Category: Sleep Apnea

Don’t Ignore Your Sleep Apnea

Post author By Carenetic Digital
Post date March 9, 2020
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The Alaska Sleep Clinic estimates that 20 million Americans live with obstructive sleep apnea, a condition that causes the cessation of breathing while one sleeps. The most obvious primary symptoms of OSA are snoring and gasping for air in the middle of the night, though the condition causes several secondary symptoms that can negatively affect one’s quality of life. If a person shows signs of having sleep apnea, it is imperative to undergo a sleep study and receive appropriate treatment.

Reasons one should never ignore the signs of sleep apnea

OSA causes brief bouts of wakefulness up to 30 times an hour throughout the night. These episodes of wakefulness, combined with the low oxygen levels, can lead to several life-altering and possibly life-threatening consequences. Below are just five reasons one should never ignore the signs of OSA.

1.Daytime fatigue

Even if a person gets the recommended eight hours of sleep each night, sleep apnea causes interrupted sleep, which results in daytime fatigue. Daytime fatigue is characterized by concentration problems, memory issues, irritability and lack of productivity. It may also cause a person to fall asleep at inconvenient or even dangerous times. For instance, according to WebMD, people with sleep apnea are five times more likely to fall asleep behind the wheel and cause an accident than those without the condition.

2.Weight gain

Individuals with sleep apnea are more likely to gain weight than those who do not have the condition. The weight gain is the result of several factors. For one, the metabolism slows down when a person is sleep deprived. Two, a sleep-deprived individual has less energy to work out or to prepare healthy meals for oneself.

Three, sleep deprivation causes a hormone imbalance. When asleep, the body produces two hormones, ghrelin and leptin. Ghrelin tells a person when to eat while leptin tells the body to stop eating. During a solid six to nine hours of uninterrupted sleep, the body produces equal amounts of the hormones. However, when a person sleeps fitfully, the body may produce more ghrelin and less leptin, which equates to weight gain.

3.Type 2 diabetes

Just like lack of sleep can affect the body’s ability to produce proper amounts of leptin and ghrelin, so too can it affect the body’s ability to regulate insulin. When the body fails to regulate insulin, a person’s risk for developing diabetes increases exponentially. In fact, WebMD suggests that 80% or more of people who live with diabetes also have OSA.

4.Heart disease

Sleep apnea disrupts how the body takes in oxygen, which leads to low oxygen levels. Low oxygen levels, combined with the stress that comes with interrupted sleep, increase one’s risk for heart attack and stroke.

5.High blood pressure

Sleep apnea can cause high blood pressure or make an existing condition worse. When a person has to constantly wake to catch their breath, the body become stressed. Stress makes the body’s hormones go into overdrive, which raises blood pressure levels. Conversely, treatment for OSA can help regulate blood pressure levels.

Conclusion

Sleep apnea is not a condition one should take lightly. With proper treatment from a qualified dental professional, one can control sleep apnea and improve overall quality of life.

Sleep Apnea

Lifestyle Changes to Treat Sleep Apnea

Post author By Carenetic Digital
Post date March 9, 2020
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If you have sleep apnea, then you have episodes where you stop breathing throughout the night. One of the most common treatments is a Continuous Positive Airway Pressure (CPAP) machine. However, if you do not want a CPAP machine, there are several lifestyle changes that can help. Read on to learn more.

Losing weight

People who are overweight are more likely to suffer from sleep apnea. Being overweight can lead to excess tissue in the neck area, which is where the airway is. When an individual has too much tissue, it can partially or fully cover the airway during sleep. The excess tissue may also place pressure on the tongue and cause it to fall back. The individual does not have as much control over this during the night.

Quitting smoking

Smoking negatively affects the lungs and breathing habits. The smoke can irritate the tissues in the airway. When the tissues become irritated, they can begin to swell, which can block the airway. Because the airway is disrupted, it can become congested. As it vibrates, individuals will snore. Even people who previously smoked are likely to have sleep apnea.

There are many studies that link snoring, smoking and sleep apnea. One study showed that people who smoke are over twice as likely to snore than those who never smoked. Another study looked at current, past and never smokers. The study showed that one in four current or past smokers snored. But only one in seven people who never smoked snored. While snoring can be a symptom of sleep apnea, it is not always.

