You may be reading this now because your partner is tired of your snoring. The statistics show that 40% of men over 40 snore and 20% of women over 40 snore. The bad news is that snoring can be indicative of a more serious condition called Sleep Apnea, the good news is that if not completely curable, snoring is at least manageable.

Normally Air passes through the nose and past the flexible structures in the back of the throat, soft palate, uvula and tongue.

Causes

Snoring is created by the vibration of the pharyngeal soft tissues as air passes through an airway that is too small to allow for smooth unimpeded flow

You may have noticed that your snoring is correlated with increasing age which is often accompanied by increasing weight. It may also be caused by nasal conditions such as sinus problems or a deviated septum, enlarged tonsils or uvula. Additionally, too much alcohol close to bed time can cause the muscles to relax and contribute to snoring

Cures

The first step is to discuss the problem with your doctor to evaluate your tonsils, nose & other pharyngeal anatomy. In these cases the best treatment may be soft tissue surgery. Losing 10-20 pounds may be effective for reducing snoring and is probably the best thing you could do for overall health.

Often the most effective treatment will be to have your dentist fit you with an oral appliance. These prevent the oral tissues and the base of the tongue from collapsing and obstructing the upper airway.

Risk- Sleep Apnea

Because the drug companies don’t have a pill for it, at present the American public is not receiving the benefits of new findings on sleep disorders. 95% of victims remain undiagnosed, largely because health professionals have not had the opportunity to learn about sleep disorders and sleep deprivation. Because of this high level of undiagnosed disease statistics are just now being collected but if you snore there may be as much as a 50% chance that you have a serious disorder called Sleep Apnea which, if not managed, can reduce your life expectancy by 8 years!

Sleep Apnea- Do Ihave it?auses

Obstructive sleep apnea (OSA) is a situation in which the entire upper airway is blocked causing air flow and breathing to stop. Some of the signs and symptoms are:

• Snoring, intermittent with pauses
• Excessive daytime sleepiness
• Awakenings with gasping or choking
• Fragmented, non refreshing light sleep
• Poor memory, irritability
• Depression, personality changes
• Decreased sex drive, impotence
• Morning Headaches
• Acid reflux- GERD

SDB- Sleep Disordered Breathing Epidemic

• About 24 percent of men and 9 percent of women have the breathing symptoms of OSA with or without daytime sleepiness.
• 56 million people based on US Population
• About 80 percent to 90 percent of adults with OSA remain undiagnosed.
• 44 – 50 Million remain undiagnosed

Risks of OSA- Adequate sleep is vital to our health. The statistical risks of sleep Apnea include:

• Stroke- 90% of stroke victims have OSA
• Heart Disease- People with OSA are 4 times as likely to have a heart attack
• Driving Accidents- People with OSA are 7 times as likely to have a motor vehicle accident
• Sudden Death- People with OSA are twice as likely to die in their sleep

CPAP- Continuous Positive Airway Pressure (CPAP): CPAP works by gently blowing pressurized room air through the airway at a pressure high enough to keep the throat open. This pressurized air acts as a "splint." The pressure is set according to the patient's needs at a level that eliminates the apneas and hypopneas that cause awakenings and sleep fragmentation. Pressure that is too low will not be as effective in eliminating the apneas and hypopneas.

CPAP is considered the “Gold Standard” for OSA treatment. However many patients find it bothersome and end up not using it much to their detriment. If you are one of these and your doctor has not been able to resolve your problems, then we strongly suggest that you ask your dentist about an Oral Appliance for Sleep Apnea.

Oral appliances: Oral appliances, sometimes called dental appliances, are intended to treat apnea by keeping the airway open in one of three ways: by pushing the lower jaw forward (a mandibular advancement device or MAD), by preventing the tongue from falling back over the airway (a tongue-retaining device), or by combining both mechanisms. Oral appliances are typically more effective for people with mild sleep apnea and for non-obese people but can, for some, be effective for moderate and severe sleep apnea. The most common type of oral appliance, a MAD is often adjustable so that the dentist can move the jaw further or reduce the advancement as necessary. The goal is to find the most comfortable and effective position for the patient. Not all dentists have the necessary knowledge of sleep apnea, so if you wish to pursue this therapy, ask your sleep doctor to refer you to a dentist who is familiar with apnea and who works with oral appliances.

The Sleep Study

The primary method for diagnosing OSA at present is to have the patient undergo a sleep study, known as polysomnography.

A sleep technician administers and attends the study. To prepare the patient for sleep study, numerous physiological monitors are attached to the patient to record nighttime breathing, brain activity, and physical activity. Several electrodes are pasted to the patient's head to measure brain electrical activity with an electroencephalogram, or EEG. Electrical activity in the brain during the different stage

s of sleep is distinctly different from that while awake. The EEG allows the physician to see if the patient is reaching all the stages of sleep to the appropriate depth and if the patient is being aroused excessively from these stages.

Electrodes are also taped to the skin near the outer edges of the eyes to record data for an electrocculogram (EOG). This tells the examiner where the patient is in rapid eye movement sleep (REM). A device is placed near the patient's nose and mouth to measure airflow. Electrodes are connected to an electromyogram (EMG) and taped or pasted on the patient's chin to detect activity in the jaw muscles. The EMG detects the presence of REM sleep when the jaw muscles relax.

