|
Obstructive sleep apnea affects around 20 million Americans and can lead to hypertension, heart attack, stroke, depression, muscle pain, fibromyalgia, morning headaches, and excessive daytime sleepiness.
Showing posts with label CPAP ALTERNATIVES. Show all posts
Showing posts with label CPAP ALTERNATIVES. Show all posts
Friday, July 13, 2012
Survey on Sleep Apnea for patients and physicians
Saturday, March 5, 2011
Wisconsin Sleep Apnea Treatment: Oral Appliances are a comfortable alternative to CPAP, BiPAP or A-PAP
Treatment of sleep apnea is vital to the health and welfare of patients diagnosed with sleep apnea. CPAP treatment was once the only treatment offered to most patient. This is no longer the case. Dental Sleep Medicine ofers comfortable oral appliances as a comfortable alternative to CPAP.
Most sleep physicians follow the AASM guidline and offer oral appliance therapy as a treatment choice. Some sleep physicians have not kept up with the research and are not aware that recent studies have shown that properly titrated cpap oral appliances can be as effective as cpa.
60% of all patients who try cpap cannot tolerate and discontinue treatment while 90-95% of patients are successful with oral appliance therapy. The majority of patients offered a choice prefer oral appliance therapy to cpap and most insurance companies now cover oral appliance therapy.
Coverage of sleep apnea treatment saves insurance companies money by reducing heart attacks and strokes, hypertension, aiding in diabetes treatment and reducing motor vehicle and work-place accidents.
Employers have found that employees who have had effective sleep apnea treatment have higher output, lower medical expenses, and fewer workplace accidents and worker compensation claims.
Some sleep physicians continue to bad mouth oral appliance out of ignorance or due to bad experiences with untrained dentists providing poor quality treatment in the past.
Many dentists do not understand the importance of follow-up polysomnography in all patients. Failure to follow proper protocols can put patients at risk.
Other physicians have financial intrests in DME companies and are loathe to lose the income sales of cpap and cpap supplies generate.
I provide Dental Sleep Medicine treatment with oral appliances to patiens in Southeast Wisconsin including Lake Geneva, Kenosha, Racine and Milwaukee. I am certified in Dental Sleep Medicine and a Diplomate of the American Board of Dental Sleep Medicine. I am a former Asistant Professor at Rush Medicak Schools sleep center and have over 25 years successfully treating sleep apnea with oral appliances.
Most sleep physicians follow the AASM guidline and offer oral appliance therapy as a treatment choice. Some sleep physicians have not kept up with the research and are not aware that recent studies have shown that properly titrated cpap oral appliances can be as effective as cpa.
60% of all patients who try cpap cannot tolerate and discontinue treatment while 90-95% of patients are successful with oral appliance therapy. The majority of patients offered a choice prefer oral appliance therapy to cpap and most insurance companies now cover oral appliance therapy.
Coverage of sleep apnea treatment saves insurance companies money by reducing heart attacks and strokes, hypertension, aiding in diabetes treatment and reducing motor vehicle and work-place accidents.
Employers have found that employees who have had effective sleep apnea treatment have higher output, lower medical expenses, and fewer workplace accidents and worker compensation claims.
Some sleep physicians continue to bad mouth oral appliance out of ignorance or due to bad experiences with untrained dentists providing poor quality treatment in the past.
Many dentists do not understand the importance of follow-up polysomnography in all patients. Failure to follow proper protocols can put patients at risk.
Other physicians have financial intrests in DME companies and are loathe to lose the income sales of cpap and cpap supplies generate.
I provide Dental Sleep Medicine treatment with oral appliances to patiens in Southeast Wisconsin including Lake Geneva, Kenosha, Racine and Milwaukee. I am certified in Dental Sleep Medicine and a Diplomate of the American Board of Dental Sleep Medicine. I am a former Asistant Professor at Rush Medicak Schools sleep center and have over 25 years successfully treating sleep apnea with oral appliances.
Friday, January 28, 2011
Which oral appliance works best for treating sleep apnea?.
I usually know what type of oral appliance, CPAP, BiPAP or surgery will best suit my patient with obstructive sleep apnea after a short interview and exam. Success is not only efficacy of the appliance but also compliance which is a complex issue poorly addressed by randomized trials. The way the patient responds to the exam, impressions and bite often give the final clues to which treatment will be most beneficial. (many types of appliances are shown on the I HATE CPAP! site)
I present below a recent study on which appliances are the most effective. I review the information but I would like to make some personal comments about evidence based medicine and how it ignores the clinical knowledge and experience of trained physicians and dentists. Having done thousands of appliances I believe I am very adept at determining which patients will do best with various appliances. Unfortunately, clinical experience is not easy to integrate into randomized controlled studies. In fact, clinical experience and "gut feelings" about patients are ruled out of these studies. Randomized controlled studies work best with a limited number of variables. A problem many patients who try oral appliances have is that there dentist was trained by a manufacturers course and the doctor only has a single tool in his belt or only one appliance he understands and is comfortable using.
I teach a dental sleep medicine course that extensively covers the entire field of dental sleep medicine. I do give dentists who take my course a handful of appliances that are extremely effective for different patient groups. I also know that experience is vital to treating patients and therefore offer unlimited phone follow-up for 6 months with doctors that I train. I review sleep studies and frequently help them thru the diagnostic regimen to pick an appropriate appliance.
My article review follows and I include the PUB MED abstract with additional comments.
