUENTLY WILL WORK WITH THE OTHER MEDICAL SPECIALISTS FOR OPTIMUM RESULTS.

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posted by Dr Shapira at 3:50 AM

Wednesday, January 20, 2010

YOU CAN'T CATCH UP ON LOST SLEEP

A RECENT STORY ON THE NATIONAL SLEEP FOUNDATION WEBSITE QUOTES A HARVARD STUDY THAT "the effects of chronic sleep loss on performance and demonstrates that it is nearly impossible to "catch up on sleep" to improve performance."

THE NSF'S STORY ALSO STATES "According to the study, even when you sleep an extra 10 hours to compensate for sleeping only 6 hours a night for up to two weeks, your reaction times and ability to focus is worse than if you had pulled an all-nighter. This is not good news for shift-workers such as doctors, truckers, and law enforcement officers.

The bottom line is that there is no real way to recoup lost sleep.There are things shift workers can do to get quality sleep during their off hours, for example, wearing dark glasses to block out the sunlight on your way home, keeping the same bedtime and wake time schedule, even on weekends, eliminate noise and light from your sleep environment (use eye masks and ear plugs)."


I HIGHLY RECOMMEND THAT YOU VISIT THE NATIONAL SLEEP FOUNDATION WEBSITE, SIGN UP FOR THEIR E-MAIL ALERTS AND HELP THEM FINANCIALLY. THEY ARE FRIENDS OF ANYONE SUFFERING FROM SLEEP DISORDERS.

Web site: http://www.sleepfoundation.org

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posted by Dr Shapira at 7:49 PM

DEFENDING THE CHARGE: I HATE CPAP! ACCUSED OF MISLEADING PATIENTS

The following response was sent to me on the I HATE CPAP site and because it was from a Registered POLYSOMNOGRAPHIC TECHNOLOGIST I felt it should be posted and responded to. I would appreciate your feedback as well.

Madeleine H RPSGT

comments : How do you address criticisms that your website and information misleads patients with moderate to severe apnea? It is well documented that oral appliances are not effective for most patients with sleep apnea. It seems you efforts would serve patients better if you helped them adjust to CPAP versus feeding anxieties around the gold standard treatment for sleep apnea.

Dear Madeleine,

I take very seriously criticisms that I mislead patients because it is not true. All of the information that is found on the I HATE CPAP site is backed by scientific evidence. The American Academy of Sleep Medicine now considers oral appliances to be FIRST LINE TREATMENT for mild to MODERATE sleep apnea along with CPAP. Further, the AASM considers oral appliances as an alternative to CPAP for patients with severe apnea who do not tolerate CPAP. It is documented that oral appliances do work for severe sleep apnea but they may not be as effective as CPAP especially in the morbidly obese., That is why it is essential that all patients receiving an oral appliance have a follow-up sleep study to insure efficacy. I have had patients with severe apnea (indexes over 100 AHI with de-sats into 50-60's) with complete response to oral appliances. I also have patients that use combinations of CPAP and appliances to lower CPAP pressure from 24 cm or more of pressure (which can damage lung alveoli) to 6-8 cm pressure by combination treatment.

I believe it is cavalier attitudes that patients need to be taught to adjust to their CPAP are more dangerous. While it is true that CPAP is considered the Gold Standard it is only because compliance is not factored into success. Published studies show that the majority of patients abandon CPAP use and even patients who use CPAP average only 4-5 hours of nightly use not the 7 1/2 hours recommended. Strokes are most common in the early morning hours with Sleep Apnea, most patients have already quit using their machines by then. There is a subgroup of patients who love their CPAP from first use and are very successful with CPAP use. That group only makes up 25% of the total population. I do not want patients who are successful and happy with CPAP to abandon it, I am more concerned with the 75% of patients who are untreated or under-treated.

I have seen thousands of patients in the last 28 years of treating sleep apnea who were only offered CPAP so chose no treatment. These untreated patients are left to suffer severe medical consequences because they are not offered alternatives they can accept.

You should seriously consider that a full night of oral appliance use is probably far superior to CPAP that is not used or only used for a couple of hours. I do not feed anxieties of patients but I do recognize them. This website took its name from what patients who came to my office told me, "I HATE CPAP!"

I do not Hate CPAP, but I offer a comfortable alternative for patients who do hate it. My goal is for every patient to know all of the options available to treat their sleep apnea including changes in health habits, cpap, oral appliances, surgery position etc.

