Treatment of sleep apnea is vital to the health and welfare of patients diagnosed with sleep apnea. CPAP treatment was once the only treatment offered to most patient. This is no longer the case. Dental Sleep Medicine ofers comfortable oral appliances as a comfortable alternative to CPAP.
Most sleep physicians follow the AASM guidline and offer oral appliance therapy as a treatment choice. Some sleep physicians have not kept up with the research and are not aware that recent studies have shown that properly titrated cpap oral appliances can be as effective as cpa.
60% of all patients who try cpap cannot tolerate and discontinue treatment while 90-95% of patients are successful with oral appliance therapy. The majority of patients offered a choice prefer oral appliance therapy to cpap and most insurance companies now cover oral appliance therapy.
Coverage of sleep apnea treatment saves insurance companies money by reducing heart attacks and strokes, hypertension, aiding in diabetes treatment and reducing motor vehicle and work-place accidents.
Employers have found that employees who have had effective sleep apnea treatment have higher output, lower medical expenses, and fewer workplace accidents and worker compensation claims.
Some sleep physicians continue to bad mouth oral appliance out of ignorance or due to bad experiences with untrained dentists providing poor quality treatment in the past.
Many dentists do not understand the importance of follow-up polysomnography in all patients. Failure to follow proper protocols can put patients at risk.
Other physicians have financial intrests in DME companies and are loathe to lose the income sales of cpap and cpap supplies generate.
I provide Dental Sleep Medicine treatment with oral appliances to patiens in Southeast Wisconsin including Lake Geneva, Kenosha, Racine and Milwaukee. I am certified in Dental Sleep Medicine and a Diplomate of the American Board of Dental Sleep Medicine. I am a former Asistant Professor at Rush Medicak Schools sleep center and have over 25 years successfully treating sleep apnea with oral appliances.
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.
Showing posts with label oral appliances. Show all posts
Showing posts with label oral appliances. Show all posts
Saturday, March 5, 2011
Saturday, February 5, 2011
Childhood Sleep Disorderes, ADD, ADHD and other "Mental Disorders"
I was directed here from a childhood sleep forum after investigating the connection between sleep and ADHD and other mental illnesses from the book It's Not Mental and the blog on sleep being a causative factor.
I didn't know alternative devices to CPAP even existed, and have a family member who absolutely hates the CPAP and the parents will be very happy with the information you have provided.
Thank you!
Dr Shapira Response: Research is finding that sleep is involved in almost every physiologic and disease process to some extent. I believe that early intervention with young children willl make incredible changes in developing children. Research has shown that the speed of brain development is strongly affected by the quality of sleep (especially in the case of sleep apnea). Patients with undiagnosed and untreated sleep apnea have permanent changes in brain development.
Treatment of pediatric sleep apnea is often limited to removal of tonsils and adenoids and this can be a grave mistake. The developmental changes in the oral, nasal and pharyngeal tissues do not normalize after T&A surgery.
Orthopedic widening of the maxilla (and maybe mandible) is incredibly safe and effective in children should always be considered as part of the total treatment. It has also been suggested that Rapid Maxiallry Expmansion or RME be considered prior to removal of tonsils oradenois to reduce surgical risk and morbidity. I frequently build expansion into appliances that treat sleep apnea. The same bite changes that are considered problematic in some adults are actually beneficial to children wearing oral appliances.
Parents in the Midwest have access to Dr Alexander Golbin (http://chicagosbmi.com/about-us) who is a leading expert on children and sleep disorders. He wrote the book on Children's Sleep and was head of Child Psychiatry at cook County Hospital for 25 years. He is an excellent resource for parents of children with Autism, ADD, ADHD, and bedwetting and other developmental challenges.
I have an adult practice with the exception of children with sleep disordeers, TMJ disorders, TMD or chronic headaches. Chronic headaches in children and adolescents are almost always related to the stomtognathic sytem including teeth, jaws, jaw joints, jaw muscles, sinus regions and the all important Trigeminal Nerve.
I have thousands of visitors sent to my site from other health blogs and I thank you for listing my site on those blogs. We can improve the health and quality of life for patients
I didn't know alternative devices to CPAP even existed, and have a family member who absolutely hates the CPAP and the parents will be very happy with the information you have provided.
Thank you!
Dr Shapira Response: Research is finding that sleep is involved in almost every physiologic and disease process to some extent. I believe that early intervention with young children willl make incredible changes in developing children. Research has shown that the speed of brain development is strongly affected by the quality of sleep (especially in the case of sleep apnea). Patients with undiagnosed and untreated sleep apnea have permanent changes in brain development.
Treatment of pediatric sleep apnea is often limited to removal of tonsils and adenoids and this can be a grave mistake. The developmental changes in the oral, nasal and pharyngeal tissues do not normalize after T&A surgery.
Orthopedic widening of the maxilla (and maybe mandible) is incredibly safe and effective in children should always be considered as part of the total treatment. It has also been suggested that Rapid Maxiallry Expmansion or RME be considered prior to removal of tonsils oradenois to reduce surgical risk and morbidity. I frequently build expansion into appliances that treat sleep apnea. The same bite changes that are considered problematic in some adults are actually beneficial to children wearing oral appliances.
Parents in the Midwest have access to Dr Alexander Golbin (http://chicagosbmi.com/about-us) who is a leading expert on children and sleep disorders. He wrote the book on Children's Sleep and was head of Child Psychiatry at cook County Hospital for 25 years. He is an excellent resource for parents of children with Autism, ADD, ADHD, and bedwetting and other developmental challenges.
I have an adult practice with the exception of children with sleep disordeers, TMJ disorders, TMD or chronic headaches. Chronic headaches in children and adolescents are almost always related to the stomtognathic sytem including teeth, jaws, jaw joints, jaw muscles, sinus regions and the all important Trigeminal Nerve.
I have thousands of visitors sent to my site from other health blogs and I thank you for listing my site on those blogs. We can improve the health and quality of life for patients
Thursday, November 25, 2010
WHAT IS THE GOLD STANDARD OF TREATMENT FOR SLEEP APNEA?
THE QUESTION OF WHAT IS THE BEST SLEEP APNEA TREATMENT IS ACTUALLY A VERY POOR QUESTION. THE CORRECT QUESTION IS WHAT IS THE BEST SLEEP APNEA TREATMENT FOR A SPECIFIC PATIENT. Most patients prefer oral appliances to CPAP.
CPAP or Continuous Positive Air Pressure has long been considered the "Gold Standard" for treating sleep apnea. It is extremely effective when patients use it but patient compliance has always been a major problem It is interesting that the NHLBI lists oral appliances before CPAP. (See website info below) but also says that oral appliances are for mild apnea and snoring while it has now been shown that when properly titrated Oral Appliances are equally effective to CPAP for treating mild to moderate sleep apnea. Oral Appliances are also considered to be an alternative to CPAP when it is not tolerated.
The NHLBI website states
"The goals of treating sleep apnea are to:
Restore regular breathing during sleep
Relieve symptoms such as loud snoring and daytime sleepiness
Treatment may improve other medical problems linked to sleep apnea, such as high blood pressure. Treatment also can reduce your risk of heart disease, stroke, and diabetes."
Approximately one in four CPAP users actually meet those goals. Those patients generally adapt easily to CPAP and rarely go without using it. 60% of patients abandon CPAP entirely and 15% struggle with it and use it in less that effective manner. It is the 75% that are not adequately treated with CPAP that usually utilize oral appliances or surgery. Oral Appliances are also not tolerated by everyone and patients need significant numbers of teeth or implants to use many types of appliances. While most patients prefer oral appliances to CPAP there are some patients who do not tolerate appliances and must seek alternative treatments.
This Goal statement is a very interesting statement. Is use of CPAP a restoration of "Normal Breathing" or "Regular Breathing" ? I would propose that an effectively titrated oral appliance actually restores both regular and normal breathing. CPAP breathing is not "normal" trhough it may be regular. BiPAP breathing is probably closer to "normal" breathing.
Secondly treatment should relieve snoring and daytime sleepiness. Daytime sleepiness is an interesting aspect as it can be measured subjectively (patient opinion) or objectively by MSLT (multiple sleep latency test) or MWT (Maintenance of Wakefulness Test)
Patients utilizing oral appliances frequently report being more rested with an oral appliance than when treated with CPAP even when the CPAP machine gave more complete resolution of AHI. This may be a difference between regular and normal breathing.
The statement "Treatment may improve other medical problems linked to sleep apnea, such as high blood pressure. Treatment also can reduce your risk of heart disease, stroke, and diabetes" is extremely important. Treatment of sleep apnea has numerous health benefits. These benefits are achieved with CPAP, Surgery and Oral Appliances.
The NHLBI site also discusses that some patients may benefit from surgery. It is important to note that the surgery must meet the goals stated. Soft palate surgery does not restore regular breathing and should be cosidered adjunctive surgery not curative surgery.
THE FOLLOWING INFORMATION IS TAKEN FROM THE NATIONAL HEART LUNG AND BLOOD INSTITUTE WEBSITE http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_Treatments.html
How Is Sleep Apnea Treated?
Lifestyle changes, mouthpieces, breathing devices, and surgery are used to treat sleep apnea. Medicines typically aren't used to treat the condition.
The goals of treating sleep apnea are to:
Restore regular breathing during sleep
Relieve symptoms such as loud snoring and daytime sleepiness
Treatment may improve other medical problems linked to sleep apnea, such as high blood pressure. Treatment also can reduce your risk of heart disease, stroke, and diabetes.
If you have sleep apnea, talk with your doctor or sleep specialist about the treatment options that will work best for you.
