SLEEP HARMONY trains energetic, caring people to become highly qualified Sleep Coordinators and assists them to be placed in dental offices where they will screen patients and assist dentists in the treatment of sleep apnea.

WHY WOMEN ARE LESS LIKELY TO BE DIAGNOSED FOR SLEEP APNEA

By Charles Kravitz, DDS in Women’s Health
Swedish scientist Dr. Karl Franklin and his team set out to find out how prevalent sleep apnea is among women and how often symptoms occur. Out of a population-based random sample of 10,000 women between the ages of 20 and 70 years, they gathered data on 400 of them. The test group were given questionnaires which included several questions regarding their sleeping habits and sleep quality. They also underwent overnight polysomnography.

WOMEN ARE LESS LIKELY TO BE DIAGNOSED FOR SLEEP APNEA

Women with sleep apnea are less likely to be diagnosed compared to men. In studies of patients registering for evaluation for sleep apnea, the ratio of men to women has sometimes been extremely lopsided, with 8 or 9 men diagnosed with obstructive sleep apnea (OSA) for each woman found to have OSA. However, we know from studies in the general population that the actual ratio is likely to be closer to 2 or 3 men with OSA for each woman who has the condition.  Women make up about 45 percent of sleep study referrals and most sleep studies are still done to screen for sleep apnea.

WHY ARE WOMEN LESS LIKELY TO BE DIAGNOSED FOR SLEEP APNEA?

 First, there is an unfortunate predefined notion of the make-up of a sleep apnea patient. The stereotype is a middle-age, overweight or obese male. Physicians may not be thinking of this OSA diagnosis when the patient is female. Second, women may present with slightly different symptoms than the “classic” symptoms of snoring, witnessed breathing pauses at night and excessive sleepiness during the day.

Instead, women may present with fatigue, insomnia, disrupted sleep, chronic fatigue and depression morning headaches, mood disturbances or other symptoms that may suggest reasons other than OSA for their symptoms. Because these symptoms are not specific for OSA, women may be misdiagnosed and are less likely to be referred to a sleep study for further evaluation. Another problem is that women with sleep apnea have more subtle breathing disturbances and are more likely to have REM-related apneas, so they may be tougher to diagnose.

COMMON SLEEP APNEA MISDIAGNOSES
Women are often diagnosed in error with one of the following conditions, rather than sleep apnea.
  • Anemia
  • Cardiac or pulmonary illnesses
  • Depression
  • Diabetes
  • Fatigue from overwork
  • Fibromyalgia
  • Hypertension
  • Hypochondria
  • Hypothyroidism
  • Insomnia
  • Menopausal changes
  • Obesity

Sources

Dr. Karl Franklin, European Respiratory Journal

Grace W. Pien MD, MS, assistant professor of medicine, divisions of Sleep Medicine and Pulmonary and Critical Care at the University of Pennsylvania School of Medicine.

Nancy A. Collop , MD, medical director at Johns Hopkins Hospital Sleep Disorders Center and associate professor of medicine atHopkins’ Division of Pulmonary and Critical Care Medicine in Baltimore, Md .

Fiona C. Baker, PhD, sleep physiologist, Center for Health Sciences, SRI International, in Menlo Park, Calif.

Anita L. Blosser, MD, with Duke Primary Care at the Henderson Family Medicine Clinic in Henderson, N.C.

This year August 18th was the 100th anniversary of the passage of the 19th Amendment to the U.S. Constitution- heralded as the turning point for women’s voting rights in America.
Textbooks hail the amendment, ratified on August 18, 1920, under President Warren Harding, as a “milestone” guaranteeing voting rights to women.
In 1973, Congress designated August 26, the date the amendment was officially certified, as Women’s Equality Day — honoring, in the words of then-President Richard Nixon, “the first step toward full and equal participation of women in our Nation’s life.”  

The 19th Amendment reads: “the right of citizens of the United States to vote shall not be denied or abridged by the United States or by any state on account of sex.

