Lack of sleep is causally connected to many physical problems.

We know that from numerous reliable studies.

Obstructive Sleep Apnea (OSA) is a major cause of sleep loss and one of the common symptoms of (OSA) is being overweight. Sleeping less than six hours, or more than nine hours, a night appears to increase the likelihood of weight gain. So then, how does OSA effect weight gain?
There are three hormones that factor in the equation of lack of sleep contributing to weight gain.  

1. Ghrelin: the Hunger Hormone

Lack of sleep increases ghrelin, and decreases leptin, both effects producing increased hunger and obesity. Ghrelin is produced in the gastrointestinal tract and functions as a neurotransmitter. When the circadian rhythm is interrupted by exposure to light at night, gherlin is released.

 2.  Leptin: the Anti-hunger Hormone. 

Leptin is the satiety hormone that has opposite effects from ghrelin.  The receptor for leptin is found on the same cells in the brain as the receptor for ghrelin.

3.  Melatonin:

Melatonin maintains the body’s circadian rhythm by regulating the other hormones. The circadian rhythm is an internal 24-hour “clock” that plays a critical role in when we fall asleep and when we wake up. When it is dark, your body produces more melatonin. When it is light, the production of melatonin drops. Being exposed to bright lights in the evening, or too little light during the day, can disrupt the body’s normal melatonin cycles. For example, jet lag, shift work, and poor vision can disrupt melatonin cycles.

Melatonin supplements can be helpful for those who are sleep disadvantaged but adherence to directions is recommended.

melatonin 5-6-15

The Process

An inverse relationship between the hours of sleep and blood concentrations of ghrelin exists: as the hours of sleep increase, ghrelin levels trend lower and obesity is less likely.  Short sleep duration is associated with high levels of ghrelin and obesity.

When the stomach is empty, ghrelin is secreted. When we eat something the stomach is stretched and ghrelin secretion stops. Ghrelin acts to increase hunger and to increase gastric acid secretion and gastrointestinal motility to prepare the body for food intake.

What else does Ghrelin do to effect weight gain?
Beyond regulating hunger, ghrelin also plays a significant role in other systemic functions. Ghrelin influences body composition, it stimulates the release of growth hormone and regulates the distribution and rate of use of energy.


This is just another convincing reason to get adequate healthy sleep…. at the right time. Light is the circadian rhythm disrupter. Avoid light disturbances during sleep: have no lights in the bed room, pull the shades down to block any outside light, wear an eye mask.