Avoiding drinking

Alcohol can relax an individual, so it makes sense that it can also relax the muscles in the airway. This can cause sleep apnea. However, for individuals who have mild sleep apnea, alcohol can worsen it. Several studies have shown that alcohol can lengthen the amount of time that a sleep apnea episode lasts. It allows more time to pass between the time an individual stops breathing and when the patient wakes up.

Changing positions

Sometimes, the simplest solution can work. Sleeping on the back is not a good idea for those with sleep apnea. This allows the jaw to fall back over the airway. Other tissues near the airway also become crowded when individuals sleep on their backs.

Instead, sleeping on the side is a better option. This does not cause airway blockage. It can also provide better blood flow. This is why sleeping on the left side is slightly better than sleeping on the right.

Visit a doctor for sleep apnea treatment

Sleep apnea is a serious condition. If left untreated, it can cause many health problems. If you suspect that you may have sleep apnea, it is a good idea to make the lifestyle changes above. However, it is also important to visit a doctor. Getting a sleep study can help a doctor determine if you have sleep apnea. A dentist can provide you with an oral appliance to help.

Sleep Apnea

Sleep Apnea Warning Signs and Symptoms

Post author By Carenetic Digital
Post date March 5, 2020
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Most health conditions have warning signs, and that holds true for sleep apnea. Understanding the common symptoms means you can speak with a professional about these concerns and progress towards a diagnosis and treatment plan.

Commons symptoms of sleep apnea

While some symptoms can be present in a range of conditions, it is a good idea to understand the various warning signs that may be present in an individual with this sleep disorder. Take a look at five common signs:

1. Snoring

Snoring is perhaps the most common symptom of this sleep disorder. This does not mean light, gentle snores that occasionally happen or are a result of a stuffy nose from a common cold. Rather, heavy snoring that is strong enough to wake a person or someone lying next to an individual during sleep is a sign that may potentially indicate a sleep disorder. This is usually tested for during a sleep study to determine if sleep apnea is present and how severe it may be.

2. Lethargy

Constantly feeling tired is a sign of poor sleep. This can lead to daytime drowsiness, falling asleep at work or even when driving. This is beyond simply being tired from staying up too late. It can lead to serious and even potentially dangerous situations, so it is important to not ignore this warning sign.

3. Gasping or choking when waking up

A person’s breathing should remain normal during sleep, so if someone wakes up while gasping for breath or choking it may be a sign that normal breathing was disturbed. Sleep apnea occurs when the airway is temporarily closed, which leads to a pause in breathing. The brain wakes the body when this happens, which results in a person gasping for air and attempting to breathe normally once again.

4. Mood changes

Another common symptom of sleep disorders is changes in a person’s mood. This includes irritability and depression. Please note that these can also be signs of other medical or mental health conditions and should be treated accordingly. That being said, people diagnosed with this sleep disorder have noticed some mood changes before being diagnosed, and that could be contributed to restless and disrupted sleep.

5. Pauses in breathing

This one is difficult because it is usually not noticed until a sleep study test is performed. However, if a person has observed pauses in breathing during sleep, it is a significant warning sign that should not be ignored for any reason. Pauses in breathe during sleep is the very definition of sleep apnea and should be brought to a doctor’s attention immediately.

Conclusion

There are many warning signs that are related to sleep apnea, so being aware of these can help you and a medical team decide on the next steps. Taking note of any symptoms experienced can help lead to a diagnosis and treatment for better health and safe sleep.

29976177 - illustration of an irritated wife covering her ears while her husband snores

Sleep Apnea Snoring Women & Pain

Snoring Is Not Funny

Post author By Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain
Post date August 8, 2018
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For years snoring has prompted humorous cartoon depictions of bed partners sorting out their different views of the problem and hilarious videos revealing what the non-snoring bed partner will resort to in order to get a good night’s sleep.

The problem with snoring, however, is that both parties – the snorer and snoree (what I call the person who is forced to listen to the noise) are ultimately impacted. Sometimes severely.

Let’s start with the snorer. Although snoring was once regarded as merely an annoyance, research now shows that it is actually the result of airway turbulence, often accompanied by obstructive sleep apnea or upper airway resistance syndrome. Both conditions cause sleep arousals and lead to less than refreshing sleep and excessive daytime drowsiness.