As you are probably aware the NHLBI considers sleep apnea to be a TMJ disorder. Please read their report "CARDIOVASCULAR AND SLEEP-RELATED
CONSEQUENCES OF TEMPOROMANDIBULAR
DISORDERS" http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf

If you talk to anyone who knows CPR you will be aware that the first step is to check airway and if the patient isn't breathing the airway is opened with a jaw thrust.

Ira L Shapira DDS, D,ABDSM, D,AAPM, FICCMO

I am posting you question and my response on the I HATE CPAP blog. I will not post your full name or e-mail unless you give me permission.

Madelaine H RPGST Response: Please note that "success" in most apnea studies is defined as 50% or greater reduction in AHI. This is not the clinical definition of "success", though, even as defined by the AASM and Stanford University's suggested protocols.

While oral appliances may be helpful for some patients, I hope your organization is responsible enough to inform patients when they could benefit from cpap or bipap treatment.

Thank you for your prompt response.

I define success as an AHI under 5 and ideally "0" and no snoring. For the majority of my patients we achieve that success though we sometimes have to cheat and combine positional therapy with oral appliance therapy.

The most difficult patient for oral appliances are the morbidly obese, Cheyne Stoke Breathing and Central apnea, and patients who have had severe pharyngeal scarring after UP3 surgery.

It is important to note that to get these high success rate we usually work with sleep techs who have been taught how to titrate an appliance. Rem supine sleep with high AHI on patients who must sleep on their back can be a difficult situation. I have many patients who we try to place on CPAP who again fail. In those patients oral appliances are used to make their disease less severe. Some treatment is better than no treatment. Many appliance patients that are "merely partially improved" polysomnographically have total relief of EDS and cognitive consequences during the day.

I also hope that all those involved with patient care recognize that less than 50% of CPAP patients continue use and are responsible enough to refer those who do not use CPAP for oral appliance therapy. CPAP success is defined as 4 hour use 4 nights a week in most studies and as you say this is not clinical success. 7- 7 1/2 hours nightly is needed for full benefit.

Dr Shapira

WHILE IT IS TRUE IT IS NOT ALWAYS POSSIBLE TO ACHIEVE 100% SUCCESS IN ALL PATIENTS THE MAJORITY OF PATIENTS WITH MILD TO MODERATE APNE ASHOW EXCELLENT RESULTS WITH ORAL APPLIANCE TREATMENT. PATIENTS OFFERED A CHOICE BETWEEN ORAL APPLIANCES CHOSE AN APPLIANCE 90-95% OF THE TIME. IN SOME CASESIT IS NECESSARY TO USE CPAP OR COMBINATION THERAPY SUCH AS TAP-PAP TO ACHIEVE COMPLETE CONTROL OF SLEEP APNEA.

APPLIANCE DESIGN IS ALSO VERY IMPORTANT AS WELL AS HAVING A DOCTOR WHO CAN "TROUBLESHOOT" A PATIENT WHO HAS LESS THAN COMPLETE CONTROL OF SLEEP APNEA. IT IS VITAL TO HAVE A FOLLOW-UP SLEEP STUDY TO INSURE THAT THE MEDICAL PROBLEM IS RESOLVED. SOME PATIENTS ARE RESISTANT TO DOING A FOLLOW-UP STUDY IF THEIR SNORING IS RESOLVED AND THEIR DAYTIME SYMPTOMS RELIEVED. POLYSOMNOGRAPHY AND APPLIANCE TITRATION COMBINED WILL LEAD TO SUPERIOR RESULTS. MADELAINE IS CORRECT THAT SOME DOCTORS AND PATIENTS DO NOT TAKE THE RESPONSIBLE ROUTE OF DOING FOLLOW-UP POLYSOMNOGRAPHY WHEN TREATING SLEEP APNEA.

Tom Farrell has left a new comment on your post "DEFENDING THE CHARGE: I HATE CPAP! ACCUSED OF MIS...":

Agree with the use of oral appliances as a potential treatment for SDB. Especially think the concept of combination treatment- cpap and an oral appliance- needs further study. Great idea.

