Your Doctor Should Ask You about Your Sleep

About 90% of sleep apnea of sufferers in the United States do not know they have the condition and that their health is at risk. Because of this, sleep experts are urging doctors to ask patients questions regarding the quality of their sleep at each doctor’s visit. Asking patients about their sleep will help doctors discover if their patients have any symptoms of sleep apnea and will lead to the necessary diagnosis and treatment of the condition.

Sleep apnea disturbs the quality of sleep a patient is receiving by causing the patient to frequently wake up during the night and by repeatedly blocking the flow of oxygen resulting in periods of stopped breathing. A disrupted night’s sleep can negatively affect how a person functions during the day. Children with sleep apnea tend to have difficulty paying attention at school and often have poor grades.

The many symptoms of sleep apnea can warn a patient that they may have this serious condition. However, most of the symptoms only reveal themselves during sleep while other symptoms can be easily misdiagnosed.

Common symptoms of sleep apnea are:

• Snoring
• Episodes of stopped breathing during sleep
• Feelings of excessive sleepiness during the day
• Depression
• Difficulty paying attention
• High blood pressure
• Insomnia

If you are having difficulty with your quality of sleep or have symptoms of sleep apnea, please contact a sleep dentist in your area to discuss sleep apnea.

Sleep Apnea: A Silent, but Loud Killer

Obstructive sleep apnea blocks the airway during sleep preventing the flow of air from entering your body. The lack of oxygen to the brain and the rest of the body can leave you at risk for many health disorders and can take approximately ten years off your life expectancy.

The health risks untreated sleep apnea can cause include:

• High blood pressure
• Stroke
• Heart attacks
• Heart failure
• Irregular heart beats
• Depression
• Diabetes

Most people who suffer from sleep apnea have no idea they have the condition or that their health is at risk. Many times, a significant other will hear the sufferer snoring or notice that the sufferer stops breathing during sleep. One of the most noticeable signs of sleep apnea is snoring. Many people who snore visit their dentist to find out what can be done to stop the snoring so their significant other does not lose sleep. However, only about 70% of obstructive sleep apnea sufferers snore, so it’s important to be aware of the other symptoms of sleep apnea.

Other symptoms of sleep apnea are:

• Excessive daytime sleepiness
• Depression
• High blood pressure
• Dry mouth
• Sore throat
• Weight gain
• Gastric reflux
• Insomnia

If you are snoring and have other symptoms of sleep apnea, please contact a sleep dentist in your area to find out if you are suffering from sleep apnea.

Shocking the Low Road for Central Sleep Apnea

Central sleep apnea is rarer than obstructive sleep apnea. In obstructive sleep apnea, the tissues of the airway collapse, closing the airway, preventing air from entering. CPAP and oral appliance therapy treat sleep apnea by keeping the airway open, but are of limited value for central sleep apnea. In central sleep apnea, the brain stops sending signals telling the body to breathe. CPAP is used for central sleep apnea, and it can be helpful because it ensures there is always some amount of fresh air in the lungs that can partly keep the blood oxygenated. But even for patients that tolerate the treatment, it can only improve the condition, not fully treat it.

Now researchers at Ohio State University think they may have found a good solution to the problem. Similar to the tongue shocker for obstructive sleep apnea, they have invented a pacemaker-like device targeted at the diaphragm. When this device senses that the sleeper has stopped breathing, it shocks the diaphragm, stimulating it to function.

Currently, the device is being tried on one patient, but if it works, it may be the long-sought best treatment option for central sleep apnea.

If you are looking for a successful sleep apnea treatment, talk to a local sleep dentist today to learn the full range of options available.

Sleep Apnea Treatment with Oral Appliances

Some doctors will try to convince you that CPAP is the best treatment for your sleep apnea. The truth is, you don’t have to settle for CPAP. No one needs to struggle with CPAP when there are many oral appliances that can treat your sleep apnea just as well as, if not better than, CPAP.

