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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.

Tuesday, July 27, 2010

Treatment Options for Sleep Apnea

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 7:19 AM

Tuesday, July 20, 2010

FMCSA Medical Guidelines for OSA: What is right and what is wrong with these guidelines. HOW SAFE ARE TRUCKERS ON THE ROAD?

THE FOLLOWING WAS WRITTEN IN REPLY TO A TRUCK DRIVER QUESTIONING RULES OF FCSMA AND ADVOCATING ONLY THE USE OF CPAP. BECAUSE OF THIS DRIVER I ACTUALLY READ THRU THE RULES FOR THE FIRST TIME AND WAS APPALLED AT THE RECOMENDATIONS BECAUSE THEY ARE BASED ON FAULTY AND CONTRADICTORY STATEMENTS. I HAVE REPRINTED SECTIONS WITH MY COMMENTS. I BELIEVE THAT THERE IS AN UNFAIR BIAS TOWARD CPAP DUE TO IGNORANCE, COMFORT LEVELS, HISTORICAL STUDIES THAT LOOKED AT CPAP AS THE ONLY TREATMENT AND ENORMOUS AMOUNTS OF CASH THAT CPAP COMPANIES CONTROL. IF CPAP IS THE BEST TREATMENT IT SHOULD CERTAINLY BE USED BUT IT IS DISHONEST TO SAY MINIMAL TO PARTIAL TREATMENT WITH CPAP IS BETTER THAN COMPLETE AND EFFECTIVE TREATMENT WITH AN ORAL APPLIANCE. DENTAL SLEEP MEDICINE HAS AN IMPORTANT ROLE IN THE GLOBAL TREATMENT OF SLEEP APNEA.


I had not read the report "Expert Panel Recommendations Obstructive Sleep Apnea and Commercial Motor Vehicle Driver Safety" and have only read thru it briefly to this point. I do not know whether or not this report has been accepted by the Dept of Transportation and placed into written regulations. If it has been accepted as a DOT rule, I would absolutely advise every driver to follow these rules though they are seriously flawed based on research published after the date of this review. The medical review was seriously flawed an intellectually dishonest as I explain in some detail below. I will address this issue quite vocally. COMMENT: GUIDELINES ARE NOT NECESSARILY LAW.

I am 100% in favor of all patients, especially CMV drivers with OSA being treated totally. I also understand that yu were successfully treated with CPAP and I am sure from your discussion that you use it the recommended 7 1/2 hours every single night.

The report states that using CPAP 70% of nights for 4 hours a night is acceptable. It also states that AHI of 20 or less does not need to be treated. A paper presented 2 years ago at the Chest physicians meeting showed that patients with mild apnea and no symptoms of daytime tiredness had a 300% increase in MVA's with serious injury to one ore more occupants of vehicles.

The report states
"A diagnosis of obstructive sleep apnea, however, should not exclude all individuals with the
disorder from driving a CMV; certification may be possible in some instances. An individual with
a diagnosis of obstructive sleep apnea may be certified to drive a CMV if that individual meets
the following criteria:
– Has untreated obstructive sleep apnea with an AHI ≤ 20, AND COMMENT: THIS LEVEL OF UNTREATED APNEA SHOULD ABSOLUTELY PRECLUDE DRIVING....SLOWER RX TIMES THAN LEGALLY INTOXICATED
– Has no daytime sleepiness, OR COMMENT: THIS STATEMENT HAS BEEN SHOWN TO NOT BE A RELIABLE ASSESSMENT TOOL
– Has obstructive sleep apnea that is being effectively treated. " COMMENT: THIS IS WHAT ORAL APPLIANCES DO BUT IT MUST BE CONFIRMED BY FOLLOW-UP TITRATION BY POLYSOMNOGRAPHY!!!

"An individual with OSA who meets the requirements for certification described above should be
recertified on an annual basis, based on demonstrating satisfactory compliance with therapy. " COMMENT: THIS DOES MAKE SENSE WITH CPAP BUT ORAL APPLIANCE COMPLIANCE TESTING IS JUST COMING FORWARD. OBJECTIVE TESTING IS ONLY NECESSARY IF YOU BELIEVE TRUCK DRIVERS CAN NOT BE TRUSTED TO BE TRUTHFUL ABOUT APPLIANCE USE.

OBJECTIVE TESTING WILL BE AVAILABLE IN THE NEXT FEW MONTHS. STUDIES DONE COMPARING ORAL APPLIANCE COMPLINCE AND CPAP SHOW MUCH HIGHER COMPLIANCE WITH ORAL APPLIANCE THERAPY THAN CPAP. MORE IMPORTANT IS THE FACT THAT PATIENTS UTILIZE CPAP MORE FREQUENTLY AND FOR MANY ADDITIONAL HOURS AS A GROUP THAN CPAP USERS.

EFFECTIVE TREATMENT WITH ORAL APPLIANCE IMPIES THAT POLYSOMNOGRAPHY HAS SHOWN THAT APNEA IS ELIMINATED/SUCESSFULLY TREATED.

The next statement explains the folly of this report " Studies comparing individuals with
excessive sleepiness to those who do not have sleepiness find that having an apnea/hypopnea index ≥20
episodes/hour is a risk factor for excessive sleepiness (Pack et al. 2006). The expert panel thus believed
that individuals with an AHI <20 who were not excessively sleepy could be certified to drive." IF TRUCK DRIVERS ARE NOT TRUTHFUL ABOUT WHETHER THEY USE CPAP THAN YOU CERTAINLY CANNOT BELIEVE THAT THEY ARE TRUTHFUL ABOUT DAYTIME SLEEPINESS. THEREFORE IT WOULD MAKE SENSE THAT EVERY DRIVER WITH ANY LEVEL OF APNEA SHOULD BE REQUIRED TO HAVE BOTH MSLT AND MWT TESTING TO INSURE PUBLIC SAFETY.