As far as I know, most sleep labs- and most of the physicians who medically direct them- are strictly cpap-oriented. But I agree that all methods of relieving SDB should be evaluated when looking at treatment options.
Second: most people may not know this, but all registered sleep techs and any and all techs working in a hospital and/or accredited sleep facility are CPR credentialed, and in some cases ACLS certified.
My best to you,

Tom Farrell, BS, RPsgT, RPFT, CRT

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posted by Dr Shapira at 7:04 PM

Tuesday, January 19, 2010

Sleep apnea, including obstructive, central or mixed apnea, was present in 50%-70% of stroke patients

Should all stroke patients be evaluated for sleep apnea? The answer is yes according to a new study that showed that sleep apnea was present in 50-70% of stroke patients. Unfortunately when patients are diagnosed with sleep apnea they are usually placed on CPAP machines that are very effective but have historically have not been used by most patients. The authors stated "SDB, presenting with obstructive, central, or mixed apneas, is present in 50%-70% of stroke patients. We recommend screening for SDB in all stroke patients by respirography. Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive SDB, which reverses the vascular risk of the patients." The medical term for patients following medical advice is compliance. CPAP has very poor compliance, a recent study showed 60% of patients are non-compliant with CPAP. That means 60% do not use this life saving technology. Dental Sleep Medicine offers and alternative to CPAP. Oral appliances are preferred by most patients offered a choice of CPAP or Appliances and compliance is much higher than CPAP approaching 90-95%.

It is obvious that the authors of this article are not aware of the fact that the majority of patients are CPAP intolerant.

The NHLBI considers sleep apnea to be a TMJ disorder "CARDIOVASCULAR AND SLEEP-RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS " (http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf) and considers treatment essential.

Early diagnosis of sleep apnea may prevent a large number of strokes according to scientists. Heart Attacks and Stokes are two of the top three causes of death (cancer is third) and sleep apnea is highly associated with both conditions.

Neurology. 2009 Oct 20;73(16):1313-22.
Sleep-related breathing and sleep-wake disturbances in ischemic stroke.
Hermann DM, Bassetti CL.

Department of Neurology, University Hospital Essen, Essen, Germany. dirk.hermann@uk-essen.de
BACKGROUND: Sleep-related breathing disturbances (SDB) and sleep-wake disturbances (SWD) are often neglected in stroke patients. Recent studies suggest that they are frequent and have an impact on stroke outcome. METHODS: We review current knowledge about frequency, clinical presentation, and consequences of poststroke SDB and SWD, and discuss treatment options. RESULTS: SDB, presenting with obstructive, central, or mixed apneas, is present in 50%-70% of stroke patients. We recommend screening for SDB in all stroke patients by respirography. Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive SDB, which reverses the vascular risk of the patients. In the absence of controlled trials, CPAP treatment should be reserved for patients with severe obstructive SDB, daytime symptoms (e.g., sleepiness), or high cardiovascular risk profile. Oxygen and adaptive servoventilation may be used for central SDB. SWD including insomnia, disturbances of wakefulness (hypersomnia, excessive daytime sleepiness, fatigue), sleep-related movement disorders (restless legs syndrome, periodic limb movements during sleep), and parasomnias (REM sleep behavior disorder) are found in 10%-50% of patients. SWD are associated with cognitive disturbances and may compromise neurologic recovery. Hypnotics and sedative antidepressants may aggravate SDB and neurologic recovery and should be used with caution. For disturbances of wakefulness, dopaminergic drugs, modafinil, or activating antidepressants may be considered. Poststroke sleep-related movement disorders can be treated with dopaminergic drugs; REM sleep behavior disorder with clonazepam. CONCLUSIONS: Sleep-related breathing disturbances and sleep-wake disturbances are frequent conditions that affect stroke outcome. In view of existing treatment options, these conditions deserve the neurologist's awareness.

PMID: 19841384 [PubMed - indexed for MEDLINE]

T

posted by Dr Shapira at 8:47 PM

Are Arrhythmias and Atrial Fibrillation caused by Sleep Disordered Breathing and Sleep Apnea

This interesting article about research at Vanderbilt,"Triggering of nocturnal arrhythmias by sleep-disordered breathing events." in the J Am Coll Cardiol. 2009 Nov 3;54(19):1797-804 makes these significant conclusions: CONCLUSIONS: Although the absolute arrhythmia rate is low, the relative risk of paroxysmal atrial fibrillation and NSVT during sleep is markedly increased shortly after a respiratory disturbance. These results support a direct temporal link between SDB events and the development of these arrhythmias.

This actually is an example of how a Dental Sleep Appliance can be used to treat Arrythmias and Atrial Fibrilation by protecting a patients airway. Because the majority of patients with sleep apnea do not tolerate CPAP or BiPAP treatment it is absolutely essential that all sleep physicians and Cardiac physicians stress the dangers of sleep apnea and refer patients who do not tolerate CPAP for a comfortable alternative with oral appliances.