Zarouna SWozniak, G, Papachristou, Stalo Zarouna,
Psychology Department, University of Cyprus, Nicosia 1678, Cyprus.
  • Department of Cell Biology, Physiology and Immunology, University of Cordoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), and CIBER Fisiopatología de la Obesidad y Nutrición, 14004 Córdoba, Spain.
One of the most common symptoms of Obstructive Sleep Apnea (OSA) is Gastro-Esophageal Reflux Disease (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.
Patients in the dental office can be easily screened for Obstructive sleep Apnea (OSA) at the initial oral exam. The signs of Acid Reflux (GERD) are screaming to be noticed: Acid tooth erosion is one consequence,  bruxism is another.  A sleep questionnaire and other signs and symptoms of sleep apnea will prompt the need for a HSS (home sleep study).  This will help determine the diagnosis of OSA and  the severity. By treating the sleep apnea we can save teeth and possibly the patient’s life.
It’s so important to treat sleep apnea for many reasons.  GERD is just one of them.  One out of 3 people have a sleep disorder.  Everyone knows someone with sleep apnea and has a story to tell about it.   Don’t we, as dental professionals, have an obligation to help our patients live healthier and live longer? Every dentist should receive training to identify and treat their OSA affected patients.
By Charles Kravitz, DDS
Every dentist wants to develop a strong presence in the exciting and profitable world of Dental Sleep Medicine. We have all heard the stories of phenomenal success some dentists have in treating patients for Obstructive Sleep Apnea.
This article will provide you with the solutions to your questions and get you excited about incorporating Dental Sleep Medicine (DSM).into your Dental Practice.
 “How Will Benefit by DSM in my Dental Practice?”
     This is a huge winner for your practice, for you, for your team, and for your patients.
    A.  The Benefits for you and your Dental Practice
              1.  Acquire New Patients- lots of them.
You will be sought for your unique professional dental service. 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 their brains and to other organs. Strokes. Heart attacks. Diabetes. Dementia. People are recognizing that they have the symptoms and are asking their Dentists about it. 
When people learn that you are “The Sleep Dentist” or “The Snore Clinic”, and you can help them, they will call you. “Build a field and they will come.”( from Field of Dreams.)Your New Patient flow will increase.
            2.  Greatly Increased Income
With the new patients come new needed services. People who are health conscious and are concerned about their sleep disorder will be equally concerned about their oral health. You will enjoy new opportunities to help your new patients.
We know that this dental practice “niche” has quickly evolved into a full time “specialty” for energetic, dedicated dentists. The revenues generated from sleep services are impressive.
            3. A Unique Life-saving Service
I’m sure you understand that now, more than ever, you need to stand out and be able to offer not only EXCELLENCE, but also DIFFERENCE.  In this sluggish economy, where there is a perception of “financial doom”, (I personally don’t believe in that.), dental consumers have a tight hold on their wallets, and reports of dental service acceptance show a concerning drop. With DSM you will offer a unique dental/medical service.
What are YOU doing now to offer a unique service? Your First Class Service and Patient Engagement are expected as basic “givens”.  But what is your niche ? Are YOU the dental practice they must go to? 
            4. Serve an Underserved Need
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). 
            5. Significance
One of the basic human needs is to feel significant. It is a personal reward we can give ourselves. We dentists enjoy a lifetime of helping our patients. Caring for people is one of the driving forces that made us choose this career. It makes us feel good to know we are helping people to avoid pain, eat healthier, and feel more confident about their appearance. That is all great. But how does it compare to the feeling of saving a patient’s life? When you know you have taken patients who spend half their night’s sleep without oxygen going through their airway and to their brain- and you have corrected their life threatening disease, how does that make you feel? Significant! You will be seen as a hero.
    B.  The Benefits to Your Dental Team
Every member of your team plays an important role in the Dental Sleep Medicine service and they will enjoy the following benefits: 
            1. Professional Pride, Prestige 
All team members will know, as you know, that they are steps above the dental community in truly providing comprehensive health care. 
            2. Providing a Needed Service
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 and of those that are new patients, are there for you to help them.
Your team members will be perfectly positioned to help their family, neighbors, and new friends.
According to a Harvard health report there are 18.9 million undiagnosed cases of obstructive sleep apnea. 
            3.  Rewards  
On top of the emotional rewards that your team members receive, they are contributing to the financial success of your practice. DSM is over 80 percent staff driven and you may feel they deserve to share rewards with you. 
            4.  Job Security  
DSM in a practice can build quickly and strong.Your employees make valuable contributions to its success and have the good feeling of being needed. By the same token, you will know that they are critical to your success and would not want to lose them. 
            5.  Feeling of Significance 
Like you, your employees enjoy the feeling of “making a difference”. Everyone needs to feel significant. It is a personal reward we can give ourselves. Caring for people is one of the driving forces that made your staff want to be a dental professional.  When they know they have taken patients who spend half their night’s sleep without oxygen going through their airway and to their brain- and they have contributed to correcting their life threatening disease, how does that make them feel? Significant! They will be seen as heros.
    C.  Benefits for Your Patients
              1. Your patients will now have a convenient and caring source (you) that can discover and treat that serious disease- Obstructive Sleep Apnea- that wakes them up all through the night and diminishes their quality of living.
            2.  They will understand that trained dental professionals are the best source for discovery of  Obstructive Sleep Apnea. They will spread the word – referrals.
            3. They will know their dentist will be able to offer them the most comfortable and popular treatment for OSA- the Oral Appliance Therapy. (OAT). 
              4. They will be delighted that Medicare and their private insurance, in most cases, will pay for the OAT. 
              5. Your patients will sleep better, feel better, be healthier and live longer. 
Contact me to learn more:

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 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.