You can speak with your sleep apnea dentist about which oral appliance is best to treat your sleep apnea. A few of the sleep apnea oral appliances are:

• Thornton Adjustable Positioner (TAP)
• SomnoMed MAS
• Herbst Telescopic Appliance
• Tongue Retaining Device (TRD)

Oral appliances are designed to prevent the obstruction of your airway during sleep by stopping the collapse of the soft tissue in the mouth. The soft tissue collapses during sleep and blocks the airway cutting off the flow of oxygen. Oral appliances prevent obstruction in many different ways. Some oral appliances reposition the lower jaw to open the airway wider. Other oral appliances support the soft palate so it does not collapse. Your sleep apnea dentist will determine which oral appliance fits your needs. The oral appliance you and your dentist choose will be custom made to fit perfectly and comfortably inside your mouth.

The oral appliance that is best to treat your sleep apnea depends on your symptoms. To learn more about oral appliances to treat sleep apnea, please contact a sleep apnea dentist in your area.

Dental Sleep Medicine is promoted by I HATE CPAP.com

Sleep Medicine and Dental Sleep Medicine have received wide coverage due to I HATE CPAP.com

This site has probably referred more patients for CPAP therapy than any other dental site in America. Because the majority of patients do not tolerate CPAP and these patients proclaim "I HATE CPAP!' they are drawn to this site.

I do not HATE CPAP but consider it a valuable and successful treatment for sleep apnea. The problem is that the majority of patients prescribed CPAP hate it.

the I HATE CPAP! website was actually named by the patients who have told me this for over 30 years.

For many years oral appliance therapy was considered by many sleep physicians to be a joke. That is no longer the case. When compliance and effectiveness are both considered oral appliances are far more effective than CPAP for many patients.

Many patients who are "successfully" treated with CPAP do not improve subjectively with CPAP treatment. In fact, many feel worse with CPAP than with no treatment. This is in spite of CPAP effectively trreating their apnea. Patients who utilize oral appliance frequently feel dramatic improvement in quality of life compared to CPAP treatment even though objective measurement shows resolution of apnea with CPAP.

CPAP can disrupt a patient's sleep even as it successfully treats their sleep apnea. Oral appliances frequently produce dramatic increases in QOL or quality of life even when apnea is not completely eliminated.

Successful treatment of sleep apnea requires both subjective and objective success. CPAP is often lacking when "feeling better" is considered important.

Learn more about comfortable oral appliance as an alternative to CPAP.

Better sleep caan lead to a better quality of life. Contact us today for information on Dental Sleep Medicine, oral appliances and improving the quality of your life.

I NEED HELP WITH MY CPAP MASK!

TOM:

I NEED HELP WITH MY CPAP MASK. I HAVE TRIED SEVERAL BUT HAVE CONTINUOUS PROBLEMS WITH LEAKS AND DRY EYES. THE NASAL PILLOWS WERE AN IMPROVEMENT OVER THE NASAL MASK FOR A WHILE BUT THE QUIT WORKING. I AM NOW USING A FULL FACE MASK WHICK IS OK ON SOME NIGHTS BUT I FEEL WORSE THAN I DID BEFORE CPAP. MY DOCTOR TOLD ME I AM NOT A CANDIDATE FOR AN ORAL APPLIANCE BECAUSE MY APNEA IS SEVERE. I QUIT BREATHING 50 TIMES AN HOUR. I USUALLY MANAGE TO GET AN HOUR OF TWO OF SLEEP BEFORE I GIVE UP ON IT. HELP!

DR SHAPIRA RESPONSE: Tom, I understand your frustration and I commend you on your efforts to comply with treatment. 60% of patients give up on CPAP and that is very dangerous. I suggest that you get a copy of your sleep study and contact a dentist who is experienced in treating sleep apnea. Oral appliances are a comfortable alternative to CPAP and are a first line choice for treatment of mild to moderate sleep apnea according to the American Academy of Sleep Medicine. They are an acceptable alternative to CPAP for severe sleep apnea when patients do not tolerate or want CPAP treatment.

