Archives for category: SLEEP
One of the most common symptoms of Obstructive Sleep Apnea (OSA) is
Gastro-Esophageal Reflux Disease (GERD)
Have you ever awakened in the middle of the night choking on acid because you’ve inhaled it and can’t breathe? You try taking in a breath and all you get is a burning in your throat and lungs. You try to expel it but it takes many tries and coughing, burning, burning. You panic,  thinking,  “Am I going to die?”  You possibly could if you hadn’t woken up!
   
HOW DOES OSA CAUSE GERD?
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 up the esophagus.
The efforts to breathe also increase a negative pressure in the esophagus which also
 pull up acid.
Secondary effects of Obstructive Sleep Apnea, resulting from the GERD, are esophagus and larynx damage, aspiration pneumonia, permanent lung damage, tooth erosion, and tooth sensitivity.
GERD CAN EAT YOU AWAY
GERD, or Acid Reflux, is a digestive disorder affecting the lower or reflux esophageal sphincter (LES), the muscle connecting the esophagus and stomach. The LES is a high-pressure zone that acts as a barrier to protect the esophagus against the back flow of gastric acid from the stomach.
Normally, the LES works something like a dam, opening to allow food to pass into the stomach and closing to keep food and acidic stomach juices from flowing back into the esophagus. Gastroesophageal reflux occurs when the LES relaxes when it shouldn’t or becomes weak, allowing contents of the stomach to flow up into the esophagus.
Overweight people and pregnant women may suffer more heartburn episodes because increased abdominal pressure contributes to reflux. Pregnant women are also more prone to heartburn because the LES relaxes in response to the high levels of the hormone progesterone that occur with pregnancy. Generally, though, GERD is uncommon in people under age 40.  
Smoking can irritate the entire GI tract. Frequent sucking on a cigarette causes air to be swallowed, increasing stomach pressure and encouraging reflux. Smoking sometimes also relaxes the LES muscle. 


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By Charles Kravitz, DDS in Women’s Health
According to an article in the European Respiratory Journal, “Obstructive sleep apnea occurs in 50% of females aged 20-70 years. 20% of females have moderate and 6% severe sleep apnea.” 
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.

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.

Women who are obese, pregnant women, and post-menopausal women all have a greater risk for OSA. Finally, women with the endocrine disorder, polycystic ovary syndrome, are more likely to have sleep apnea even after controlling for weight and should seek clinical evaluation.

THE DIFFERENCES BETWEEN OSA AND HYPERTENSION IN WOMEN AND MEN

Obstructive sleep apnea is a significant risk factor for heart disease . The prevalence of hypertension in people with sleep apnea ranges between 30-70 percent and is similar in men and women. However, when taking body mass index (BMI) into consideration, some gender differences emerge: men with OSA who are markedly obese (BMI > 37) have a two-fold higher risk of hypertension than obese women with OSA.

THE DIFFERENCES BETWEEN OSA AND DIABETES IN WOMEN AND MEN

Women with OSA tend to be more obese and have lower AHI  than males; however, studies have also suggested that women may have a higher mortality.   OSA is associated with an increased risk for the development of type 2 diabetes independent of obesity.

Women who are obese, pregnant women, and post-menopausal women all have a greater risk for OSA. Finally, women with the endocrine disorder, polycystic ovary syndrome, are more likely to have sleep apnea even after controlling for weight and should seek clinical evaluation.

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 at Hopkins’ 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.

You are in an excellent position to screen for sleep apnea and to help identify your undiagnosed (and therefore, untreated) OSA patients.

How can you miss these clinical signs?

You…..

• have direct observational access to the physiological structures of your patients’ upper airways

• are already screening chair side for other health conditions that can be easily spotted during a dental visit

• may see these patients more frequently than primary care physicians will, with nearly one quarter more likely to see a dentist than a physician over any given time period. 

Your field of operations is right next to the opening of the airway.

Clinical signs of Obstructive Sleep Apnea:
~constricted airway – measured by a Mallampati score *
~ large neck circumference

          Over 15 inches in women
          Over 16 inches in men
  
~ oversized and/or inflamed uvula
~ extra large tongue
~ scalloped tongue edges-caused by tongue forced against the teeth, gasping for breath.
~ enlarged tonsils     
~ a droopy soft palate
 ~ retrognathic mandibular jaw.
~ obesity
~ heavy or struggled breathing
~ bruxism
~ obvious lack of energy
~ lack of focus in children causing ADHD -in 20% of ADHD victims.
~ sleepiness during dental appointment.
                                                                                                   *MALLAMPATI CLASSIFICATION

   Want more information, email me cskdoc@aol.com.

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

He contacted a dental transition realtor 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 support him and his wife and their medical bills.