Lifestyle changes and/or mouthpieces may be enough to relieve mild sleep apnea. People who have moderate or severe sleep apnea may need breathing devices or surgery.
If you continue to have daytime sleepiness despite treatment, your doctor may ask whether you're getting enough sleep. (Adults should get at least 7 to 8 hours of sleep; children and adolescents need more.)
If treatment and enough sleep don't relieve your daytime sleepiness, your doctor will consider other treatment options.
Lifestyle Changes
If you have mild sleep apnea, some changes in daily activities or habits may be all the treatment you need.
Avoid alcohol and medicines that make you sleepy. They make it harder for your throat to stay open while you sleep.
Lose weight if you're overweight or obese. Even a little weight loss can improve your symptoms.
Sleep on your side instead of your back to help keep your throat open. You can sleep with special pillows or shirts that prevent you from sleeping on your back.
Keep your nasal passages open at night with nasal sprays or allergy medicines, if needed. Talk with your doctor about whether these treatments might help you.
If you smoke, quit. Talk with your doctor about programs and products that can help you quit smoking.
Mouthpieces
A mouthpiece, sometimes called an oral appliance, may help some people who have mild sleep apnea. Your doctor also may recommend a mouthpiece if you snore loudly but don't have sleep apnea.
A dentist or orthodontist can make a custom-fit plastic mouthpiece for treating sleep apnea. (An orthodontist specializes in correcting teeth or jaw problems.) The mouthpiece will adjust your lower jaw and your tongue to help keep your airways open while you sleep.
If you use a mouthpiece, tell your doctor if you have discomfort or pain while using the device. You may need periodic office visits so your doctor can adjust your mouthpiece to fit better.
Breathing Devices
CPAP (continuous positive airway pressure) is the most common treatment for moderate to severe sleep apnea in adults. A CPAP machine uses a mask that fits over your mouth and nose, or just over your nose. The machine gently blows air into your throat.
The air presses on the wall of your airway. The air pressure is adjusted so that it's just enough to stop the airways from becoming narrowed or blocked during sleep.
Treating sleep apnea may help you stop snoring. But not snoring doesn't mean that you no longer have sleep apnea or can stop using CPAP. Sleep apnea will return if CPAP is stopped or not used correctly.
Usually, a technician will come to your home to bring the CPAP equipment. The technician will set up the CPAP machine and adjust it based on your doctor's prescription. After the initial setup, you may need to have the CPAP adjusted on occasion for the best results.
CPAP treatment may cause side effects in some people. These side effects include a dry or stuffy nose, irritated skin on your face, dry mouth, and headaches. If your CPAP isn't adjusted properly, you may get stomach bloating and discomfort while wearing the mask.
If you're having trouble with CPAP side effects, work with your sleep specialist, his or her nursing staff, and the CPAP technician. Together, you can take steps to reduce these side effects. These steps include adjusting the CPAP settings or the size/fit of the mask, or adding moisture to the air as it flows through the mask. A nasal spray may relieve a dry, stuffy, or runny nose.
There are many types of CPAP machines and masks. Tell your doctor if you're not happy with the type you're using. He or she may suggest switching to a different type that may work better for you.
People who have severe sleep apnea symptoms generally feel much better once they begin treatment with CPAP.
Surgery
Some people who have sleep apnea may benefit from surgery. The type of surgery and how well it works depend on the cause of the sleep apnea.
Surgery is done to widen breathing passages. It usually involves shrinking, stiffening, or removing excess tissue in the mouth and throat or resetting the lower jaw.
Surgery to shrink or stiffen excess tissue in the mouth or throat is done in a doctor's office or a hospital. Shrinking tissue may involve small shots or other treatments to the tissue. A series of such treatments may be needed to shrink the excess tissue. To stiffen excess tissue, the doctor makes a small cut in the tissue and inserts a small piece of stiff plastic.
Surgery to remove excess tissue is done in a hospital. You're given medicine that makes you sleep during the surgery. After surgery, you may have throat pain that lasts for 1 to 2 weeks.
Surgery to remove the tonsils, if they're blocking the airway, may be very helpful for some children. Your child's doctor may suggest waiting some time to see whether these tissues shrink on their own. This is common as small children grow.
CPAP or Continuous Positive Air Pressure has long been considered the "Gold Standard" for treating sleep apnea. It is extremely effective when patients use it but patient compliance has always been a major problem It is interesting that the NHLBI lists oral appliances before CPAP. (See website info below) but also says that oral appliances are for mild apnea and snoring while it has now been shown that when properly titrated Oral Appliances are equally effective to CPAP for treating mild to moderate sleep apnea. Oral Appliances are also considered to be an alternative to CPAP when it is not tolerated.
The NHLBI website states
"The goals of treating sleep apnea are to:
Restore regular breathing during sleep
Relieve symptoms such as loud snoring and daytime sleepiness
Treatment may improve other medical problems linked to sleep apnea, such as high blood pressure. Treatment also can reduce your risk of heart disease, stroke, and diabetes."
Approximately one in four CPAP users actually meet those goals. Those patients generally adapt easily to CPAP and rarely go without using it. 60% of patients abandon CPAP entirely and 15% struggle with it and use it in less that effective manner. It is the 75% that are not adequately treated with CPAP that usually utilize oral appliances or surgery. Oral Appliances are also not tolerated by everyone and patients need significant numbers of teeth or implants to use many types of appliances. While most patients prefer oral appliances to CPAP there are some patients who do not tolerate appliances and must seek alternative treatments.
This Goal statement is a very interesting statement. Is use of CPAP a restoration of "Normal Breathing" or "Regular Breathing" ? I would propose that an effectively titrated oral appliance actually restores both regular and normal breathing. CPAP breathing is not "normal" trhough it may be regular. BiPAP breathing is probably closer to "normal" breathing.
Secondly treatment should relieve snoring and daytime sleepiness. Daytime sleepiness is an interesting aspect as it can be measured subjectively (patient opinion) or objectively by MSLT (multiple sleep latency test) or MWT (Maintenance of Wakefulness Test)
Patients utilizing oral appliances frequently report being more rested with an oral appliance than when treated with CPAP even when the CPAP machine gave more complete resolution of AHI. This may be a difference between regular and normal breathing.
The statement "Treatment may improve other medical problems linked to sleep apnea, such as high blood pressure. Treatment also can reduce your risk of heart disease, stroke, and diabetes" is extremely important. Treatment of sleep apnea has numerous health benefits. These benefits are achieved with CPAP, Surgery and Oral Appliances.
The NHLBI site also discusses that some patients may benefit from surgery. It is important to note that the surgery must meet the goals stated. Soft palate surgery does not restore regular breathing and should be cosidered adjunctive surgery not curative surgery.
THE FOLLOWING INFORMATION IS TAKEN FROM THE NATIONAL HEART LUNG AND BLOOD INSTITUTE WEBSITE http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_Treatments.html
How Is Sleep Apnea Treated?
Lifestyle changes, mouthpieces, breathing devices, and surgery are used to treat sleep apnea. Medicines typically aren't used to treat the condition.
The goals of treating sleep apnea are to:
Restore regular breathing during sleep
Relieve symptoms such as loud snoring and daytime sleepiness
Treatment may improve other medical problems linked to sleep apnea, such as high blood pressure. Treatment also can reduce your risk of heart disease, stroke, and diabetes.
If you have sleep apnea, talk with your doctor or sleep specialist about the treatment options that will work best for you.
Lifestyle changes and/or mouthpieces may be enough to relieve mild sleep apnea. People who have moderate or severe sleep apnea may need breathing devices or surgery.
If you continue to have daytime sleepiness despite treatment, your doctor may ask whether you're getting enough sleep. (Adults should get at least 7 to 8 hours of sleep; children and adolescents need more.)
If treatment and enough sleep don't relieve your daytime sleepiness, your doctor will consider other treatment options.
Lifestyle Changes
If you have mild sleep apnea, some changes in daily activities or habits may be all the treatment you need.
Avoid alcohol and medicines that make you sleepy. They make it harder for your throat to stay open while you sleep.
Lose weight if you're overweight or obese. Even a little weight loss can improve your symptoms.
Sleep on your side instead of your back to help keep your throat open. You can sleep with special pillows or shirts that prevent you from sleeping on your back.
Keep your nasal passages open at night with nasal sprays or allergy medicines, if needed. Talk with your doctor about whether these treatments might help you.
If you smoke, quit. Talk with your doctor about programs and products that can help you quit smoking.
Mouthpieces
A mouthpiece, sometimes called an oral appliance, may help some people who have mild sleep apnea. Your doctor also may recommend a mouthpiece if you snore loudly but don't have sleep apnea.
A dentist or orthodontist can make a custom-fit plastic mouthpiece for treating sleep apnea. (An orthodontist specializes in correcting teeth or jaw problems.) The mouthpiece will adjust your lower jaw and your tongue to help keep your airways open while you sleep.
If you use a mouthpiece, tell your doctor if you have discomfort or pain while using the device. You may need periodic office visits so your doctor can adjust your mouthpiece to fit better.
Breathing Devices
CPAP (continuous positive airway pressure) is the most common treatment for moderate to severe sleep apnea in adults. A CPAP machine uses a mask that fits over your mouth and nose, or just over your nose. The machine gently blows air into your throat.
The air presses on the wall of your airway. The air pressure is adjusted so that it's just enough to stop the airways from becoming narrowed or blocked during sleep.
Treating sleep apnea may help you stop snoring. But not snoring doesn't mean that you no longer have sleep apnea or can stop using CPAP. Sleep apnea will return if CPAP is stopped or not used correctly.
