Archives for category: SLEEP

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.

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

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.?
                                                                                                                                                                                                      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

 

Learn at home to treat Snoring and Sleep Apnea during the social isolation and travel ban.  Here is your solution to counter decreased income and cancellations of appointments. We can train you by telephone, email and webinars. By the time the Coronavirus is over you will be set to welcome the large number of DSM candidates who are searching for your help. Contact me for more information:  cskdoc@aol.com

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.  Snoring may be a warning that you may have OSA.

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.

Dentists perform exams of  patient’s mouth, neck, and airway on a regular basis while screening for oral cancer. These health screenings are important, lifesaving moments in a patient’s health journey– we can do that with a similarly deadly condition like untreated sleep apnea.

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

Symptoms of both oral cancer and sleep apnea should be screened for everyone, especially for heavy drinkers and tobacco users. The irritation from cigarettes and other forms of tobacco may cause inflammation that’s disruptive to the airway. Smoking, of course, is known for its carcinogenic properties, but perhaps more surprising is that around 70% people diagnosed with oral cancer turn out to be heavy drinkers. Alcohol use is also known to cause apneic events by relaxing muscles in the airway (this is particularly dangerous when people use alcohol to help get to sleep due to an already existing issue with sleep apnea).

WOMEN WITH SLEEP APNEA HAVE INCREASED RISK OF CANCER 

We know that men are more at risk of developing sleep apnea. But if you happen to be a woman and you suffer from 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, 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.

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

MORE CASE STUDIES

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.

 

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.

 If you have any concern about your risk, ask us about it.  We’re here to help.

A dentist asked me, “ How do I find sleep apnea patients that I can treat?“

Here’s how I answered him, “They will find you.“
If you saw the award winning movie “Field of Dreams” you will remember Ray Kinsella (Kevin Costner) being told, “Build a field and they will come.”   He did build a baseball field in a Kansas corn field and sure enough the great legends of the game came to play there.
After you have been trained and become confident in your screening and treatment skills you’ll be pleasantly surprised at the vast number of sleep apnea patient resources.  Build your field and they will come.
These are just a few of the sources available to you:
  • word gets around that you are the sleep doctor and new patients will seek you out
  • your patient base will produce enough candidates to keep your schedule filled  
  • you will be developing a network of healthcare professionals that will send you patients
  • patients you have treated will be referring their family and friends
Success in Dental Sleep Medicine, unlike in other ventures, does not have to be long and drawn out. If you focus on all the “little things“ and stay dedicated you will reach your objective in a few months.
Studies reveal OSA is prevalent. 
-A 2015 study in Switzerland reported 50% of men and 23% of women had at least moderate OSA.1
-In 2002, the Sleep Heart Health study found that 24% of men and 9% of women have at least mild OSA.2

-In the Wisconsin Sleep Study Cohort, it was reported that 10% of men and 3% of women age 30 to 49 have at least moderate OSA, while 17% of men and 9% of women age 50 to 70 have at least moderate OSA.

-Over 50% of children diagnosed with ADHD suffer from sleep apnea
-According to a Harvard health report there are 18.9 million undiagnosed cases of obstructive sleep apnea and 40% (1.3 million) of CPAP users are non-compliant. So that alone conservatively projects 20.2 million victims of obstructive sleep apnea who may be helped by a dentist trained in Oral Appliance Therapy (OAT). 
-OSA is highly underrecognized, and it is estimated that 82% of men and 93% of women in the United States with OSA are undiagnosed.4
Is there any better opportunity today in dentistry?
Are you ready to build your field of dreams?
Write me with any questions at cskdoc@aol.com.
References
  1. Heinzer R, Vat S, Marques-Vidal P, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015;3(4):310-318.
  2. Young T, Shahar E, Nieto FJ, et al; for the Sleep Heart Health Study Research Group. Predictors of sleep-disordered breathing in community-dwelling adults. Arch Intern Med. 2002;162(8):893-900.
  3. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006-1014.
  4. Young T, Evans L, Finn L, Palta M. Estimation of clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep. 1997;20(9):705-706.