 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.



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.

These American war veterans are standing at the WWII Memorial in Normandy, France.


Two respected, established dentists, Stan Cohen and Bill Cummen took a Sleep Group Solutions dental sleep medicine seminar on the same day.

Dr. Cohen was a cautious, careful, analytic perfectionist and had a highly respected career as a cosmetic dentist. His natural-looking restorations defied detection.

Dr. Cummen, an adventurist, self confident would try anything that sounds good and he succeeded with almost everything he tried. He was, by no means, reckless. He, too was very respected by his patients and his peers.

These two dentists are completely opposite in their personalities and they both were very successful in their practice of dentistry. They both were dedicated to truly helping people and 
saw the opportunity to gain significance in the rapidly evolving niche of Dental Sleep Medicine.

On the first work day after the two day training seminar Dr. Cummen and Susan his Sleep Coordinator were screening their scheduled patients for sleep breathing disorders with medical and sleep questionnaires. Of the 14 patients seen by the doctor and his Periodontal Therapist (Hygienist) five of them subjectively indicated that they had sleep issues. Those same five also had histories of systemic issues. They all had acid reflux, high blood pressure and daytime sleepiness. Some also indicated diabetes and stroke.

Dr. Cummen proceeded through the screening and treatment protocol for his patient. After a few weeks, his patient, wearing an oral appliance while asleep, began to have more energy and less sleepiness during the day.  His other systemic symptoms diminished in time. He called Dr. Cummen his “hero”.
And Dr. Cohen? He continued to “analyse” and evaluate every facet of the DSM protocol. While Dr. Cummen was helping many victims of sleep apnea achieve a healthier life his contemporary was enviously hearing the stories about the phenomenal success of others. 
What can we learn from this story?
“If it’s a good opportunity, do it now.” Don’t let “Paralysis by analysis” make you lose out. 
More and more dentists are getting trained and implementing Sleep Apnea screening and treatment into their patient services.  Are you willing to wait and watch your colleagues become “sleep dentists”?
Procrastination is the bad habit of putting off until the day after tomorrow what should have been done the day before yesterday.”
Napoleon Hill
In order to fulfill the essential number of regenerating sleep cycles the average adult needs 7-8 hours. A five stage sleep cycle repeats consistently throughout the night. One complete sleep cycle lasts about 90 minutes. So during an average night’s sleep (8 hours), an adult will experience about four or five cycles of sleep.
A Little History of Daylight Saving Time
The concept of setting the clocks ahead in the spring in order to make better use of natural daylight was first introduced in the US by inventor Benjamin Franklin in 1784.

12-30-11 Benjamin_Franklin_1767
US President Franklin D. Roosevelt instituted year-round DST in the United States, called “War Time” during World War II from February 9, 1942 to September 30, 1945. The change was implemented 40 days after the bombing of Pearl Harbor and during this time, the U.S. time zones were called “Eastern War Time”, “Central War Time”, and “Pacific War Time”. After the surrender of Japan in mid-August 1945, the time zones were relabeled “Peace Time”.
Congress decided to end the confusion and establish the Uniform Time Act of 1966 that stated DST would begin on the last Sunday of April and end on the first Sunday of November. However, states still had the ability to be exempt from DST by passing a local ordinance.
This fall, dentists will not need to “fall backward” in their practice. They have the opportunity to “spring forward” with Dental Sleep Medicine and help the millions of their Sleep Apnea victims. 
Upcoming training seminars by DSM experts are available in the following cities:
Nov 2017
PHILADELPHIA, PA – 11/03/2017 – 11/04/2017
SAN JOSE, CA – 11/03/2017 – 11/04/2017
ANAHEIM, CA – 11/10/2017 – 11/11/2017
NASHVILLE, TN – 11/10/2017 – 11/11/2017
PHOENIX, AZ – 11/10/2017 – 11/11/2017
ALBUQUERQUE, NM – 11/17/2017 – 11/18/2017
CHICAGO, IL – 11/17/2017 – 11/18/2017
TORONTO, CANADA – 11/17/2017 – 11/18/2017
 You can view the dates and course outlines and register here: