Wednesday, December 24, 2008

Doctors Begin to Recognize Importance of Sleep Medicine

Obstructive sleep apnea was discovered in 1965, shortly after the application of EEG to sleeping subjects. As the EEG was combined with other body metrics, such as blood oxygen saturation measurements to create the polysomnogram, it became possible to positively diagnose sleep apnea. However, respect for sleep medicine was a long time coming. During the 60s and 70s, sleep medicine was considered mumbo jumbo and quackery, but once the biochemistry of sleep began to be revealed, allowing treatment of sleep disorders, sleep medicine began to be recognized, and finally, in 1996, the American Medical Association recognized sleep medicine as a legitimate specialty.

Not so sleep dentistry, which is still not a specialty recognized by the American Dental Association. Nonetheless, sleep dentists have been working for decades to help people get a good night's sleep through oral appliances that can stop snoring and remedy obstructive sleep apnea.

If you are a snorer or have been diagnosed with sleep apnea, especially if you have been started on CPAP treatment by a sleep doctor but it is not working for you, schedule a sleep dentistry consultation at the Snoring and Sleep Apnea Treatment Center in Gurnee, Illinois, today.

Wednesday, December 17, 2008

Baby Boomers Losing Sleep

According to Research by the National Sleep Foundation, the average American spends six hours 40 minutes sleeping a night, close to the recommended seven to nine hours. But according to a poll by the Better Sleep Council, one segment of America’s population is doing far worse. According to the poll, 43 percent of Baby Boomers, Americans aged 44 to 62 years old, get six hours of sleep or less every night, and 55 percent of them have difficulty falling asleep at least one night a week, with 15 percent reporting difficulty falling asleep every night. After financial concerns and family worries, what is the most common complaint?

About 18 percent of Baby Boomers report that they don’t get enough sleep because their significant other snores or tosses and turns. No wonder so many of them are moving into separate bedrooms. But it doesn’t have to be this way. If you snore or if your loved one snores, you may be able to get relief with oral appliance therapy.

These days, there is enough to worry about with the economy and financial stress, and with everyone getting older, family worries just keep multiplying. Don’t let snoring keep you awake at night. Schedule an oral appliance therapy consultation at the Snoring and Sleep Apnea Treatment Center in Gurnee, Illinois.

Wednesday, December 10, 2008

Circadian Rhythms Related to Metabolism

We've been discussing the relationship between obesity and sleep apnea, and the relationship between diabetes and sleep apnea, and it appears that researchers at the Institute for Diabetes, Obesity, and Metabolism at the University of Pennsylvania School of Medicine has discovered another piece of the puzzle about their relationship. Unfortunately, it is one that muddies the waters a little bit, suggesting that ties between metabolism and sleep may be beyond our understanding at this moment.

The researchers studied a pair of molecules, known to modulate the body's response to metabolic hormones. They created a mutation in mice which prevented the two hormones, NCoR and HDAC3, from working together. This partnership is known to affect animals' metabolism responses to food, but when they disrupted this partnership, they found a surprising side effect: suddenly the mice were on a different sleep schedule. Suddenly, they had a different circadian rhythm than unaltered mice. They were sleeping less, but their bodies responded more readily to insulin. This means they did not gain as much weight when put on a high-fat diet, and seemed healthy.

Researchers are hopeful that this discovery might someday lead to new therapies in the battle against obesity and diabetes. They warn, however, that the discovery shows sleeping less and greater insulin response may be triggered by the same mutation, not that people who sleep less, or who have disrupted sleep patterns as a result of sleep apnea or snoring, will lose weight. In fact, the evidence suggests the opposite.

If losing weight has been a problem for you, especially if you can't seem to control your diet or appetite, perhaps sleep apnea is a contributing factor. Schedule a sleep apnea treatment consultation at the Snoring and Sleep Apnea Treatment Center in Gurnee, Illinois, today.

Wednesday, December 3, 2008

Husbands and Wives Being Driven Apart by Sleep Disorders

According to a National Sleep Foundation survey, as many as one in every four married couples sleeps in separate bedrooms. The main reason cited for the increasing numbers of couples seeking separate quarters is sleep disorders, especially snoring, which prevents cosleepers from getting a good rest. However, psychologists and doctors caution that this solution is less than ideal.

Psychologists say that although it is important for people to get sleep, simply moving into another room can cause irreparable damage to your relationship. Although sleeping in separate rooms might defuse the tension surrounding snoring or RLS-related disturbance to your partner, it also reduces the amount of bonding you do with him or her. Sleeping in the same bed is important for establishing intimacy which is the foundation of a healthy marriage. Although used as a euphemism for sexual relations (also affected by snoring and sleep apnea), intimacy is a combination of psychological and biochemical mechanisms that help couples to feel close to one another.

And simply moving to another room leaves potentially dangerous conditions untreated. Snoring is often just the most audible symptom of obstructive sleep apnea, which can lead to a number of dangerous health effects. If you truly love your husband or wife, you will not abandon them to gasp and suffer alone, but will help them get treatment, using either CPAP or the more comfortable and less invasive oral appliance therapy.

The best solution to a snoring problem is not to run away, but to seek treatment through sleep medicine. To schedule a snoring relief consultation, contact the Snoring and Sleep Apnea Treatment Center in Gurnee, Illinois, today.

Tuesday, November 25, 2008

Sleep Apnea Diagnosis Delays in Canada

There are many problems with the American health care system, but as we are considering health care reform, it is important to pay attention to the weaknesses of alternate systems. Canada's health system often receives high marks for both its ability to provide universal care and its ability to resist industry pressures that can put profit above public good. However, one of the most common complaints about the Canadian system is long wait times for treatments, especially treatments involving specialists who are in demand and can cross the border into the United States.

Sleep medicine is one area where people can suffer potentially deadly delays as a result of the system. In Saskatchewan, for example, there are very few labs able to diagnose sleep apnea. One lab has a waiting list of over 2000 people, and some of these people have been waiting five years for diagnosis and treatment of sleep apnea. Because of the myriad dangers of sleep apnea, Health Canada guidelines recommend a maximum wait time for sleep apnea diagnosis of two to six months.