Snoring Is Much More Than An Annoyance

People who have obstructive sleep apnea experience episodes (sometimes lots of them) when their breathing completely stops while they’re asleep. Breathing only resumes when a drop in blood oxygen wakes up the brain and causes them to take a breath. This repetitive cycle of stopping breathing and loss of oxygen to the brain often leads to injury and inflammation in the lining of the blood vessels and cardiac tissue, which makes snorers more susceptible to heart attacks and strokes.

And if that’s not enough, snorers with obstructive sleep apnea airway problems are more likely to have gastrointestinal reflux (heartburn) and experience brain matter degeneration, which is one of the causes of Alzheimer’s disease.

Sadly, the majority of snorers do not realize that their snoring is more than just an annoyance and, therefore, never even think to seek care. The link between snoring and cardiac problems, reflux, and brain degeneration is proof that it’s much more than a social annoyance. Plus, even if the snorer does not have an airway problem, research shows that the vibrational trauma created by snoring will eventually lead to tissue floppiness in the pharynx, which leads to more snoring noise, combined with injury to the nerves that help maintain airway health.

It’s obvious that snoring carries serious health risks for the snorer. But what about the poor snoree?

The Majority Of Snorees Are Women

The majority of snorers are men and, therefore, women are the majority of snorees. Countless women suffer a considerable toll due to the disrupted sleep caused every night by their snoring bed partner. And it’s loud. A snorer’s roar can reach the decibel levels of a construction jackhammer. Imagine trying to sleep with a jackhammer being operated in your bedroom.

For the snoree, constant sleep arousals can lead to chronic muscle and joint pain (TMJ problems included), headaches, daytime sleepiness, and cognitive impairment – to name just a few. In addition, we have evidence that fragmented sleep with multiple arousals can also be responsible for tooth grinding when sleeping.

CPAP Is Not The Only Option

Putting this all together makes a real case for snorers to realize that by not seeking care they’re going way beyond simply being insensitive to their bed partners. Happily, medical professionals now have many ways to treat snoring including oral appliances, which are an extremely helpful therapy for snoring and obstructive apnea. CPAP is not the only option!

So, if you’re a snorer it’s time to get help. Not only is it a smart decision for your health, it’s a smart decision for your relationship, too.

The Connection Between Sleep Apnea and TMJ

Medical research continues to assess how poor sleep quality and sleep disorders in general influence pain thresholds and the experience of muscle and joint pain. One common area of study pertains to obstructive sleep apnea and the larger field of sleep-related breathing disorders – conditions that can lead to fragmented sleep.

Therefore, if you have TMJ pain, it’s really important to tell your doctor if you have a sleep-related breathing disorder (including sleep apnea), and here’s why.

The Connection Between Sleep Apnea & TMJ

According to the Mayo Clinic, sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. You may have sleep apnea if you snore loudly, and you feel tired even after a full night’s sleep. [ The most common type of sleep apnea is called obstructive sleep apnea and occurs when your throat muscles relax and cause pauses in breathing. Each pause in breathing can last from a few seconds to several minutes and can occur up to hundreds of times per hour.

This fragmented sleep can have a detrimental impact on your overall health. Aside from the obvious impact of not getting enough sleep that can include irritability, trouble concentrating, and being sleepy during the day, sleep apnea can trigger headaches, migraines, heart problems, and increase your sensitivity to pain. There are a myriad of reasons that people develop sleep apnea. Obesity, a narrow airway, large tonsils, sedatives, and smoking or drinking alcohol before bed are just some of the risk factors.

The bottom line is this. When something restricts normal breathing, oxygen levels will drop. When your oxygen levels drop, your brain will become stressed. And a stressed brain opens up the possibility of many other problems, including sleep bruxism, which is when you grind and clench your teeth while you’re sleeping. Bruxism can cause your jaw joints (TMJs) to be overworked leading to all kinds of problems, including pain.

Sleep Apnea Can Lead To Bruxism

A number of years ago, TMJ doctors began to notice that a large percentage of their patients had the signs and symptoms of sleep apnea. Studies revealed that breathing restrictions, like those accompanying sleep apnea, can trigger the nightly occurrence of sleep bruxism.

The Role Of Pain – A Double-Edged Sword

If you’ve ever been in chronic pain you know that getting a good night’s sleep can be quite a challenge. Moreover, studies reveal that insufficient sleep can actually lower your threshold of pain, meaning you feel pain more intensely than if you were well-rested. The reason is this: when you don’t sleep well your body can’t produce a normal level of endorphins (the “feel-good” chemicals that promote a sense of well-being). On top of that, poor sleep can cause your nerve pathways to malfunction – which causes a more intense experience of pain.

So, it can go both ways.

When breathing difficulties disrupt your sleep, you become more at risk of developing bruxism. And if your overworked jaw muscles become painful, the pain can cause fragmented sleep. It’s a symbiotic relationship.

Hopefully, you can now see the connection between sleep apnea and TMJ. Please consider getting evaluated for sleep apnea if you’re suffering from TMJ pain. A careful evaluation process, which may include an overnight sleep study (which can now be done at home!) will determine the best type of treatment.

Conclusion

As the associations between jaw pain, sleep disruption and sleep bruxism continue to unfold, the need to be evaluated by a well-rounded team of medical professionals becomes even more important. The ability to have sleep testing done at home and the more recent emergence of telemedicine consults to assist patients in obtaining preliminary sleep consultations, improve doctors’ ability to arrive at accurate diagnoses. This in turn will lead to more effective treatment.

If you’re suffering from TMJ-related pain and have tried everything, it’s time to see a specialist in orofacial pain. If you live in the NYC metro area, I invite you to make an appointment for a consultation at my Manhattan or Long Island office. If you are outside of New York, go to this website www.aaop.org and search for a Diplomate in your area.

Note: BOTOX®, which has been frequently been mentioned in the news, can at times be a helpful treatment once the assessment process has been completed. You can read about the experience of one of my patients and how BOTOX® helped her here.

Tags Sleep Apnea, TMJ

Sleep Apnea

5 Options For Sleep Apnea Treatment

In the United States, it is estimated that 50-70 million adults experience insufficient sleep on a regular basis, with sleep apnea being one important cause. Depending on whom you ask (sleep physician, dentist, respiratory therapist, ENT surgeon, oral surgeon, dietician) you’ll get a wide variety of opinions on the best sleep apnea treatment options.

Regardless of which treatment is chosen to address apnea, attention to nasal breathing is the key. The oxygen that passes through your nose is filtered, warmed, humidified and combined with nitric acid, all of which increase the percentage of oxygen absorbed in your lungs. In my practice, we work hard to combine the best of multiple treatment strategies to result in outcomes that speak for themselves. We consistently hear commentary that indicates that the treatment strategies employed are truly working. It is not uncommon for my patients to tell me how much better they sleep.

“For the first time in ten years I wake up refreshed and I no longer fall asleep at my desk at three in the afternoon.”

With a focus on individual attention and quick responsiveness to a patient’s needs we, often treat these problems with multiple therapies; sometimes during the same night and/or week. The successful outcomes of this approach have become the foundation of our care. These are the five sleep apnea treatment options that my office relies upon.

5 Options For Sleep Apnea Treatment

1. CPAP (Continuous Positive Airway Pressure)

CPAP continues to be first line therapy for most severe and some moderate apnea patients. The problem is that more than 50% of those who choose CPAP discontinue using it within 6-12 months. In most of these cases, it is because they can’t tolerate the facemask (or even partial mask) due to feelings of claustrophobia, the noise of the machine, or its interference with comfortable sleep positions.

For others, the airflow can be cold and feel dehydrating, which prompts them to remove the mask in the middle of the night. Although quieter machines with built-in humidifiers and heaters are now available, leakage of the masks often produces distressing drafts across the face and less than adequate efficiency.

For young patients, the CPAP sleep apnea treatment option often does not sit well, especially when dating and establishing new relationships. As a result, compliance suffers.

2. Oral Appliances

[Oral appliances] (or MRDs) are mouthpieces that move the jaw forward and subsequently move the tongue base forward. This is designed to keep the airway open. These devices are most effective when custom-made, adjusted, titrated and watched over by a dentist with expertise.

This sleep apnea treatment option has been shown to be extremely effective in patients with mild and moderate apnea and less problematic sleep-related breathing disorders, which are often associated with social snoring.