A brand new article looked at the effectiveness of various oral appliances. They found 1475 articles comparing efficacy of various appliances. The study showed that 116 of these studies compared an oral appliance to a control. They gave weight to only 14 of these studies that were randomized controlled trials (RCTs). All of the studies concerned MAD or mandibular advancement devices. The study concludes that "The evidence shows that there is no one MAD design that most effectively improves polysomnographic indices, but that efficacy depends on a number of factors including severity of OSA, materials and method of fabrication, type of MAD (monobloc/twin block), and the degree of protrusion (sagittal and vertical). These findings highlight the absence of a universal definition of treatment success. Future trials of MAD designs need to be assessed according to agreed success criteria in order to guide clinical practice as to which design of OAs may be the most effective in the treatment of OSA."
Eur J Orthod. 2011 Jan 13. [Epub ahead of print]
A systematic review of the efficacy of oral appliance design in the management of obstructive sleep apnoea.
Ahrens A, McGrath C, Hägg U.
Discipline of Dental Public Health.
Abstract
Oral appliances (OAs) are increasingly advocated as a treatment option for obstructive sleep apnoea (OSA). However, it is unclear how their different design features influence treatment efficacy. The aim of this research was to systematically review the evidence on the efficacy of different OAs on polysomnographic indices of OSA. A MeSH and text word search were developed for Medline, Embase, Cinahl, and the Cochrane library. The initial search identified 1475 references, of which 116 related to studies comparing OAs with control appliances. Among those, 14 were randomized controlled trials (RCTs), which formed the basis of this review. The type of OA investigated in these trials was mandibular advancement devices (MADs), which were compared with either inactive appliances (six studies) or other types of MADs with different design features. Compared with inactive appliances, all MADs improved polysomnographic indices, suggesting that mandibular advancement is a crucial design feature of OA therapy for OSA. The evidence shows that there is no one MAD design that most effectively improves polysomnographic indices, but that efficacy depends on a number of factors including severity of OSA, materials and method of fabrication, type of MAD (monobloc/twin block), and the degree of protrusion (sagittal and vertical). These findings highlight the absence of a universal definition of treatment success. Future trials of MAD designs need to be assessed according to agreed success criteria in order to guide clinical practice as to which design of OAs may be the most effective in the treatment of OSA.
PMID: 21239397 [PubMed - as supplied by publisher]
The article states " These findings highlight the absence of a universal definition of treatment success." The definition of success should be the elimination of all obstructive apneas, hypopneas and RERA's or respiratory related arousals and/or UARS upper airway resistance syndrome. Ideally snoring should also be resolved. Success should also consider central apneas that are not treated by appliances. If there are substantial episodes of central apnea other alternatives may need to be considered.
Positional treatment and oral appliance therapy are frequently used together if incomplete results are obtained with just an oral appliance. It is important to remember that even patial therapy with an oral appliance is far superior to no therapy in patients who reject CPAP. The physician/dentist should try to eliminate all sleep disordered breating.
Allergies and nasal congestion can be addresses with nasal breathing strips, medication, correction of deviated septums or reduction of turbinates.
Irrigation with a Netti Pot utilizing saline or black tea and saline can reduce mucous congestion. I have seen several patients who clain great relief from NAET, I do not understand or endorse this therapy but I have seen many patients who claim significant relief.
The bottom line, it is essential to control all apneic episodes. Untreated sleep apnea is dangerous and can be fatal. Heart disease, hear attacks, strokes, hypertension, short term memory loss, increased risk of motor vehicl accidents, earlier and more severe onset of dementia and/or Alzheimers are just the tip of the iceberg for possible negative consequences related to sleep apnea.
My advice: See a sleeep apnea dentist with experience and/or a mentor who is trained in multiple oral appliances. I am a Diplomate of the American Academy of Dental Sleep Medicine. There are many dentists who are well trained but have not received Diplomate status. Choosing a Diplomate in dental sleep medicine does insure a wide range of experience but is only one of many considerations.
I present below a recent study on which appliances are the most effective. I review the information but I would like to make some personal comments about evidence based medicine and how it ignores the clinical knowledge and experience of trained physicians and dentists. Having done thousands of appliances I believe I am very adept at determining which patients will do best with various appliances. Unfortunately, clinical experience is not easy to integrate into randomized controlled studies. In fact, clinical experience and "gut feelings" about patients are ruled out of these studies. Randomized controlled studies work best with a limited number of variables. A problem many patients who try oral appliances have is that there dentist was trained by a manufacturers course and the doctor only has a single tool in his belt or only one appliance he understands and is comfortable using.
I teach a dental sleep medicine course that extensively covers the entire field of dental sleep medicine. I do give dentists who take my course a handful of appliances that are extremely effective for different patient groups. I also know that experience is vital to treating patients and therefore offer unlimited phone follow-up for 6 months with doctors that I train. I review sleep studies and frequently help them thru the diagnostic regimen to pick an appropriate appliance.
My article review follows and I include the PUB MED abstract with additional comments.
A brand new article looked at the effectiveness of various oral appliances. They found 1475 articles comparing efficacy of various appliances. The study showed that 116 of these studies compared an oral appliance to a control. They gave weight to only 14 of these studies that were randomized controlled trials (RCTs). All of the studies concerned MAD or mandibular advancement devices. The study concludes that "The evidence shows that there is no one MAD design that most effectively improves polysomnographic indices, but that efficacy depends on a number of factors including severity of OSA, materials and method of fabrication, type of MAD (monobloc/twin block), and the degree of protrusion (sagittal and vertical). These findings highlight the absence of a universal definition of treatment success. Future trials of MAD designs need to be assessed according to agreed success criteria in order to guide clinical practice as to which design of OAs may be the most effective in the treatment of OSA."