A relatively new program in Saskatchewan, though, has given thousands of Canadians an option. Instead of waiting in line for diagnosis at a sleep lab, people who suspect sleep apnea can take home a portable testing kit to determine whether they are likely to be suffering from sleep apnea.

The only problem with the program? Funding. Although it has successfully reduce the waiting lists at the area sleep clinic and brought wait times into the recommended length, the provincial government is unsure whether it wants to continue funding the program. With funding up in the air, it is uncertain whether the program will be cut off despite its early success.

At the Snoring and Sleep Apnea Treatment Center in Gurnee, Illinois, we can make sure you receive timely diagnosis and treatment for your sleep apnea. Schedule a sleep apnea consultation today.

Tuesday, November 18, 2008

Sleep Apnea and Post-Traumatic Stress Disorder

As we experience the return of another generation of veterans of foreign wars, we have to prepare ourselves for the onset of post-traumatic stress disorder (PTSD) in thousands of veterans. And for many sufferers of PTSD, sleep apnea is either a contributing cause or, at least, what is known as a comorbidity, a disease that occurs alongside as a result of the same causes. If we are to facilitate the transition of veterans and others back into normal life following traumatic events, diagnosis and treatment of sleep apnea must be part of the solution.

In one study of crime victims suffering from PTSD, 90 % of the victims also suffered from respiratory disruption, and half also suffered from obstructive sleep apnea. Other studies have found similar results, and it has been determined that insomnia and daytime sleepiness within a month after the traumatic event are important predictors for the development of PTSD.

With PTSD, as with obesity, it is hard to determine which came first. But sleep apnea saps a person's mental and physical resources for dealing with life events. Since it is impossible to predict who will suffer from PTSD after a traumatic event, all that we can say is that people with sleep disorders are more likely to develop PTSD.

In one case study of a Vietnam Veteran who suffered from both sleep apnea and PTSD, the treatment of sleep apnea led to a significant reduction in PTSD symptoms. The man had frequent waking episodes, often accompanied by choking, and he complained of nightmares and flashbacks to his combat experience. Once the man began CPAP treatment, and his level of REM sleep increased, his PTSD all improved. His doctors attributed this in part to the dramatic reduction of his waking instances during REM sleep and more time spent in REM sleep.

If you or a loved one have suffered a traumatic event and are finding it hard to get back to normal life. If your sleep is disrupted and you fear for your physical and mental health, sleep apnea might be part of the problem, and treatment part of the solution. Schedule a sleep apnea consultation at the Snoring and Sleep Apnea Treatment Center in Gurnee, Illinois today.

Tuesday, November 11, 2008

Even Mild Sleep Apnea Can Be Serious Health Risk

According to a study published this month in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine, even people with "minimally-symptomatic" obstructive sleep apnea (OSA) can face serious consequences in terms of cardiovascular health.

The symptoms of sleep apnea are relatively easy to identify once you know what you're looking for. Snoring, daytime sleepiness, weight gain, impaired cognitive function and focus, can make a very clear pattern pointing in the direction of sleep apnea. But as little as 1 in 5 sleep apnea sufferers actually manifests the discernible symptoms of sleep apnea. Because they are harder to identify and study, the risk these people, with only mild to moderate OSA, face has not been studied in the past. However, this study, conducted by the Oxford Centre for Respiratory Medicine, identifies the significant risk of cardiovascular damage even in very mild cases of OSA.

According to the study's results, people with sleep apnea had blood vessels less able to expand and contract to regulate blood flow, and their arteries were significantly more stiff than non-apneic subjects. Surprisingly, apnea sufferers had higher blood pressure, but not significantly.

Although blood pressure was not determined to be a factor in this study, the cardiovascular symptoms pointed to by the study still represent an increased risk for people with even mild, largely asymptomatic OSA.

If you experience even intermittent hints that you may suffer from sleep apnea, the potential dangers of sleep apnea justify undergoing evaluation to determine the presence or absence of the condition. And if you have only mild OSA, it is more likely that you can receive good results with non-invasive, comfortable oral appliance therapy. Schedule a sleep apnea consultation with the Snoring and Sleep Apnea Treatment Center in Gurnee, Illinois, to learn more.

Tuesday, November 4, 2008

Apnea Leads to Poor Diet

In research similar to our earlier discussion about Sleep Apnea as a Cause of Obesity, rather than vice-versa, researchers in Arizona published a study showing that people with sleep disordered breathing (SDB) consumed more fatty foods and cholesterol if their SDB was more severe. The researchers looked at baseline data collected as part of The Apnea Positive Pressure Long-term Efficacy Study (APPLES), an attempt to gauge the effectiveness of CPAP and related treatments over time. Then they correlated the information with a number of different variables, especially what is known as respiratory disturbance index (RDI).

All of the patients in the study had sleep apnea. In looking at the data, researchers also found that people with an RDI > 50, meaning people with more disturbed sleep breathing, consumed a diet that was higher in cholesterol, protein, total fat, and total saturated fat. In fact, those with higher RDI's consumed, on a daily basis,

88.16 mg more cholesterol

21.96 g more protein

27.75 g more total fat

9.24 g more saturated fat

Although apnea is commonly correlated with obesity, these results were after correction based on body mass index (BMI), meaning that there seems to be an independent correlation between SDB and diet. Although it seems unwise to jump to conclusions, this study points strongly in the direction that, in some cases at least, sleep apnea causes obesity rather than the other way around.

If you find you are having trouble sticking to a diet and losing weight because of unexplained cravings or appetite that is out of control, perhaps SDB is to blame. Schedule a sleep apnea consultation at the Snoring and Sleep Apnea Treatment Center in Gurnee, Illinois, today.

Thursday, October 30, 2008

Epilepsy and Sleep Apnea

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 make 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.

Thursday, October 23, 2008

PBS Feature on Sleep Apnea Neglects Oral Appliance Therapy

PBS' NewsHour is one of the most respected in-depth news programs on television. Known for its long investigative pieces that daily delve into important news stories, these reports give vital minutes to stories that receive only seconds of attention even from 24-hour news networks. Therefore, a recent feature, first aired on August 13, was a vital opportunity to educate and inform Americans about the potentially deadly effects of one of our nation's most underdiagnosed conditions: sleep apnea. For the most part, the story, which used a narrative focus on a number of patients to explore the risks, diagnosis, and treatment of sleep apnea, did its job of being informative.