Usually, a technician will come to your home to bring the CPAP equipment. The technician will set up the CPAP machine and adjust it based on your doctor's prescription. After the initial setup, you may need to have the CPAP adjusted on occasion for the best results.
CPAP treatment may cause side effects in some people. These side effects include a dry or stuffy nose, irritated skin on your face, dry mouth, and headaches. If your CPAP isn't adjusted properly, you may get stomach bloating and discomfort while wearing the mask.
If you're having trouble with CPAP side effects, work with your sleep specialist, his or her nursing staff, and the CPAP technician. Together, you can take steps to reduce these side effects. These steps include adjusting the CPAP settings or the size/fit of the mask, or adding moisture to the air as it flows through the mask. A nasal spray may relieve a dry, stuffy, or runny nose.
There are many types of CPAP machines and masks. Tell your doctor if you're not happy with the type you're using. He or she may suggest switching to a different type that may work better for you.
People who have severe sleep apnea symptoms generally feel much better once they begin treatment with CPAP.
Surgery
Some people who have sleep apnea may benefit from surgery. The type of surgery and how well it works depend on the cause of the sleep apnea.
Surgery is done to widen breathing passages. It usually involves shrinking, stiffening, or removing excess tissue in the mouth and throat or resetting the lower jaw.
Surgery to shrink or stiffen excess tissue in the mouth or throat is done in a doctor's office or a hospital. Shrinking tissue may involve small shots or other treatments to the tissue. A series of such treatments may be needed to shrink the excess tissue. To stiffen excess tissue, the doctor makes a small cut in the tissue and inserts a small piece of stiff plastic.
Surgery to remove excess tissue is done in a hospital. You're given medicine that makes you sleep during the surgery. After surgery, you may have throat pain that lasts for 1 to 2 weeks.
Surgery to remove the tonsils, if they're blocking the airway, may be very helpful for some children. Your child's doctor may suggest waiting some time to see whether these tissues shrink on their own. This is common as small children grow.
Sunday, November 7, 2010
Can Carbon Dioxide help treat central and mixed sleep apnea? Should CO2 be added to CPAP Flow to Treat Central Sleep Apnea & Cheyne-Stokes Breathing?
Patients with central and mixed sleep apnea are different than obstructive sleep apnea patients. There has been work done with increased dead space in CPAP units and addition or carbon dioxide to treat central sleep apnea and Cheye-Stokes breathing. It is actually a build-up in CO2 that cause awakening and breathing in all apnea patients.
If Carbon Dioxide can be judiciously supplied to these patients it could solve the problems of central sleep apnea and emerging central apnea in patients treated with CPAP or Oral Appliances.
It may also explain why appliances like the TAP that limit opening seem more effective in some patients than Herbsts, Suad,, or Somnomed appliances. Appliances that allow easier oral opening and breating are more likely to have decreased CO2 levels.
Remember, it is the rise in CO2 (carbon dioxide) that turns on the drive to breathe.
If Carbon Dioxide can be judiciously supplied to these patients it could solve the problems of central sleep apnea and emerging central apnea in patients treated with CPAP or Oral Appliances.
It may also explain why appliances like the TAP that limit opening seem more effective in some patients than Herbsts, Suad,, or Somnomed appliances. Appliances that allow easier oral opening and breating are more likely to have decreased CO2 levels.
Remember, it is the rise in CO2 (carbon dioxide) that turns on the drive to breathe.
Saturday, November 6, 2010
CPAP USE CAUSES SIGNIFICANT CHANGES IN POSITION OF BONES OF FACE AND TEETH. THESE CHANGES MAY CAUSE TMJ DISORDERS OR SMASHED FACES.
A new study in Chest shows significant changes in bone and teeth positio secondary to CPAP use. The changes are retropositioning of the upper maxillary teeth and the bones of the face. Smashed Face Syndrome resulting from long term CPAP use could have negative consequences of a cosmetic and physiologic nature.
It is important to note that treatment of sleep apnea is essential and that CPAP and Oral Appliances the only First Line treatments can cause changes. These changes should not be considered a reason to discontinue life-saving treatment with either modality.
The changes that occur with Oral Appliance treatment are not the same as changes that occur with CPAP use. There are ominous problems that could be associated with the CPAP specific changes. These changes could cause worsening of Sleep Apnea if CPAP use is discontinued and even lead to an addiction to CPAP. I have discussed problems with "CPAP Addiction" with Dr Alex Golbin a prominent sleep physician and pioneer of the field of Sleep Medicine.
The change that occured with use of CPAP include "Significant retrusion of the anterior maxilla, a decrease in maxillary-mandibular discrepancy, a setback of the supramentale and chin positions, a retroclination of maxillary incisors, and a decrease of convexity" These findings were visible on cephalometric radiographs but were not reported by patients. All of these changes have the potential to cause TMJ problems, tension headaches and migraines. The changes CPAP cause will lead to retropositioning of the mandible. The changes caused by oral appliances are anterior positioning of the mandible. Studies have shown that these changes do not adversly affect the TM Joints (TMJ). In fact these are the same changes that take place when treating TMJ disorders with a neuromuscular orthotic. Part of the effect of neuromuscular treatment of headaches and migraines (see www.ihateheadaches.org) is thought to be do to improvements in airway and quality of sleep.
Dentists routinely explain to their patients that oral appliances can change bites and move teeth as part of their informed consent for treatment.
The responsibility for informing patients of negative orthopedic changes from CPAP falls on the prescribing physicians and on CPAP manufacturers. The FDA should make device manufcturers include information on this subject in their materials.
Chest. 2010 Oct;138(4):870-4. Epub 2010 Jul 8.
Craniofacial changes after 2 years of nasal continuous positive airway pressure use in patients with obstructive sleep apnea.
Tsuda H, Almeida FR, Tsuda T, Moritsuchi Y, Lowe AA.
Department of Oral Health Sciences, The University of British Columbia, Vancouver, BC, Canada. htsuda@dent.kyushu-u.ac.jp
Abstract
BACKGROUND: Many patients with obstructive sleep apnea (OSA) use nasal continuous positive airway pressure (nCPAP) as a first-line therapy. Previous studies have reported midfacial hypoplasia in children using nCPAP. The aim of this study is to assess the craniofacial changes in adult subjects with OSA after nCPAP use.
METHODS: Forty-six Japanese subjects who used nCPAP for a minimum of 2 years had both a baseline and a follow-up cephalometric radiograph taken. These two radiographs were analyzed, and changes in craniofacial structures were assessed. The cephalometric measurements evaluated were related to face height, interarch relationship, and tooth position.
RESULTS: Most of the patients with OSA were men (89.1%), and the mean baseline values for age, BMI, and apnea-hypopnea index (AHI) were 56.3 ± 13.4 years, 26.8 ± 5.6 kg/m(2), and 42.0 ± 18.6/h. The average duration of nCPAP use was 35.0 ± 6.7 months. After nCPAP use, cephalometric variables demonstrated a significant retrusion of the anterior maxilla, a decrease in maxillary-mandibular discrepancy, a setback of the supramentale and chin positions, a retroclination of maxillary incisors, and a decrease of convexity. However, significant correlations between the craniofacial changes, demographic variables, or the duration of nCPAP use could not be identified. None of the patients self-reported any permanent change of occlusion or facial profile.
CONCLUSION: The use of an nCPAP machine for > 2 years may change craniofacial form by reducing maxillary and mandibular prominence and/or by altering the relationship between the dental arches.
PMID: 20616213 [PubMed - indexed for MEDLINE]
It is important to note that treatment of sleep apnea is essential and that CPAP and Oral Appliances the only First Line treatments can cause changes. These changes should not be considered a reason to discontinue life-saving treatment with either modality.
The changes that occur with Oral Appliance treatment are not the same as changes that occur with CPAP use. There are ominous problems that could be associated with the CPAP specific changes. These changes could cause worsening of Sleep Apnea if CPAP use is discontinued and even lead to an addiction to CPAP. I have discussed problems with "CPAP Addiction" with Dr Alex Golbin a prominent sleep physician and pioneer of the field of Sleep Medicine.
The change that occured with use of CPAP include "Significant retrusion of the anterior maxilla, a decrease in maxillary-mandibular discrepancy, a setback of the supramentale and chin positions, a retroclination of maxillary incisors, and a decrease of convexity" These findings were visible on cephalometric radiographs but were not reported by patients. All of these changes have the potential to cause TMJ problems, tension headaches and migraines. The changes CPAP cause will lead to retropositioning of the mandible. The changes caused by oral appliances are anterior positioning of the mandible. Studies have shown that these changes do not adversly affect the TM Joints (TMJ). In fact these are the same changes that take place when treating TMJ disorders with a neuromuscular orthotic. Part of the effect of neuromuscular treatment of headaches and migraines (see www.ihateheadaches.org) is thought to be do to improvements in airway and quality of sleep.
Dentists routinely explain to their patients that oral appliances can change bites and move teeth as part of their informed consent for treatment.
The responsibility for informing patients of negative orthopedic changes from CPAP falls on the prescribing physicians and on CPAP manufacturers. The FDA should make device manufcturers include information on this subject in their materials.
Chest. 2010 Oct;138(4):870-4. Epub 2010 Jul 8.
Craniofacial changes after 2 years of nasal continuous positive airway pressure use in patients with obstructive sleep apnea.
Tsuda H, Almeida FR, Tsuda T, Moritsuchi Y, Lowe AA.