Patient with mild to moderate apnea should be offered a choice of CPAP or Oral Appliances at their initial evaluation. Unfortunately many sleep physicians automatically prescribe CPAP due to habit, ignorance or personal financial interests. Due the the increased success of oral appliances over CPAP when compliance is considered along with effectiveness it may be time to offer patients with mild to moderate apnea oral appliances as a first line treatment and CPAP as a back-up treatment. It has been established in numerous studies that the majority of patients (fail CPAP) or are CPAP intolerant. Other studies have also shown that patients offered a choice of Oral Appliances vs CPAP overwhelmingly prefer the comfortable oral appliances.


J Am Coll Cardiol. 2009 Nov 3;54(19):1797-804.
Triggering of nocturnal arrhythmias by sleep-disordered breathing events.
Monahan K, Storfer-Isser A, Mehra R, Shahar E, Mittleman M, Rottman J, Punjabi N, Sanders M, Quan SF, Resnick H, Redline S.

Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Comment on:

J Am Coll Cardiol. 2009 Nov 3;54(19):1810-2.
OBJECTIVES: This study sought to evaluate respiratory disturbances as potential triggers for arrhythmia in patients with sleep-disordered breathing (SDB). BACKGROUND: SDB is associated with an increased risk of atrial fibrillation and nonsustained ventricular tachycardia (NSVT) as well as a predilection for sudden cardiac death during nocturnal sleeping hours. However, prior research has not established whether respiratory disturbances operate as triggers for nocturnal arrhythmias. METHODS: Overnight polysomnograms from the Sleep Heart Health Study (n = 2,816) were screened for paroxysmal atrial fibrillation and NSVT. We used the case-crossover design to determine whether apneas and/or hypopneas are temporally associated with episodes of paroxysmal atrial fibrillation or NSVT. For each arrhythmia, 3 periods of sinus rhythm were identified as control intervals. Polysomnograms were examined for the presence of respiratory disturbances, oxygen desaturations, and cortical arousals within a 90-s hazard period preceding each arrhythmia or control period. RESULTS: Fifty-seven participants with a wide range of SDB contributed 62 arrhythmias (76% NSVT). The odds of an arrhythmia after a respiratory disturbance were nearly 18 times (odds ratio: 17.5; 95% confidence interval: 5.3 to 58.4) the odds of an arrhythmia occurring after normal breathing. The absolute rate of arrhythmia associated with respiratory disturbances was low (1 excess arrhythmia per 40,000 respiratory disturbances). Neither hypoxia nor electroencephalogram-defined arousals alone increased arrhythmia risk. CONCLUSIONS: Although the absolute arrhythmia rate is low, the relative risk of paroxysmal atrial fibrillation and NSVT during sleep is markedly increased shortly after a respiratory disturbance. These results support a direct temporal link between SDB events and the development of these arrhythmias.

PMID: 19874994 [PubMed - indexed for MEDLINE]

posted by Dr Shapira at 8:31 PM

Treating Diabetes with better sleep and treatment of sleep apnea

Researchers at the University of Chicago led by Dr. Renee Aronsohn say that they have shown a "clear, graded, inverse relationship between obstructive sleep apnea" Sleep apnea is characterized by repetitive episodes of interrupted breathing during sleep. This disorder when properly treated can control Glucose in patients with type 2 diabetes.

"Relative to patients without the sleep disorder, the presence of mild, moderate or severe obstructive sleep disorder significantly increased mean adjusted HbA1c values -- a measure of glucose control not affected by short-term fluctuations due to meals -- by 1.49 percent, 1.93 percent and 3.69 percent, respectively."

The study was published in the American Journal of Respiratory and Critical Care Medicine. The study showed that 77% of the sleep apnea patients had obstructive sleep apnea. Only 5 patients had previously been evaluated for diabetes and none had previous treatment. According to Dr Aronsohn's statment "Our findings have important clinical implications as they support the hypothesis that reducing the severity of obstructive sleep apnea may improve glycemic control," ;and "Thus effective treatment of obstructive sleep apnea may represent a novel and non-pharmacologic intervention in the management of type 2 diabetes."

This is an exciting study and once again shows how important oral appliances are for patients with sleep apnea. Because the majority of patients do not tolerate CPAP treatment it is essential that all patients are offered oral appliances as an alternative to CPAP.