The story showed three men, one who was just being diagnosed with sleep apnea, one who was getting ready to begin treatment for sleep apnea, and one who had been undergoing treatment with CPAP successfully for three years. The man prepared to begin treatment was fitted with a CPAP mask, and openly expressed his distaste for the machine. The story revealed that CPAP treatment only works for about 25 % of patients, and that the man who was fitted with the CPAP mask didn't feel he had slept any better with it than without it.

However, the story failed to give any mention to CPAP alternatives, such as oral appliance therapy. Oral appliance therapy is not for everyone, but neither is CPAP, and with the potentially deadly effects of sleep apnea, people need to be informed of all their options so they can find the treatment that works best for them.

If you have been diagnosed with sleep apnea and are trying to undergo treatment, but are finding that CPAP just isn't working for you, schedule a consultation with the Snoring and Sleep Apnea Treatment Center in Gurnee, Illinois today.

Thursday, October 16, 2008

You Can Lose the Weight and Not the Apnea

In a study published August 15 in the Journal of Clinical Sleep Medicine, researchers studied 24 adults with obstructive sleep apnea through bariatric surgery. Before the surgery, subjects had an average BMI of 51, while after the surgery they had a BMI of 32. What they found was that, one year after surgery, only 4 % of the subjects had resolved their sleep apnea, and the majority of them still had moderate to severe sleep apnea, putting them at an elevated risk for mortality.

The study would seem to lend credibility to the theory we talked about last time: that obesity is an effect, not a cause, of sleep apnea, but it may not be true. It is important to remember that while all the patients experienced a dramatic reduction in BMI, they were by no means reduced to patients with an ideal BMI. Although they were no longer severely morbidly obese, they were still technically obese following their surgery.

More importantly, the study also found that although patients were still suffering from a potentially deadly degree of sleep apnea, the majority of them had discontinued use of their sleep apnea treatment, which in the study was CPAP. Most of them thought their sleep apnea was resolved, but this was probably due to the increase in energy they felt as a result of their weight loss. Once they felt this increase in energy, they were happy to be rid of the nuisance and discomfort of CPAP forever. It's possible that if the study had involved people being treated with oral appliance therapy, more of them might have continued their treatment following surgery.

If you have had bariatric surgery or lost a great deal of weight through diet and exercise, you may think your apnea is cured, but most likely it is not. However, there may be a more comfortable treatment option for your sleep apnea than your CPAP. To learn more about oral appliance therapy for sleep apnea, contact the Snoring and Sleep Apnea Treatment Center in Gurnee, Illinois today to schedule your sleep apnea consultation.

Thursday, October 9, 2008

Obesity and Sleep Apnea: A New Chicken-and-Egg Paradox

We have mentioned several times that obesity puts people at significant risk for sleep apnea. Obese people have a much greater risk of suffering from obstructive sleep apnea than people of a more ideal body weight. But correlation doesn't equal causation, and there is some evidence that in some, many, or all cases, the causal arrow may point the other way.

In human beings, two hormones that have a powerful effect on appetite are leptin and ghrelin. It is more complicated than this, but in general leptin suppresses appetite, while ghrelin stimulates appetite. In studies, the level of both hormones were found to be correlated with low sleep levels. In fact, in a Wisconsin Sleep Cohort Study of 1024 individuals, shorter sleep time was found to correlate both with increased ghrelin levels and lower leptin levels. Since leptin also stimulates the body to burn energy, the combination of elevated ghrelin levels and reduced leptin levels will lead to decreased energy consumption and increased appetite, leading to higher levels of obesity. The study's only caveat is that because of the population it contained more snorers than the overall population.

Interestingly, not all studies have confirmed these results. Some have found sleep apnea sufferers have elevated levels of leptin, not ghrelin, while others suggest that sleep apnea sufferers seem to have elevated levels of both hormones. What is agreed by all the studies, however, is that sleep deficiencies can have a significant impact on the levels of these hormones. And there is evidence that sleep apnea treatment with CPAP can regulate the level of these hormones. It is likely that in cases where oral appliance treatment is called for, it will also help regulate these levels.

So if you are a sleep apnea sufferer who is overweight, it is possible that your apnea is the cause of your weight gain, not the other way around. And if you have been trying to lose weight but have so far been unsuccessful, it may be due to sleep apnea. If you would like to learn more about the possible benefits of sleep apnea treatment, contact the Snoring and Sleep Apnea Treatment Center in Gurnee, Illinois today to schedule your sleep apnea consultation.

Monday, September 29, 2008

Heavy Snoring Increases Risk of Carotid Atherosclerosis

If you are a heavy snorer, you are more likely to suffer from carotid atherosclerosis, according to a recent study published in the journal "Sleep." Carotid atherosclerosis is the buildup of plaque within the carotid arteries in the neck. This can lead to a narrowing of the artery, which can contribute to high blood pressure and reduce blood supply to the brain. However, the main danger of carotid atherosclerosis is that portions of the plaque can break off and lodge themselves in blood vessels in the brain, starving portions of the brain of blood supply, causing a stroke.

Researchers studied 110 adults, both snorers and nonsnorers, and evaluated them using polysomnography (commonly used to diagnose sleep apnea) and scanned them for carotid and femoral atherosclerosis. Based on the polysomnography, study subjects were divided into categories of mild, moderate, and heavy snorers. It was found that the risk of carotid atherosclerosis was 20 % for mild snorers, 32 % for moderate snorers, and 64 % for heavy snorers. There was no association between snoring and femoral atherosclerosis.

Snoring is more than just a nuisance. Not only can it be associated with sleep apnea, but it can have serious health complications of its own. If you are a snorer, you should seek snoring treatment today at the Snoring and Sleep Apnea Treatment Center in Gurnee, Illinois.

Thursday, September 25, 2008

Obstructive Sleep Apnea Contributes to Erectile Dysfunction

A recent study sponsored by the American Thoracic Society shows that erectile dysfunction (ED) can be one of the dangers of sleep apnea. The study looked at mice, exposing them to chronic intermittent hypoxia (CIH), oxygen deprivation, similar to what a person with sleep apnea suffers. After a week of CIH exposure, the mice showed a 55 percent decline in their daily spontaneous erections. After five weeks of exposure, the mice showed a 60-fold increase in their average interval between mounting mates, and a 40-fold increase in latency to intromission. Latency to ejaculation was also seriously affected, increasing from just a few minutes to eleven hours.