Eur J Orthod. 2011 Jan 13. [Epub ahead of print]
A systematic review of the efficacy of oral appliance design in the management of obstructive sleep apnoea.
Ahrens A, McGrath C, Hägg U.
Discipline of Dental Public Health.
Abstract
Oral appliances (OAs) are increasingly advocated as a treatment option for obstructive sleep apnoea (OSA). However, it is unclear how their different design features influence treatment efficacy. The aim of this research was to systematically review the evidence on the efficacy of different OAs on polysomnographic indices of OSA. A MeSH and text word search were developed for Medline, Embase, Cinahl, and the Cochrane library. The initial search identified 1475 references, of which 116 related to studies comparing OAs with control appliances. Among those, 14 were randomized controlled trials (RCTs), which formed the basis of this review. The type of OA investigated in these trials was mandibular advancement devices (MADs), which were compared with either inactive appliances (six studies) or other types of MADs with different design features. Compared with inactive appliances, all MADs improved polysomnographic indices, suggesting that mandibular advancement is a crucial design feature of OA therapy for OSA. The evidence shows that there is no one MAD design that most effectively improves polysomnographic indices, but that efficacy depends on a number of factors including severity of OSA, materials and method of fabrication, type of MAD (monobloc/twin block), and the degree of protrusion (sagittal and vertical). These findings highlight the absence of a universal definition of treatment success. Future trials of MAD designs need to be assessed according to agreed success criteria in order to guide clinical practice as to which design of OAs may be the most effective in the treatment of OSA.
PMID: 21239397 [PubMed - as supplied by publisher]
The article states " These findings highlight the absence of a universal definition of treatment success." The definition of success should be the elimination of all obstructive apneas, hypopneas and RERA's or respiratory related arousals and/or UARS upper airway resistance syndrome. Ideally snoring should also be resolved. Success should also consider central apneas that are not treated by appliances. If there are substantial episodes of central apnea other alternatives may need to be considered.
Positional treatment and oral appliance therapy are frequently used together if incomplete results are obtained with just an oral appliance. It is important to remember that even patial therapy with an oral appliance is far superior to no therapy in patients who reject CPAP. The physician/dentist should try to eliminate all sleep disordered breating.
Allergies and nasal congestion can be addresses with nasal breathing strips, medication, correction of deviated septums or reduction of turbinates.
Irrigation with a Netti Pot utilizing saline or black tea and saline can reduce mucous congestion. I have seen several patients who clain great relief from NAET, I do not understand or endorse this therapy but I have seen many patients who claim significant relief.
The bottom line, it is essential to control all apneic episodes. Untreated sleep apnea is dangerous and can be fatal. Heart disease, hear attacks, strokes, hypertension, short term memory loss, increased risk of motor vehicl accidents, earlier and more severe onset of dementia and/or Alzheimers are just the tip of the iceberg for possible negative consequences related to sleep apnea.
My advice: See a sleeep apnea dentist with experience and/or a mentor who is trained in multiple oral appliances. I am a Diplomate of the American Academy of Dental Sleep Medicine. There are many dentists who are well trained but have not received Diplomate status. Choosing a Diplomate in dental sleep medicine does insure a wide range of experience but is only one of many considerations.
Thursday, November 4, 2010
Inland Empire Sleep Solutions offers alternatives to CPAP for Patients in Washington State and Idaho. Live a Better Life Through Sleep!
Reprinted information from 24/7 Press Release
Inland Empire Sleep Solutions: The Best Sleep Apnea Treatment: CPAP vs. Oral Appliances. A Question of Compliance and Effectiveness. Oral Appliances Win the Compliance Award. Snoring Can Be Cured!
CPAP is considered the gold standard for sleep apnea treatment but poor compliance issues with CPAP often make oral appliances the best sleep apnea treatment. For the morbidly obese patient, CPAP is the best first line treatment.
What is the best sleep apnea treatment? It is not CPAP, according to a recent study that showed 60% of patients abandon CPAP use. At least it is not the best treatment for the 60% of patients who abandoned it. This does not mean CPAP is not the most effective treatment, what it means is no matter how effective a treatment may be, it is a poor treatment if it is not used. Oral appliances are an extremely effective treatment for mild to moderate sleep apnea but less effective for morbidly obese patients and those with severe sleep apnea.
Oral appliances are the "Best Sleep Apnea Treatment" because patients actually use them. Compliance issues have always been the biggest problem with CPAP. Studies have shown most patients quit CPAP completely but even patients who use CPAP average only 4-5 hours/ night 4-5 nights a week. That is not the best treatment but it is better than no treatment. The best site for information on oral appliance therapy and dental sleep medicine is http://www.ihatecpap.com.
Dr Ira L Shapira is a Diplomate of the American Board of Dental Sleep Medicine. He is the president of I HATE CPAP LLC. He is proud to announce a new resource for Washington State and Idaho to help patients with sleep apnea and snoring find solutions. Inland Empire Sleep Solutions http://www.inlandempiresleepsolutions.com/ is bringing the best information on Sleep Apnea Treatment to the Inland Empire region.
