PROBLEMS WITH PURE SLEEP appliance

I received a phone call from Scott about problems from his Pure Sleep Appliance. I would like to thank him for voluntaring this info for my blog. See below and them my commentary.

My name is Scott Kizzia. I bought a Puresleep device about a year ago to alleviate a snoring problem. After approximately nine or ten months I started having some pain in my jaw and a little difficulty opening my mouth fully, especially early in the morning. As time progressed, it continued to get worse to the point that it was painful to put the devise in my mouth. Additionally, the pain opening my mouth fully was such that I could no longer eat items that required a fully open mouth such as a sandwich. I have recently reset my Puresleep devise where the forward movement of my jaw has been decreased and my jaw problem has gotten somewhat better. I still can not open my mouth wide enough to eat many larger items, but the pain has subsided noticeably.

Scott Kizzia
Centerville, TX

Scott has graciously sent me this e-mail for publicatin on my sleep blogs. The principle behind pure sleep is sound but not necessarily safe for an over the counter appliance. The FDA in the past would have prevented sales of such a device but has suspened any and all regulation that I know of.

Oral appliances can cause tooth movement and bite changes. The American Academy of Sleep Medicine Reccomended that dentists experience in treating TMJ disorders utilize oral appliances to treat sleep apnea.

The real danger is that sleep apnea diagnosis is not made leaving patienbts at greatly increase risk or heart attack , stroke and motor vehicle accidents. I fear it is only a matter of time until we see late night ads from attorneys looking for accident victims when the driver used pure sleep appliances.

In addition patients like Scott can suffer irreparable damage from unsupervised use of orthopeic appliances. The FDA has abdicated it's role in protecting the public.
dentists are often guilty of abicating their legal responsibilities by fitting patients with oral appliances for treating snoring and sleep apnea without adequate follow-up.

The symptoms Scott describes may be a Close-Lock of the TM Joint disc. Please, if you think you have sleep apnea see a qualified sleep physician and utilize CPAP. If you want a CPAP alternative find a dentist with training in Dental Sleep Meicine and always have a follow-up sleep test with the appliance. Additional information on TMJ disorders can be found at www.ihateheadaches.org

Dentists are not legally qualified to diagnose the presence or absence of sleep apnea. A few dentists may have the required medical expertise but diagnosis is still not within the scope of their dental licensce.

Risk Factors for Sleep Apnea

Obstructive sleep apnea (OSA) is a very common but serious sleep disorder that affects millions of Americans. OSA is caused by a blockage in your airway, usually when the soft tissue in the back of the throat collapses while you sleep. Some people who suffer from sleep apnea will stop breathing for several seconds several times a night, sometimes as many as hundreds of times a night. Spouses and partners of sleep apneics are often the ones who realize the person has this disorder; many people who have this know something is wrong because of how they feel the next day, but they are not aware of what is actually causing the problem.

People with sleep apnea may suffer from:

• Fatigue
• Daytime sleepiness
• Memory and concentration problems
• Hypertension
• Stroke
• Weight problems
• Insomnia
• Anxiety
• Depression
• Diabetes

Some people are more at risk than others of developing sleep apnea. Though sleep apnea can affect men, women and children of all ages, the following risk factors do make someone more inclined to suffer from this serious medical condition:

• Males
• Overweight
• Over age forty
• Large neck (greater than 16 inches in women and greater than 17 in men)
• Family history of sleep apnea
• GERD (gastroesophageal reflux disorder)
• Deviated septum or some other sinus problem
• Large tonsils
• Large tongue
• Small jaw bone

A highly trained sleep disorder dentist can relieve you of your symptoms with a variety of treatment modalities. If you live in Gurnee, Illinois or anywhere in Illinois, please contact sleep apnea dentist, Dr. Ira Shapira today to schedule a thorough evaluation.

Sleep Apnea: Not an Easy Diagnosis

Sleep apnea can be very tricky to diagnose. If you sleep alone, or if you and your sleep partner are not aware of the symptoms of sleep apnea, you may not even realize you are waking (though just slightly) as many as hundreds of times per night, gasping for air and causing undue strain on your hard-working heart. The condition can go on undetected for some time until it becomes life-threatening.

For most individuals, their sleep partner is the first to notice something is not right. While snoring is a frequent nighttime occurrence, especially among overweight males, the gasping, choking and gurgling sounds that occur as your body is repeatedly deprived of oxygen can be disconcerting.

A patient's husband had been disturbing his sleep and his wife's with his snoring for about a year. One night, she awoke to hear him stop breathing completely, and within a few seconds, he began snoring again. She thought it was odd, but soon went back to sleep and didn't give it another thought. However, as the nights went on, she heard him stop breathing more often and for longer periods of time. She would try to wake him up, but most times he rolled into a different position, stopped snoring for a few minutes, and then started up all over again. In the morning, he rarely remembered being woken up many times by his wife. But he was very fatigued during the day, began to gain weight, felt generally unwell, and lost his usual charm and zest for life.