Approximately 25% of my patients who use an oral appliance will alternate with CPAP. Sometimes switching randomly during the week. It is also commonplace for some of my patients to go to sleep with CPAP then switch to the oral appliance in the early morning hours. This way they get the best of both worlds. In many cases, a patient will use an oral appliance when traveling instead of transporting his or her CPAP machine.

These strategies help minimize the complications of a full-time oral appliance which can include jaw discomfort, bite changes and moving teeth.

Note: It is essential that people who use oral appliances be monitored by their dentist. Monitoring by home pulse oximetry and home sleep studies ensure the effectiveness.

3. Nasal Plugs

Some of my patients have had success with nasal plug therapy called Provent. Nasal plugs make it easy to breathe in, but hard to breathe out. This leaves some air chambered (like the air in a balloon) and supports the soft nasal tissues which can collapse and cause apnea.

When tolerated, nasal plugs are a worthwhile option but require clear nasal pathways to work. In a patient who has nasal obstructions due to a deviated septum and/or enlarged turbinates (the shelves on the inside of the nose) the complaint “I was suffocating with the plugs in place” is not uncommon.

Recently a patient developed jaw soreness wearing a night oral appliance, switched to this option with success, and is now splitting the week between these two options.

4. Positional Apnea Aids

Many people experience breathing interruptions only when they are sleeping on their backs. To keep a patient from sleeping on his or her back, I recommend sewing two tennis balls into a tube sock and attaching it to the back of pajamas. The discomfort of the tennis balls forces the patient to stay on his or her side.

In one study, 38% of people who tested this method were still using it six months later.

Body positioners are also available and can be purchased online. This effort to promote side sleeping is essential and when used with oral appliances, can reduce the amount of jaw positioning required. This is what we strive to achieve.

5. Weight Loss

A big risk factor in the development of obstructive apnea is obesity. Since stress often promotes overeating, I have begun to put into place programs that address stress-related behaviors. The challenge here is to build and maintain collaborative relationships with other health care providers, as well.

Summary

Sleep apnea treatments used in combinations seem to be the best way to address the problem at this juncture. The key to more successful outcomes in the future will require the integration of medical, dental and other health related practitioners. This still remains to be achieved, but we are getting closer.

In the meantime, I will continue to bring together the latest ideas and technologies available and will share them with you here.

Note: The Centers For Disease Control and Prevention has designated insufficient sleep as one of our most serious public health problems. To find out more: [http://www.cdc.gov/features/dssleep]

Dr. Donald Tanenbaum is a dentist with offices in New York City and Long Island, NY. He is uniquely qualified to diagnose and treat problems associated with facial pain, TMJ and sleep apnea

Tags Sleep Apnea Treatment

Case Studies Sleep Apnea Snoring

Is Your Sleep Apnea Appliance Working?

Snoring and obstructive sleep apnea are not only disruptive to your bed partner; they may also be the cause of many other illnesses. And as we have seen in the news recently, can result in deadly vehicle accidents. If you have opted to wear an oral appliance at night for snoring and/or sleep apnea (as opposed to using a CPAP machine) you may have noticed that it’s not working as well as it did when it was first fitted by your dentist. So, how do you know if your sleep apnea appliance is working?

John: A Case Study

My patient John is a 45-year old who had chosen to wear a sleep appliance to spare his wife from the disrupted sleep she was experiencing as “he snored like a jackhammer.” However, after a period of time his snoring (and consequently his wife’s nighttime annoyance) had reappeared.

John came to my office and we sat down to talk. He confessed that he had gained a whopping 15 pounds over nine months, so it wasn’t surprising that the appliance was no longer effective. I subsequently corrected the fit of his appliance (basically moving it slightly forward), which took care of his nightly jackhammer snoring (and probably saved his marriage!). But, another problem developed.

John began experiencing morning jaw tension and an awkward bite, which lasted for about an hour. Another visit to the office and a bit more adjustment took care of the issue. Now John is sleeping peacefully and not worried about a TMJ problem. So, if you use an oral appliance to manage sleep apnea/snoring, and your weight varies you should be going back to your dentist to reset the appliance

How To Determine If Your Oral Appliance Is Working

For those snoring without sleep apnea, your bed partner feedback will certainly alert you as to when the appliance is not working, but how do you know if you live alone? If you sleep alone and are wearing an appliance to protect the tissues in the back of your throat from the consequences of snoring over time, monitoring is key.