Medicare recognized how poor CPAP compliance was and now has minimum usage schedules for CPAP that will save Medicare millions of dollars because such a small percentage of patients actually utilize their machines on a regular basis. Inland Sleep Solutions will feature dental offices where there has been training in Dental Sleep Medicine.
CPAP is the "best treatment" for the 25% of patients who love their CPAP, and use it all night, every night.
Oral appliances may be less effective across a range of all patients at eliminating sleep apnea but they are much more effective at achieving patient compliance. A treatment that is used will always be superior to a treatment that is not used.
Oral appliance success can be greatly improved by titration of appliances in the sleep lab. When an appliance eliminates sleep apnea based on a sleep study it is effectively equivalent to CPAP. The issue of compliance almost always favors oral appliances but objective monitors for oral appliance use are not yet available. They probably will be available in the very near future making oral appliances a leading choice of sleep medicine physicians who care about patients desires.
The best treatment is one that works and is used. For most patients with mild to moderate sleep apnea the best treatment is an oral appliance due to much higher compliance. If compliance is equal and CPAP or appliances are equally effective than both would qualify as the best treatment. The patient can chose their desired treatment. Studies have shown the majority of patients offered a choice prefer a comfortable oral appliance over CPAP.
Some severe sleep apnea patients refuse CPAP, for those patients an oral appliance is superior to "no treatment".
CPAP is almost always the best treatment for the morbidly obese patients but an oral appliance is still better than no treatment if CPAP is refused.
There are patients who are severe and/or morbidly obese and the "best treatment" is actually combination treatment of an oral appliance and CPAP combined. A mask retained by the teeth instead of straps may be considerably more comfortable for many patients and lower pressure from combined use makes CPAP easier to tolerate.
The best treatment may be CPAP but with a custom made nasal mask that is made from an impression of the patients face similar to how dentures are made. Custom masks combined with oral appliances are a new entry in the field coming from airway management.
Cleanliness is of major importance with both CPAP and oral appliance treatments. Dirty masks and hoses can lead to sinus infections, bronchitis and pneumonia while poor oral hygiene with an oral appliance can lead to periodontal disease. Dr Shapira advise all patients to keep their masks and hoses scrupulously clean. It is vital to be just as thorough in cleaning oral appliances and in maintaining oral hygiene care when wearing an oral appliance. They are not well suited for patients who do not regularly brush their teeth.
What is the best CPAP mask for patients who utilize CPAP? Studies have shown that different masks and machines usually do not increase patient compliance but they do increase comfort for patients who actually use CPAP. Other studies have shown that patients' usage of CPAP initially predicts long term compliance with CPAP. Patients who reject CPAP initially rarely embrace CPAP use in the long term. What is the best CPAP mask? A mask the patient actually uses. This will be very patient specific.
What is the best type of CPAP machine? There is standard CPAP machines that come in many styles and shapes. The industry has done a good job of making CPAP machines quieter and smaller. BiPAP machines have lower pressure during expiration that reduces claustrophobic feelings in some patients and often eliminates the sensation of drowning on air. Ramping is a gradual increase in pressure allowing patients to fall asleep prior to pressure increasing. Humidification and heated hoses are also increasing patient comfort. Unfortunately all of these advances have not been shown to increase overall patient compliance.
Servo-ventilation machines are more efficient and effective in treating central sleep apnea, which is a neurological condition where the brain "forgets" to breathe.
The best sleep apnea treatment is always patient specific. The 60% of patients who do not tolerate CPAP will likely find comfortable oral appliances are the best treatment.
A small minority of patients do not tolerate CPAP or oral appliances. The best treatment for these patients may be surgery.
What is the best sleep apnea surgery? The morbidly obese and extremely severe sleep apneics may find that a tracheotomy is the best treatment. Patients breathe through their throat bypassing the pharyngeal blockages. Most patients do not want a trach.
Soft palate surgery is almost never the best sleep apnea treatment. UP3 or Uvulopalatopharyngealplasty is painful and has very high morbidity but more importantly rarely eliminates sleep apnea and patients still require CPAP or oral appliance therapy. Pillars, somnoplasty, LAUP or laser-assisted uvuloplasty are less painful but still ineffective in treating most apnea patients completely.
Maxilo mandibular advancement is extremely effective but is major surgery where the upper jaw (maxilla) is cut loose from the skull and often split in pieces, the lower jaw (mandible) is sectioned into 3 pieces and the hyoid bone is sectioned in pieces and then the patient is wired shut for six weeks. This surgery is often very successful. A geniohyoid surgery is less invasive only splitting the lower jaw in pieces and advancing the chin and tongue. While it is effective in patients with severely recessed lower jaws (weak chin) in most patients it is the "Jay Leno" surgery creating his unique profile.
For severely obese patients with severe sleep apnea bariatric surgery may be the best sleep apnea treatment.
It is also possible to do several tongue reduction surgeries that vary in effectiveness. Dr Shapira suggests that patients attempt CPAP and/or Oral Appliances before considering surgery. Patients with blocked nasal airways frequently improve with partial turbinectomies and correction of deviated septums but while helpful this will usually not eliminate sleep apnea.
Dr Shapira reminds patients of the famous quote: "There is no disease or disorder known to man that can't be made worse by sticking a knife in it." This does not mean to avoid surgery cautions Dr Shapira but rather to approach any surgery with caution and consider the possible problems associated with surgery.
Information on the dangers of sleep apnea, sleep apnea treatment and comfortable oral appliances is available at http://www.ihatecpap.com.