Department of Oral Health Sciences, The University of British Columbia, Vancouver, BC, Canada. htsuda@dent.kyushu-u.ac.jp
Abstract
BACKGROUND: Many patients with obstructive sleep apnea (OSA) use nasal continuous positive airway pressure (nCPAP) as a first-line therapy. Previous studies have reported midfacial hypoplasia in children using nCPAP. The aim of this study is to assess the craniofacial changes in adult subjects with OSA after nCPAP use.
METHODS: Forty-six Japanese subjects who used nCPAP for a minimum of 2 years had both a baseline and a follow-up cephalometric radiograph taken. These two radiographs were analyzed, and changes in craniofacial structures were assessed. The cephalometric measurements evaluated were related to face height, interarch relationship, and tooth position.
RESULTS: Most of the patients with OSA were men (89.1%), and the mean baseline values for age, BMI, and apnea-hypopnea index (AHI) were 56.3 ± 13.4 years, 26.8 ± 5.6 kg/m(2), and 42.0 ± 18.6/h. The average duration of nCPAP use was 35.0 ± 6.7 months. After nCPAP use, cephalometric variables demonstrated a significant retrusion of the anterior maxilla, a decrease in maxillary-mandibular discrepancy, a setback of the supramentale and chin positions, a retroclination of maxillary incisors, and a decrease of convexity. However, significant correlations between the craniofacial changes, demographic variables, or the duration of nCPAP use could not be identified. None of the patients self-reported any permanent change of occlusion or facial profile.
CONCLUSION: The use of an nCPAP machine for > 2 years may change craniofacial form by reducing maxillary and mandibular prominence and/or by altering the relationship between the dental arches.
PMID: 20616213 [PubMed - indexed for MEDLINE]
Saturday, October 2, 2010
DEPRESSION AND SLEEP APNEA: RESEARCH SHOWS SLEEP APNEA TREATMENT MAY RESOLVE RESIDUAL DEPRESSIVE SYMPTOMS. CPAP and Oral Appliances are indicated
A new study "Effect of CPAP treatment on residual depressive symptoms in patients with major depression and coexisting sleep apnea: Contribution of daytime sleepiness to residual depressive symptoms." (see abstract below) suggests that treatment of sleep apnea will aid in resolution of symptoms. While this study used CPAP, Oral Appliances should have identical results.
The study concludes that "The results suggest that MDD patients with residual depressive symptoms despite pharmacotherapy who also have symptoms of suspected OSA, such as loud snoring, obesity, and daytime sleepiness, should be evaluated for sleep apnea by polysomnography and treated with an appropriate treatment such as CPAP. CPAP treatment may result in a significant improvement of residual depressive symptoms due to the improvement of daytime sleepiness in these patients.
Another study "Obstructive sleep apnea and depression." (see abstract below) reports 21-41% depression in sleep pne patients. It sites a previous study that lists sleep apnea as a risk factor for depression. It is not surprising that " Patients who have depression as well as OSA appear worse off than those with OSA only" ties together symptoms and treatments of sleep apnea, headaches and depression.
An opinion statement in Curr Treat Options Neurol. 2010 Jan;12(1):1-15 on on "SLEEP AND HEADACHES" ties together headaches, psychiatric problems and sleep apnea but stops short of what the NHLBI report that focuses on masticatory/trigeminal orgin of these problems.
The NHLBI published a report on the "CARDIOVASCULAR AND SLEEP RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS" THAT LOOKS AT MASTICATORY SYSTEM AS A COMMON CAUSE OF SLEEP APNEA, HEADACHES AND MANY OTHER PROBLEMS. Shimshak et al published two articles in Cranio that showed a 200-300% increase in medical costs in every field of medicine in patients diagnosed with TMJ disorders. This would include headache, migraine, depression and other diverse conditions.
The National Heart Lung and Blood Institue report states:
"The term TMD refers to a collection of medical and dental conditions affecting the temporomandibular joint (TMJ) and/or muscles of mastication, as well as contiguous tissue components. Symptoms range from occasional discomfort to debilitating pain and severely compromised jaw function. The masticatory apparatus is not only involved in chewing and swallowing but also in other critical tasks, including breathing and talking. Specific etiologies such as trauma and degenerative arthritides underlie some forms of TMD but there is no common etiology or biological explanation. TMD is hence comprised of a heterogeneous group of health problems whose signs and symptoms are overlapping but not identical.
Although broad longitudinal and cross-sectional epidemiological studies have not been carried out, TMD is estimated to affect about 12% of the general population, representing more than 34 million Americans. The majority of those seeking treatment are women in their reproductive years. As for many other pain conditions, the clinical scenario of TMD also tends to be more severe in women than men. TM disorders are considered a serious health problem because many individuals lose their ability to hold regular jobs and to function productively even within the context of a household environment.
The report talks about symptoms including "TMD has been used to characterize a wide range of conditions diversely presented as pain in the face or jaw joint area, masticatory muscle pain, headaches, earaches, dizziness, limited mouth opening due to soft or hard tissue obstruction, TMJ clicking or popping sounds, excessive tooth wear and other complaints."
The report also discusses effects on swallowing and breating ease: "There appears to an associated increase in coughing in subjects with sleep apnea. Occlusion of the pharynx can force residual secretions into the glottis and trigger coughing reflexes, swallowing reflexes, and other reflexes that could contribute to the disorganization of breathing during sleep. In addition to the muscles of mastication, the tongue plays an important role in the coordinated events of swallowing and breathing. The integration of breathing and swallowing is tightly linked, and these events in turn are in some manner linked to blood pressure regulation. Each of these pathways has been studied by scientists in individual disciplines, but there is a need for interdisciplinary studies to determine the interactions of the peripheral and central neural pathways controlling breathing, chewing, swallowing, and cardiovascular events. The presence of pain in patients with TMD would be expected to seriously impact upon these reflex and motor pathways. Little is known about the role of tongue position and how this may be altered in subjects with altered jaw location and structure. Sleep state has been shown to alter the central modulation of the coordination of breathing, airway dynamics, swallowing, and associated cardiovascular events. Differences in central modulation of these events in subjects with sleep apnea and TMD need to be evaluated using sleep as a dynamic change in the state of the individual. Cardiovascular, neuroendocrine, respiratory and swallowing alterations in awake and sleeping subjects need to be studied in a systematic manner in both in animal models and human subjects."
There are common developmental aspects that have been well documented between sleep apnea and TMJ disorders. There is an enormous cross over of signs and symptoms as well. While all sleep apnea may not be entirely related to masticatory structures there is unquestionably a large amount of crossover. There is a solid base of evidence based studies showing how airway issues change growth and development. There is also solid evidence based studies on treatment of sleep apnea with appliances that anteriorly position the mandible. there are numerous clinical reports and studies showing treatment of headaches and TMJ disorders with anterior positiong.
Is it time to look at a large proportion of sleep apnea as being related to jaw development. This would make it a treatment that could be treated and corrected by early interventions such as tonsilectomy and maxillary expansion. Maxillary expansion allows the mandible to automatically anteriorly position and frequently grow a healthier airway. A recent study showed that most pediatric patients having tonsils removed should also have expansion. Expansion according to many experts should precede tonsilectomy to reduce post operative risks.
The early correction of airway and jaw disorders could possibly save massive dollars in lifetime medical expenses if we extrapolate from the work of Shimshak. Shimshak did not show a correlation not cause and effect of TMJ disorders to increased medical expenses.
My opinion is that there is a definite cause and effect of TMJ disorders to massive increases in medical expenses. I believe that for the majority of patients sleep apnea are due to masticatory conditions that should be defined as a TMJ disorder. If we define sleep apnea as a TMJ disorder that other problems like ADD and ADHD are secondary TMJ disorders. This would also apply to morning headaches, cardiovascular, neurological, and psychiatric disorders
Sleep Med. 2010 Jun;11(6):552-7. Epub 2010 May 21.
Effect of CPAP treatment on residual depressive symptoms in patients with major depression and coexisting sleep apnea: Contribution of daytime sleepiness to residual depressive symptoms.
Habukawa M, Uchimura N, Kakuma T, Yamamoto K, Ogi K, Hiejima H, Tomimatsu K, Matsuyama S.
Department of Neuropsychiatry, Kurume University School of Medicine, Kurume, Fukuoka, Japan. hmitsu@med.kurume-u.ac.jp
Abstract
BACKGROUND: Although extensive studies have indicated a relationship between obstructive sleep apnea (OSA) and depressive symptoms, the effect of continuous positive airway pressure (CPAP) treatment on residual depressive symptoms in patients with both major depressive disorder (MDD) and coexisting OSA has not been examined.
METHODS: Seventeen patients with continued MDD despite pharmacotherapy such as antidepressants and/or benzodiazepines, who also had comorbid OSA, were required to complete the Beck Depression Inventory (BDI), Hamilton Rating Scale for Depression (HRSD), and Epworth sleepiness scale (ESS) at the commencement of the study and then again after 2 months of CPAP treatment.
RESULTS: BDI and HRSD scores decreased from 19.7 to 10.8 and 16.7 to 8.0 after 2 months of CPAP treatment (both p<0.01). We also found significant correlations among the improvement rates in BDI, HRSD and ESS scores (R=0.86 and 0.75, both p<0.01). The mixed effect model demonstrated a significant ESS effect on BDI and HRSD.
CONCLUSIONS: The results suggest that MDD patients with residual depressive symptoms despite pharmacotherapy who also have symptoms of suspected OSA, such as loud snoring, obesity, and daytime sleepiness, should be evaluated for sleep apnea by polysomnography and treated with an appropriate treatment such as CPAP. CPAP treatment may result in a significant improvement of residual depressive symptoms due to the improvement of daytime sleepiness in these patients.