The study looked at mice who were exposed to nocturnal CIH, and it monitored not only the visible sexual behaviors, but connected sexual hormones include testosterone and estrodiol, endothelial and neuronal nitric oxide synthase. Endothelial nitric oxide synthase is the hormone affected by sildenafil, tadalafil, and vardenafil, the active ingredients in Viagra, Cialis, and Levitra, respectively.

If you want to sleep better and be able to better enjoy your waking hours, contact the Snoring and Sleep Apnea Treatment Center in Gurnee, Illinois, for a free sleep apnea consultation today.

Monday, September 22, 2008

Daytime Sleeping Leads to Poor Recovery

Earlier, we looked at how sleep apnea can lead to an increased risk of surgical complications. Now it seems that daytime sleeping, one of the possible outcomes of sleep apnea, can have a detrimental impact on the recovery of patients in rehabilitation following a heart attack, stroke, or orthopedic condition. According to a study published in the September issue of the journal Sleep, residents of rehab had significantly decreased functional recovery if they slept more during the day.

The study was conducted by researchers at UCLA's David Geffen School of Medicine. The study focused primarily on daytime sleeping and correlated it with the rate of functional recovery following three months of rehab. Although it did not focus directly on sleep apnea, researchers described sleep disturbances as one of the primary causes leading to daytime sleeping.

The value of the study is that sleep apnea treatment and treatment of other sleep disturbances can be more readily quantified than other variables that inhibit recovery during rehab. Factors like cognitive function and the likelihood of hospital readmission, which have also been shown to be significant variables in determining a patient's rate of recovery during rehab, are less remediable. On the other hand, sleep apnea treatment, whether through CPAP or oral appliance therapy, has a consistent record of documentable success.

If you would like to learn more about how sleep apnea treatment can increase your general health and ability to recover from surgery or injury, contact the Snoring and Sleep Apnea Treatment Center in Gurnee, Illinois, today for a free initial consultation.

Monday, September 15, 2008

Have Diabetes? Get Screened for Sleep Apnea

About 85 % of sleep apnea cases among diabetics go undiagnosed, simply because doctors do not screen for the condition, according to a speaker at the 35th annual meeting of the American Association of Diabetes Educators. The speaker urged doctors treating diabetics to institute effective screening protocols to identify possible sufferers and send them to specialists for diagnosis of sleep apnea and, if necessary, sleep apnea treatment.

As part of the numerous dangers of sleep apnea, sleep apnea sufferers are at an increased risk of suffering diabetes. Some studies suggest that sleep apnea may worsen insulin resistance. In addition, behavioral effects related to daytime sleepiness, such as snacking and stimulant consumption, followed by inactivity, can worsen diabetes and impair behaviors such as exercise and diet control that are an important part of diabetes treatment.

If you suffer from diabetes, it is important to be tested for sleep apnea to make sure that you can effectively treat both conditions together for maximum effect. If you have diabetes and have not been tested for sleep apnea, but think you might have the condition, contact the Snoring and Sleep Apnea Treatment Center in Gurnee, Illinois, today for a free initial sleep apnea consultation.

Monday, August 25, 2008

Oral Appliances More Effective and Comfortable than CPAP

When provided by doctors and dentists trained in sleep apnea, such as Dr. Shapira, oral appliances are a better option for the treatment of sleep apnea than CPAP. Patients who are prescribed CPAP complain about the noise of the machine, or the claustrophobic feeling of the mask, which can cause nightmares. Patients do not like feeling tethered by the hose. Some patients report problems with allergies, acne, bronchitis, dizziness, and dry mouth or nose, and many suffer chronic sinus infections. As a result, only about 23-45 % of patients actually use their CPAP machine, meaning that their sleep apnea goes untreated and they continue to suffer the dangers of this condition.

Patients given the choice between CPAP and an oral appliance will generally choose the oral appliance, and because it is more comfortable, they will actually use their oral appliances and experience relief.

The comfort and relief provided make oral appliances a more effective sleep apnea treatment in most cases, and that is the reason why Dr. Shapira trains dentists and doctors in the use of oral appliance therapy for the treatment of sleep apnea. Dentists trained with Dr. Shapira provide oral appliance treatment in Grand Rapids, Michigan to Dallas, Texas; Tampa Bay, Florida to Palo Alto, California.

If you have either been prescribed CPAP, and either cannot use it or would rather try a better alternative, contact Dr. Shapira at the Snoring and Sleep Apnea Treatment Center today to learn how oral appliances can provide relief.

Monday, August 18, 2008

Ringing in the Ears or Tinnitus? You Could Be a Victim of the Great Impostor.

Many people experience an occasional ringing in the ears, but for some this phenomenon becomes persistent and may even lead to a reduction in productivity, an increase in irritability, and a general decrease in one's quality of life. In seeking treatment, people may see some of the best experts in the field of medicine, but still find no relief, despite many years and much money spent on numerous treatments and medications.

Why can something so simple be so hard to treat? Because it is often due to what is known as temporomandibular dysfunction (TMD), one of the hardest conditions to treat because it masquerades as so many other things. If you look at a partial list of the symptoms, you can see why. In addition to tinnitus, symptoms for TMD include:

· Headaches

· Facial and/or sinus pain

· Earache

· Dizziness

· Shoulder, neck, and other muscle pain

· Sleep disorders

· Irritable bowel, abdominal pain, and gastric reflux are often associated secondarily

Looking at the symptoms, it's easy to see why TMD can be confused with one or more other illnesses. If you have tinnitus or any of these other symptoms, and your doctor has been unable to provide relief, you should consult with a neuromuscular dentist. These specially-trained dentists specialize in treatment of TMD and its related symptoms.

Dr. Ira Shapira, founder of the Snoring and Sleep Apnea Treatment Center, is a neuromuscular dentist who can provide relief for TMD and its symptoms. Please contact him today to schedule a consultation.