We are currently looking for Dentists with training in Dental sleep Medicine in the following communities. Dentist wishing to become part of the program can contact Meg at meg@hamiltonsaunderson.com
Washington State
Clarkston
Colfax
Ellensburg
Ephrata
Kennewick
Moses Lake
Pasco
Pullman
Richland
Ritzville
Spokane
Spokane Valley
Walla Walla
Washougal
Wenatchee
Yakima
Idaho
Coeur d'Alene
Lewiston
Moscow
Priest Lake
Inland Empire Sleep Solutions: The Best Sleep Apnea Treatment: CPAP vs. Oral Appliances. A Question of Compliance and Effectiveness. Oral Appliances Win the Compliance Award. Snoring Can Be Cured!
CPAP is considered the gold standard for sleep apnea treatment but poor compliance issues with CPAP often make oral appliances the best sleep apnea treatment. For the morbidly obese patient, CPAP is the best first line treatment.
What is the best sleep apnea treatment? It is not CPAP, according to a recent study that showed 60% of patients abandon CPAP use. At least it is not the best treatment for the 60% of patients who abandoned it. This does not mean CPAP is not the most effective treatment, what it means is no matter how effective a treatment may be, it is a poor treatment if it is not used. Oral appliances are an extremely effective treatment for mild to moderate sleep apnea but less effective for morbidly obese patients and those with severe sleep apnea.
Oral appliances are the "Best Sleep Apnea Treatment" because patients actually use them. Compliance issues have always been the biggest problem with CPAP. Studies have shown most patients quit CPAP completely but even patients who use CPAP average only 4-5 hours/ night 4-5 nights a week. That is not the best treatment but it is better than no treatment. The best site for information on oral appliance therapy and dental sleep medicine is http://www.ihatecpap.com.
Dr Ira L Shapira is a Diplomate of the American Board of Dental Sleep Medicine. He is the president of I HATE CPAP LLC. He is proud to announce a new resource for Washington State and Idaho to help patients with sleep apnea and snoring find solutions. Inland Empire Sleep Solutions http://www.inlandempiresleepsolutions.com/ is bringing the best information on Sleep Apnea Treatment to the Inland Empire region.
Medicare recognized how poor CPAP compliance was and now has minimum usage schedules for CPAP that will save Medicare millions of dollars because such a small percentage of patients actually utilize their machines on a regular basis. Inland Sleep Solutions will feature dental offices where there has been training in Dental Sleep Medicine.
CPAP is the "best treatment" for the 25% of patients who love their CPAP, and use it all night, every night.
Oral appliances may be less effective across a range of all patients at eliminating sleep apnea but they are much more effective at achieving patient compliance. A treatment that is used will always be superior to a treatment that is not used.
Oral appliance success can be greatly improved by titration of appliances in the sleep lab. When an appliance eliminates sleep apnea based on a sleep study it is effectively equivalent to CPAP. The issue of compliance almost always favors oral appliances but objective monitors for oral appliance use are not yet available. They probably will be available in the very near future making oral appliances a leading choice of sleep medicine physicians who care about patients desires.
The best treatment is one that works and is used. For most patients with mild to moderate sleep apnea the best treatment is an oral appliance due to much higher compliance. If compliance is equal and CPAP or appliances are equally effective than both would qualify as the best treatment. The patient can chose their desired treatment. Studies have shown the majority of patients offered a choice prefer a comfortable oral appliance over CPAP.
Some severe sleep apnea patients refuse CPAP, for those patients an oral appliance is superior to "no treatment".
CPAP is almost always the best treatment for the morbidly obese patients but an oral appliance is still better than no treatment if CPAP is refused.
There are patients who are severe and/or morbidly obese and the "best treatment" is actually combination treatment of an oral appliance and CPAP combined. A mask retained by the teeth instead of straps may be considerably more comfortable for many patients and lower pressure from combined use makes CPAP easier to tolerate.
The best treatment may be CPAP but with a custom made nasal mask that is made from an impression of the patients face similar to how dentures are made. Custom masks combined with oral appliances are a new entry in the field coming from airway management.
Cleanliness is of major importance with both CPAP and oral appliance treatments. Dirty masks and hoses can lead to sinus infections, bronchitis and pneumonia while poor oral hygiene with an oral appliance can lead to periodontal disease. Dr Shapira advise all patients to keep their masks and hoses scrupulously clean. It is vital to be just as thorough in cleaning oral appliances and in maintaining oral hygiene care when wearing an oral appliance. They are not well suited for patients who do not regularly brush their teeth.
What is the best CPAP mask for patients who utilize CPAP? Studies have shown that different masks and machines usually do not increase patient compliance but they do increase comfort for patients who actually use CPAP. Other studies have shown that patients' usage of CPAP initially predicts long term compliance with CPAP. Patients who reject CPAP initially rarely embrace CPAP use in the long term. What is the best CPAP mask? A mask the patient actually uses. This will be very patient specific.
What is the best type of CPAP machine? There is standard CPAP machines that come in many styles and shapes. The industry has done a good job of making CPAP machines quieter and smaller. BiPAP machines have lower pressure during expiration that reduces claustrophobic feelings in some patients and often eliminates the sensation of drowning on air. Ramping is a gradual increase in pressure allowing patients to fall asleep prior to pressure increasing. Humidification and heated hoses are also increasing patient comfort. Unfortunately all of these advances have not been shown to increase overall patient compliance.
Servo-ventilation machines are more efficient and effective in treating central sleep apnea, which is a neurological condition where the brain "forgets" to breathe.