PMID: 20488748 [PubMed - indexed for MEDLINE]
Sleep Med Rev. 2009 Dec;13(6):437-44. Epub 2009 Jul 10.
Obstructive sleep apnea and depression.
Harris M, Glozier N, Ratnavadivel R, Grunstein RR.
Australasian Sleep Trials Network, Adelaide Institute for Sleep Health, Flinders University, Adelaide, Australia. melanie.harris@flinders.edu.au
Abstract
There are high rates of depression in people with obstructive sleep apnea (OSA) in both community and clinical populations. A large community study reported a rate of 17% and reports for sleep clinic samples range between 21% and 41%. A large cohort study found OSA to be a risk factor for depression, but we are unaware of any longitudinal study of the reverse association. However correlations have not generally been found in smaller studies. Well-designed longitudinal studies are needed to examine temporal relationships between the two conditions and further research is needed to establish the role of confounders, and effect modifiers such as gender, in any apparent relationship. Symptoms common to OSA and depression, such as sleepiness and fatigue, are obstacles to determining the presence and severity of one condition in the presence of the other, in research and clinically. Sleep clinicians are advised to consider depression as a likely cause of sleepiness and fatigue. Several possible causal mechanisms linking OSA and depression have been proposed but not established. Patients who have depression as well as OSA appear worse off than those with OSA only, and depressive symptoms persist in at least some patients in short term studies of treatment for OSA. Direct treatment of depression in OSA might improve acceptance of therapy, reduce sleepiness and fatigue and improve quality of life, but intervention trials are required to answer this question.
PMID: 19596599 [PubMed - indexed for MEDLINE]
Curr Treat Options Neurol. 2010 Jan;12(1):1-15.
Sleep and headache.
Rains JC, Poceta JS.
Center for Sleep Evaluation, Elliot Hospital, One Elliot Way, Manchester, NH, 03103, USA, jrains@elliot-hs.org.
Abstract
OPINION STATEMENT: Headache has been linked to a wide range of sleep disorders that may impact headache management. There are no evidence-based guidelines, but the authors believe that literature supports the following clinical recommendations: 1. Diagnose headache according to standardized criteria. Specific diagnoses are associated with increased risk for specific sleep and psychiatric disorders. 2. Collect sleep history in relation to headache patterns. Screening questionnaires and prediction equations are cost-effective. 3. Rule out sleep apnea headache in patients with awakening headache or higher-risk headache diagnoses (cluster, hypnic, chronic migraine, and chronic tension-type headache); patients with signs and symptoms of obstructive sleep apnea warrant polysomnography and treatment according to sleep medicine practice guidelines. There is no evidence for suspending conventional headache treatment in suspected or confirmed cases of sleep apnea. Treatment of sleep apnea with CPAP may improve or resolve headache in a subset of patients. The impact on sleep apnea headache of other treatments for sleep apnea (eg, oral appliances, surgery, weight loss) is largely untested. At a minimum, sedative-hypnotic drugs should be avoided in suspected apneics until the sleep apnea is treated. 4. Among patients with migraine and tension-type headache, insomnia is the most common sleep complaint, reported by one half to two thirds of clinic patients. Patients who suffer from chronic migraine or tension-type headache may benefit from behavioral sleep modification. Pharmacologic treatment may be considered on a case-by-case basis, with hypnotics, anxiolytics, or sedating antidepressants used to manage insomnia, tailoring treatment to the symptom pattern. 5. Individuals with chronic headache are at increased risk for psychiatric disorders. Assessment for depression and anxiety may be warranted when either insomnia or hypersomnia is present. Psychiatric symptoms affect the choice of sedating versus alerting versus neutral pharmacologic agents for headache. 6. All headache patients, particularly those with episodic migraine and tension-type headaches, may benefit from inclusion of sleep variables in trigger management.
The study concludes that "The results suggest that MDD patients with residual depressive symptoms despite pharmacotherapy who also have symptoms of suspected OSA, such as loud snoring, obesity, and daytime sleepiness, should be evaluated for sleep apnea by polysomnography and treated with an appropriate treatment such as CPAP. CPAP treatment may result in a significant improvement of residual depressive symptoms due to the improvement of daytime sleepiness in these patients.
Another study "Obstructive sleep apnea and depression." (see abstract below) reports 21-41% depression in sleep pne patients. It sites a previous study that lists sleep apnea as a risk factor for depression. It is not surprising that " Patients who have depression as well as OSA appear worse off than those with OSA only" ties together symptoms and treatments of sleep apnea, headaches and depression.
An opinion statement in Curr Treat Options Neurol. 2010 Jan;12(1):1-15 on on "SLEEP AND HEADACHES" ties together headaches, psychiatric problems and sleep apnea but stops short of what the NHLBI report that focuses on masticatory/trigeminal orgin of these problems.
The NHLBI published a report on the "CARDIOVASCULAR AND SLEEP RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS" THAT LOOKS AT MASTICATORY SYSTEM AS A COMMON CAUSE OF SLEEP APNEA, HEADACHES AND MANY OTHER PROBLEMS. Shimshak et al published two articles in Cranio that showed a 200-300% increase in medical costs in every field of medicine in patients diagnosed with TMJ disorders. This would include headache, migraine, depression and other diverse conditions.
The National Heart Lung and Blood Institue report states:
"The term TMD refers to a collection of medical and dental conditions affecting the temporomandibular joint (TMJ) and/or muscles of mastication, as well as contiguous tissue components. Symptoms range from occasional discomfort to debilitating pain and severely compromised jaw function. The masticatory apparatus is not only involved in chewing and swallowing but also in other critical tasks, including breathing and talking. Specific etiologies such as trauma and degenerative arthritides underlie some forms of TMD but there is no common etiology or biological explanation. TMD is hence comprised of a heterogeneous group of health problems whose signs and symptoms are overlapping but not identical.
Although broad longitudinal and cross-sectional epidemiological studies have not been carried out, TMD is estimated to affect about 12% of the general population, representing more than 34 million Americans. The majority of those seeking treatment are women in their reproductive years. As for many other pain conditions, the clinical scenario of TMD also tends to be more severe in women than men. TM disorders are considered a serious health problem because many individuals lose their ability to hold regular jobs and to function productively even within the context of a household environment.
The report talks about symptoms including "TMD has been used to characterize a wide range of conditions diversely presented as pain in the face or jaw joint area, masticatory muscle pain, headaches, earaches, dizziness, limited mouth opening due to soft or hard tissue obstruction, TMJ clicking or popping sounds, excessive tooth wear and other complaints."
The report also discusses effects on swallowing and breating ease: "There appears to an associated increase in coughing in subjects with sleep apnea. Occlusion of the pharynx can force residual secretions into the glottis and trigger coughing reflexes, swallowing reflexes, and other reflexes that could contribute to the disorganization of breathing during sleep. In addition to the muscles of mastication, the tongue plays an important role in the coordinated events of swallowing and breathing. The integration of breathing and swallowing is tightly linked, and these events in turn are in some manner linked to blood pressure regulation. Each of these pathways has been studied by scientists in individual disciplines, but there is a need for interdisciplinary studies to determine the interactions of the peripheral and central neural pathways controlling breathing, chewing, swallowing, and cardiovascular events. The presence of pain in patients with TMD would be expected to seriously impact upon these reflex and motor pathways. Little is known about the role of tongue position and how this may be altered in subjects with altered jaw location and structure. Sleep state has been shown to alter the central modulation of the coordination of breathing, airway dynamics, swallowing, and associated cardiovascular events. Differences in central modulation of these events in subjects with sleep apnea and TMD need to be evaluated using sleep as a dynamic change in the state of the individual. Cardiovascular, neuroendocrine, respiratory and swallowing alterations in awake and sleeping subjects need to be studied in a systematic manner in both in animal models and human subjects."
There are common developmental aspects that have been well documented between sleep apnea and TMJ disorders. There is an enormous cross over of signs and symptoms as well. While all sleep apnea may not be entirely related to masticatory structures there is unquestionably a large amount of crossover. There is a solid base of evidence based studies showing how airway issues change growth and development. There is also solid evidence based studies on treatment of sleep apnea with appliances that anteriorly position the mandible. there are numerous clinical reports and studies showing treatment of headaches and TMJ disorders with anterior positiong.
Is it time to look at a large proportion of sleep apnea as being related to jaw development. This would make it a treatment that could be treated and corrected by early interventions such as tonsilectomy and maxillary expansion. Maxillary expansion allows the mandible to automatically anteriorly position and frequently grow a healthier airway. A recent study showed that most pediatric patients having tonsils removed should also have expansion. Expansion according to many experts should precede tonsilectomy to reduce post operative risks.
The early correction of airway and jaw disorders could possibly save massive dollars in lifetime medical expenses if we extrapolate from the work of Shimshak. Shimshak did not show a correlation not cause and effect of TMJ disorders to increased medical expenses.
My opinion is that there is a definite cause and effect of TMJ disorders to massive increases in medical expenses. I believe that for the majority of patients sleep apnea are due to masticatory conditions that should be defined as a TMJ disorder. If we define sleep apnea as a TMJ disorder that other problems like ADD and ADHD are secondary TMJ disorders. This would also apply to morning headaches, cardiovascular, neurological, and psychiatric disorders
Sleep Med. 2010 Jun;11(6):552-7. Epub 2010 May 21.
Effect of CPAP treatment on residual depressive symptoms in patients with major depression and coexisting sleep apnea: Contribution of daytime sleepiness to residual depressive symptoms.
Habukawa M, Uchimura N, Kakuma T, Yamamoto K, Ogi K, Hiejima H, Tomimatsu K, Matsuyama S.
Department of Neuropsychiatry, Kurume University School of Medicine, Kurume, Fukuoka, Japan. hmitsu@med.kurume-u.ac.jp
Abstract
BACKGROUND: Although extensive studies have indicated a relationship between obstructive sleep apnea (OSA) and depressive symptoms, the effect of continuous positive airway pressure (CPAP) treatment on residual depressive symptoms in patients with both major depressive disorder (MDD) and coexisting OSA has not been examined.
METHODS: Seventeen patients with continued MDD despite pharmacotherapy such as antidepressants and/or benzodiazepines, who also had comorbid OSA, were required to complete the Beck Depression Inventory (BDI), Hamilton Rating Scale for Depression (HRSD), and Epworth sleepiness scale (ESS) at the commencement of the study and then again after 2 months of CPAP treatment.
RESULTS: BDI and HRSD scores decreased from 19.7 to 10.8 and 16.7 to 8.0 after 2 months of CPAP treatment (both p<0.01). We also found significant correlations among the improvement rates in BDI, HRSD and ESS scores (R=0.86 and 0.75, both p<0.01). The mixed effect model demonstrated a significant ESS effect on BDI and HRSD.
CONCLUSIONS: The results suggest that MDD patients with residual depressive symptoms despite pharmacotherapy who also have symptoms of suspected OSA, such as loud snoring, obesity, and daytime sleepiness, should be evaluated for sleep apnea by polysomnography and treated with an appropriate treatment such as CPAP. CPAP treatment may result in a significant improvement of residual depressive symptoms due to the improvement of daytime sleepiness in these patients.
PMID: 20488748 [PubMed - indexed for MEDLINE]
Sleep Med Rev. 2009 Dec;13(6):437-44. Epub 2009 Jul 10.
Obstructive sleep apnea and depression.
Harris M, Glozier N, Ratnavadivel R, Grunstein RR.
Australasian Sleep Trials Network, Adelaide Institute for Sleep Health, Flinders University, Adelaide, Australia. melanie.harris@flinders.edu.au
Abstract
There are high rates of depression in people with obstructive sleep apnea (OSA) in both community and clinical populations. A large community study reported a rate of 17% and reports for sleep clinic samples range between 21% and 41%. A large cohort study found OSA to be a risk factor for depression, but we are unaware of any longitudinal study of the reverse association. However correlations have not generally been found in smaller studies. Well-designed longitudinal studies are needed to examine temporal relationships between the two conditions and further research is needed to establish the role of confounders, and effect modifiers such as gender, in any apparent relationship. Symptoms common to OSA and depression, such as sleepiness and fatigue, are obstacles to determining the presence and severity of one condition in the presence of the other, in research and clinically. Sleep clinicians are advised to consider depression as a likely cause of sleepiness and fatigue. Several possible causal mechanisms linking OSA and depression have been proposed but not established. Patients who have depression as well as OSA appear worse off than those with OSA only, and depressive symptoms persist in at least some patients in short term studies of treatment for OSA. Direct treatment of depression in OSA might improve acceptance of therapy, reduce sleepiness and fatigue and improve quality of life, but intervention trials are required to answer this question.
PMID: 19596599 [PubMed - indexed for MEDLINE]
Curr Treat Options Neurol. 2010 Jan;12(1):1-15.
Sleep and headache.
Rains JC, Poceta JS.
Center for Sleep Evaluation, Elliot Hospital, One Elliot Way, Manchester, NH, 03103, USA, jrains@elliot-hs.org.
Abstract
OPINION STATEMENT: Headache has been linked to a wide range of sleep disorders that may impact headache management. There are no evidence-based guidelines, but the authors believe that literature supports the following clinical recommendations: 1. Diagnose headache according to standardized criteria. Specific diagnoses are associated with increased risk for specific sleep and psychiatric disorders. 2. Collect sleep history in relation to headache patterns. Screening questionnaires and prediction equations are cost-effective. 3. Rule out sleep apnea headache in patients with awakening headache or higher-risk headache diagnoses (cluster, hypnic, chronic migraine, and chronic tension-type headache); patients with signs and symptoms of obstructive sleep apnea warrant polysomnography and treatment according to sleep medicine practice guidelines. There is no evidence for suspending conventional headache treatment in suspected or confirmed cases of sleep apnea. Treatment of sleep apnea with CPAP may improve or resolve headache in a subset of patients. The impact on sleep apnea headache of other treatments for sleep apnea (eg, oral appliances, surgery, weight loss) is largely untested. At a minimum, sedative-hypnotic drugs should be avoided in suspected apneics until the sleep apnea is treated. 4. Among patients with migraine and tension-type headache, insomnia is the most common sleep complaint, reported by one half to two thirds of clinic patients. Patients who suffer from chronic migraine or tension-type headache may benefit from behavioral sleep modification. Pharmacologic treatment may be considered on a case-by-case basis, with hypnotics, anxiolytics, or sedating antidepressants used to manage insomnia, tailoring treatment to the symptom pattern. 5. Individuals with chronic headache are at increased risk for psychiatric disorders. Assessment for depression and anxiety may be warranted when either insomnia or hypersomnia is present. Psychiatric symptoms affect the choice of sedating versus alerting versus neutral pharmacologic agents for headache. 6. All headache patients, particularly those with episodic migraine and tension-type headaches, may benefit from inclusion of sleep variables in trigger management.
Friday, September 24, 2010
I HATE CPAP! blog is winner of top blog award! Determined to be one of best blogs that "exude overall brilliance."
I JUST RECEIVED THIS E-MAIL AND WANT TO THANK ALL THE INTERNET FANS THAT HELPED ME WIN THIS AWARD.
DR SHAPIRA
LETTER FOLLOWS:
Dear Dr. Shapira,
Congratulations! Sarah here, and your blog, I Hate CPAP!, was determined to
be one of the best blogs to exude overall brilliance. And so, it has
received our 2010 Top 15 Sleep Disorder Blogs award presented by Medical
Billing and Coding!
You can see your name amongst our winners here at:
www.medicalbillingandcoding.org/top_sleep_disorders/#I_Hate_CPAP
Winners were chosen through a scoring system that included Internet
nominations, which came from your reader base!
You can let your readers know you won by embedding the badge code to one of
the different awards graphics found at:
www.medicalbillingandcoding.org/top_sleep_disorders/badges/.
If you choose to accept or decline the award, please let me know.
Please do not hesitate to call or em ail if you have any questions. Many
questions can be answered at
www.medicalbillingandcoding.org/top_sleep_disorders/about/,
bloggingawards.org/about/, or bloggingawards.org/disclaimer/.
Again, Congratulations, and I hope to see your badge soon!
Cheers,
Sarah Johns
bloggingawards.org
DR SHAPIRA
LETTER FOLLOWS:
Dear Dr. Shapira,
Congratulations! Sarah here, and your blog, I Hate CPAP!, was determined to
be one of the best blogs to exude overall brilliance. And so, it has
received our 2010 Top 15 Sleep Disorder Blogs award presented by Medical
Billing and Coding!
You can see your name amongst our winners here at:
www.medicalbillingandcoding.org/top_sleep_disorders/#I_Hate_CPAP
Winners were chosen through a scoring system that included Internet
nominations, which came from your reader base!
You can let your readers know you won by embedding the badge code to one of
the different awards graphics found at:
www.medicalbillingandcoding.org/top_sleep_disorders/badges/.
If you choose to accept or decline the award, please let me know.
Please do not hesitate to call or em ail if you have any questions. Many
questions can be answered at
www.medicalbillingandcoding.org/top_sleep_disorders/about/,
bloggingawards.org/about/, or bloggingawards.org/disclaimer/.
Again, Congratulations, and I hope to see your badge soon!
Cheers,
Sarah Johns
bloggingawards.org
OBESITY A PROBLEM? YOUR ANSWER CAN COME TO YOU IN YOUR SLEEP.
A new article "Chronic intermittent hypoxia caused by obstructive sleep apnea may play an important role in explaining the morbidity-mortality paradox of obesity." in Medical Hypothesis (abstrct below) may explain the problems of morbidity and mortality related to obesity. Obesity has become pandemic according to the article and "threatens the health of millions of people and is associated with numerous morbidities such as hypertension, type II diabetes mellitus, dyslipidemia, cor pulmonale, gallbladder disease, obstructive sleep apnea (OSA), certain cancers, osteoarthritis, increased surgical risk and postoperative complications, lower extremity venous and/or lymphatic problems, pulmonary embolism, stroke/cerebrovascular diseases and coronary arterial disease"
The article sttes that it may be the repetitive intermittent hypoxia from sleep apnea that is responsible for the adverse health effects of obesity.
TREATMENT OF SLEEP APNEA HAS BEEN SHOWN TO HELP A WIDE ASSORTMENT OF MEDICAL CONDITIONS ASSOCIATED WITH OBESITY. UNFORTUNATELY MOST PATIENTS DO NOT TOLERATE CPAP. IN PATIENTS THAT DO NOT TOLERATE CPAP ORAL APPLIANCES MAY BE A LIFE-SAVING THERAPY.
Med Hypotheses. 2010 Sep 3. [Epub ahead of print]
Ozeke O, Ozer C, Gungor M, Celenk MK, Dincer H, Ilicin G.
Bayindir Hospital Sogutozu, Department of Cardiology, Ankara, Turkey.