Thursday, August 14, 2008

The Effectiveness of the SomnoDent MAS

The SomnoDent MAS (Mandibular Advancement Splint) is a relatively simple oral appliance for the treatment of snoring and sleep apnea. It is manufactured by the SomnoMed corporation. Compared to both CPAP and most other oral appliances, it represents a minimalist solution to the problem of snoring and sleep apnea. The SomnoDent consists of two pieces that are custom-fitted to the teeth of the patient. One piece has flanges that fit into pockets in the other piece to maintain the jaw in an appropriate position during sleep.

Although it is a minimalist solution, it is highly effective. Objective studies showed that 63 % of patients treated with the device saw complete cessation of clinical obstructive sleep apnea (OSA) (reduction of apneic events to less than 5 per hour) or a 50 % improvement in their apnea/hypoxia index, a measure of blood oxygen levels during sleep. This includes mild, moderate, and severe sleep apnea sufferers. Studies also showed that SomnoDent users saw an increase in REM sleep, and a reduction in waking.

SomnoDent also improved snoring. On average, snorers saw a 43 % reduction in the number of snores per hour. The snoring was also quieter. Both the average snoring volume and the maximum snoring volume were reduced by 3 decibels.

Subjectively, 83 % of SomnoDent users said they had "significant improvement" in snoring, sleep quality, and reduction of daytime sleepiness. Its ease of use meant that 86 % of patients reported using the device every night. And the combination of comfort and effectiveness led 96 % of patients to say they would continue using SomnoDent MAS.

Because it is a minimalist solution, SomnoDent also has the benefit of being less expensive than other snoring and sleep apnea treatment options. If you would like to learn more about this inexpensive and effective treatment option, contact the Snoring and Sleep Apnea Treatment Center in Gurney, Illinois, today for a free initial consultation.

Monday, August 11, 2008

How to Correct the Sinus and Ear Pain of CPAP

Many users of CPAP complain about frequent sinus and ear pain. This pain can be the result of the positive pressure being forced into the otolaryngal cavity.

Obstructive sleep apnea is caused by the relaxation of soft tissues in the throat, which then collapse, constricting the airways. CPAP works by forcing enough air pressure into these airways to keep them open. However, air pressure cannot be selective. It fills the entire otolaryngal cavity, which means that the same pressure that is holding your airway open is pushing against your ears and your sinuses. This can lead to sinus pain and ear pain.

CPAP can be compared to carpet bombing an entire city to root out one nest of radicals, while in many cases what you really need is a targeted solution, a "smart bomb" that goes right to the source of your obstructive sleep apnea and leaves the rest of your airway alone.

For many people, oral appliances are that smart bomb. By correcting the actual obstructive configuration of tissues, oral appliances are a targeted therapy that corrects your sleep apnea without the collateral damage left by CPAP.

Stop fighting so hard against your sleep apnea that you do more harm than good. Instead, contact the Snoring and Sleep Apnea Treatment Center today to learn how you can fight smart and sleep better without sinus and ear pain.

Monday, July 28, 2008

Study Provides Objective Evidence for Benefits of Chiropractics

People are split on chiropractors. There are those who believe they are quacks and those who believe they are skilled medical practitioners capable of providing lasting relief to serious medical conditions. Patients have long been able to describe and voice the benefits they receive from going to the chiropractor, but objective measurement of these benefits has been difficult to obtain.

However, a recent study shows that adjusting the atlas, the top cervical vertebra, can lead to a significant decrease in blood pressure, one of the dangers of sleep apnea. The decrease was the equivalent of taking a double dose of prescribed blood pressure medications. Chiropractors who have eschewed full-spine adjustments in favor of delicate manipulations of the atlas vertebra see this finding as a vindication of their approach.

In a different study, it has been shown that neuromuscular dental treatment can help adjustments of the atlas vertebra to stay in place. Because the alignment of the atlas depends almost exclusively on soft tissue, including muscles and ligaments that can be affected by TMD.

To learn more about how neuromuscular dentistry can increase the effectiveness of your chiropractic treatments, contact Dr. Ira Shapira, neuromuscular dentist, at his Gurnee, Illinois office.

Tuesday, July 22, 2008

Treat Headaches without Medication Using Neuromuscular Dentistry

The first thing most people do for a headache is go to the medicine cabinet to take an aspirin, acetaminophen, or ibuprofen. However, all medications produce side effects, and these medications are no exception. Aspirin side effects include bleeding in the brain, kidney failure, and increased risk of stroke. Acetaminophen has been shown to be very bad for the liver, and ibuprofen is an NSAID, in the same class of medications as Vioxx, which was pulled from the market because of it increased risks for heart attack and stroke. As a result, it is wise to seek non-drug relief from chronic headaches.

Instead, consider neuromuscular dentistry. The trigeminal nerve, or dental nerve, accounts for half of all input into the central nervous system, and it controls the front 2/3 of the meninges (membranes) that control blood flow to the brain. Because of this role in controlling blood flow, the trigeminal nerve can be blamed for many chronic headaches.

Neuromuscular dentistry, by relieving pressure and dysfunction of the jaw, has, among other effects, the ability to improve the function of the trigeminal nerve.

To learn more about how neuromuscular dentistry can relieve your suffering from chronic headaches, contact Dr. Ira Shapira at his Gurnee, Illinois office.

Tuesday, July 15, 2008

Meticulous Cleaning Essential for CPAP

One common complaint among CPAP users is that they get sinus and ear infections. They are more likely to suffer bronchitis than the general population. The constant mucous surplus created by your body in an attempt to fight against infection can be almost as disruptive as the sleep apnea that CPAP is designed to cure. These infections are the result of exposure to the micro-organisms that breed on the mask and hose of the CPAP machine. With daily use, the CPAP machine can host a dangerous menagerie of bacteria, fungi, and viruses that feed on the skin, mucous, and oils from your body that accumulate on the mask.

Then, once these populations have been breeding all day, the CPAP machine becomes a delivery system that pushes them inside your body. The positive airway pressure makes sure these micro-organisms are forced throughout your otolaryngal cavity. The inside of your ears, your throat, even your lungs are all seeded with a breeding population, making it highly likely that the populations will take hold. This is made even more likely as a result of the drying of your mucous membranes that can be a side effect of CPAP treatment.

To avoid the dangers of the CPAP machine, it is essential that you maintain an impeccable cleaning routine for the mask and hose. It is often advisable that you have several sets of hoses and masks so that you can rotate them and clean them in soap and water and completely dry them between uses.