The best sleep apnea treatment is always patient specific. The 60% of patients who do not tolerate CPAP will likely find comfortable oral appliances are the best treatment.
A small minority of patients do not tolerate CPAP or oral appliances. The best treatment for these patients may be surgery.
What is the best sleep apnea surgery? The morbidly obese and extremely severe sleep apneics may find that a tracheotomy is the best treatment. Patients breathe through their throat bypassing the pharyngeal blockages. Most patients do not want a trach.
Soft palate surgery is almost never the best sleep apnea treatment. UP3 or Uvulopalatopharyngealplasty is painful and has very high morbidity but more importantly rarely eliminates sleep apnea and patients still require CPAP or oral appliance therapy. Pillars, somnoplasty, LAUP or laser-assisted uvuloplasty are less painful but still ineffective in treating most apnea patients completely.
Maxilo mandibular advancement is extremely effective but is major surgery where the upper jaw (maxilla) is cut loose from the skull and often split in pieces, the lower jaw (mandible) is sectioned into 3 pieces and the hyoid bone is sectioned in pieces and then the patient is wired shut for six weeks. This surgery is often very successful. A geniohyoid surgery is less invasive only splitting the lower jaw in pieces and advancing the chin and tongue. While it is effective in patients with severely recessed lower jaws (weak chin) in most patients it is the "Jay Leno" surgery creating his unique profile.
For severely obese patients with severe sleep apnea bariatric surgery may be the best sleep apnea treatment.
It is also possible to do several tongue reduction surgeries that vary in effectiveness. Dr Shapira suggests that patients attempt CPAP and/or Oral Appliances before considering surgery. Patients with blocked nasal airways frequently improve with partial turbinectomies and correction of deviated septums but while helpful this will usually not eliminate sleep apnea.
Dr Shapira reminds patients of the famous quote: "There is no disease or disorder known to man that can't be made worse by sticking a knife in it." This does not mean to avoid surgery cautions Dr Shapira but rather to approach any surgery with caution and consider the possible problems associated with surgery.
Information on the dangers of sleep apnea, sleep apnea treatment and comfortable oral appliances is available at http://www.ihatecpap.com.
We are currently looking for Dentists with training in Dental sleep Medicine in the following communities. Dentist wishing to become part of the program can contact Meg at meg@hamiltonsaunderson.com
Washington State
Clarkston
Colfax
Ellensburg
Ephrata
Kennewick
Moses Lake
Pasco
Pullman
Richland
Ritzville
Spokane
Spokane Valley
Walla Walla
Washougal
Wenatchee
Yakima
Idaho
Coeur d'Alene
Lewiston
Moscow
Priest Lake
Wednesday, September 1, 2010
SLEEP APNEA AND ANXIETY: A PUBMED SEARCH ON THOSE TERMS YIELDS 243 RESULTS.
THERE ARE MANY STUDIES THAT SUGGEST NEGATIVE HEALTH EFFECTS FROM POOR SLEEP. AN ARTICLE IN Behav Sleep Med. 2010 Jul;8(3):157-71. TITLED Sleepiness and health in midlife women: results of the National Sleep Foundation's 2007 Sleep in America poll CONCLDES THAT " sleep disruptions and daytime sleepiness negatively affect the daily life of midlife women."
ANOTHER ARTICLE IN J Adolesc Health. 2010 Feb;46(2):124-32. Epub 2009 Aug 3.
Sleep patterns and predictors of disturbed sleep in a large population of college students CONCLUDES THAT "insufficient sleep and irregular sleep-wake patterns, which have been extensively documented in younger adolescents, are also present at alarming levels in the college student population. Given the close relationships between sleep quality and physical and mental health, intervention programs for sleep disturbance in this population should be considered."
A THIRD ARTICLE IN Acta Otorrinolaringol Esp. 2009 Sep-Oct;60(5):325-31. Epub 2009 Aug 13.
[Neurocognitive and behavioural abnormalities in paediatric sleep-related breathing disorders] CONCLUDES THAT " A high prevalence of behavioural and neurocognitive abnormalities was observed in children with sleep-related breathing disorders compared to a control group of healthy children. The use of objective assessment such as psychological tests revealed more abnormalities than were expressed by parents in response to clinical interviews."
IT APPEARS THAT RGARDLESS OF AGE AND/OR HEALTH STATUS SLEEP DISORDERS WREAK HAVOC ON BOTH PHYSICAL AND EMOTIONAL WELL BEING.
Behav Sleep Med. 2010 Jul;8(3):157-71.
Sleepiness and health in midlife women: results of the National Sleep Foundation's 2007 Sleep in America poll.
Chasens ER, Twerski SR, Yang K, Umlauf MG.
School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA 15261, USA. chasense@pitt.edu
Abstract
The 2007 Sleep in America poll, a random-sample telephone survey, provided data for this study of sleep in community-dwelling women aged 40 to 60 years. The majority of the respondents were post- or perimenopausal, overweight, married or living with someone, and reported good health. A subsample (20%) reported sleepiness that consistently interfered with daily life; the sleepy subsample reported more symptoms of insomnia, restless legs syndrome, obstructive sleep apnea, depression and anxiety, as well as more problems with health-promoting behaviors, drowsy driving, job performance, household duties, and personal relationships. Hierarchical regression showed that sleepiness along with depressive symptoms, medical comorbidities, obesity, and lower education were associated with poor self-rated health, whereas menopause status (pre-, peri- or post-) was not. These results suggest that sleep disruptions and daytime sleepiness negatively affect the daily life of midlife women.