Abstract
Obesity has reached global pandemic that threatens the health of millions of people and is associated with numerous morbidities such as hypertension, type II diabetes mellitus, dyslipidemia, cor pulmonale, gallbladder disease, obstructive sleep apnea (OSA), certain cancers, osteoarthritis, increased surgical risk and postoperative complications, lower extremity venous and/or lymphatic problems, pulmonary embolism, stroke/cerebrovascular diseases and coronary arterial disease. Despite all these adverse associations, numerous studies and meta-analyses have documented an "obesity paradox" in which overweight and obese population with established cardiovascular disease have a better prognosis than do their lean counterparts. There are potential and plausible explanations offered by literature for these puzzling data; however, it still remains uncertain whether this phenomenon is attributable to a real protective effect of high body fat mass. In recent years, the survival advantage of patients with OSA, combined with the potential cardioprotective effects of chronic intermittent hypoxia, raise the possibility that apneas during sleep may activate preconditioning-like cardioprotective effect. Chronic intermittent hypoxia, one of the physiological markers of OSA, is characterized by transient periods of oxygen desaturation followed by reoxygenation, and is a major cause of its systemic harmful (oxidative stress, inflammation, sympathetic activity, vasculature remodelling and endothelial dysfunction) and/or protective (preconditioning-like cardioprotective) effects. Since many OSA subjects are obese, and obesity is an independent risk factor for many comorbidities associated with OSA; and also most OSA has never been diagnosed in obese patients, we hypothesed that the chronic intermittent hypoxia caused by OSA in obese patients may be one of the underlying mechanisms in morbi-mortality paradox of obesity.
PMID: 20822856 [PubMed - as supplied by publisher]
The article sttes that it may be the repetitive intermittent hypoxia from sleep apnea that is responsible for the adverse health effects of obesity.
TREATMENT OF SLEEP APNEA HAS BEEN SHOWN TO HELP A WIDE ASSORTMENT OF MEDICAL CONDITIONS ASSOCIATED WITH OBESITY. UNFORTUNATELY MOST PATIENTS DO NOT TOLERATE CPAP. IN PATIENTS THAT DO NOT TOLERATE CPAP ORAL APPLIANCES MAY BE A LIFE-SAVING THERAPY.
Med Hypotheses. 2010 Sep 3. [Epub ahead of print]
Ozeke O, Ozer C, Gungor M, Celenk MK, Dincer H, Ilicin G.
Bayindir Hospital Sogutozu, Department of Cardiology, Ankara, Turkey.
Abstract
Obesity has reached global pandemic that threatens the health of millions of people and is associated with numerous morbidities such as hypertension, type II diabetes mellitus, dyslipidemia, cor pulmonale, gallbladder disease, obstructive sleep apnea (OSA), certain cancers, osteoarthritis, increased surgical risk and postoperative complications, lower extremity venous and/or lymphatic problems, pulmonary embolism, stroke/cerebrovascular diseases and coronary arterial disease. Despite all these adverse associations, numerous studies and meta-analyses have documented an "obesity paradox" in which overweight and obese population with established cardiovascular disease have a better prognosis than do their lean counterparts. There are potential and plausible explanations offered by literature for these puzzling data; however, it still remains uncertain whether this phenomenon is attributable to a real protective effect of high body fat mass. In recent years, the survival advantage of patients with OSA, combined with the potential cardioprotective effects of chronic intermittent hypoxia, raise the possibility that apneas during sleep may activate preconditioning-like cardioprotective effect. Chronic intermittent hypoxia, one of the physiological markers of OSA, is characterized by transient periods of oxygen desaturation followed by reoxygenation, and is a major cause of its systemic harmful (oxidative stress, inflammation, sympathetic activity, vasculature remodelling and endothelial dysfunction) and/or protective (preconditioning-like cardioprotective) effects. Since many OSA subjects are obese, and obesity is an independent risk factor for many comorbidities associated with OSA; and also most OSA has never been diagnosed in obese patients, we hypothesed that the chronic intermittent hypoxia caused by OSA in obese patients may be one of the underlying mechanisms in morbi-mortality paradox of obesity.
PMID: 20822856 [PubMed - as supplied by publisher]
Sunday, September 19, 2010
What is the best oral appliance for treating sleep apnea?
Any appliance that eliminates sleep apnea is a "best" choice.
The TAP appliances are the most effective for severe sleep apnea. I discuss which appliance is most appropriate for each patient based on their sleep study results, overall health, dental health and many other factors.
This is why I always set up each patient for a one hour consultation to explore multiple alternatives and to help my patients make informed choices on which treatment is most effective for treating each individuals sleep disorder.
I believe each patient deserves to understand how sleep apnea occurs and all treatment alternatives not just be "sold" an Appliance.
It is also important to insure successful treatment by doing follow-up sleep studies with appliances in place to insure efficacy.
I always give a full year of necessary follow-up visits when I make a patient an appliance. Appliances are not 100% successful but with proper follow-up they are 90-95% successful and vastly prefered to CPAP. Most patients have minimal problems with appliances but a small percentage may need several problem solving appointments.
Chosing the proper appliance for each patient eliminates the majority of problems.
The TAP appliances are the most effective for severe sleep apnea. I discuss which appliance is most appropriate for each patient based on their sleep study results, overall health, dental health and many other factors.
This is why I always set up each patient for a one hour consultation to explore multiple alternatives and to help my patients make informed choices on which treatment is most effective for treating each individuals sleep disorder.
I believe each patient deserves to understand how sleep apnea occurs and all treatment alternatives not just be "sold" an Appliance.
It is also important to insure successful treatment by doing follow-up sleep studies with appliances in place to insure efficacy.
I always give a full year of necessary follow-up visits when I make a patient an appliance. Appliances are not 100% successful but with proper follow-up they are 90-95% successful and vastly prefered to CPAP. Most patients have minimal problems with appliances but a small percentage may need several problem solving appointments.
Chosing the proper appliance for each patient eliminates the majority of problems.
Wednesday, September 1, 2010
IS INSOMNIA A RISK FACTOR FOR POOR CPAP COMPLIANCE? THIS IS PROBABLY THE CASE ACCORDING TO AN ARTICLE IN SEPTEMBER SLEEP MEDICINE.
THIS ARTICLE IN SLEEP MED SEES LOW ADHERENCE TO CPAP AS A SERIOUS PROBLEM AND A "significant challenge for sleep medicine clinicians". THIS STUY FOUND THAT PATIENTS WITH PRE-TREATMENT COMPLAINTS OF INSOMNIA AS MEASURED BY " Difficulty initiating sleep, difficulty maintaining sleep, and early morning awakening". THE STUDY FOUND THAT "sleep maintenance insomnia displayed a statistically significant negative relationship with average nightly minutes of CPAP use (p<.05) as well as adherence status as defined by the Centers for Medicaid and Medicare Services (p<.02)."
PATIENTS WITH COMPLAINTS OF INSOMNIA, PARTICULARLY SLEEP MAINTENANCE INSOMNIA MAY NOT BE GOOD CANDIDATES FOR CPAP TREATMENT. ORAL APPLIANCES ARE AN EXCELLENT ALTERNATIVE TO CPAP FOR PATIENTS WITH SLEEP MAINTENANCE INSOMNIA.
Sleep Med. 2010 Sep;11(8):772-6. Epub 2010 Jul 31.
Sleep maintenance insomnia complaints predict poor CPAP adherence: A clinical case series.
Wickwire EM, Smith MT, Birnbaum S, Collop NA.
Center for Sleep Disorders, Pulmonary Disease and Critical Care Associates, Columbia, MD 21044, USA. ewickwire@pulmdocs.com
Abstract
BACKGROUND: Although CPAP is a highly efficacious treatment for obstructive sleep apnea (OSA), low adherence presents a significant challenge for sleep medicine clinicians. The present study aimed to evaluate the relationship between insomnia symptoms and CPAP use. We hypothesized that pre-treatment insomnia complaints would be associated with poorer CPAP adherence at clinical follow-up.
METHODS: This was a retrospective chart review of 232 patients (56.5% men, mean age=53.6+/-12.4years) newly diagnosed with OSA (mean AHI=41.8+/-27.7) and prescribed CPAP in the Johns Hopkins Sleep Disorder Center. Difficulty initiating sleep, difficulty maintaining sleep, and early morning awakening were measured via three self-report items. CPAP use was measured via objective electronic monitoring cards.
RESULTS: Thirty-seven percent of the sample reported at least one frequent insomnia complaint, with 23.7% reporting difficulty maintaining sleep, 20.6% reporting early morning awakening and 16.6% reporting difficulty initiating sleep. After controlling for age and gender, sleep maintenance insomnia displayed a statistically significant negative relationship with average nightly minutes of CPAP use (p<.05) as well as adherence status as defined by the Centers for Medicaid and Medicare Services (p<.02).
CONCLUSIONS: To our knowledge, these are the first empirical data to document that insomnia can be a risk factor for poorer CPAP adherence. Identifying and reducing insomnia complaints among patients prescribed CPAP may be a straightforward and cost-effective way to increase CPAP adherence.
PMID: 20673741 [PubMed - in process]
PATIENTS WITH COMPLAINTS OF INSOMNIA, PARTICULARLY SLEEP MAINTENANCE INSOMNIA MAY NOT BE GOOD CANDIDATES FOR CPAP TREATMENT. ORAL APPLIANCES ARE AN EXCELLENT ALTERNATIVE TO CPAP FOR PATIENTS WITH SLEEP MAINTENANCE INSOMNIA.
Sleep Med. 2010 Sep;11(8):772-6. Epub 2010 Jul 31.
Sleep maintenance insomnia complaints predict poor CPAP adherence: A clinical case series.
Wickwire EM, Smith MT, Birnbaum S, Collop NA.