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posted by Dr Shapira at 8:19 PM

TONSILS AND ADENOIDS CAUSING SLEEP APNEA.

My nearly 6 yr old son has developed sleep apnea nearly 1yr ago, we've seen an ENT who recommended T&A surgery. we decided not to have the surgery yet and leave it for last resort, now we have come to be desperate, he isn't sleeping very well at all. wondering if there is anything we need to know before going ahead with the surgery. thank you, looking forward to your response

DR SHAPIRA RESPONSE: I would encourage you to go ahead with the T&A ASAP because rersearch has shown permenant changes in brain development associated with Apnea in children.

There is always risk associated with any surgery. The biggest risk is the general anaesthesia, I recommend having a pediatric anaesthesiologist for the surgery if one is available in your area. The surgery can have risks of post op bleeding but this is usually not a big concern.

I believe the T & A was the best thing we ever did for my sons health and welfare.

ADD ADHD, DYSLEXIA AND OTHER LEARNING AND BEHAVIORAL DISORDERS HAVE BEEN SHOWN TO HAVE HIGH CORRELATION TO SLEEP APNEA. IN FACT 80% OF ADD AND ADHD PATIENTS HAVE SLEEP APNEA. PROBLEMS LIKE DIABETES, OBESITY AND DEPRESSION ARE ALSO LINKED TO SLEEP APNEA.

IT IS IN THE BEST INTEREST OF CHILDREN TO HAVE EARLY TREATMENT OF AIRWAY OBSTRUCTION AND MAY HAVE MAJOR LIFETIME EFFECTS.

A NEW STUDY HAS SHOWN THAT URINE OR BLOOD TESTS MAY BE EXCELLENT SCREENIG TOOLS FOR PEDIATRIC SLEEP APNEA.


hello, and thank you for your quick response, we appreciate the advice, it's very reassuring and even relieving:). i'm not a big fan of surgery(i prefer to try the most natural routes first and leave it for last resort, plus I had a bad experience with the anesthesia myself a few years ago and have dreaded the idea of it ever since. I do realize that was just me and he will probably be fine. for the last couple of days we have been doing more sinus rinses and that has seemed to help him quite a bit with his sleeping but we'll still go ahead with the surgery... thanks again for the info, really appreciate it, sincerely The C....... family

I HOPE ALL GOES WELL WITH YOUR SON'S SURGERY AND I UNDERSTAND COMPLETELY. IT TOOK ME TWO YEARS BEFORE MY WIFE ELISE AND I FELT READY TO DO SURGERY. IN HINDSIGHT I AM SORRY I DID NOT HAVE IT DONE SOONER. SINUS IRRIGATION PRIOR TO SURGERY WILL MKE FOR AN EASIER RECOVERY. DR SHAPIRA

Response: very interesting! thanks! this is helpful, can't wait to share it with my husband. is there any research that shows he should just skip right to this mouth widening surgery instead of the T&A? I did read about that on your site, that it is a most effective solution to apnea. what is your recommendation?

Dr S response: Excellent Thought but you still need to do T&A. There was a presentation at the Baltimore meeting discussing doing widening first in ages as young as 2. The thought was less post op problems but this should probably be reserved for the most severe cases with high probability of post op problems.

response: once again, thanks sooo much:) feel so much more confident that we are doing the right thing for him, funny how someone else sharing their experience with you can do that, i guess that is one of the reasons the Lord puts "strangers" and there situations together GOD BLESS you and yours... keep up the helpful work, it's worth it to families like us:)

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posted by Dr Shapira at 7:37 PM

Sleep apnea,snoring,TAP 1,Somnomed, and Neuromuscular Dentistry

I recently treated a patient who a a continuous headache for over 50 years. I originally saw hew husband and my Schaumburg Chicagoland Dental Sleep Medicine Associates office to treat his sleep apnea with an oral appliance. We successfully treated his sleep apnea and in the process eliminated his snoring which she commented greatly improved her life. We then discussed her headaches and did spray and stretch with ethyl chloride and relieved her 50 year headache and gave her an Aqualizer appliance as a temporary "crutch" Her headache stayed away until the Aqualizer broke.

I nest saw "M" at my Gurnee office and did a diagnostic appointment and a diagnostic orthotic. Her next visit she reported being totally headache free. LIFE CHANGING! Over the last few months we have reconstructed her mouth to the position determined by the diagnostic orthotic and she remains headache free despite extremely high family stress due to medical issues.

Her grandchildren would ask her everyday "Do you still not have a headache."