After an evaluation at a sleep clinic, the man was fitted with a CPAP machine. It was dreadful to sleep with, and he soon abandoned it. A few months later, during a routine physical, our family doctor noticed he had a smaller than normal airway and sent him to a specialist. That visited resulted in a surgery called "Uvulopalatopharyngoplasty" (UPPP) and, for this patient, it was a lifesaver.

Some sleep apnea signs and symptoms include:

Stopping breathing frequently during sleep.
Choking or gasping for air while sleeping
Unusually loud snoring
Frequent wakening to gasp for air
Night sweats
Daytime fatigue
Morning dry mouth, headaches and sore throat

It's important to know that snoring is not the same as sleep apnea. Snoring is a loud vibration from the throat that is not necessarily harmful. Individuals with sleep apnea, however, are deprived of oxygen, and suffer major health issues. If you find it confusing, just remember that if you have sleep apnea you will snore, but if you do snore, it does not necessarily mean you are suffering from sleep apnea.

If you suspect you have sleep apnea, don't wait to get help. For more information about scheduling a private consultation in Gurnee, Illinois, please contact Dr. Ira Shapira at www.ihatecpap.com

Sleep Apnea Treatment

Sleep apnea is a very common disorder but there are treatments for sleep apnea that have proven to be quite successful. CPAP is the least popular treatment for sleep apnea.


Oral Appliances

Most oral appliances are made from acrylic and fit inside your mouth like an athletic mouth guard or braces. Some appliances fit around your head and chin to help reposition your lower jaw. All dental appliances are designed to open your airway, bringing your jaw or tongue forward during sleep to reduce obstruction. Unfortunately, individuals suffering from more severe forms of sleep apnea cannot find relief with these devices.

Side effects from dental appliances include:

Mouth soreness
Permanent changes or damage to the jaw, teeth, or mouth
Build up of saliva
Nausea

Anti-Snoring Medications

Specialized medication may help curb the effects of sleep apnea or complement more aggressive treatment options when taken before bedtime. Natural plant enzymes and herbs reduce congestion and swelling in the nose and throat and minimize snoring. Special nose drops or nasal sprays, and aromatherapy, have proven beneficial.

Surgery

Surgery can treat sleep apnea by increasing airway size by surgically removing excess tissue inside the nose or back of the throat, and may include the removal of tonsils and adenoids. The jaw may be reconstructed to enlarge the upper airway. Surgery certainly carries risks, but for some, this is the best option.

To learn more about snoring and sleep apnea, please contact Dr. Ira L. Shapira in Gurnee, Illinois today to schedule your initial consultation.

RAPID MAXILLARY EXPANSION TO TREAT SLEEP APNEA IN CHILDREN

wHEN SLEEP APNEA OCCURS IN YOUNG CHILDREN REMOVAL OF TONSILS AND ADENOIDS IS THAT BLOCK THE AIRWAY IS USUALLY THE FIRST LINE OF TREATMENT.

a SECOND APPROACH IS RAPID MAXILLARY EXPANSION TO INCREASE NASAL AIRWAY AND AND TONGUE SPACE IN THE MOUTH. a PAPER PRESENTED AT THE AMERICAN ACADEMY OF DENTAL SLEEP MEDICINE SUGGESTED THAT rem SHOULD PROCEED SURGICAL INTERVENTION TO REDUCE POST-OPERATIVE RISKS.

3% OF CHILDREN SUFFER FROM SLEEP APNEA AND OVER 10% SNORE. THIS MAY PARTIALLY DUE TO THE FACT THAT FEWER TONSILLECTOMIES ARE BEING DONE. iDEALLY WITH PROPER MANAGEMENT EARLY TREATMENT OF SLEEP APNEA MAY PROVIDE A LIFETIME CURE OF THE PROBLEM. tHIS IS IMPORTANT BECAUSE UP TO 60% OF PATIENTS REFUSE CPAP.

SOME OF THE PROBLEMS ASSOCIATES WITH SLEEP APNEA IN CHILDREN INCLUDE POOR SCHOOL PERFORMANCE, DAYTIME SLEEPINSS, HYPERACTIVITY AND INNATEN5TIVENESS IN SCHOOL AS WELL AS BEHAVIORAL DISORDERS. hYPERACTIVITY AND ADHD CAN BE PREDICTED WITH UP TO 70% ACCURACY BASED ON SLEEP PATTERNS ALONE.

cLUES TO PROBLEMS WITH SLEEP APNEA IN CHILDREN INCLUDE SNORING, MOUTHBREATHING,ENURESIS, ENLARGED TONSILS AND/OR ADENOIDS, LARGE TOUNGUES, DROOLING AND A SMALL JAW OR RETROGNATHIA.