                                                                                     

                                                                                          ‘it’s THE START that STOPS most People’

We know you are interested in developing a strong presence in the exciting and profitable world of Dental Sleep Medicine.    Here are answers to the most frequently asked questions.
  1. “Are there enough patients who need my DSM Service?”

If  you did not get one new patient coming to your office because of your new magnet (DSM) you could keep a schedule filled with your existing patients. Studies show that 34 percent of the American public have symptoms of sleep disorder. That means that one of every three people that you currently treat (IN ADDITION TO those new patients that hear about you), are there for you to help.

According to a Harvard health report there are 18.9 million undiagnosed cases of obstructive sleep apnea and 40% (1.3 million) of CPAP users are non-compliant. So that alone conservatively projects 20.2 million victims of obstructive sleep apnea who may be helped by a dentist trained in Oral Appliance Therapy (OAT). Is there any better opportunity today in dentistry?

  1. “Why is THIS the best time for me to learn DSM?

Dental Sleep Medicine is the hottest button in dentistry today.
Awareness of sleep apnea in America is at an all-time peak. The fires of awareness are being stoked by the public media and by social media. Patients are understanding and becoming increasingly more concerned about the blockage of oxygen to the brain and to other organs. Strokes. Heart attacks. Diabetes. Dementia. People are recognizing that they have the symptoms and are asking their Dentists about it. Some Dentists have the solutions. Every Dentist would like to be “The Sleep Dentist.

  1. “How would I get paid? Do Insurances cover the Services?”

With training in Dental Sleep Medicine you will learn the answers to these often asked questions about reimbursement:

-What is the difference between dental and medical codes?
-What is Durable Medical Equipment and how does that apply to us, as dentists?
-How some dentists leave thousands of dollars of medical reimbursement on the table and lose case acceptance in the process    -What  are the deductibles?
-What documents do I need for successful medical insurance processing?
-What do I need to know about Medicare?

-The number one medical billing error you should not make

 4.  “How do I get Started?”

If you are interested enough to have read this far, you have already started. To succeed in DSM you must have passion for helping people and excitement for being at the forefront of a new medical/dental science. With only 4% of dental practices qualified to offer these services, you can be proud to be a medical/dental pioneer.

The first step in your education is to attend a DSM training seminar. There you will learn all the basics. Sleep Group Solutions presents two-day seminars every weekend in two different cities. The “Introduction to Dental Sleep Medicine” covers all aspects “from A to Pay”. You will learn the mysteries of the science of sleep, a functional protocol for screening and treating patients, how to find patients who need your services, the various intra-oral appliances and how to monitor their efficacy. and billing benefits with medical codes.

Oral appliance therapy (OAT) is the most convenient and preferred therapy for the mild and moderate cases and for those patients who cannot tolerate the CPAP device. Fortunately, this is where The Dentist rides in on a white horse to the rescue. We dentists like to say we are on the front line of the battle against sleep apnea. Dentists are in the optimum position to see the signs and symptoms and can offer the most preferred solutions to the problem..
In the words of the Great Master Yoda, in the classic Star Wars movies, “There is no ‘try’; there is only ‘do’ or ‘do not’.”

                                                                                                                                                                                     “It’s the Start that Stops Most People”

Every member on the team is a potential marketing agent for the Dental Sleep Medicine practice.

Wherever you go and whomever you meet you can promote your passion because people will respect you as authorities.  You have opportunities to help people by educating them about the dangers of Sleep Apnea.
You can “talk up” your DSM service, your teammates and your doctor.
The cashier at the grocery store, the technician at the beauty parlor and the nail salon, the bus or Uber driver are among your friends who will be happy to chat with you for a few moments about their sleep breathing issues. They will always tell you about someone they know who snores loudly or gasps for breath while sleeping. It may often be their own situation.  Your personal friends and family members deserve to be educated on how to live a healthier life and how to live longer.
You don’t need to think of this as “selling”–  you are educating and helping people because you care about them.
This is what teammates are expected to do; It is part of their role. They do this for loyalty to the doctor and to their teammates, for their job security, and above all for love.