I WOULD PREFER TO TRUST DRIVERS TO BE TRUTHFUL BUT IF WE DO NOT TRUST THEM TO BE TRUTHFUL ABOUT APPLIANCE USE THAN WE SHOULDN'T TRUST THEM TO BE TRUTHFUL ABOUT TIRDNESS.

THE NEXT ISSUE I HAVE IS IN THIS ASPECT
Guideline 2: Specific Guideline Statement 1 – Drivers who should be
disqualified immediately or denied certification
The Medical Expert Panel identified several populations of individuals who they believe should not be
certified or recertified as being medically qualified to drive a commercial motor vehicle. These
populations are:
• Individuals that report that they have experienced excessive sleepiness while driving, OR ARE THEY TRUTHFUL?
• Individuals who have experienced a crash associated with falling asleep, OR ARE THEY TRUTHFUL?
• Individuals with an AHI that is greater than 20, until such an individual has been adherent to
Positive Airway Pressure (PAP). They can be conditionally certified based on the criteria for
CPAP compliance as outlined in Guideline 3 OR
• Individuals who have undergone surgery and who are pending the findings of a 3 month post- operative evaluation.
• Individuals who have been found to be non-compliant with their treatment at any point, OR
COMMENT:
ACCORDING TO THIS IF A DRIVER MISSES CPAP 2 DAYS SHOULD BE DROPPED ...PERIOD.

• Individuals who have a BMI of greater than 33 kg/m2 (pending evaluation by a sleep study) (80percent of the panel)
COMMENT: THEY LATER DISCUSS GUIDELINES FOR CPAP USE THAT ARE INSUFFICIENT TO TREAT THE DISORDER 4 HOUR 70% 0F NIGHTS

The next section exposes how cost of tests is more important than safety of drivers and public
"One member of the expert panel was concerned that individuals with BMI between 30 kg/m2 and 33
kg/m2 were also at increased risk for OSA (Young et al., 1993). Dr Pack proposed that the cut-point for
determining who requires a sleep study be a BMI of 30 kg/m2. The other members of the panel were
concerned about the feasibility of this and noted that according to a recent study (Pack et al., 2006),
41.9% of truck drivers would have to be given only temporary certification, pending a sleep apnea
evaluation, based on this recommendation. If 33 kg/m2 is used, this number of drivers to be studied drops
substantially since 24.0% of drivers have a BMI greater than 33 kg/m2. Moreover, by focusing on this
group, the majority of the panel believed that we would identify the vast majority of commercial drivers
with severe sleep apnea. "
COMMENT: THE TESTING IS BEING LIMITED TO BMI OVER 33 BECAUSE AT 30 BMI TO MANY TRUCKERS MIGHT BE AFFECTED. THEREFORE IGNORE THE EVIDENCE.

IN TRUTH, TESTING OF 100% OF COMMERCIAL DRIVERS SHOULD PROBABLY BE CONSIDERED BECAUSE SO MANY PATIENTS WITH SLEEP APNEA DO NOT FIT THE "TYPICAL IMAGE" OF OVERWEIGHT BIG NECK ETC.

FROM REPORT "Risk factors for obstructive sleep apnea are:
– Advancing age
– BMI ≥28 kg/m2 NOTE BMI 28 BUT PREVIOUS THEY DID BMI33 CUT OFF
– Small jaw
– Large neck size (≥ 17 inches (male) ≥15.5 (female))
– Small airway (a narrow or edematous oropharynx)
– Family history of sleep apnea " COMMENT: THESE PATIENTS SHOULD ALSO BE TESTED!

COMMENT: ANOTHER FOOLISH ASPECT OF THIS REPORT CAN BE FOUND HERE
" Individuals recently diagnosed with OSA may be conditionally certified for one month during
which time they will be started on CPAP therapy. At the end of this month, they can be
conditionally certified for 3 months if compliance to CPAP is documented in the two previous
weeks. Compliance should be reassessed at 3 months. If at the three month assessment such an
individual demonstrates treatment compliance, that individual may be certified for a period of one
year. The commercial driver needs to receive information that if they stop using their CPAP
during this one year period, they should stop driving a commercial vehicle." COMMENT: A TRUCKER CAN BE BELIEVED HE IS UTILIZING CPAP IF HE USES IT FOR 3 MONTHS AND NO LONGER NEEDS MONITORING. WHY IS HE MORE BELIEVABLE THAN A PATIENT UTILIZING AN ORAL APPLIANCE. IF MONITORING IS NECESSARY WHY SHOULD IT NOT BE CONTINUALLY MONITORED?

THE ACCEPTED TREATMENT PROTOCOL"Minimally acceptable compliance is defined here as greater than 4 hours of use for at least 70% of the days, based on current standards of practice (Gay P, Weaver T, Loube D, Iber C.
Evaluation of positive airway pressure treatment for sleep related breathing disorders in adults.
Positive Airway Pressure Task Force; Standards of Practice Committee; American Academy of
Sleep Medicine. Sleep 29:381-401, 2006)." COMMENT: THIS IS WIDELY CONSIDERED INSUFFICIENT. 4 HOUR NIGHTLY USAGE MEANS THAT IN THE EARL MORNING HOURS WHEN HEART ATTACKS, STROKES AND OTHER VASCULAR EVENTS OCCUR THE PATIENT HAS ALREADY ABANDONED USAGE. THIS IS NOT THE AMOUNT OF TIME TO MAKE DRIVERS AND THE PUBLIC SAFE BUT IS AN ARBITRARY FIGURE USED IN RESEARCH TO DESCRIBE SUCCESSFUL TREATMENT. SUCCESSFUL TREATMENT WITH CPAP IS 7 -7 1/2 HOURS EVERY SINGLE NIGHT.

THE ONLY REASON THIS IS NOT USE IN RESEARCH IS BECAUSE USING THAT GUIDELINE CPAP WOULD BE A FAILURE FOR OVER 75% OF PATIENTS. APPROXIMATELY ONE IN FOUR PATIENTS ARE SUCCESSFUL WITH CPAP USING THOSE DEFINITIONS. THOSE ARE USUALLY THE SAME PATIENTS THAT LIKE CPAP THERAPY FROM THE VERY BEGINING

• Individuals with OSA who are treated with PAP must demonstrate compliance with treatment and
this must be documented objectively
– Compliance is defined as using PAP for the duration of total sleep time.
• Optimal treatment efficacy occurs with seven hours or more of use during sleep; however, four hours of documented time at pressure per major sleep episode is minimally acceptable. COMMENT: DO WE REALLY WANT LESS THAN OPTIMUM TREATMENT IN OUR DRIVERS? IS OPTIMAL TREATMENT WITH AN ORAL APPLIANCE LESS ACCEPTABLE THAN SUB-OPTIMAL TREATMENT WITH CPAP? WHY? THIS IS LUDICROUS. THE ONLY REASON THIS IS ACCEPTABLE IS IF ALL TRUCK DRIVERS LIE! IF A TRUCK DRIVER WOULD BE HEALTHIER AND SAFER BY UTILIZING AN ORAL APPLIANCE THAN THERE IS NO QUESTION HE OR SHE SHOULD BE ENTITLED TO THE BEST TREATMENT AVAILABLE FOR THEM BE IT CPAP, A COMFORTABLE ORAL APPLIANCE OR SURGERY.

• Based on current standards of practice, an acceptable CPAP use is at least 4 hours of use per night on at least 70% of nights. COMMENT: DOES THIS MAKE ANY SENSE TO YOU????

THIS IS THE STATMENT ON ORAL APPLIANCES
"• Dental appliances and surgery are considered to be potential alternatives to PAP for the treatment of
obstructive sleep apnea.
– Currently there is no method of measuring compliance among individuals treated with dental
appliances. Consequently, use of dental appliances cannot be considered an acceptable alternative" COMMENT: THE ONLY REASON ORAL APPLIANCES ARE NOT CONSIDERED ACCEPTABLE IS THERE IS NO COMPLIANCE MONITOR. MONITORS ARE COMING VERY SOON!
to PAP in individuals who require certification to drive a commercial motor vehicle for the purposes of interstate commerce. COMMENT: THE REASON COMPLIANCE MONITORS ARE NEEDED? BECAUSE THE GOVERNMENT AND EMPLOYERS BELIEVE THAT TRUCK DRIVERS LIE AND CANNOT BE TRUSTED. IS THIS TRUE? IF IT IS THEN ANY SUBJECTIVE REPORTING MUST BE DISCARDED.

THESE STATEMENTS ARE TRUE. "An alternative therapy to nasal positive airway pressure is use of intra-oral devices worn during sleep.
These devices reposition the mandible thereby increasing the size of the upper airway. The benefit of
these devices has been shown in randomized trials (Chan et al., 2007). However, not all individuals
benefit from this therapy and in some subjects OSA may get worse (Henke et al., 2000). There is,
moreover, no method currently available to monitor compliance with this form of therapy. Given this,
and the variable efficacy with this treatment, the expert panel took the view that this form of therapy
could not be recommended for use in commercial drivers as an acceptable treatment for OSA." COMMENT: THIS IS WHY IT IS NECESSARY TO TO DO TITRATION POLYSOMNOGRAPHY ON ALL PATIENTS. IF ORAL APPLIANCES DO NOT SUCCESSFULLY TREAT THE PATIENT THAN ALTERNATIVE TREATMENT MODALITIES ARE NECESSARY.

UTILIZING CPAP 4 HOURS A DAY INSTEAD OF SUCCESSFULLY TREATING PATIENTS ALL NIGHT IS FOOLISH AND STATISTICS SHOW THAT 60% OF PATIENTS ABANDON CPAP AND AVE USE IS 4-5 HOURS A NIGHT 4-5 NIGHT A WEEK. THIS IS INSUFFICIENT.

I AM SURE THAT TRUCK DRIVERS SEE THE FOOLISHNESS OF THE COMPARISON.

++++JUST ADDED TO THIS BLOG!! +++++++FROM THE DOT
Medical Advisory Criteria for Evaluation Under 49CFRPart391.41
Print
Note Unlike regulations which arecodifiedand have a statutory base, the recommendations in this advisory are simply guidance established to help the medical examiner determine a driver's medical qualifications pursuant to Section 391.41 of the Federal Motor Carrier Safety Regulations (FMCSRs). The Office of Motor Carrier Research and Standards routinely sends copies of these guidelines to medical examiners to assist them in making an evaluation. The medical examiner may, but is not required to, accept the recommendations. Section 390.3(d) of the FMCSRs allows employers to have more stringent medical requirements

THESE ARE MERELY RECOMENDATIONS; READ FROM DOT AT THE FOLLOWING SITE
http://www.fmcsa.dot.gov/rules-regulations/administration/medical.htm.

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posted by Dr Shapira at 8:44 PM

Sleep Apnea and Heart Disease

For quite some time, we have known the dangers of sleep apnea and how this disorder can adversely affect your general health and wellbeing. New research from the American Heart Association has found that adults with sleep apnea have more heart problems than those who do not have sleep apnea. Sufferers of sleep apnea will stop breathing in their sleep for seconds at a time, sometimes hundreds of time per night. The disorder can result in:

• Extreme fatigue
• Depression
• Anxiety
• Stroke
• Diabetes
• Insomnia
• Daytime sleepiness
• Cognitive problems
• Memory problems
• Weight gain
• High blood pressure
• Mood swings
• Impotence

According to the American Heart Association, men with severe OSA (obstructive sleep apnea) were 58% more likely to develop congestive heart failure than men without OSA. Researchers believe the connection between the two begins with the shutting off of air when you sleep. The lack of oxygen as you gasp for air sets the body into a panic, which raises blood pressure, stresses the heart, and puts sugar into the blood.

If you or your partner suffers from sleep apnea, there is help available to you. Please contact one of the highly trained sleep apnea dentists today to schedule a sleep apnea consultation.

posted by Lynn at 6:26 AM

Monday, July 19, 2010

TREATMENT OF OBSTRUCTIVE SLEEP APNEA BOOSTS MEMORY

Treatment of sleep apnea helps restore memory consolidation in adults with obstructive sleep apnea. The report was done with CPAP but similar results are should be expected with Oral Appliancs as well.

The study results indicated that patients treated with CPAP outperformed untreated OSA patients on overnight picture memory consolidation tasks. This suggests that CPAP is effective at recouping memory abilities that are impaired by OSA. The treated patients correctly identified more photographs after one night of sleep. I expect that similar rsults will be shown with Oral Appliance Therapy.

CPAP while effective is poorly tolerated by most patients unlike Oral Appliances that patients prefer.

"The most surprising result of our study, thus far, is the noticeable improvement in memory that CPAP patients experience," according to author Ammar Tahir of the Memory Laboratory at the University of Notre Dame in South Bend, Ind. "These results suggest the success of CPent of psychologyAP therapy in regenerating obstructive sleep apnea patients' memory deficits."

An intriguing discovery that obstructive sleep apnea patients utilizing CPAP therapy performed better on the memory task than a control group. The control group did not have OSA but may have had milder forms of airway resistance. This important finding could provide direction for future research to study the effect of diminished airwayon brain function and memory processes. Treatment with CPAP and oral appliances should be considered for even mild airway problems in my view.

It has long been known that tonsils and snoring were associated with lower school performance in children.This study looked at 113 adult patients between the ages of 33 and 65 years who were divided into three groups. The experimental group had used CPAP for at least three weeks. The baseline group were diagnosed with OSA but had not been utilizing CPAP.

The treatment of choice for mild to moderate OSA is CPAP or Oral Appliances but CPAP is still considered the first line treatment for severe apnea. CPAP is considered the Gol Standard despite being rejected by 60% of patients. Studies of this sort are usually done with money from the CPAP industry. CPAP manufacturers have a 4 1/2 billion dollar business and frequently pay for research grants. Studies that compare oral appliances with CPAP SHOW SIMILAR RESULTS WITH TREATMENT.

The fact that non-OSA patients performed lower than CPAP users suggests that we are underdiagnosing milder forms of airway disruption.

Oral Appliances are preferred 90-95 % of mild to moderate OSA patients.

A joint venture of the American Academy of Sleep Medicine and the Sleep Research Society, the annual SLEEP meeting brings together an international body of more than 5,000 leading clinicians and scientists in the fields of sleep medicine and sleep research. At SLEEP 2010 more than 1,100 research abstract presentations will showcase new findings that contribute to the understanding of sleep and the effective diagnosis and treatment of sleep disorders such as insomnia, narcolepsy and sleep apnea.

Abstract Title: Regeneration of overnight memory consolidation ability in CPAP patients
Abstract ID: 0101
Category: Learning, Memory and Cognition
Presentation Date: Wednesday, June 9, 2010
Presentation Type: Poster - #62
Presentation Time: 10:15 a.m. - 12:15 p.m.
Source: American Academy of Sleep Medicine

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posted by Dr Shapira at 7:47 AM

Sleep Apnea and Epilepsy

A third or more of epilepsy patients may suffer from sleep apnea, and the number may be even higher in cases of treatment-resistant epilepsy. Some researchers have suggested that treating sleep apnea may be an important step toward reducing the frequency of epileptic seizures. A recent case study by researchers in Brazil makes an important causal link between apneic events and epileptic seizures and suggest that all patients with treatment-resistant epilepsy should be evaluated for sleep apnea.

The study followed a 28-year old obese man who suffered both epilepsy and sleep apnea following brain trauma. They used a combination of EEG and polysomnography to monitor him for both seizures and apneic events. They detected both obstructive sleep apneas and central sleep apneas. They also found that there seemed to be a reinforcing effect between the two conditions. Sometimes apneic events were brought on by seizures, and sometimes seizures were brought on by apneic events.

As part of the case study, the researchers recommended that all epileptic patients whose condition is resistant to treatment, whether they present snoring or not, should be studied using a polysomnogram to determine both the presence of sleep apnea and what relationship it might have to their epilepsy.

Epilepsy is just one of many conditions that can be worsened by sleep apnea. If you have a medical condition that is resistant to treatment, it is possible that sleep apnea is a contributing factor. Consult with your doctor and contact the Snoring and Sleep Apnea Treatment Center in Gurnee, Illinois, to schedule a sleep apnea consultation.

posted by Lynn at 5:40 AM

Thursday, July 15, 2010

Lexi has left a new comment on your post "New Medicare Guidelines for CPAP":

We are currently doing research on CPAP compliance and Medicare converage. However, I cannot find a Medicare definition of CPAP Compliance. Could you please tell me where you found this information where Medicare defined CPAP compliance as, "at least 4 hours a night and wear CPAP 70% of the time for a 30 consequtive day period"?

Thank you in advance,
Alexia Adams

Dear Lexi,
I cannnot reply directly as you did not leave an e-mail address

This is from ResMed "CONTINUED COVERAGE BEYOND THE FIRST THREE MONTHS OF THERAPY:
Continued coverage of a PAP device (E0470 or E0601) beyond the first three months of therapy requires that, no sooner than the 31st day but no later than the 91st day after initiating therapy,
documentation of clinical benefit is demonstrated by:
Face-to-face clinical re-evaluation by the treating physician with documentation that symptoms of obstructive sleep apnea are improved; and,
Objective evidence of adherence to use of the PAP device reviewed by the treating physician.
*************
********Adherence to therapy is defined as use of PAP > 4 hours per night on 70% of nights during a consecutive thirty (30) day period anytime during the first three (3) months of initial usage.
If the above criteria are not met, continued coverage of a PAP device and related accessories will be denied as not medically necessary.
Beneficiaries who fail the initial 12 week trial are eligible to requalify for a PAP device but must have both:
Face-to-face clinical re-evaluation by the treating physician to determine the etiology of the failure to respond to PAP therapy; and,
Repeat sleep test in a facility-based setting (Type 1 study)." It came from
http://www.resmed.com/us/dealers/reimbursement/cpap.html?nc=dealers
For more info use Google search "medicare cpap coverage minimal usage for coverage" it was hard to find, I know it from many different sources.

Medicare has issued these new rules because they are tired for paying for CPAP that is not used. Statistics show only 60% of patients use CPAP long term and the fact that 4 hours a night is not acceptable treatment but it is certainly better than no treatment. Sleep Apnea is a dangerous and serious condition and most heart attacks and strokes are in the early morning hours when patients have abandoed their CPAP.

Dr Shapira

Dr Shapira

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posted by Dr Shapira at 6:54 PM

BITE CHANGES AND TOOTH MOVEMENT FROM SOMNOMED APPLIANCE

PATIENT;
I have been using somnomed dental appliance for several years. I love it, but it has moved my lower teeth forward and to the left so that I can't close my teeth together -- the top teeth go behind the bottom ones. Do you have suggestion for an appliane that might keep this from happening or maybe allow my teeth to go back to normal positioning? Thanks so much.

Dr Shapira Response
I have written a lot about tooth movement and bite changes with appliance use. It is important to do the exercises daily to prevent this type of problem. I frequently find that patients have stopped doing their exercises because their chronic headaches or neck pain went away as the bite changes.

I strongly advise that patients seek treatment from dentists trained in treating TMJ disorders. The American Academy of Sleep Medicine also Rx that Dental Sleep Medicine and Oral Appliances for Sleep Apnea be provided by dentists with extensive training in treating TMJ disorders. The AADSM does a very poor job of stessing this to new mwmbers, I stress it to doctors who take my Sleep Apnea treatment course. Personally, I Rx seeing a dentist specifically trained in Neuromuscular Dentitry. See my sister site www.ihateheadaches.org

I have seen many patients in whom we uoptimizee the bite changes by combining Neuromuscular treatment utilizing a daytime diagnostic orthotic with the sleep appliance. The NHLBI (http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf) considers sleep apnea to be a TMJ disorder and we combine treatment. Reconstruction via crown and bridge or orthodontics lead to a long term stable position. This frequently also corrects forward head position, chronic headaches, migraines and/or neck pain.

Oral appliances can have problems but they are minimal to the problems from untreated sleep apnea. An interesting fact is that CPAP also can move teeth but the movement is different than that caused by dental appliances.

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posted by Dr Shapira at 5:31 PM

Tuesday, July 6, 2010

CPAP and Memory in Adults with Sleep Apnea

According to Science Daily, CPAP therapy may provide a memory boost for adults who suffer with obstructive sleep apnea (OSA). Though CPAP has always been the gold standard in the treatment of this common, though very dangerous condition, CPAP is often uncomfortable and patient compliance is very low. While we don’t actually hate CPAP, we do believe there are alternate methods of sleep apnea treatment that are much more comfortable for the patient and therefore lead to more patient compliance.

CPAP stands for Continuous Positive Airway Pressure and is usually the first treatment modality prescribed in most sleep centers across the country. However, we have found great success with other treatments such as:

• Oral appliances
• Changes in behavior
• Changes in diet
• Medication
• Surgery

But according to a recent study, "CPAP helps restore memory consolidation in adults with obstructive sleep apnea." The findings were presented in San Antonio on June 9, 2010 at the 24th annual Associated Professional Sleep Societies LLC meeting. The study found that patients with OSA who were treated with CPAP outperformed patients who did not receive CPAP. The study used an overnight picture memory consolidation task as its tool of measurement. CPAP patients, after only one night of sleep, identified more photos than the patients who did not receive CPAP.

If you suffer from OSA, there is help available to you. You just need to contact us. There are dentists all over the country who are successfully treating patients with sleep apnea using a variety of treatment methods. After a thorough evaluation, your sleep dentist will decide which is best for you.

Please seek relief from the numerous symptoms of sleep apnea by contacting www.ihatecpap.com today to schedule an appointment with one of our world-renowned sleep apnea physicians.

posted by Lynn at 12:41 PM

Monday, July 5, 2010

SNORING IS NO LONGER A PROBLEM! ORAL APPLIANCES CAN CHANGE YOR LIFE!

If loud snoring is keeping your girlfriend or spouse awake I Hate CPAP has the answers you are looking for. Snoring can be cured with a comfortable oral appliance. The TAP 1 appliance has a volume control for your bedmate.

Ending your snoring may not spice up your sex life butit will stop you from riving your special someone out of the bedroom.

You can't blame someone for not wanting to sleep with ungodly noise. Would you want to sleep with a sub-woofer?

Find out more about how a comfortable oral appliance can end your snoring. Soring is certainly not a sexy attribute.

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posted by Dr Shapira at 7:14 PM

Sunday, July 4, 2010

Nasal Symptoms from CPAP Decreased with Heated Humidification. Patients Prefer Oral Appliances.

This blog entry is a reprint of a recent press release:

Nasal CPAP frequently causes problematic nasal symptoms including congestion, dry nasal tissues, nasal itchin, and sinus pain. A recent study showed that heated humidification decreases nasal inflamation.

FOR IMMEDIATE RELEASE

PRLog (Press Release) – Jul 03, 2010 – A recent study "Nasal inflammation in sleep apnoea patients using CPAP and effect of heated humidification." (see PubMed abstract below) looked at nasal symptoms caused by nasal CPAP. CPAP is considred the gold stanard of treatment but is rejected by 60% of patients accoring to recent studies. Many patients abandon CPAP in favor of Comfortable Oral Appliances http://www.ihatecpap.com The current study concluded that heated humidification "nasal obstruction of OSA patients on CPAP treatment is inflammatory in origin, and the addition of heated humidification decreases nasal resistance and mucosal inflammation. "

The percentage of patients who tolerate CPAP is usually determined by the initial experience with CPAP. CPAP suppliers should consider starting CPAP on all patients with the use heated humidification to improve compliance.

Many studies have shown that oral appliances have much higher compliance and patient satisfaction ratings than CPAP. There is a growing sentiment that for mild to moderate sleep apnea and snoring Dental Sleep Medicine and Oral Appliances should precede CPAP trial.

Oral Appliance compliance and patient satisfaction far exceeds those ratings for CPAP. Examples of many oral appliances can be found at: http://www.ihatecpap.com/oral_appliance.html

Patients in Chicago, Northern Illinois an Southern Wisconsin should contact Dr Ira L Shapira at Chicagoland Dental Sleep Medicine Associates for information and treatment of sleep apnea and snoring with a comfortable appliance.

Dr Shapira can be reached at 1-8-NO-PAP-MASK or thru his websites:
http://www.chicagoland.ihatecpap.com/
http://www.delanydentalcare.com/sleep_apnea.html
http://www.ihateheadaches.org
http://www.ihatecpap.com

Eur Respir J. 2010 Jul 1. [Epub ahead of print]
Nasal inflammation in sleep apnoea patients using CPAP and effect of heated humidification.
Koutsourelakis I, Vagiakis E, Perraki E, Karatza M, Magkou C, Kopaka M, Roussos C, Zakynthinos S.

Medical School of Athens University, Dept of Critical Care and Pulmonary Services, Evangelismos Hospital.
Abstract
Nasal continuous positive airway pressure (CPAP) can cause undesirable nasal symptoms such as congestion to obstructive sleep apnoea (OSA) patients, which symptoms can be attenuated by the addition of heated humidification. However, neither the nature of nasal symptoms nor the effect of heated humidification on nasal pathophysiology and pathology are convincingly known. Twenty patients with OSA on nasal CPAP who exhibited symptomatic nasal obstruction were randomized to receive either 3 weeks of CPAP treatment with heated humidification or 3 weeks of CPAP treatment with sham-heated humidification, followed by 3 weeks of the opposite treatment, respectively. Nasal symptom score, nasal resistance, nasal lavage interleukin-6, interleukin-12 and tumour necrosis factor-a, and nasal mucosa histopathology were assessed at baseline and after each treatment arm. Heated humidification in comparison with sham-heated humidification was associated with decrease in nasal symptomatology, resistance and lavage cytokines, and attenuation of inflammatory cell infiltration and fibrosis of the nasal mucosa. In conclusion, "nasal obstruction of OSA patients on CPAP treatment is inflammatory in origin, and the addition of heated humidification decreases nasal resistance and mucosal inflammation. Trial Registration clinicaltrials.gov Identifier: NCT00850876.

PMID: 20595158 [PubMed - as supplied by publisher]

# # #

Dr Shapira is the founder of I HATE CPAP LLC that promotes awareness of the dagers of sleep apnea and promotes the field of Dental Sleep Medicine.

He is a Diplomate of the American Board of Dental Sleep Medicine and founder of Chicagoland Dental Sleep Medicine Associates. He is a former Assistant Professor at Rush Medical School's Sleep center and has been involved in research and treatment of sleep apnea with oral appliances since the early 1980's.

Dr Shapira also founded I HATE Headaches LLC and the website www.ihateheadaches.org. He has several device and/or method patents on collection of stem cells from the jaws and developing wisdom tooth buds.

Dr Shapira is the Dental Section Editor of Sleep and Health Journal and has chaptered a chapter in a bmedical textbook on Anti-Aging Medicine.

Delany Dental Care was founded in 1984 as a general dental practice with special emphasis on treating sleep apnea, snoring, headaches, migraines and Temporomandibular (TMJ) disorders

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posted by Dr Shapira at 7:14 PM

Obstructive Sleep Apnea Is An Independent Risk Factor For Stroke. Prevent Strokes with Treatment!

This blog entry is a reprint of a recent press release:

A recent article looked at the severe medical problems associated with sleep apnea and found that apnea increased the risk of stroke. CPAP and Oral Appliances are accepted as First Line Treatments for Sleep Apnea and Snoring.

FOR IMMEDIATE RELEASE

PRLog (Press Release) – Jul 03, 2010 – A recent article "Is obstructive sleep apnea an independent risk factor for stroke?: a critically appraised topic." in Neurologist. 2010 Jul;16(4):269-73 (see PubMed abstract below) looked at the risks of sleep apnea. Their background information stated "Obstructive sleep apnea (OSA) is associated with hypertension, atrial fibrillation, coronary artery disease, congestive heart failure, and diabetes. These disorders are also risk factors for stroke"

Sleep apnea is a very dangerous condition and CPAP is usually the first line of treatment. Unfortunately the majority of patients refuse CPAP or abandon CPAP use. I HATE CPAP! is a frequent complaint among sleep apnea patients and many of these patients are never told that comfortable oral appliances (http://www.ihatecpap.com/oral_appliance.html ) are considered a first line treatment (along with CPAP) for mild to moderate sleep apnea. More than half of patients suspend CPAP completely. Even patients who use CPAP average only 4-5 hours a night not the recommended 7-7 1/2 hours. What is frightening is that most strokes occur in the early morning hours after the majority of CPAP users have discontinued use. The website http://www.ihatecpap.com offers valuable and timely information to patients who do not tolerate CPAP.

The raw data is quite scary with the authors rporting "he unadjusted analysis revealed that OSA (apnea-hypopnea index >5) was associated with stroke or death from any cause (hazard ratio, 2.24; 95% confidence interval [CI], 1.30-3.86; P = 0.004). The adjusted OSA analysis retained a statistically significant association with stroke or death (hazard ratio, 1.97; 95% CI, 1.12-3.48; P = 0.01). In separate unadjusted analyses, OSA was associated with death and stroke with relative risks of 1.68 (95% CI, 1.10-2.25) and 5.16 (95% CI, 3.72-6.60), respectively." and concluding that Obstructive Sleep Apnea " independently contributes to stroke risk."

It is incumbent medically-legally for sleep physicians to inform patients of the fact that CPAP has poor compliance overall and that part-time use may be dangerous as well. Should all physicians inform patients who have difficulties with CPAP about Dental Sleep Medicine.

Dental Sleep Medicine offers comfortable Oral Appliances that most patients prefer to CPAP. Oral Appliances are considered a first line treatment for mild to moderate sleep apnea and an alternative to CPAP for severe apnea when patients do not tolerate CPAP. It has been shown to be more efficacious and have lower morbidity than most surgical procedures. Surgery is not considered a first line treatment for sleep apnea, CPAP and Oral Appliances are first line treatment approaches according to the Academy of Sleep Medicine .
Patients in Chicago, Chicago Suburbs, Northern Illinois and Southern Wisconsin who feel they may be canidates for an oral appliance should contact Dr Ira L Shapira a Diplomate of The American Board of Dental Sleep Medicine and a Pioneer in the field of Dental Sleep Medicine.

CALL DR SHAPIRA TODAY! 1-8-NO-PAP-MASK Treat your Sleep Apnea and avoid the possibly severe medical consequences, including stroke.

http://www.chicagoland.ihatecpap.com/
http://www.delanydentalcare.com/sleep_apnea.html
http://WWW.IHATECPAP.COM
http://www.IHATEHEADACHES.org

Neurologist. 2010 Jul;16(4):269-73.
Is obstructive sleep apnea an independent risk factor for stroke?: a critically appraised topic.
Capampangan DJ, Wellik KE, Parish JM, Aguilar MI, Snyder CR, Wingerchuk D, Demaerschalk BM.

From the *Department of Neurology, Mayo Clinic, Scottsdale, AZ; daggerDepartment of Library Services, Division of Education Administration, Mayo Clinic, Scottsdale, AZ; and double daggerDivision of Pulmonary Medicine and Sleep Disorders Center, Mayo Clinic, Scottsdale, AZ.
Abstract
BACKGROUND:: Obstructive sleep apnea (OSA) is associated with hypertension, atrial fibrillation, coronary artery disease, congestive heart failure, and diabetes. These disorders are also risk factors for stroke. OBJECTIVE:: To determine whether OSA increases the risk of stroke independently of other cerebrovascular risk factors. METHODS:: The objective was addressed through the development of a structured critically appraised topic. This evidence-based methodology included a clinical scenario, structured question, search strategy, critical appraisal, results, evidence summary, commentary, and bottom line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and content experts in the field of sleep medicine and vascular neurology. RESULTS:: A large observational cohort study was selected and appraised to address this prognostic question. The unadjusted analysis revealed that OSA (apnea-hypopnea index >5) was associated with stroke or death from any cause (hazard ratio, 2.24; 95% confidence interval [CI], 1.30-3.86; P = 0.004). The adjusted OSA analysis retained a statistically significant association with stroke or death (hazard ratio, 1.97; 95% CI, 1.12-3.48; P = 0.01). In separate unadjusted analyses, OSA was associated with death and stroke with relative risks of 1.68 (95% CI, 1.10-2.25) and 5.16 (95% CI, 3.72-6.60), respectively. CONCLUSIONS:: OSA independently contributes to stroke risk.

PMID: 20592572 [PubMed - in process]

# # #

Dr Shapira is the founder of I HATE CPAP LLC that promotes awareness of the dagers of sleep apnea and value of Dental Sleep Medicine.

Dr Shapira is a Diplomate of the American Board of Dental Sleep Medicine and founder of Chicagoland Dental Sleep Medicine Associates. He is a former Assistant Professor at Rush Medical School's Sleep center and has been involved in research and treatment of sleep apnea with oral appliances since the early 1980's. Dr Shapira also founded I HATE Headaches LLC and the website www.ihateheadaches.org. He has several device and/or method patents on collection of stem cells from the jaws and developing wisdom tooth buds.

Dr Shapira is the Dental Section Editor of Sleep and Health Journal and has chaptered a chapter in a bmedical textbook on Anti-Aging Medicine.

Delany Dental Care was founded in 1984 as a general dental practice with special emphasis on treating sleep apnea, snoring, headaches, migraines and Temporomandibular (TMJ) disorders.

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posted by Dr Shapira at 7:11 PM

Occupational Medicine And Sleep Apnea Treatment. Creating a Safe and Healthy Workplace.

This blog entry is a a reprint of a recent press release about Slee Apnea and Occupational Medicine

Occupational Medicine is acutely aware of the importance of Sleep Apnea Treatment. Occupational Medicine Physicians recognize that poor CPAP compliance is a major problem for patients health and workplace safety.

A recent article "Obstructive Sleep Apnea Syndrome (OSAS): The role model of the Occupational Health Physician in specific clinical cases." (see PubMed abstract below) in Clin Ter. 2010 May-Jun;161(3):269-72 recognizes the importance of sleep apnea treatment in optimal health and as an ntegral part of Occupational Medicine.

The article states " they ( sleep apnea) are involved in reduction of working performances and increased risk of work accidents". Successful treatment is extremely important and CPAP is failing in that role. CPAP is extremely successful when it is used but recent studies show 60% of patients abandon CPAP use completely and even those patients who use CPAP average only 4-5 hours of daily use.

Oral Appliances are accepted by the American Academy of Sleep Medicine as a first line approach to treatment of mild to moderate sleep apnea. Dr Ira L Shapira a Chicago Dentist and Diplomate of the American Board of Dental Sleep Medicine has created the website http://www.ihatecpap.com to spread the word about Dental Sleep Medicine and about comfortable Oral Appliances that most patients prefer to CPAP.

Dr Shapira treats patients in Chicago, Chicago Suburbs, Northern Illinois and Southern Wisconsin. He works with accredited sleep labs across the Chicago metropolitan area.

Patients who desire oral appliance therapy should contact Dr Shapira at 1-8-NO-PAP-MASK OR THRU HIS WEBSITES.
http://www.chicagoland.ihatecpap.com/
http://www.delanydentalcare.com/sleep_apnea.html
http://WWW.IHATECPAP.COM
http://www.IHATEHEADACHES.org

Sleep apnea is a serious disease that can severely endanger your health and the safety of your workplace. CPAP while effective fails the majority of patients. Oral Appiances may be the first line treatment best accepted by patients with mild to moderate sleep apnea.

Clin Ter. 2010 May-Jun;161(3):269-72.
[Obstructive Sleep Apnea Syndrome (OSAS): The role model of the Occupational Health Physician in specific clinical cases.]
[Article in Italian]

Proietti L, Sciacchitano C, Strano S, Scifo N, Rapisarda V.

Dipartimento di Medicina Interna e Patologie Sistemiche, Sezione Medicina del Lavoro, Università degli Studi di Catania, Italia. proietti@unict.it
Abstract
Nowadays Sleeping disorders are a very interesting topic in Occupational medicine, they are involved in reduction of working performances and increased risk of work accidents (in work environment or while driving). Medical surveillance made from the Occupational Health Physician can be very helpful in early diagnosis of this kind of disease; during 2008 we fi nd out Obstructive Sleeping Apnea Disease (OSAS) in some Healthcare workers. We reported some clinical cases that show the role model of the occupational health physician in this kind of sickness. Our Experience shows the duty of Occupational health physician it's not limited to medical surveillance, but also to Health Promotion (as wrote in D.Lgs 81/08). This can be obtained by clinical and occupational solutions, like correct work shift planning and lifestyle changes; so the interest of the occupational physician have to be focused on introducing in medical surveillance also measures of health promotion regarding sleep disorders with the aim of preserving health condition in workers.

PMID: 20589361 [PubMed - in process]

Dr Shapira is the founder of I HATE CPAP LLC that promotes awareness of the dagers of sleep apnea and value of Dental Sleep Medicine.

Dr Shapira is a Diplomate of the American Board of Dental Sleep Medicine and founder of Chicagoland Dental Sleep Medicine Associates. He is a former Assistant Professor at Rush Medical School's Sleep center and has been involved in research and treatment of sleep apnea with oral appliances since the early 1980's. Dr Shapira also founded I HATE Headaches LLC and the website www.ihateheadaches.org. He has several device and/or method patents on collection of stem cells from the jaws and developing wisdom tooth buds.

Dr Shapira is the Dental Section Editor of Sleep and Health Journal and has chaptered a chapter in a bmedical textbook on Anti-Aging Medicine.

Delany Dental Care was founded in 1984 as a general dental practice with special emphasis on treating sleep apnea, snoring, headaches, migraines and Temporomandibular (TMJ) disorders.

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posted by Dr Shapira at 7:03 PM

Thursday, July 1, 2010

Longevity May be Shortened by Sleep Apnea

For the past eight years, researchers at Johns Hopkins University have studied the lives and sleep patterns of men and women between the ages of 40 and 70 years old. The study showed that about one-third of the people studied suffered from some form of sleep apnea. 8 percent of men and 3 percent of women in the study suffered from severe sleep apnea.

Sleep apnea occurs when the muscles in the throat become over-relaxed during sleep, closing the passageway and preventing the lungs from receiving the oxygen they need. When this happens, the brain wakes from sleep temporarily to open the passageway and give the body the air it needs.

For people with severe sleep apnea, or Obstructive Sleep Apnea (OSA), the brain can wake the body more than 30 times in just an hour. Obstructive Sleep Apnea prevents the brain from staying in deep, REM sleep, which allows it to rejuvenate and rest. The dangers of sleep apnea include high blood pressure, depression, and heart attack.

The results of the sleep research concluded that men aged 40 to 70-years-old who suffer from severe sleep apnea are twice as likely to die early than men who do not suffer from a sleep disorder.

To make sure you are not at risk of suffering an early death, or putting your body at risk for serious health side effects, please contact Gurnee, Illinois sleep dentist, Dr. Ira Shapira to schedule a sleep evaluation today.

posted by Lynn at 10:03 AM