How To Monitor Snoring and Apnea With Technology

There are a number of mobile apps that can monitor your snoring at night. The best ones are SnoreLab and SnoringU.

For those with obstructive sleep apnea (with or without a bed partner) the absolute best way to know if your appliance is working properly is to use a pulse oximeter on two consecutive nights. A pulse oximeter will measure your blood oxygen levels while you are sleeping. If there is less than optimal oxygen your blood, then your appliance needs to be adjusted. The pulse oximeter can be purchased online or provided by your dentist.

Even more information can be obtained through using a HST (home sleep test), which is often covered under insurance plans and obtained through a sleep clinic or your dentist.

Important: technologies such as FitBit and JawBone cannot be used for monitoring oral appliances and Basis Peak and Microsoft Band, though sensing body motion and monitoring heart rate, also come up short.

The message is clear…don’t assume that once fitted, your oral appliance will always maintain its effectiveness. It’s necessary to have it monitored at least once, preferably twice, every year.

Dr. Donald Tanenbaum is a specialist with offices in New York City and Long Island, NY. He is uniquely qualified to diagnose and treat problems associated with facial pain, TMJ, headaches and sleep apnea.

Tags Case Study, Sleep Apnea, Snoring

Sleep Apnea

Communter Train Operators To Be Treated For Sleep Apnea

[NOTE: This post was previously published on October 15, 2014. In light of the recent announcement that Metro-North railroad will be starting a pilot project in January 2015 to test drivers for sleep apnea, I thought I’d post it again.

“The railroad’s 410 train operators and 20 more in training will be screened for the sleep disorder by a Metro-North health department,” according to the New York Post. “Those recommended for additional screening after the initial evaluation will be referred to a company that specializes in sleep disorders, according to the MTA.”

This is truly good news for anyone who uses the railroad every day to commute to and from work. Yes, the public is becoming more aware of the dangers of sleep disorders, but unfortunately, it sometimes takes a horrific accident such as this one to get things moving.

On the morning of December 1, 2013 a Metro North derailment in the Bronx cost four passengers their lives and injured 59 more, many seriously. Although the National Transportation Safety Board has not determined the exact cause of the accident, the agency has stated that the driver suffers from a condition called Obstructive Sleep Apnea, also known as OSA.

OSA is characterized by excessive daytime sleepiness, which is a result of night after night of poor quality sleep. When you have OSA your airway is partially blocked and your breathing repeatedly stops and starts multiple times during the night. Your blood oxygen level drops causing your brain to be aroused – essentially waking you up.

The airway obstruction and thus the drop in blood oxygen levels can be caused by a number of risk factors of which you may have one or more:

Excessive weight
Large tongue
Big tonsils
Small lower jaws that fall backwards while sleeping
Long and floppy soft palates and uvulas.

If you snore, stop breathing, and toss and turn all night, it’s likely that you have OSA. Certainly if you are awakened frequently throughout the night, you will be exhausted when you get up and more exhausted as the day wears on.

Obstructive Sleep Apnea Treatment

Medical care for OSA is focused on encouraging patients to lose weight, a change in sleeping position, and even surgery in some cases. Tonsils, the uvula, and even the size of the tongue can be adjusted. But, the most common therapy is called C-PAP (continuous positive airway pressure) which involves the nightly use of a mask which is connected to a small machine that sits next to your bed.

As an alternative, or in addition to C-PAP, are oral appliances, which bring the jaw forward and move the tongue away from the airway. Ongoing research has shown that these appliances not only work well, but compared to C-PAP may be easier for patients to deal with night after night. Happily, there are now ways to test whether an oral appliance would be a good option for you (ahead of time while in your own bed!).

My Opinion About OSA Related Accidents

Let’s get back to last year’s Metro North accident. The driver reported that he had gone into a “daze” as the train careened many miles above the speed limit toward the curve. Before the accident, doctors had diagnosed him as obese and having hypothyroidism, high cholesterol, low testosterone, vitamin D deficiencies, B12 deficiencies, and mild high-frequency hearing loss.

But the driver had never been screened or examined for Obstructive Sleep Apnea until after the accident!

It’s impossible to ascertain how many deadly vehicle accidents are related to undiagnosed or poorly treated OSA. We will likely never know.