Another option is the use of oral appliance therapy, which not only fosters less in the way of bacterial and other micro-organismal populations, but is easier to clean, and, even if it becomes populated, does not give these infectious disease organisms a free ride into your lungs. Most people prescribed CPAP therapy can actually get as good or better results from oral appliance therapy, without this health-threatening side effect.

To learn more about how oral appliance therapy can be healthier than CPAP, contact Dr. Ira Shapira at the Snoring and Sleep Apnea Treatment Center today.

Tuesday, July 8, 2008

Dr. Shapira to Team with Other Sleep Expert to Provide Care in Bannockburn

Dr. Shapira has been treating people for sleep apnea in the Chicago area from his Gurnee office for over 25 years, and will soon extend the same high quality care to more patients through his partnership with another sleep apnea expert.

Dr. Alex Golbin is the founder of Sleep and Behavioral Medicine. He is a well-known expert on children with sleep disorders, and has written the only textbook on Sleep Psychiatry. He maintains three offices on the North Shore, in Vernon Hills, Skokie, and Bannockburn, all accredited by the Academy of Sleep Medicine. At these state-of-the-art offices, Dr. Golbin treats sleep apnea, insomnia, and bedwetting in children. He also coordinates a number of advanced research projects through his Vernon Hills office, constantly advancing the state of sleep medicine.

The hope is not only that this cooperative effort will not only give patients in the North Shore better access to advanced sleep medicine, but by sharing ideas, experience, and practices, the doctors will be able to improve the treatment of sleep disorders for all their patients.

If you are suffering any of the symptoms of sleep apnea, please contact the Snoring and Sleep Apnea Treatment Center today for a free initial sleep apnea consultation.

Thursday, June 26, 2008

Sleep Apnea Personal Quest for Dr. Shapira

Dr. Shapira became interested in sleep apnea treatment because his 3-year-old son, Billy, had severe snoring and suffered from night sweats. When he mentioned his concerns to his son's pediatricians, the concerns were brushed off. When his son was held back from starting kindergarten at age five, Dr. Shapira took matters into his own hands. He took Billy to Rush Medical School's sleep center, where it was determined that the boy had severe sleep apnea. Billy's apnea was treated, and he became a straight "A" student and graduated college with a double major Magna Cum Laude. This experience instilled in him a lifetime interest in sleep disorders. He became a Visiting Assistant Professor at Rush in the sleep service in the 1980's and returned as an Assistant Professor in the 1990's until early this century where he treated sleep apnea and snoring with oral appliances.

Partly as a result of Dr. Shapira's long campaign, the American Academy of Sleep Medicine now recognizes oral appliances as a first-line treatment of mild to moderate sleep apnea and an alternative treatment for severe apnea in patients who do not tolerate CPAP, and in winter 2008, The National Sleep Foundation declared oral appliances "A Therapy Whose Time Has Come."

To learn more about oral appliance therapy, and its ability to correct the major detriment of sleep apnea, please contact the Snoring and Sleep Apnea Treatment Center today for a free consultation.

Thursday, June 19, 2008

The Epworth Sleepiness Scale

The Epworth Sleepiness Scale (ESS) is, like the Pittsburgh Sleep Quality Index a questionnaire designed to measure daytime sleepiness. It is used both to indicate whether a person should undergo more conclusive sleep apnea diagnosis and to determine the success of sleep apnea treatment.

The ESS asks patients to rate their likelihood of falling asleep during certain activities, including sitting and reading, watching TV, at a meeting or in a movie theater, while driving, and others. The questionnaire makes sure patients know not to consider just feeling tired, but actually falling asleep. Patients rate each activity from 0 (no chance of falling asleep) to 3 (high chance of falling asleep).

The ESS was designed by doctors at the Epworth Hospital in Melbourne, Australia in 1991. The initial study used the ESS on a group of 180 patients, including 30 normal men and women, and 150 men and women with many different sleep disorders. The ESS was able to distinguish the controls from the rest of the group with a high degree of accuracy, and even distinguished persons with sleep apnea from those who merely snored.

Although the ESS is not a sufficient diagnostic tool, it can be used as a first-screening tool for determining whether you may have sleep apnea.

If you suspect you have sleep apnea, please contact the Snoring and Sleep Apnea Treatment Center for a free sleep apnea consultation.

Tuesday, June 10, 2008

The Pittsburgh Sleep Quality Index

The Pittsburgh Sleep Quality Index (PSQI) is a questionnaire designed to determine the quality of sleep experienced by a person. The PSQI seeks to measure the sleep quality of a patient over the course of the last month. Originally designed by professors at the Pittsburgh School of Medicine to measure the sleep quality among psychiatric patients, since its introduction in 1989, the PSQI has been applied in many different contexts to many different populations, with a high degree of success.

In its initial test over an 18-month period, the test showed almost a 90 % sensitivity and specificity in distinguishing between good and bad sleepers. Month-to-month repeatability of results was high. Later clinical trials have also established that the test also had a high level of stability over two years.

The PSQI questionnaire includes questions directed at many different parameters over one month. First, it asks about the time a person goes to sleep, how long it takes to fall asleep, time of waking, and the amount of actual sleep per night. It asks questions about disruptions to sleep, including difficulty falling asleep, night waking, breathing difficulties, and bad dreams. The questionnaire also asks the respondent to get information from any cosleeper(s) about nighttime behaviors such as snoring and restless leg syndrome.

Although the PSQI cannot diagnose sleep apnea, it can be a useful tool for helping clarify a suspicion of the condition. It also can be very useful as a source document for starting your sleep diary, since it identifies many key parameters related to the quality of your sleep.

If you suspect you may have sleep apnea, please contact the Snoring and Sleep Apnea Treatment Center, serving patients in the Chicago area, northern Illinois and southern Wisconsin, for a free sleep apnea consultation.

Friday, May 30, 2008

Post-Surgical Risks for Sleep Apnea Sufferers

If you have central, obstructive, or mixed sleep apnea, you may be at risk for dangerous complications following surgery. According to studies, patients with obstructive sleep apnea (OSA) were at double the risk of suffering complications following surgery, and nearly triple the risk for suffering serious complications, including transfer to the intensive care unit and cardiac events. In addition, patients with OSA had an average of 33 % longer hospital stay than patients with normal sleep patterns.