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Oral Appliances and Sleep Study results. What are my options

QUESTION: I have a dental appliance that works great. I sleep soundly, my mental alertness has increased since changing from the CPAP. The problem is I had a sleep study and it did not go well. There were a lot of noises that woke me up. The leads kept pulling my body hair so I never really could relax enough to sleep well. Is the sleep study the end all be all for determining the effectiveness of a dental appliance? I can't go back to using a CPAP. Do I have any recourse for insisting on using the dental appliance?

ANSWER: There are actually several questions. First, like many patients you feel great with the appliance and symptoms have been resolved. When you said the sleep study did not go well you discussed problems with the study not your results. Did they still show you have sleep apnea and if so how severe?

Important considerations are the apnea hypopnea index and oxygen nadir. Think of the sleep test as a opportunity to continue to improve the effectiveness of your oral appliance. It sounds like it was not an ideal situation , sometimes sleep medication can help for study night. The only way to know treatment is successful is a sleep study but it is posible to do home studies. I prefer to use a lab study because your appliance can be titrated uring the night for improved quality of treatment but this means your expert in Dental Sleep Medicine has taught the lab how to titrate appliances.

Some sleep labs are very negative about oral appliances and only offer CPAP. This is an example of poor medical treatment. Stuies have shown that the majority of patients reject CPAP. Oral appliances are a safe and effective treatment and it is medically-legally incumbent that all options are offered. For severe apnea oral appliances are an alternative when CPAP is not tolerated or refused by the patient. MANY PATIENTS CAN CONBINED POSITIONAL TREATMENT WITH ORAL APPLIANCE THERAPY AND VASTLY IMPROVE RESULTS. Frequently an oral appliance can be combined with nasal surgery to reduce turbinates or correct deviated septums improving results. I suggest that patients avoid labs and physicians that are completely negative about oral appliances. These labs often have financial intreasts in CPAP treatment. I would also suggest patients avoid dentists who are not careful in doing follow-up sleep studies with physicians your health is always the primary concern. The I HATE CPAP site is sometimes seen as being negative about CPAP but that is certainly not the case. CPAP is excellent treatment and highly effective, when used. The I HATE CPAP site is interested in insuring that patients who do not tolerate CPAP find effective alternatives.

I would suggest you continue to work to improve the results you obtained with your appliance. You are definitively better with some treatment than no treatment but your health is at stake.

QUESTION ABOUT THE PILLAR PROCEDURE

Question: What do you think of the pillar procedure?

Answer: The pillar procedure is not effective for treating blockage at the base of the tongue where almost all obstructive apnea occurs. If you have sleep apnea the pillar procedure alone will almost never cure it and you will still need CPAP or an appliance. I would not suggest this procedure for patients who have sleep apnea. This may be be considered for patients with simple snoring only especially if the frequency of the snoring suggests it is specifically from the soft palate. Otherwise, it would seem to be a surgery looking for a problem it can cure. It will rarely, if ever be an apnea cure and then only in the mildest cases.

What is CPAP?

Continuous Positive Airway Pressure (CPAP) has been the main treatment modality for patients suffering with the very dangerous condition known as sleep apnea. The CPAP machine works by using pressure to send air flowing through the nasal passages, keeping the throat from collapsing during sleep--the main reason why individuals with sleep apnea stop breathing periodically throughout the night. CPAP, however, is uncomfortable and many people do not use CPAP because of the inconvenience and bulkiness of the apparatus.

Sleep apnea must be treated; if it is not, it can lead to many serious medical problems including:

Fatigue
Depression
High blood pressure
Diabetes
Sore throat
Dry mouth
Excessive daytime drowsiness
Poor concentration
Short--erm memory problems
Anxiety
Mood swings
Impotence
Cognitive deterioration

Most of us are aware that a good night's sleep is essential. REM Sleep, the time during sleep when we dream, contributes to overall health and proper body function. But during a sleep apnea event, the individual leaves REM sleep many times throughout the night to restart his or her breathing. The result is a lack of deeply restful sleep that seriously affects the body's ability to function.

There are three different types of CPAP machines:

CPAP: delivers one continuous air pressure
APAP: adjusts to your need for oxygen by starting out at low pressure, senses raising the pressure during a sleep apnea event
BiPAP: uses a higher pressure when you inhale and lower pressure when you exhale

To learn more about snoring and sleep apnea, please contact sleep apnea specialist, Dr. Ira L. Shapira, in Gurnee, Illinois today to schedule your initial consultation.