We recently switched her husband from a Tap 1 appliance used for titration to a Somnomed Appliance.

Both of these patients had a TMJ problem with very different results.

He had apnea and she had headaches and both conditions resolved by changing the position of the jaw.

An interesting fact is that the treatment of sleep apnea by changing the jaw position is covered by medical insurance while treatment of headaches is not covered by by medical insurance.

There has been a concentrated effort by the insurance companies to limit treatment of a "female" problem TMJ and Headaches while no such limitation exists for "Male " Sleep Apnea.

Both of these conditions are found in men and women but apnea is more commonly found in males and headaches and TMJ disorders (TMD) in women. The NHLBI (National Heart Lung and Blood Institute) considers sleep apnea to be a TMJ disorder. Neuromuscular orthotics are more successful than drugs for treating headaches and have NO ADVERSE DRUG EFFECTS. IT IS TIME FOR INSURANCE COMPANIES TO TREAT FEMALE PATIENTS MORE FAIRLY.

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posted by Dr Shapira at 7:25 PM

Monday, January 18, 2010

Oral Appliances for Severe sleep Apnea

I have severe sleep apnea 56 per minute is your process appropriate?

The answer is yes, Oral Appliances are appropriate for treating severe apnea when patients do not tolerate CPAP. I have treated many patients with severe apnea successfully. The AASM and the AADSM consider oral appliances as a first line treatment for mild to moderate sleep apnea and an alternative treatment for severe sleep apnea. The TAP appliance is the most effective appliance , in my opinion, for severe sleep apnea.

It is vital to have a follow-up study to insure efficacy.

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posted by Dr Shapira at 7:01 PM

Weight Loss May Ease Sleep Apnea Symptoms

According to an article on the Website Medicine.net, losing some of those extra pounds may relieve or even cure your sleep apnea altogether. As you know, sleep apnea is a breathing/sleep disorder in which the sufferer stops breathing several times a night, possibly for several seconds each time. The most common type of sleep apnea, obstructive sleep apnea (OSA), affects millions of Americans and their partners.

A new study confirms that losing weight can significantly reduce sleep apnea symptoms in obese people. Some of the most common symptoms of sleep apnea include:

Fatigue
Memory problems
Concentration problems
High blood pressure
Diabetes
Stroke
Slowed metabolism
Anxiety
Depression
Mood swings
Decreased libido and impotence

Obese people who lost the amount of weight recommended by their treatment provider were three times more likely to experience a complete remission of their symptoms compared to those who lost no weight.

If you or your partner suffers from obesity and sleep apnea, there is help available to you. If you live in the Gurnee, Illinois area, Ira Shapira, D.D.S. can help you as he has helped countless other patients suffering with this potentially life-threatening disorder. Please contact our office today to schedule a thorough evaluation.

posted by Lynn at 11:58 AM

Tuesday, January 12, 2010

How is Sleep Apnea Treated?

Sleep apnea is a very common and very serious medical condition in which the sufferer experiences stoppages in breathing while he/she sleeps. People with sleep apnea may stop breathing for several seconds hundreds of time throughout the night. Needless to say, this condition can have some very serious side effects on the mind and body including:

Depression
Anxiety
High blood pressure
Fatigue
Mood swings
Short-term memory problems
Memory problems Attention problems
Dry mouth
Diabetes
Sore throat

We have become very well-known for our saying, "I hate CPAP," but, in actuality, we don't really hate CPAP; we just realize that it's terribly uncomfortable and inconvenient for the patient. For this reason, we provide our patients with a variety of treatment options for sleep apnea that are much more pleasant than CPAP. It is estimated that a very low percentage of people using CPAP actually tolerate it as directed. Some of the other sleep apnea treatments Dr. Ira Shapira, Gurnee, Illinois dentist and his patients have had great success with include:

Use of dental appliances
Behavior modification
Medication
Surgery

After a thorough evaluation, Dr. Shapira will discuss with you which treatment plan would be best for your needs and the severity of your case.

To learn more about treatments for sleep apnea, please visit the website of I Hate CPAP! today. Cosmetic dentist, Dr. Ira Shapira, and his dental team in Gurnee, Illinois will work hard to find the right treatment for you.

posted by Lynn at 9:31 AM

Positve feedback on Sleep Apnea Blog

I just happened to come across your blog. Nice posts. I like this one very much. They are more content oriented than the usual ones you find these days. And the best part is the simplicity in your posts and the language you use in them. I have added you to my favorites. And I will continue to pay frequent visits to your blog. Expecting more such quality stuff from you. Carry on

Thank You for your support. I am on a mission to make this vital information easily available and understood.