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

Sidney’s astute transition Broker came up with an idea. If he could implement a dental sleep medicine program he could add another two to three hundred thousand dollars in value to his sale price.
With his health scare Sidney made some major business decisions. He hired an associate, he cut back to three half days a week, he took a training course, got some private coaching and concentrated on screening and treating his patients for sleep apnea.
Within two months of making his decision he was treating two patients, on average, each day for sleep apnea. His average income for each case was $3500. This amounted $21,000 a week for three easy, relaxed, rewarding half days a week. This projected to revenues of an incr
 edible $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 his practice for 2.5 times more than that original market value and he 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?
If you are interested in getting into this exciting, rewarding, life-saving Dental Sleep Medicine field you may contact me at cskdoc (aol) for more information.

 

“If you told an athlete you had a treatment that would reduce the chemicals associated with stress, that would naturally increase human growth hormone, that enhances recovery rate, that improves performance, they would all do it. Sleep does all of those things.”  ~ Casey Smith, Head Athletic Trainer, Dallas Mavericks

The Boston Red Sox built a “Sleep Room” in Fenway Park because they knew the Value of Sleep.

The Red Sox are flush with advantages on the field and deep inside Fenway Park. According to the Boston Globe,, the team has what they’ve dubbed a “sleep room,” a 145-square-foot space with two sets of bunk beds where players and coaches can get in a power nap ahead of home games. Many sports teams have learned that sleep improves performance.

Dentists are learning how to treat the victims of Obstructive Sleep Apnea. There are 18 million people undiagnosed. Are you ready to help them?   http://www.SleepGS.com

Hello! Dr. Smith’s office?
– No sir it’s Dr. Google.
So it’s a wrong number?
– No sir, Google bought it.
OK. Can I make an appointment, please ..
– Well sir, you’re calling because you snore, wake up often and feel tired all day?
How do you know that? Do you know me?
– According to our caller ID, we see you recently searched the internet for “snoring”, “daytime sleepiness” and “nocturnal bruxism”
OK,I did that.
– May I suggest to you that we give you a Home Sleep Test?
– No, I don’t need that
– But your blood oxygen saturation is not good
How do you know?
– Through the subscribers’ guide. We have the result of your blood tests for the last 7 years
– Okay, but I do not want this test,  I already have a CPAP
– You do not use it regularly, 7 months ago, you only purchased cleaning kits at Drugsale Network
– I bought more from another source
– It’s not showing on your credit card
– I paid in cash
– But you did not withdraw that much cash according to your bank statement
– I have other source of cash
– This is not showing in your last Tax form unless you got it from undeclared income source
-WHAT THE HELL? Enough! I’m sick of Google, Facebook, twitter, WhatsApp. I’m going to an Island without internet,where there is no cell phone line and no one to spy on me
– I understand sir, but you need to renew your passport as it has expired 5 weeks ago..
THE OPPORTUNITY
It was only three years ago that I read that less than 1% of American licensed dentists were practicing sleep medicine. In those few years that number has risen to 4%. If we have approximately 205,000 practicing dentists in the USA, then there are only 8200 Dentists serving the needs of The multitude of people affected with sleep disorders.
According to a Harvard health report there are 18.9 million undiagnosed cases of obstructive sleep apnea and a minimum of 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 in dentistry?                                                                                                                                                                                                                         
Dental sleep medicine: 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 into other organs. Strokes. Heart attacks. Diabetes. Dementia. People are recognizing that they have the symptoms and are asking their Dentists about it. Some doctors have the solutions. Every Dentist would like to be “The Sleep Dentist.”
Where to begin?
Seminar training courses are now available through Sleep Group Solutions every week, in different cities, throughout the United States. They are training dentists to discover the victims of sleep apnea and to treat them with the most appropriate modalities. 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 in shining armor rides in on a white horse to the rescue. Dentists, we like to say, 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. A professional coach guiding the development of the process will make the
process advance quicker, smoothly and more effectively.
Keys to success
Success in treatment acceptance and end point attainment varies with, and depends upon, each individual dentist’s knowledge and determination and his or her patient’s cooperation. The training program will present the tools, screening protocols, diagnostic equipment, techniques and some verbal skills for success. As in other healthcare therapies, a partnership between the professional provider and the patient is the key to success. The patient’s cooperation is essential. Compliance will keep them under control. So that explains the patient’s role in the “Partnership for Success”.
The Dentist’s Responsibilities
Beginning with the seminar training program, the dentist must be 100% committed to success. (Anything we endeavor will be more likely to be achieved when we are positive that we will succeed.) The seminar training is only the beginning of the learning process. We must retain what we have learned, continue to study, to research all new ideas and to practice our treatment plan presentations with our teams. 

You are in the right place at the right time. As a Care Giver, think of how you can serve a critical need of your patients. They are looking for your help.
You may contact me with questions or for assistance in becoming “The Dental Sleep Professional”.
Yours for better health,
Charles Kravitz DDS
Are you ready to join the battle?  
       
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Strike while the iron is hot