I believe that it should be mandatory for all drivers of public transportation vehicles (and all truck drivers who spend long hours on the road) to be tested and treated for OSA. Imagine…oral appliances could find their way into the overnight supplies carried by truck drivers who park at rest stops, pilots who sleep at airports, and train conductors who similarly catch a few hours of sleep during the course of their work schedules.

We have the tools, now is the time to become more effective educators and providers of care and keep the public safe from these mostly avoidable deadly disasters.

Read more about the Metro North accident here: http://www.huffingtonpost.com/2014/04/07/metro-north-driver_n_5107612.html

Dr. Donald Tanenbaum is a specialist with offices in New York City and Long Island, NY. He is uniquely qualified to diagnose and treat problems associated with Obstructive Sleep Apnea.

Tags Snoring

Sleep Apnea Snoring

An Implant for Obstructive Sleep Apnea?

There has been a lot in the news lately about implants as a way to treat sleep apnea. As a dentist involved in helping patients with their snoring and obstructive sleep apnea, my biggest challenge has been figuring out strategies to keep the tongue from falling back into the oropharyngeal region. Once this happens, airflow is compromised, leading to diminished levels of oxygen in the blood and frequent arousals while sleeping.

As a result, these patients never feel rested, experience daytime sleepiness, and often underperform at school or in the workplace. Others develop significant heart-related problems or even fall asleep behind the wheel with tragic outcomes. Moreover, for patients who have small lower jaw, large tonsils, fat uvulas, and long sloping and floppy soft palates: nighttime airway compromise is a big problem (even if tongue size is normal!). For obese patients with large necks, fat tongues, and weak tongue muscle strength, the problem is further compounded.

Treatment over the years has included weight loss, airway surgery, CPAP (essentially blowing air through the obstruction), and oral oral devices to prevent the tongue from falling backwards while sleeping (tongue retaining devices) or designed to actively keep the jaw forward, carrying the tongue in the process (mandibular positioning devices). Tongue retaining devices that pull the tongue forward past the lips have also been used with variable levels of success.

On the horizon, however, is a new kind of implant that may be an alternative treatment option for those with obstructive sleep apnea. As reported in the January 9th issue of the New England Journal of Medicine this implant will serve as a pacemaker of sorts, delivering electrical impulses to the nerve that is responsible for maintaining tone in the muscles that keep the tongue in a forward posture.

Tests conducted to date found that “these impulses reduced nightly sleep apnea events by about 68 percent, according to the results of the one year clinical trial. The technology also decreased by 70 percent the number of times that a person’s blood oxygen level dropped due to sleep apnea. Not surprisingly, patients reported a 40 percent improvement in their ability to stay awake during the day.”

According to new reports that reference the Journal article “the device operates by having an electrode run from the pacemaker to the hypoglossal nerve located under the tongue. Another lead wire runs down to the muscles between the ribs of the chest and keeps track of the person’s breathing. As the patient breathes in and out, the pacemaker sends electrical impulses to the nerve, which causes the person’s tongue to move slightly forward and their upper airway to contract open. Both movements keep the airway from collapsing.”

“It’s a unique and promising new treatment,” said study co-author Dr. Ryan Soose, director of the division of sleep surgery of Pittsburg Medical Center. The surgery is minimally invasive, and patients typically were back to regular activity within in a day or two.”

Though more research is needed, this new option will be a welcome addition to the treatment options that are currently available.

Dr. Donald Tanenbaum is a specialist with offices in New York City and Long Island, NY. He is uniquely qualified to diagnose and treat facial pain associated with jaw problems, TMJ, referred pain, nerve pain, and migraines. Find out more at www.nytmj.com.

Tags Dr Donald Tanenbaum, implant for obstructive sleep apnea, implants for sleep apnea

Nightguards & Oral Appliances Sleep Apnea Snoring

Who is Monitoring Your Snoring or Sleep Apnea Appliance?

Based on the number of emails I weekly receive advertising courses for dentists to learn how to make and provide oral appliances for snoring and sleep apnea I can only assume that an increasing number of adults are receiving these devices. Though these devices can provide great benefit socially (allowing bed partners to sleep in the same room) and medically by reducing the risk of heart related problems, once inserted these devices must be monitored.