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posted by Dr Shapira at 4:46 AM

Monday, January 11, 2010

E-mail about sleep apnea from a reader

I received this e-mail and decided to add to this blog specifically because of the Stanford study quoted about truckers. I think it is important to let everyone in the transportation industry know about this important conference from the American Sleep Apnea Association "Sleep Apnea & Trucking Conference"

The following is from the ASAA site
"The impact of obstructive sleep apnea (OSA) on the health and safety of commercial truck drivers, as well as all transportation operators, has been a hot topic of discussion for years. While some progress is being made, much misinformation, policy confusion, and a lack of industry-specific research have prevented further progress on this important health and safety issue.

The Sleep Apnea & Trucking Conference 2010 is organized by the American Sleep Apnea Association and brings together trucking, regulatory, medical, insurance, legal and policy experts to provide accurate and reliable information about OSA diagnosis, treatment and compliance. This landmark event offers a forum for addressing key issues and guidance to improve driver health and safety, which can have a positive impact for the company.


Gain up-to-date, accurate and reliable information about sleep apnea and its bearing on trucking industry health and safety
Learn new cost-effective approaches to sleep apnea diagnosis, treatment and compliance
Receive a take-home resource toolkit with presentations, DVDs, reports, articles and materials to help company management address sleep apnea in their workplace
Interact with experts, colleagues and government officials to get your questions answered

Body mass index (BMI) guidelines
Interstate medical exams and enforcement
Affordability of diagnosis and treatment
Future research needs on prevalence and impact"

The following is the e-mail I received.


Although vastly underdiagnosed and virtually untreated, sleep apnea
can contribute to high blood pressure, cardiovascular problems and
strokes. It also can be deadly.

In one study, Stanford University researchers looked at 159 truck
drivers. They found that 79 percent had sleep apnea, and many were
unable to control when they fell asleep driving. In another study
looking at accidents in which drivers fell asleep at the wheel, 87
percent of the drivers died, taking with them one or two other
people.

Men suffer from the condition almost three times more often than
women, , in part because of anatomical differences in the upper
airways. But because many women who suffer from it are
post-menopausal, there is some speculation it also may be
hormone-related, he said.

The most common and severe form of sleep apnea is obstructive sleep
apnea. In many cases, it's caused by sagging muscles at the base of
the throat, enlarged tonsils, a small airway opening or a large
tongue, according to the American Medical Association Encyclopedia
of Medicine. In about 20 percent of cases, being overweight is a
major cause of the problem.

Obstructing the airway makes breathing labored and causes loud
snoring. If there is complete blockage, the breathing stops
altogether and the sleeper is briefly silent. This makes the
diaphragm and chest muscles work harder; the sleeper gasps and
briefly awakes as breathing is started again.

In central sleep apnea, the airway is opened but the diaphragm and
chest muscles don't work, perhaps because of a disturbance in the
brain's regulation of breathing during sleep, according to the AMA
encyclopedia.

If you suspect you're suffering from sleep apnea, talk to your
doctor, who may refer you to a lab where your sleep can be
monitored. Losing weight and avoiding alcohol before bedtime may
help. Wearing a mask attached to an air compressor that forces
oxygen into the airway is an effective treatment for severe cases.
And surgery that removes excess tissue from the throat is another
possibility.

Obviously the writer of this e-mail has not read the I HATE CPAP website. There are excellent alternatives to CPAP besides surgery

Dr Ira L Shapira

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posted by Dr Shapira at 9:57 PM

Friday, January 8, 2010

Kite Surfing in Aruba

I am learning to Kite Surf in Aruba. Shades of Kerry.

If I survive the experience so will my blog

posted by Dr Shapira at 7:06 PM

Cold Hands and Cold Feet During Sleep

Cold hands and feet are a frequent complaint in patients. The typical way patients attempt to treat it is an extra blanket, electric blankets, heated mattress covers or of a pair of socks. There is an easy cure for most patients that is inexpensive and extremely effective. The use of a heating pad placed on the stomach will overheat the bodies core and the bodies attempt to regulate temperature will cause vasodilation in the limbs. In simple English the body uses the arms, legs and head as radiators to disperse heat from the core. I have had patients who have spent years dealing with cold feet tell me they now kick off blankets becuase their feet ore too hot.