Special belts are placed around the patient's chest and abdomen to detect and record the rising and falling movements associated with the respiration. A pulse oximeter, a noninvasive device for measuring oxygen content in the blood, is attached to the finger, and electrodes to provide an electrocardiogram (ECG) are attached to the chest to measure heart rate. Various types of instruments, either straps around the feet or electrodes pasted to the lower legs, measure leg movements, which may indicate another sleep disorder called periodic limb movement disorder.

Obstructive sleep apnea is diagnosed if the patient has an apnea index greater than 5, that is, has more than five apneic episodes per hour, or a respiratory disturbance index (RDI), the combination of apneas and hypopneas, greater than 10 per hour. In the appropriate clinical setting, sleep apnea can be diagnosed by an RDI between 5 and 10. Experts disagree somewhat on precisely where the diagnostic threshold lies, so a reliable diagnosis needs to be made in the context of the individual. Furthermore, the criteria are even less precise in children, making an individual approach to diagnosis even more important.

Problems with the Hospital Sleep Study

While the “hospital” or “Sleep Lab” Polysomnogram has been considered the gold standard for diagnosis of OSA it is not a popular option for the following reasons:

• You have to spend the night away from home.
• You have extensive wiring and equipment to contend with
• It is very expensive costing several thousand dollars, (although often health insurance will cover it.

Technology has advanced to the point where the key information required for a diagnosis of OSA by an experienced physician can be obtained from a simple device worn at home for a fraction of the cost of the laboratory sleep study. A New Era of Sleep Medicine is dawning with the recent approval by CMS (Medicare) to reimburse for CPAP based upon a home sleep test: 

Download Sleep Screening Questionnaire (pdf.file)  

Take Epworth Sleepiness Scale (ESS) On Line Click Here

The ARES

The Watermark Medical ARES home sleep testing device is an FDA cleared, CMS approved, TYPE II device. A Type II device is approved by Medicare and most insurance companies. By definition: sleep study test with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation.

The ARES Unicorder is a reimbursable home sleep testing device that enables a physician to prescribe the appropriate therapy. This product is one of the easiest to use in the market. It’s simple design and comfortable application leads to more compliance and better results. The process for this test is to have the patient’s primary care physician (or dentist) screen patients for sleep abnormalities during their routine visits. When abnormalities are found, the physician will dispense a take home device that they have available in their office's. The patient will take the device home, wear it that evening while they sleep, and return it to the physician office the next day. Results will be available usually within 24 hours.

Based on the results, the physician can:

a) determine if the snoring is harmless and rule out OSA

b) diagnose OSA and prescribe therapy or

c) prescribe further testing or titration to be performed in a sleep laboratory using PSG. Prior to the home sleep test, only option 3 was available to primary care physicians (or dentists) at the expense and inconvenience of millions of patients.

Home Sleep Tests (HST) usually monitor anywhere from 4 to 9 channels of data for the physician. ARES Unicorder measures blood oxygen saturation (SpO2) and pulse rate (reflectance pulse oximetry), airflow (by nasal cannula connected to a pressure transducer), respiratory effort (a combined signal using pressure transducer sensing forehead venous pressure, venous volume by photoplethysmography, and actigraphy), snoring levels (calibrated acoustic microphone), head movement and head position (accelerometers). Some HST devices (like the ARES) are sophisticated enough to include EEG, EOG, and EMG making it clinically comparable to a laboratory PSG.

• Easy & Convenient
• Are you just a snorer?
• Do you have Sleep Apnea?
• Will an Oral Appliance solve your problem?
• Find out today!

Welcome to our Center for Dental Medicine.

We are learning about and applying information regarding the connection between Oral Health and Systemic Health Every Day.

The “Oral Systemic Connection” has a long history:

• Your browser may not support display of this image. Medical History reports that Asahaddom, King of Assyria (660-669BC) was constantly plagued with rheumatism and did not respond to any conventional method of treatment. His Dr was quoted as saying On the order of my lord and king, to tell him the true diagnosis… I have told him the diagnosis in one word: Inflammation! He, whose head, hands and feet are inflamed, suffers this trouble due to the condition of his teeth. The teeth of my Lord have to be removed; for this reason the internal organs are inflamed.

• Charles Mayo who noted, over 90 years ago, that people who keep their teeth live an average of ten years longer than people who do not.

• Your browser may not support display of this image. Donna Shalala who said in her Surgeon General’s address of 2000: “The terms oral health and general health should not be interpreted as separate entities. Oral health is integral to general health; this report provides important reminders that oral health means more than healthy teeth and that you cannot be healthy without oral health.

Since that time there have been hundreds of research papers demonstrating the link between oral disease and systemic disease. http://www.centersfordentalmedicine.com

When you come to our practice you will find an emphasis on health that is unusual for a dental practice, but that we believe will be part of general dental practice in the future:

Health History : We begin our relationship with a thorough health history of which the following screens are just an example:

This information will be combined with a physical oral examination and the sleep study data evaluated by a sleep physician, resulting in a treatment plan which will be submitted in writing to you, your doctor and your insurance company. Depending on your personal plan, copays and deductibles you may find that the majority of our services are covered by your medical insurance.

Dental Professionals

For More information About Becoming A Center For Dental Sleep Medicine phone 1-866-546-5444 ext. 1