Center for Sleep Disorders, Pulmonary Disease and Critical Care Associates, Columbia, MD 21044, USA. ewickwire@pulmdocs.com
Abstract
BACKGROUND: Although CPAP is a highly efficacious treatment for obstructive sleep apnea (OSA), low adherence presents a significant challenge for sleep medicine clinicians. The present study aimed to evaluate the relationship between insomnia symptoms and CPAP use. We hypothesized that pre-treatment insomnia complaints would be associated with poorer CPAP adherence at clinical follow-up.
METHODS: This was a retrospective chart review of 232 patients (56.5% men, mean age=53.6+/-12.4years) newly diagnosed with OSA (mean AHI=41.8+/-27.7) and prescribed CPAP in the Johns Hopkins Sleep Disorder Center. Difficulty initiating sleep, difficulty maintaining sleep, and early morning awakening were measured via three self-report items. CPAP use was measured via objective electronic monitoring cards.
RESULTS: Thirty-seven percent of the sample reported at least one frequent insomnia complaint, with 23.7% reporting difficulty maintaining sleep, 20.6% reporting early morning awakening and 16.6% reporting difficulty initiating sleep. After controlling for age and gender, sleep maintenance insomnia displayed a statistically significant negative relationship with average nightly minutes of CPAP use (p<.05) as well as adherence status as defined by the Centers for Medicaid and Medicare Services (p<.02).
CONCLUSIONS: To our knowledge, these are the first empirical data to document that insomnia can be a risk factor for poorer CPAP adherence. Identifying and reducing insomnia complaints among patients prescribed CPAP may be a straightforward and cost-effective way to increase CPAP adherence.
PMID: 20673741 [PubMed - in process]
Friday, February 26, 2010
New surgery to treat obstructive sleep apnea.
There is a new surgery designed to treat sleep apnea. Permanent sutures are placed to secure the tongu to the jaw preventing it from blocking the airway. The is a logic to this procedure and it may require more than 1 surgical procedure. There is no long term data. In general surgery has been ineffective for treating apnea unless major surgical prcedures are done. Soft palate surgery carried high risk of morbidity and poor results. Tongue reduction was more successful,especially base of the tongue reduction. A recent article showed similar rsults with base of tongue reduction and somnoplasty on the base of the tongue. The somnoplasty proceedure had lower risk and morbidity.
CPAP remains the "Gold Standard" for treatment of obstructive sleep apnea but the majority of patients do not tolerate CPAP or BiPAP. Oral appliances are the only other therapy considerd a first line treatment of mild to moderate sleep apnea. Oral Appliances are considered an alternative treatment for severe sleep apnea when patients do not tolerate CPAP. Even when sleep apnea is severe the majority of patients do not tolerate CPAP.
Bimaxillary advancement is the most successful surgical proceedure but is a major orthopedic procedure with significant risks of morbidity. The surgery works in a similar method to oral appliances. Prior to surgery a trial oral appliance can help determine the best position to place the jaws to prevent additional future surgeries.
Suturing the tongue to the jaw is a novel approach to treating sleep apnea. Hopefully it will be more successful and less painful that soft palate surgery has proven to be.
CPAP remains the "Gold Standard" for treatment of obstructive sleep apnea but the majority of patients do not tolerate CPAP or BiPAP. Oral appliances are the only other therapy considerd a first line treatment of mild to moderate sleep apnea. Oral Appliances are considered an alternative treatment for severe sleep apnea when patients do not tolerate CPAP. Even when sleep apnea is severe the majority of patients do not tolerate CPAP.
Bimaxillary advancement is the most successful surgical proceedure but is a major orthopedic procedure with significant risks of morbidity. The surgery works in a similar method to oral appliances. Prior to surgery a trial oral appliance can help determine the best position to place the jaws to prevent additional future surgeries.
Suturing the tongue to the jaw is a novel approach to treating sleep apnea. Hopefully it will be more successful and less painful that soft palate surgery has proven to be.
Wednesday, February 10, 2010
Secret Weight Loss Hormone Now Available for Free. Leptin Can Be Your Answer! Lose Weight /Cure Sleep Apnea
Sleep Apnea and weight(BMI)have long been linked. Leptin and ghrelin are two hormones that are intimately linked to sleep and weight loss or weight gain. Leptin is the hormone that helps suppress your appetite and increase your metabolism. Increases in Leptin will make it easier to lose wieght because the cravings and nervous eating are decreased by this powerful appetite suppressant. It is not available at pharmacies and not covered by insurance but you can start to receive free doses immediately.
People who sleep less hours produce less leptin and tend to have lower blood levels of leptin. Low levels of this important hormone that helps suppress your appetite and increase your metabolism causes weight gain. Poor sleep,as seen with untreated sleep apnea will aslo decrease leptin production. Sleep loss also tends to increase your level of the hormone ghrelin. Grehlin stimulates your appetite which makes trying to diet a difficult ordeal. As a result of these two hormones people who sleep less may crave more and eat more. They especially may crave and eat more foods that are unhealthy. Patients in studies with sleep restriction have been shown to crave sweets, starch and salty snacks as a result of that sleep restriction.
TO RECEIVE YOUR FREE LEPTIN: SEVEN AND ONE HALF HOURS OF GOOD SLEEP IS THE ANSWER. iF YOU HAVE SLEEP APNEA MAKE SURE IT IS TREATED ALL NIGHT/ EVERY NIGHT.
Dieters have stuggled for years with every conceivable type of diet to produce weight loss. Sleeping better may be the easy answer to solving your weight issues.
There are several cycles in sleep and control of thyroid hormone and insulin hormone as well as cortisol the stress hormone are also affected by poor sleep. Disrupted sleep seen with sleep apnea can exacerbate all of these issues. With better sleep we are more active during the day which also increases our metabolism. With sleep apnea our oxygen levels are lower and our physiology slows down. The first period of Delta Sleep is where our body produces the majority of Growth Hormone. If that is disrupted by sleep apnea we are more likely to build up fat in our bodies at the expense of lean muscles according to a Universit of Chicago study.
The "Sleep Diet" may be the answer you have been looking for and a part of solving our national health crisis. Obesity in the U.S. is rising at an alarming pace among all age groups and all races and both sexes. The majority of Americans are overweight or obese with estimates of 60-75% of the population falling in these categories. The weight alone increases risks of high blood pressure,cancer and cardiovacular diseases including atherosclerosis, heart attack and stroke.
Research has shown many intriguing links between sleep quality, sleep quantity and BMI. Sleeping fewer hours tends increse the BMI to higher levels than people who sleep longer. Numerous studies have linked sleep to some of the hormones that help control body weight and appetite. There is no question about the link of sleep to insulin resistance and sugar metabolism. Obstructive sleep apnea probably repesents the single biggest risk of obesity because apnea is resposible fer massive in several health risks. Even mild sleep apnea and/or snoring related arousals can disrupt sleep patterns sufficienty to destroy normal sleep patterns and hormonal controls.
While good sleep may not be a total answer for obesity there is no doubt that improving the quality and quantity of healthy sleep will make weight loss easier both emotionally and physically on patients.
People who sleep less hours produce less leptin and tend to have lower blood levels of leptin. Low levels of this important hormone that helps suppress your appetite and increase your metabolism causes weight gain. Poor sleep,as seen with untreated sleep apnea will aslo decrease leptin production. Sleep loss also tends to increase your level of the hormone ghrelin. Grehlin stimulates your appetite which makes trying to diet a difficult ordeal. As a result of these two hormones people who sleep less may crave more and eat more. They especially may crave and eat more foods that are unhealthy. Patients in studies with sleep restriction have been shown to crave sweets, starch and salty snacks as a result of that sleep restriction.
TO RECEIVE YOUR FREE LEPTIN: SEVEN AND ONE HALF HOURS OF GOOD SLEEP IS THE ANSWER. iF YOU HAVE SLEEP APNEA MAKE SURE IT IS TREATED ALL NIGHT/ EVERY NIGHT.
Dieters have stuggled for years with every conceivable type of diet to produce weight loss. Sleeping better may be the easy answer to solving your weight issues.
There are several cycles in sleep and control of thyroid hormone and insulin hormone as well as cortisol the stress hormone are also affected by poor sleep. Disrupted sleep seen with sleep apnea can exacerbate all of these issues. With better sleep we are more active during the day which also increases our metabolism. With sleep apnea our oxygen levels are lower and our physiology slows down. The first period of Delta Sleep is where our body produces the majority of Growth Hormone. If that is disrupted by sleep apnea we are more likely to build up fat in our bodies at the expense of lean muscles according to a Universit of Chicago study.
The "Sleep Diet" may be the answer you have been looking for and a part of solving our national health crisis. Obesity in the U.S. is rising at an alarming pace among all age groups and all races and both sexes. The majority of Americans are overweight or obese with estimates of 60-75% of the population falling in these categories. The weight alone increases risks of high blood pressure,cancer and cardiovacular diseases including atherosclerosis, heart attack and stroke.
Research has shown many intriguing links between sleep quality, sleep quantity and BMI. Sleeping fewer hours tends increse the BMI to higher levels than people who sleep longer. Numerous studies have linked sleep to some of the hormones that help control body weight and appetite. There is no question about the link of sleep to insulin resistance and sugar metabolism. Obstructive sleep apnea probably repesents the single biggest risk of obesity because apnea is resposible fer massive in several health risks. Even mild sleep apnea and/or snoring related arousals can disrupt sleep patterns sufficienty to destroy normal sleep patterns and hormonal controls.
While good sleep may not be a total answer for obesity there is no doubt that improving the quality and quantity of healthy sleep will make weight loss easier both emotionally and physically on patients.
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.
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.
Tuesday, January 19, 2010
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.
"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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