I have had diabetics who had ulcers and sores on their feet that would not heal tell me they finally healed after this little trick.

I have had patients with chronic leg pain and restless legs tell me that thos gradually eliminated the pain. I have heard similar stories from patients with carpal tunnel syndrome whose syptoms just disappear.

Why can such a simple treatment have such remarkable effects? When hands and feet are cold due to reduced blood flow every cell is partially deprived of oxygen and nutrition that the reduced blood flow no longer delivers. In addition there a decrease in the removal of toxic metabolic wastes in the tissues. The answer is that the body is designed to heal.

The above healing effect is similar into how headaches and muscle pain are relieved with Neuromuscular Dentistry (http://www.sleepandhealth.com/neuromuscular-dentistry) due in part to increased vascular flow to the muscles.

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posted by Dr Shapira at 3:26 AM

Wednesday, January 6, 2010

Treatment of OSA Can Benefit Heart Health

Patients who suffer from obstructive sleep apnea (OSA) often have enlarged and thickened hearts that do not pump as effectively as healthy hearts. OSA is a common sleep-related breathing disorder that has been linked to an increase risk of cardiac problems. People with sleep apnea may stop breathing for several seconds at a time hundreds of times during a night's sleep. There are many other symptoms associated with this life-threatening disorder including:

Fatigue
Anxiety
Depression
High blood pressure
Gastric reflux
Memory problems
Concentration problems
Diabetes
Dry throat
Impotence
Cognitive deterioration

In a study published in the Journal of the American College of Cardiology, it was found that, "Not only are the shape and size of the heart affected, the right side of the heart was dilated and the heart muscle on the left side was thicker in patients with obstructive sleep apnea. Treating the problem brought significant improvements in the affected parameters, as well as in symptoms, in a relatively short period of time of six months," according to Dr. Bharati Shivalkar.

There are treatments for OSA besides CPAP. Dr. Ira Shapira, a Gurnee, Illinois dentist, has treated countless patients with OSA with great success using oral appliances, behavioral changes, and medication. CPAP is not for everyone as it can be very uncomfortable and inconvenient.

If you or your partner suffers from OSA, please contact Dr. Ira Shapira in Gurnee, Illinois today to schedule a thorough evaluation.

posted by Lynn at 6:57 AM

Tuesday, January 5, 2010

Sleep as Life's 'Greatest Little Pleasure'

British Rank Sleep as Life's 'Greatest Little Pleasure'

There's no denying the benefits of a good night's sleep. We love waking up refreshed and ready for the day. According to a recent poll of 3,000 Brits, our friends across the pond agree. The poll, conducted by the British company Bachelors, found that a good night's sleep was voted the number one "greatest little pleasure in life," according to an article in the London Telegraph. Other items that topped the list include "finding a forgotten tenner (a $10 bill) in your pocket" and "cuddling up with a partner in bed." Bachelors spokesperson Rob Stacey told the Telegraph, "You can't beat the feeling of getting into bed after a long, hard day," adding, "And that feeling gets even better when you wake up feeling great and back to your normal self the following morning."

Helping people with sleep apnea is truly rewarding and this article from the National Sleep Foundation spells it out. There is nothing like waking up feeling great in the morning. Patients who suffer with CPAP never have this feeling. The 25 per centers, those who love their CPAP from the first day understand how treatment of Sleep Apnea improves their life. Those of you who visit the I HATE CPAP! website understand that CPAP is not "YOUR ANSWER". You do not wake up feeling great. I wish that oral appliances were the perfect answer for all of you, it isn't but studies repeatedly show that 95% of patients prefer comfortable oral appliances to CPAP when offered a choice. Please contact me and let me know what peeves you about CPAP. Those of you who love your CPAP understand that while it is a miracle for your life that CPAP may be torture for your loved ones.

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posted by Dr Shapira at 1:03 PM

Multi-prong approach to stop snoring.

How To Stop Snoring has left a new comment on your post "Pure Sleep: A Treatment For Snoring Not For Sleep ...":

"What a great blog.To stop snoring it is best to adopt a multi-pronged approach by addressing each factor in your quest for snore relief. Excess body weight, too much alcohol drinking, deviated septum, chronic nasal congestion are some of the common reasons why people snore. "

Thank you for your comment. I agree with you there are answers available and one you didn't list is sleep posture. Staying off you back can help both apnea and snoring. The hope is to find the best possible treatment for the each and every individual patient who snores or has sleep apnea.

posted by Dr Shapira at 6:21 AM