I advise you to continue to use your CPAP with your appliance until after a sleep study show the it is effective. Recent studies have shown that properly titrated appliances are as effective as CPAP and can be used for severe apnea in many patients. It is vital that a titration sleep study be done to find the ideal position to maintain an open airway.

An appliance that is not properly adjusted is a "POP" or piece of plastic not an effective treatment unless your problem is a congenital lack of plastic.

I frequently see patients who say they tried an appliance and it didn't work. This is usually because the dentist did not choose the right appliance or properly adjust it for effective treatment. Their is both art and science to the field of Dental Sleep Medicine. Many doctors take a single course from a manufacturer of appliances and only have one tool in their belt. When I teach my courses I purposely limit class size to six dentists and their teams to insure that each dentist has a comprehensive understanding of sleep medicine and the role of the dentist. It is also important to understand the basic principles and how different anatomy may demand different types of appliances. I do have my favorits based of effectiveness.

I am frequently asked by dentists what is the best oral appliance. The answer is that it depends on many factors and different appliance are best for different patients.

Surgery is also an option for treating sleep apnea but is no longer considered a first line treatment because of high morbidity and poor results. I stronly suggest you avoid soft palate surgery ie UP3, LAUP, Somnoplasty, Pillars. Tongue reduction is a more useful surgery but can be brutal. If contemplating base of tongue surgery somnoplasty is a good choice but several procedures will probably be necessary. Nasal surgery can be helpful but is rarely a cure. It can make both oral appliance therapy and CPAP more effective and comfortable and can improve your quality of life if you live with chronic impaired breathing 24/7.

Bimaxillary advancement or madibular advancement or chin advancement can be very effective but a trial with an oral appliance is recommended prior to surgery to determine the amount of advancement that is necessary. You do not want to go thru traumatic surgery and still need CPAP afterwards.

If you are in the midwest, Illinois or Wisconsin feel free to see me in Chicago, Gurnee, Skokie, Vernon Hills or Schaumburg.
Good Luck Tom

GOOD NEWS - BAD NEWS ABOUT SLEEP APNEA

The good news about sleep apnea is that it easily diagnosed and treated.

The bad news is that sleep apnea can cause Hypertension and an estimated 50-70% of people with sleep apnea have hypertension, or high blood pressure. This increases the risk for heart attack, stroke, and other health problems.

The Good news is that sleep apnea is easily and effectively treated with CPAP.

The bad news about sleep apnea is that 60% of patients diagnosed with sleep apnea cannot tolerate CPAP. When sleep apnea is not treated it can lead to Coronary Heart Disease. Sleep apnea can lead to activation of the sympathetic nervous system which is responsible for the “fight-or-flight” response. Sleep apnea also is responsible for problems with the lining of blood vessels, inflammation, and problems with metabolic regulation.

The good news is that oral appliances are a comfortable alternative to CPAP.

The bad news is that your doctor probably never told you that oral appliances are considered a first line treatment for mild to moderate sleep apnea. Because patients are unaware of this effective and comfortable alternative to CPAP they are at increased risk for Stroke, Chronic Heart Failure and Sudden Death.

The association between stroke and sleep apnea according to considerable research is as convincing as the association between smoking and stroke. During apneic episodes the blood vessels of the brain dilate when the oxygen levels fall. Patients with sleep apnea are more susceptible to clots that may lead to stroke. Research has shown that the number of strokes in patients with untreated sleep apnea are staggering and that 40-60% of people experiencing strokes have been found to have obstructive sleep apnea. In addition to stoke sleep apnea leads to chronic heart failure and numerous serious cosequences from this condition as well as a staggering risk of dying in their sleep. Half of patients with sleep apnea die between midnight and 6 AM compared to only 21% of patients without sleep apnea.

The good news is that weight loss can improve sleep apnea.

The bad news is that it is almost impossible for patients with untreated sleep apnea to lose weight because of metabolic changes associated with their sleep apnea.

The good news is that oral appliances are effective for treating sleep apnea and that the vast majority of patients prefer them to CPAP. Patients who treat their sleep apnea with oral appliances usually have more energy and find it easier to exercise and to lose weight.

The bad news is that patients who treat their sleep apnea with oral appliances need to save more for retirement.

The good new is the reason they need to save more is because they live longer.

The bad news about sleep apnea is that patients with untreated sleep apnea have a six-fold increase in motor vehicle accidents and slower reaction times than drivers who are legally drunk.

The good news is effective treatment with CPAP or a comfortable oral appliance reduces that risk to to normal. Also good news is that recent studies have shown that when properly titrated oral appliances can be as effective as CPAP for a majority of patients with severe sleep apnea.

The bad news is that snoring and associated sleep apnea can lead to marital difficulties, separate bedrooms, reduced sex drive and even impotence. According to a study at Mayo Clinic spouse of snorers lose up to 15% of their sleep. According to anecdotal evidence I have seen this pisses them off.

The good news is that there are oral appliances with volume controls for the spouse to turn off the snoring and eliminate sleep apnea. The bad news is your spouse will live longer, no thats the good news.

Saving Marriages: Elimination of Snoring and Sleep Apnea Can Improve Marriages Inside and Outside the Bedroom

Snoring is often considered funny ,but it can seriously disrupt otherwise good marriages. The spouses of snorers lose up to 15% of their sleep according to Mayo Clinic. This can lead to shortened tempers, weight gain, daytime sleepiness and buried anger and hostility for your spouse. Frequently, it leads to one of the partners leaving the marriage bed on search of quiet.

Sleep Apnea, is usually characterized by snoring and excessive daytime sleepiness but other symptoms can be devastating to marriage tranquility. Communication breakdown is frequent due to short term memory loss associated with untreated sleep apnea. Motor vehicle accidents, personality changes and trouble at work are also frequently seen in patients with sleep apnea.

Of course there are many medical problems associated with sleep apnea and snoring but often the damage to interpersonal relationships can be the most damaging. There is frequently hostility directed toward the patient who refuses treatment.

The primary reason patients refuse treatment is the the "HATE CPAP!". Studies have shown that 60 % of patients abandon CPAP. Not wanting to wear CPAP is also a major reason that patients avoid being evaluated for sleep apnea. This avoidance can lead to heart attacks, strokes and other serious medical consequences.

It is vital that sleep apnea be treated effectively but it does not matter if the effective treatment is CPAP, BiPAP, and Oral appliance or surgery.

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

Sound Sleep for Your Children

Anyone with sleep apnea may not notice they suffer from the disorder because the symptoms of sleep apnea are usually only apparent while sleeping or are nonspecific and may be attributed to other factors. Most of the time, a significant other notices that their partner snores and stops breathing several times a night because they are sleeping in the same room.

The symptoms of sleep apnea in children are more difficult to notice because children usually sleep in a room by themselves. Snoring is a good indicator in adults that they may have sleep apnea. However, many children snore and snoring is not always a sign of sleep apnea in children.

Sleep apnea symptoms to look out for in children include:

• Breathing through the mouth
• Difficulty sleeping or restless sleep
• Excessive sleepiness during the day
• Failure to either lose or gain weight
• Tonsils that are enlarged
• Problems paying attention at school
• Hyperactivity or aggressive behavior

A pediatric ENT is the best person to diagnose your child’s sleep apnea. Diagnosis of sleep apnea in children is usually based on their behavioral symptoms and enlarged tonsils. Depending on your child’s symptoms and needs, a sleep study may be performed.

Children with sleep apnea who are treated for the condition will get a good night’s sleep and have the rest required to do well in school. You will notice improvement in your child’s behavior and grades at school after treatment.

If you believe your child is suffering from sleep apnea, please speak with a sleep apnea dentist in your area for help.