In addition, OSA sufferers are at a greater risk for complications related to sedatives or painkillers, and should be given limited dosages and closely monitored while on these drugs. Any surgery which may lead to swelling in the mouth and throat can become a deadly combination for OSA sufferers.

If you have sleep apnea, make sure your surgeon knows about it prior to any procedure, and make sure you ask your doctor explicitly about possible sleep-apnea-related complications with any prescribed medications.

If you have any sleep apnea symptoms, it may be best to have a conclusive diagnosis for sleep apnea performed before any major surgery. Please contact the Snoring and Sleep Apnea Treatment Center today for a free initial consultation.

Thursday, May 22, 2008

New Sleep Apnea Screening Test Seeks to Reduce Surgical Complications

Because sleep apnea sufferers are at an increased risk for post-surgical complications, a team of Canadian Anesthesiologists has developed a very brief sleep apnea screening tool that can quickly be administered to all patients during preoperative interviews. The screening tool, known as STOP, consists of 4 questions:

Do you Snore loudly?

Do you often feel Tired, fatigued, or sleepy during the day?

Has anyone Observed you stop breathing during sleep?

Do you have or are you being treated for high blood Pressure?

A patient who answers yes to two or more questions is considered to be at high risk for sleep apnea. In an initial study, the questionnaire was found to have an 80 % sensitivity for those patients suffering from the highest level of sleep apnea-hypopnea. When combined with other risk factors for sleep apnea, such as body mass index, age, neck circumference, and gender, the sensitivity rose to virtually 100 % for the highest levels of sleep apnea-hypopnea.

If you suffer from sleep apnea, you could be placing yourself at risk for serious postoperative complications, complications that can be prepared against if you know about your condition beforehand. If you suspect you may have sleep apnea, please contact the Snoring and Sleep Apnea Treatment Center today to set up your free sleep apnea consultation.

Thursday, May 15, 2008

Sleep Apnea no "Get Out of Jail Free" Card for Mafioso

Carmen "The Cheeseman" DiNunzio, underboss of the Boston Mafia, was recently arraigned on charges of Conspiracy to Commit Bribery, Extortion, and various violations of gaming laws. When he was brought before the judge during his bail hearing, he cited sleep apnea as one of the reasons he should be released from prison. Other health ailments that he said should merit his release included type II diabetes, an overburdened heart, and clogged lungs, all of which are related to his severe obesity and are dangers of sleep apnea.

The 400-pound Mafioso was arrested when an FBI agent played the role of a state highway inspector seeking a bribe to give DiNunzio a $6 million contract for laying loam along Boston's Rose Fitzgerald Kennedy Greenway. The mobster described himself and his operation to the agent, who was carrying a concealed microphone and video camera.

Although it may not merit release for a "dangerous" mobster, sleep apnea is a serious condition that is not given enough regard by police officers and prison administrators. Many people arrested for even such free-speech related offenses as participating in sit-ins have noted that police do not allow the use of CPAP machines in jail. However, it is possible that, with education, police may be more receptive to the use of oral appliance therapy.

If you suffer from sleep apnea, you should consider the full range of treatment options beyond CPAP, whether or not you plan on being arrested! To learn more about sleep apnea treatment options, contact the Snoring and Sleep Apnea Treatment Center today for your free sleep apnea consultation.

Thursday, May 8, 2008

May is Better Sleep Awareness Month

Sponsored by the Better Sleep Council, Better Sleep Awareness month hopes to help the 40 % of Americans that suffer from some form of sleep disorder, including sleep apnea. Whether you know what's causing you to lose sleep or not, there are some ways that you can improve your level of rest.

One way to improve your level of rest is to take a nap. For most people, some time during the hours between 12 and 3 in the afternoon, our bodies begin to prepare themselves for sleep. A drop in body temperature, a drop in alertness, a decrease in pulse rate and breathing rate, all combine to help the body prepare itself for the mid-afternoon nap that has been banned by modern society. However, if you can, take a nap from between 10 to 50 minutes some time before 3pm. Let your body dictate when you take it, but make sure you're up again by 3pm to avoid interfering with your night sleep.

Second, make sure that you rest for at least half an hour before heading to bed at night. No matter when you're going to bed, taking that half hour--even at the expense of a half hour of actual sleep--can mean better rest for your entire night's rest.

And if daytime sleepiness persists, you may suffer from sleep apnea. To learn more about the dangers of sleep apnea and be diagnosed for the illness, please contact the Snoring and Sleep Apnea Treatment Center for your free initial consultation.

Wednesday, April 30, 2008

Sleep Apnea Diagnosis: X-Rays

Although thorough sleep apnea diagnosis generally involves an overnight stay at the sleep lab, but doctors are always working on new techniques. In this technique, doctors use x-rays to look at the position of the tongue and hyoid bone in suspected apeneiacs to perform diagnosis. Although the test is not currently very effective (allowing for only a 70% diagnosis rate), the hope is that future refinements may make it a substitute for the complete sleep study.

The hyoid bone is located in the neck, the only human bone not attached to any other bone. It is only attached to the muscles of the neck and the tongue muscle. Therefore, when the muscles of the throat relax, the hyoid bone can shift and become one of the main constrictors of the airway passage. By analyzing the position of the hyoid bone, researchers hope to use x-rays as a pre-screening tool to look for sleep apnea.

Since sleep apnea is significantly underdiagnosed, and since the x-rays that might be used are routinely given to teens in preparation for orthodontic treatment with braces, the assessment can be used to direct people to sleep apnea diagnosis at a young age, hopefully allowing them to avoid the dangerous consequences of untreated sleep apnea.

If you suspect you may suffer from sleep apnea, please set up a free initial consultation with the Snoring and Sleep Apnea Treatment Center, where the latest and best diagnostic tools are used to identify your sleep apnea and design an appropriate course of treatment.