PMID: 20582759 [PubMed - in process]
J Adolesc Health. 2010 Feb;46(2):124-32. Epub 2009 Aug 3.
Sleep patterns and predictors of disturbed sleep in a large population of college students.
Lund HG, Reider BD, Whiting AB, Prichard JR.
Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA.
Abstract
PURPOSE: To characterize sleep patterns and predictors of poor sleep quality in a large population of college students. This study extends the 2006 National Sleep Foundation examination of sleep in early adolescence by examining sleep in older adolescents.
METHOD: One thousand one hundred twenty-five students aged 17 to 24 years from an urban Midwestern university completed a cross-sectional online survey about sleep habits that included the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale, the Horne-Ostberg Morningness-Eveningness Scale, the Profile of Mood States, the Subjective Units of Distress Scale, and questions about academic performance, physical health, and psychoactive drug use.
RESULTS: Students reported disturbed sleep; over 60% were categorized as poor-quality sleepers by the PSQI, bedtimes and risetimes were delayed during weekends, and students reported frequently taking prescription, over the counter, and recreational psychoactive drugs to alter sleep/wakefulness. Students classified as poor-quality sleepers reported significantly more problems with physical and psychological health than did good-quality sleepers. Students overwhelmingly stated that emotional and academic stress negatively impacted sleep. Multiple regression analyses revealed that tension and stress accounted for 24% of the variance in the PSQI score, whereas exercise, alcohol and caffeine consumption, and consistency of sleep schedule were not significant predictors of sleep quality.
CONCLUSIONS: These results demonstrate that insufficient sleep and irregular sleep-wake patterns, which have been extensively documented in younger adolescents, are also present at alarming levels in the college student population. Given the close relationships between sleep quality and physical and mental health, intervention programs for sleep disturbance in this population should be considered.
PMID: 20113918 [PubMed - indexed for MEDLINE]
Acta Otorrinolaringol Esp. 2009 Sep-Oct;60(5):325-31. Epub 2009 Aug 13.
[Neurocognitive and behavioural abnormalities in paediatric sleep-related breathing disorders]
[Article in Spanish]
Esteller Moré E, Barceló Mongil M, Segarra Isern F, Piñeiro Aguín Z, Pujol Olmo A, Soler EM, Ademà Alcover JM.
Servicio de Otorrinolaringología, Hospital General de Catalunya, San Cugat del Vallès, Barcelona, España. esteller@abaforum.es
Abstract
INTRODUCTION: Behavioural and neurocognitive abnormalities in children may be a consequence of sleep-related breathing disorders. The effectiveness of assessments based on questioning parents is dubious and objective assessment tools are therefore required.
AIM: To ascertain the impact of these abnormalities in children with sleep-related breathing disorders and compare the reliability of questioning parents in relation to validated psychological tests.
METHOD: A prospective study was performed on 20 children with sleep-related breathing disorders and 20 healthy control children between 3 and 12 years of age. Both groups were subjected to a battery of validated psychological tests. The results of both groups were compared with each other and with the response to clinical questionnaires given to parents in the problem group.
RESULTS: More than 75% of the cases in the problem group presented abnormalities with regard to attention, anxiety, memory and spatial structuring. The percentage involvement in all concepts was higher in the problem group. Comparisons of attention (40% of children affected in the control group and 80% in the problem group), memory (50% and 84.2%), and spatial structuring (45% and 75%) were statistically significant. More abnormality was observed in the parameters assessed with psychological tests than the equivalent concept obtained from interviewing the parents. Comparison of abnormal concentration assessed from the questionnaires (40% of children affected) with attention during the psychological test (80%), memory (15% and 84.21%), and delayed language development (10%) compared to spatial structuring (75%) was statistically significant.
CONCLUSIONS: A high prevalence of behavioural and neurocognitive abnormalities was observed in children with sleep-related breathing disorders compared to a control group of healthy children. The use of objective assessment such as psychological tests revealed more abnormalities than were expressed by parents in response to clinical interviews.
PMID: 19814984 [PubMed - indexed for MEDLINE]Free Article
ANOTHER ARTICLE IN J Adolesc Health. 2010 Feb;46(2):124-32. Epub 2009 Aug 3.
Sleep patterns and predictors of disturbed sleep in a large population of college students CONCLUDES THAT "insufficient sleep and irregular sleep-wake patterns, which have been extensively documented in younger adolescents, are also present at alarming levels in the college student population. Given the close relationships between sleep quality and physical and mental health, intervention programs for sleep disturbance in this population should be considered."
A THIRD ARTICLE IN Acta Otorrinolaringol Esp. 2009 Sep-Oct;60(5):325-31. Epub 2009 Aug 13.
[Neurocognitive and behavioural abnormalities in paediatric sleep-related breathing disorders] CONCLUDES THAT " A high prevalence of behavioural and neurocognitive abnormalities was observed in children with sleep-related breathing disorders compared to a control group of healthy children. The use of objective assessment such as psychological tests revealed more abnormalities than were expressed by parents in response to clinical interviews."
IT APPEARS THAT RGARDLESS OF AGE AND/OR HEALTH STATUS SLEEP DISORDERS WREAK HAVOC ON BOTH PHYSICAL AND EMOTIONAL WELL BEING.
Behav Sleep Med. 2010 Jul;8(3):157-71.
Sleepiness and health in midlife women: results of the National Sleep Foundation's 2007 Sleep in America poll.
