Archives for posts with tag: Dental Sleep Medicine

 WHAT IS SLEEP COORDINATOR ACADEMY?

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.   There are approximately 200,000 licensed dentists in the USA and as of last year less than 5% of them are qualified to treat the millions of sleep apnea afflicted patients. Why such a disparity? The most common responses are, “I’m too busy to learn a new service.”,  “My staff is too busy.”,  “I don’t know where to begin.”

DO YOU SEE THE COMMONALITY?  

But we do have a solution for them

In comes Sleep Coordinator Academy, wearing a shiny suit of armor, on her/his white horse, and says, “ Doctor, I have the solution for you. I will provide you with a comprehensively trained sleep coordinator who will establish a dental sleep medicine service in your practice for you and s/he will handle all the screening of your patients, marketing for new patients, present the case plan (sell), manage the medical billing and record-keeping and assist you in taking the impressions and adjusting the appliances. S/he may be in independent contractor and you can work out the schedule of days and hours with her. 

Sleep Coordinator Academy presents an A to Z practical training course that prepares the candidates for a confident position in the most highly respected Dental Offices and after graduation assists in placement and follow up.  

You may email me with any questions

                  MALLAMPATI EXAM

The Mallampati Scale is a simple but effective test to assess your patient’s (or your own) airway .

The subject should be sitting or standing with their head on a 90 degree axis to the floor.
They protrude their tongue (not necessary to say “ahh”) and with a direct light into the  mouth, look in and/ or take a picture.
 
Class III or IV conditions are certain candidates for further testing and possible therapy.
The tongue is the most common factor in Obstructive Sleep Apnea.

Now that you learned this you will probably be heading for a mirror. How did you rate?                                     

                                  MALLAMPATI EXAM

The Mallampati Scale is a simple but effective test to assess your patient’s (or your own) airway .

The subject should be sitting or standing with their head on a 90 degree axis to the floor. They protrude their tongue (not necessary to say “ahh”) and with a direct light into the  mouth, look in and/ or take a picture.
 
Class III or IV conditions are certain candidates for further testing and possible therapy.
The tongue is the most common factor in Obstructive Sleep Apnea.
Now that you learned this you will probably be heading for a mirror. How did you rate?   

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.?

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

 
On Monday May 25th, 2020 let’s remember the Veterans of our struggles for Liberty who never returned to see this beautiful tribute.
9-10-12 flag anmd soldier

Memorial Day occurs every year on the final Monday of May. It is a day of remembering the men and women who died while serving in the United States Armed Forces.

Formerly known as Decoration Day, it originated after the American Civil War to commemorate the Union and Confederate soldiers who died in the Civil War. By the 20th century Memorial Day had been extended to honor all Americans who have died while in the military service. It typically marks the start of the summer vacation season, while Labor Day marks its end.

Many people visit cemeteries and memorials, particularly to honor those who have died in military service. Many volunteers place an American flag on each grave in national cemeteries.

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The preferred name for the holiday gradually changed from “Decoration Day” to “Memorial Day”, which was first used in 1882. It did not become more common until after World War II, On June 28, 1968, the Congress passed the Uniform Monday Holiday Act, which moved four holidays, including Memorial Day, from their traditional dates to a specified Monday in order to create a convenient three-day weekend.The change moved Memorial Day from its traditional May 30 date to the last Monday in May. Memorial Day endures as a holiday which most businesses observe because it marks the unofficial beginning of summer.

On Memorial Day the flag of the United States is raised briskly to the top of the staff and then solemnly lowered to the half-staff position, where it remains only until noon. It is then raised to full-staff for the remainder of the day.

Here’s the National Memorial Day parade on Capitol Hill Mall5-23-12 MEM DAY PARADE