Archives for posts with tag: Sleep Apnea
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: cskdoc@aol.com
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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.

WOMAN SNORING 5-25-15

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.
TWO DENTISTS
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.
DR. CUMMEN, THE MAN OF ACTION

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”.
DR. COHEN, THE THINKER  
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
LIP 8
 You can view the dates and course outlines and register here:
http://join.sleepgroupsolutions.com/seminars/
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. 


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.