Sunday, April 27, 2008

Play Your Didgeridoo, Blue, to Reduce Obstructive Sleep Apnea

According a study published in the British Medical Journal, regular didgeridoo playing can reduce the negative effects of obstructive sleep apnea. In the study, half of a group of patients who complained of snoring and had apnea-hypopnea indices of 15-30 (a shortcut method for a rough diagnosis of sleep apnea) practiced the didgeridoo an average of 25.3 minutes a day, 5.9 days a week for four months. As a result, the people who practiced the didgeridoo had significantly decreased daytime sleepiness and reduced apnea-hypopnea indices. In addition, their sleep partners reported that they had significantly less sleep disturbances.

Researchers believe that the improvement was due to the training of the upper airways which made their airways less susceptible to collapse during sleep.

This study shows one example of the wide range of behavioral therapy options available for sleep apnea treatment. Although it may not be the only answer, for many people with sleep apnea, behavioral therapy can be a big help and lead not only to reduced apnea, but increased overall quality of life.

Sleep apnea is a dangerous condition, made even more dangerous by underdiagnosis. If you snore or have any symptoms of sleep apnea, please contact the Snoring and Sleep Apnea Treatment Center today for a free initial sleep apnea consultation.

Thursday, April 24, 2008

Sleep Apnea Increases Risk of Heart Attack, Death

In a study by researchers at Yale University and reported at the American Thoracic Society International Conference in 2007, obstructive sleep apnea was associated with a 30% greater risk of heart attack and/or death over a 4-5 year period. The study followed 1,123 patients who were evaluated for sleep apnea during an overnight sleep study for 4-5 years, and recorded every incidence of heart disease (heart attack, coronary angiography, etc.) or died.

According to researchers, sleep apnea triggers the body's threat response, which distributes blood to the body in preparation for a "fight or flight" response and decreases the blood pumped to the heart. Repeated apneic events every night for years can starve the heart of oxygen, leading to the increased risk of heart failure and death.

Although sleep apnea and heart disease have common risk factors, such as obesity, this study was large enough to take that into account and adjust the findings to reflect the real risk of sleep apnea independent of other known heart disease causes.

If you have any of the symptoms of sleep apnea, it may be deadly to wait for treatment. Please contact the Snoring and Sleep Apnea Treatment Center today for a free initial consultation.

Tuesday, April 22, 2008

Research Confirms Sleep Apnea Sufferers' Increased Accident Risk

The scientific journal Thorax recently published a study showing that people with sleep apnea are twice as likely to be involved in an auto accident as those who enjoy uninterrupted sleep. Researchers from the Vancouver Coastal Health Research Institute and the University of British Columbia studied 1600 people, some with and some without apnea. And they found that sleep apnea sufferers tended to be involved in even more serious crashes as well. Sleep apnea sufferers were 3 to 5 times more likely to be involved in a crash that involves personal injury.

Although previous studies have identified the risk of car crashes among sleep apnea sufferers, this is the largest study yet, and the first time that researchers investigated the severity of the crashes. The study also found that the risk of crash was not necessarily correlated with the severity of sleep apnea. Said one researcher, "Even those patients with fairly mild sleep apnea had an increased risk of serious crashes." Even though daytime sleepiness is a common sign of sleep apnea, researchers found that the risk of crashes was not correlated with self-reported sleepiness, leading them to conclude that "patients may not be aware of the potential driving hazards caused by sleep apnea."

As a result of this increased risk, the co-author of the study said, "we feel it is important for people with suspected sleep apnea to be assessed for this common disorder for which there are several effective treatments."

If you have any of the symptoms of sleep apnea, contact the Snoring and Sleep Apnea Treatment Center today for a free initial sleep apnea consultation and avoid risking your life on the road.

Thursday, April 17, 2008

Local Dentist To Lecture On Sleep Apnea At "The Big Sleep Show" - May 9-10, 2008-Chicago, IL

Gurnee, IL (April 2008)- Dr. Ira L. Shapira, of Delany Dental Care, will be participating in "The Big Sleep Show," An Alertness & Healthy Sleep Expo being held at the Donald E. Stevens Convention Center, May 9-10, 2008. Because sleep is a vital human need, our productivity, attitude, alertness-our very well being depends on its quality and quantity. An Institute of Medicine report estimates that 50 to 70 million Americans chronically suffer from sleep disorders and confirms links to "increased risk of hypertension, diabetes, obesity, depression, heart attack and stroke." Regrettably, 95% of people with sleep Disorders remain undiagnosed and untreated.


Dr. Shapira has successfully treated hundreds of patients with sleep apnea for over 25 years. Sleep apnea is a serious, potentially life-threatening condition in which an individual repeatedly stops breathing while he or she sleeps. Typical solutions for patients with sleep apnea include a continuous positive airway pressure (CPAP) device. A CPAP device includes a mask, tubes and a fan that uses air pressure to push the tongue forward and open the throat. Although the industry's gold standard, CPAP is only 23-45% successful due to lack of patient compliance.


Dr. Shapira, a pioneer of oral appliance titration during sleep tests, will be lecturing on the benefits of intra-oral appliances, an alternative to CPAP. He will explain how intra-oral devices eliminate sleep apnea through Titration, which changes the position of the jaw causing mandibular advancement. His exhibit will display intra-oral sleep appliances. associated literature and other related materials.


For more information on Dr. Ira L. Shapira and "The Big Sleep" contact Delany Dental Care at 847-623-5530 or visit www.IHateCPAP.com.


Local Dentist To Lecture On Sleep Apnea At "The Big Sleep Show" –May 9-10, 2008-Chicago, IL

Friday, February 29, 2008

Testimonial From Rita, Patient of Dr. Siegel's

Dear Dr. Marc,


I would like to "Thank You" and your staff, for helping me in my great need.

I couldn't be happier with my new mouth piece. It works so wonderful for me. Since I have had my mouth piece, I sleep all night, I don't "snore" or "blow up with air in my stomach," like I did with the C-Pap.

I joined the BAC Health Club, I go most every day. I have a lot more energy, and I have been breathing much better. I am so very happy I got you, Dr. Siegel, off the Internet. You are my life saver! Before I got the splint, I had chest pains and breathing like I was taking my last breath. I didn't sleep at night at all. My poor husband said I was "restless" and "snoring" almost all night.

So you have made me and my husband very happy, Dr. Marc. Also, I would like to add that your staff has been the best.

Thank you again,

Rita

If you would like to learn more about Dr. Siegel, and his work, please visit Snyder Dental Group.



http://www.ihateheadaches.org/