Chasens ER, Twerski SR, Yang K, Umlauf MG.
School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA 15261, USA. chasense@pitt.edu
Abstract
The 2007 Sleep in America poll, a random-sample telephone survey, provided data for this study of sleep in community-dwelling women aged 40 to 60 years. The majority of the respondents were post- or perimenopausal, overweight, married or living with someone, and reported good health. A subsample (20%) reported sleepiness that consistently interfered with daily life; the sleepy subsample reported more symptoms of insomnia, restless legs syndrome, obstructive sleep apnea, depression and anxiety, as well as more problems with health-promoting behaviors, drowsy driving, job performance, household duties, and personal relationships. Hierarchical regression showed that sleepiness along with depressive symptoms, medical comorbidities, obesity, and lower education were associated with poor self-rated health, whereas menopause status (pre-, peri- or post-) was not. These results suggest that sleep disruptions and daytime sleepiness negatively affect the daily life of midlife women.
PMID: 20582759 [PubMed - in process]
J Adolesc Health. 2010 Feb;46(2):124-32. Epub 2009 Aug 3.
Sleep patterns and predictors of disturbed sleep in a large population of college students.
Lund HG, Reider BD, Whiting AB, Prichard JR.
Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA.
Abstract
PURPOSE: To characterize sleep patterns and predictors of poor sleep quality in a large population of college students. This study extends the 2006 National Sleep Foundation examination of sleep in early adolescence by examining sleep in older adolescents.
METHOD: One thousand one hundred twenty-five students aged 17 to 24 years from an urban Midwestern university completed a cross-sectional online survey about sleep habits that included the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale, the Horne-Ostberg Morningness-Eveningness Scale, the Profile of Mood States, the Subjective Units of Distress Scale, and questions about academic performance, physical health, and psychoactive drug use.
RESULTS: Students reported disturbed sleep; over 60% were categorized as poor-quality sleepers by the PSQI, bedtimes and risetimes were delayed during weekends, and students reported frequently taking prescription, over the counter, and recreational psychoactive drugs to alter sleep/wakefulness. Students classified as poor-quality sleepers reported significantly more problems with physical and psychological health than did good-quality sleepers. Students overwhelmingly stated that emotional and academic stress negatively impacted sleep. Multiple regression analyses revealed that tension and stress accounted for 24% of the variance in the PSQI score, whereas exercise, alcohol and caffeine consumption, and consistency of sleep schedule were not significant predictors of sleep quality.
CONCLUSIONS: These results demonstrate that insufficient sleep and irregular sleep-wake patterns, which have been extensively documented in younger adolescents, are also present at alarming levels in the college student population. Given the close relationships between sleep quality and physical and mental health, intervention programs for sleep disturbance in this population should be considered.
PMID: 20113918 [PubMed - indexed for MEDLINE]
Acta Otorrinolaringol Esp. 2009 Sep-Oct;60(5):325-31. Epub 2009 Aug 13.
[Neurocognitive and behavioural abnormalities in paediatric sleep-related breathing disorders]
[Article in Spanish]
Esteller Moré E, Barceló Mongil M, Segarra Isern F, Piñeiro Aguín Z, Pujol Olmo A, Soler EM, Ademà Alcover JM.
Servicio de Otorrinolaringología, Hospital General de Catalunya, San Cugat del Vallès, Barcelona, España. esteller@abaforum.es
Abstract
INTRODUCTION: Behavioural and neurocognitive abnormalities in children may be a consequence of sleep-related breathing disorders. The effectiveness of assessments based on questioning parents is dubious and objective assessment tools are therefore required.
AIM: To ascertain the impact of these abnormalities in children with sleep-related breathing disorders and compare the reliability of questioning parents in relation to validated psychological tests.
METHOD: A prospective study was performed on 20 children with sleep-related breathing disorders and 20 healthy control children between 3 and 12 years of age. Both groups were subjected to a battery of validated psychological tests. The results of both groups were compared with each other and with the response to clinical questionnaires given to parents in the problem group.
RESULTS: More than 75% of the cases in the problem group presented abnormalities with regard to attention, anxiety, memory and spatial structuring. The percentage involvement in all concepts was higher in the problem group. Comparisons of attention (40% of children affected in the control group and 80% in the problem group), memory (50% and 84.2%), and spatial structuring (45% and 75%) were statistically significant. More abnormality was observed in the parameters assessed with psychological tests than the equivalent concept obtained from interviewing the parents. Comparison of abnormal concentration assessed from the questionnaires (40% of children affected) with attention during the psychological test (80%), memory (15% and 84.21%), and delayed language development (10%) compared to spatial structuring (75%) was statistically significant.
CONCLUSIONS: A high prevalence of behavioural and neurocognitive abnormalities was observed in children with sleep-related breathing disorders compared to a control group of healthy children. The use of objective assessment such as psychological tests revealed more abnormalities than were expressed by parents in response to clinical interviews.
PMID: 19814984 [PubMed - indexed for MEDLINE]Free Article
Subscribe to:
Posts (Atom)
-
Australian scientists have developed a new method for detecting sleep apnea. Traditionally, the diagnosis of sleep apnea required an overni...
-
Patient describes 5 years of sleep apnea treatment with oral appliance. He initially used the CPAP machine but found it made him uncomfortab...
-
Mike describes how he was diagnosed with sleep apnea. He was less than thrilled with diagnosis and definitely did not want CPAP. He travels...