We know that men are more at risk of developing obstructive sleep apnea. But for women who suffer from OSA the risk of developing cancer is more than your male counterparts, says a recent research published in the European Respiratory Journal. During the study the scientists collected data of 20,000 patients with OSA. It was found that a large per cent of these patients were later diagnosed with cancer.

Researchers analysed data based on age, gender, alcohol consumption, body mass index and smoking. Again, there was a strong association between sleep apnea and higher cancer prevalence. Additionally, the link was stronger in women than men.

How Sleep Apnea Influences Cancer

The studies show that people suffering from sleep-disordered breathing have an increased risk of developing cancer and are up to five times more likely to die from the disease.
Once again the culprit is HYPOXIA. The lack of oxygen (hypoxia) caused by untreated Obstructive Sleep Apnea (OSA) can be a catalyst for a process called neovascularization (the creation of new blood vessels), giving a blood supply that can encourage tumor growth.

Sleep apnea leads to neurochemical imbalances. When poor sleep is the result of any untreated sleep disorder, the neurochemical balance that a whole-body process like sleep requires is disrupted.

 Two of the key hormones that fall out of balance—cortisol and melatonin—are critical for maintaining a healthy immune system (cortisol) and for regulating the body’s circadian system (melatonin). In addition, this neurochemical balance can lead to body-wide (systemic) inflammation.

 

How does this relate to cancer?

  • Without a healthy immune system, the body can struggle to fight off the aggressive cellular behaviors that can lead to tumors.
  • With an imbalance in circadian rhythms as the result of decreased melatonin, the body produces higher amounts of other substances that are risk factors for cancer (for women, higher estrogen can lead to breast cancer, and for men, higher estrogen can lead to prostate, bowel, lung, and bladder cancer).
  • Systemic inflammation causes oxidative stress to the organs. Oxidation is a breakdown of tissues that is the consequence of long-term inflammation; oxidative stress refers to the damage that results from unchecked systemic inflammation, which makes it easier for cancer—an opportunistic disease—to establish itself wherever the body is most vulnerable.

Cancer cells thrive in a low oxygen environment. Hospitals will put a patient on oxygen if their O2 levels drop below 92. Untreated OSA can cause oxygen levels to drop anywhere from the 90’s, 80’s and even in the 50’s.

Sleep apnea causes sustained low blood oxygen. 

One of the biggest problems with sleep apnea is the way in which it deprives the body of necessary oxygen. Frequent apneas (pauses in breathing that last at least 10 seconds, but often last much longer) lead to nocturnal intermittent hypoxia. 

Conclusion

Detecting OSA and leading the way for treatment can add YEARS to a  patient’s lifespan while significantly improving quality of life. Both cancer and OSA have symptoms that can be easily recognized in the chair during a regular checkup. While checking the mouth for masses and swelling, you can also check on the Mallampati score  and be alert to possible concerns you may have. 

                  MALLAMPATI EXAM

 

 More case studies

A 2012 study identified a link between sleep and aggressive breast cancers.  Ref: American Cancer Society 

In 2013, Spanish researchers reported that people with severe sleep apnea had a 65 percent increased risk for cancer. They suggested the risk is associated with increased hypoxia, a condition where the body is deprived of oxygen.

Another study from the University of Wisconsin found people with sleep-disordered breathing are five times more likely to die from cancer than people without sleep apnea. Researchers from the American study admit the study is limited in that there are no studies to compare it with that look at cancer survival in people with sleep apnea.

One recent study reported in the Journal of Sleep Medicine shows moderate and severe cases of sleep apnea are associated with increased cancer risk. That study also showed an increased risk for all “all-cause mortality” and cancer mortality due to cancer. The 20-year study showed that people with moderate to severe cases of sleep apnea are two and a half times more likely to develop cancer and three times more likely to die from cancer. The authors noted these findings confirmed previous research conducted by American and Spanish researchers. 

Animal studies have also confirmed previous findings. One 2014 study  reported in the journal Cancer Research linked sleep apnea with aggressive cancer growth in mouse models. Mice with tumors were placed in low oxygen environments that mimic the effects of sleep apnea and tumor growth in the mice progressed rapidly.

  

Researchers have also suggested a correlation between sleep apnea and increased cancer risk of any kind.   Risk of some cancers may increase. One Cancer study of 1,240 participants who underwent colonoscopies found that those who slept fewer than six hours a night had a 50 percent spike in risk of colorectal adenomas, which can turn malignant over time.
 
Sources: 

American Sleep Apnea Association
Centers for Disease Control
Mayo Clinic
National Institutes of Health
National Sleep Foundation
The New York Times
Wisconsin Cohort Study
World Health Organization

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Appreciation to D.B. Wenke
As a women in dentistry I am sure you wondered how your gender compares in statistics like age, income, hours worked, and more. Here are some interesting data followed by fascinating facts

How many dentists are there in the U.S. ?

As of 2019, there are 200,419 dentists working in dentistry (dentists using their dental degree in some fashion) in the U.S. 

Source: Supply of Dentists in the U.S.: 2001-2019

What is the dentist-to-population ratio in the United States?

As of 2019, there are 61.1 dentists working in dentistry per 100,000 U.S. population. Ratios vary by state.

Source: Supply of Dentists in the U.S.: 2001-2019 . 

How many dentists are female?

Among the 200,419 dentists working in dentistry as of 2019, 33.4% are female.

Source: Supply of Dentists in the U.S.: 2001-2019 (Tables in Excel). 

What percentage of dentists are specialists?

As of 2019, about one in five professionally active dentists (21.0%) reported that their practice, research, or administration area is an ADA-recognized specialty.

Source: Supply of Dentists in the U.S.: 2001-2019

Female dentists in the United States are younger than their male colleagues. According to the latest data available, 80 percent are age 44 or under, while more than 60 percent of male dentists are age 45 or older. Compared to their male colleagues, women are less likely to be in solo practices and more likely to be employees or independent contractors. Fifty-three percent of female dentists are solo practitioners compared to 75 percent of male dentists, and 29 percent of women are employees or independent contractors compared to 8 percent of men.4 While this discrepancy is in part a function of age differences, women tend to move more slowly into solo practice arrangements than men.

 Women are somewhat more likely than men to work part-time: 28 percent vs. 15 percent, and are less likely to work overtime: 16 percent vs. 30 percent. A recent study indicated that marital status does not appear to have an impact on work hours among female dentists. However, having children reduces women’s work hours by nearly one workday per week, on average.

Gender differences in income are frequent topics of discussion. According to an ADA survey, nearly two-thirds of female dentists believe that they earn less than their male counterparts, while nearly two-thirds of male dentists believe that there is no gender difference in dentists’ income levels. The existing data, however, indicates that the perceptions of female dentists are more accurate than those of their male colleagues.

A comparison of the average income of all female dentists with the average income of all male dentists is not a useful indicator of income inequality, because, as we have indicated, there are substantial gender differences in practice arrangements and experience among U.S. dentists. Still, when comparing the average net annual income of full-time male and female practitioners who have been out of dental school less than 10 years, women earned only 64 percent of what men earn. Additionally, among dentists in all age groups, women who were partners or who were in solo practice only earned 58 percent and 73 percent, respectively, of what men earned in the same practice arrangements. Women as employees only earned 47 percent of what men earn as dental practice employees. 

THE TREND

Women in the pipeline

The number of women in the pipeline for a career in dentistry has grown dramatically over the last 30 years. Enrollment of women in U.S. dental schools stands at 48 percent;  in 1970, only 1 percent of dental students were women. 

in an analysis of the first-year data, we found that students’ motives for attending dental school appeared to be organized into four distinct areas.   The first cluster focused on money issues, and reflected the importance of financial and job security aspects of a dental career to students.  The second cluster was a set of people-related motives. Students who gave high ratings to these motives thought that caring for and helping other people were important reasons for attending dental school.The third cluster centered on the notion of flexibility, and suggested that the freedom and flexibility that dentists have in scheduling their work relative to other professions, both health-care-related and otherwise, is important to dental students. The fourth cluster focused on business-related motives for becoming a dentist, and the degree to which students stressed self-employment and being one’s own boss as important reasons for pursuing a dental career.

Our data showed that both women and men found the financial aspects of a dental career equally important as a motive for attending dental school. The perceived flexibility of a dental career was also equally important to both men and women. On the other hand, male students rated business-related motives as being more important in their decision to pursue dental school than did female students. Conversely, female students rated caring or helping motives as more important than did their male counterparts.

When asked about their aspirations following dental school, significant gender differences among first-year students emerged. Despite the fact that first-year students are not likely to have a great deal of in-depth knowledge about dental specialties, with the exception of pediatric dentistry, women were less likely to aspire to postgraduate dental education than men. In fact, the most significant predictor of postgraduate educational aspirations among first-year students was gender. Furthermore, compared to men, women were less likely to see themselves in a solo practice following graduation and more likely to see themselves as an employee or associate in a dental practice.

 CONCLUSION

The trends show an ever improving picture in all categories for women in dentistry.

CANCER IS AN INCREASED RISK FOR WOMEN IF THEY HAVE SLEEP APNEA

We know that men are more at risk of developing sleep apnea. But if you are a woman and you suffer from obstructive sleep apnea (OSA) your risk of developing cancer is more than your male counterparts, says a recent research published in the European Respiratory Journal. During the study the scientists collected data of 20,000 patients with OSA. It was found that around 2 per cent of these patients were later diagnosed with cancer.

Researchers analysed data based on age, gender, body mass index and smoking. Again, there was a strong association between sleep apnea and higher cancer prevalence. Additionally, the link was stronger in women than men.

A 2012 study identified a link between sleep and aggressive breast cancers. Ref: American Cancer Society

ADDITIONAL CASE STUDIES

In 2013, Spanish researchers reported that people with severe sleep apnea had a 65 percent increased risk for cancer. The risk is associated with increased hypoxia.

Another study from the Univ. of Wisconsin found people with sleep-disordered breathing are five times more likely to die from cancer than people without sleep apnea. 

One recent study reported in the Journal of Sleep Medicine shows moderate and severe cases of sleep apnea are associated with increased cancer risk. That study also showed an increased risk for all “all-cause mortality” and cancer mortality due to cancer. The 20-year study showed that people with moderate to severe cases of sleep apnea are two and a half times more likely to develop cancer and three times more likely to die from cancer. The authors noted these findings confirmed previous research conducted by American and Spanish researchers.

 With a convincing condemnation of Sleep Apnea as a cause of cancer we need to be more serious about screening patients for cancer and OSA.

HOW SLEEP APNEA INFLUENCES SYSTEMIC DISORDERS AND HOW YOU CORRECT THEM
The article on women with sleep apnea raised so much interest that I am offering a follow-up with some explanations you asked for.
So, you are a woman in dentistry, caring and dedicated. You want to give your obstructive sleep apnea (OSA) afflicted patient a simple layman explanation on the importance of healthy sleep.

Try this:

1.  The key is oxygen.

Can you imagine holding your breath for 10 seconds and even up to a minute, 20 times per hour on average, when you thought you were sleeping? That’s Moderate (not Severe) sleep apnea. That’s 160 apnea events X 10 seconds  = 1600 seconds (27 minutes during an 8 hour “sleep” session. And it could be much higher.
How much oxygen would pass to your lungs and consequently to all your organs during that time? Every system in your body will suffer and break down. And that would lead to strokes among other repercussions.
2.  Why high blood pressure and acid reflux (GERD) are common co-morbidities of OSA
During the cessations of breathing the body will increase its efforts to take in air.
Abdominal contractions are exaggerated and increase until breathing resumes.  The contractions squeeze the stomach and force acid through the LES and up the esophagus.
The efforts to breathe also increase a negative pressure in the esophagus which also pull up acid and elevate blood pressure. Aha! The mystery is resolved!
3. The solution.
 Correct the sleep breathing disorder (Oral Appliance Therapy ((OAT) is effective, economical and convenient), and you will observe the symptoms of OSA diminish and in many cases disappear. Isn’t hat a lot better than popping pills every day.?

Are you ready to cut those strings that have tied you to the dental chair for all those years? You have had a long productive career of interacting with people in need and improving their quality of life. Now, after years of intense dedication to detail you are looking for alternatives. You want to hang up the loupes but are wondering what to do first and what will you do when you start to miss the patient interaction.   Here’s what one astute dentist did:

Dr. Sidney Shaw was an old-fashioned type dentist. She had a conservative treatment approach to the practice of dentistry, She exuded an obvious passion for helping her patients, and everyone loved her. She had an admired and successful general dental practice.  At the ripe young age of 66 she was diagnosed with atrial fibrillation and her doctor told her she had to slow down. That’s when she made the painful decision to put her practice up for sale and reap the rewards from the 38 years of hard work invested into building her practice. She felt she could retire comfortably on her proceeds from the sale.

She contacted a dental transition broker who conducted a very comprehensive practice valuation. To Sidney’s dismay the valuation reported a market value of 310,000. This was more than disappointing to Sidney; it was devastating. It was not enough to comfortably support her and her mounting medical bills.

“Disappointment is a temporary obstacle on the road to success.”

Sidney contacted me and we came up with a solution for her.  We implemented a new program that added another three hundred thousand dollars in value to her sale price.

Within two months of making her decision she was treating two patients, on average, each day for sleep apnea. Her average fee for each case was $3500. This amounted to $21,000 a week for three easy, relaxed, rewarding half days a week. This projected to revenues of an incredible $1,050,000 for a 50 week year. This may sound like “pie in the sky” but when you check around you will find examples like this being quietly conducted all throughout the nation.

The happy ending:

Sidney sold her practice for 2.5 times more than that original market value and she stayed on 3 half days a week as a ” sleep specialist” for the new owner. How is that for a ROI of two months’ training?

                                                                                                                                                                                                      By Charles Kravitz, DDS in Women’s Health
 

WOMEN ARE LESS LIKELY TO BE DIAGNOSED FOR SLEEP APNEA

Women with sleep apnea are less likely to be diagnosed compared to men. In studies of patients registering for evaluation for sleep apnea, the ratio of men to women has sometimes been extremely lopsided, with 8 or 9 men diagnosed with obstructive sleep apnea (OSA) for each woman found to have OSA. However, we know from studies in the general population that the actual ratio is likely to be closer to 2 or 3 men with OSA for each woman who has the condition.

Women make up about 45 percent of sleep study referrals and most sleep studies are still done to screen for sleep apnea.

WHY ARE WOMEN LESS LIKELY TO BE DIAGNOSED FOR SLEEP APNEA?

First, there is an unfortunate predefined notion of the make-up of a sleep apnea patient. The stereotype is a middle-age, overweight or obese male. Physicians may not be thinking of this OSA diagnosis when the patient is female. Second, women may present with slightly different symptoms than the “classic” symptoms of snoring, witnessed breathing pauses at night and excessive sleepiness during the day.

Instead, women may present with fatigue, insomnia, disrupted sleep, chronic fatigue and depression morning headaches, mood disturbances or other symptoms that may suggest reasons other than OSA for their symptoms. Because these symptoms are not specific for OSA, women may be misdiagnosed and are less likely to be referred to a sleep study for further evaluation. Another problem is that women with sleep apnea have more subtle breathing disturbances and are more likely to have REM-related apneas, so they may be tougher to diagnose.

WOMAN SNORING 5-25-15

SOME DIFFERENCES IN SYMPTOMS BETWEEN MEN AND WOMEN

Sleep apnea in females is related to age, obesity and hypertension but not to daytime sleepiness. 

The “classic” symptoms of OSA are snoring, witnessed apneas and daytime sleepiness, but women may not experience these things. Weight gain, depression, waking up gasping for breath, hypertension, and dry throat in the morning may be tip-offs for women that they may need an evaluation.e