Why You Should Always Monitor Oral Appliances

1. Is the oral appliance doing what it is intended to do? For the simple snoring patient the answer is easy. For the apnea patient, the answer is a guess unless a follow up sleep study (home test or laboratory) is done. Just the cessation or reduction of snoring may not mean that the apnea condition has been adequately addressed. The dentist who puts in the device must direct the follow up process.

1. These appliances can cause tooth shift, opening spaces between teeth leading to food traps, and lead to movement of front teeth that were straightened with braces. These problems can be eliminated or minimized with follow-up visits.

1. In approximately 15 percent of patients that wear these appliances over one year, there is a good chance that a bite change will occur not allowing the back teeth to hit as they once did. Heavy contacts are put on the front teeth with likely consequences such as chipping and reduced mobility. Follow-up visits can not only prevent this from happening but if noticed, modifications can be made with regard to how often the appliance is worn and where the position is set.

In some people these appliances can lead to jaw problems such as muscle or joint pain, joint noises, and even limitations in jaw motion and functional abilities. Since the jaw is an orthopedic system, healing will then be dependent on making appropriate changes, which can only be determined by follow-up visits.

The Take Home Message About Monitoring Oral Appliances

If your dentist is not insisting on follow-up visits, speak up and get back on his or her schedule. Also, these appliances do not last forever! Replacement is usually necessary after 3 -5 years based on normal wear and tear.

Tags Dr. Tanenbaum, follow-up visits oral appliances, oral appliance for sleep apnea, oral appliance for snoring, Oral Appliances

Sleep Apnea Snoring

Snorers! Now A Sleep Study Can Be Done in Your Own Home

Snoring, long considered to be no more than a social nuisance, is now seen by the medical community as a possible sign of more serious health conditions. In order, however, to determine whether a patient’s snoring indicates a more serious disorder, like obstructive sleep apnea, overnight sleep studies are critical to obtain. The problem of course is that many patients are resistant to spending the night at a Sleep Clinic, and after hearing nightmare stories from friends and family that have spent restless nights lying awake in a sleep lab, refuse to schedule an appointment.

It is not uncommon therefore to be confronted by this familiar story. The patient, a man in his mid-thirties or forties, married, with children has a history of snoring. With some gain of weight his nightly snoring has become so disruptive that his wife routinely leaves the bedroom halfway through the night. On vacations, it’s necessary to reserve two rooms instead of one just because of the snoring. Basically, dad disturbs the sleep of the entire family.

Upset and exhausted, the wife finally convinces her husband to see his physician, which he does, though reluctantly. The physician then suggests a Sleep Study, which involves a night away from home at a Sleep Center. This is where the problems really start as men often refuse to spend the night away from home, particularly since they don’t even think they have a problem and deny that they snore in the first place. So, the snoring goes on, the family suffers and more importantly the snorer may be at risk for health consequences down the road.

But, there is good news for snorers and their families. In the past 10 years advances in technology have brought sleep testing equipment to the bedroom. At-home Sleep Study equipment has been proven to provide reliable data and is currently a service that has been embraced by medical insurance carriers. In fact home studies are often being required prior to the more formal and traditional study done in a sleep lab. Although physicians have traditionally been thought of as the primary health care provider to advise patients with snoring and more serious airway problems (like apnea), dentists have begun to play a critical role in terms of assessment, and more importantly in motivating patients to pursue comprehensive evaluations inclusive of overnight sleep testing.

What then would indicate that a home study is needed?

In order for your doctor to ascertain if you are a candidate for a Sleep Study, he or she will ask you questions about your health, and how you routinely feel during the day and on arising in the morning. Pen and pencil questionnaires may also be given to you which ask questions about:

Daytime sleepiness
General fatigue levels
Frequency of sleep arousal
Morning headaches
Irritability in the morning or daytime moodiness
Problems concentrating during the day
GERD
Hypertension

If your answers indicate that a Sleep Study is recommended, your doctor will set in motion a process to pre-certify the home study through your insurance company.

The testing equipment will either be obtained at a local sleep center or it will be shipped directly to your home. The equipment is easy to use and very self -explanatory. You will need to use it for only one night, then return it so that the data can be read and interpreted by a board-certified sleep physician. A report is then sent to your doctor who will then be able to make a recommendation based upon the findings.

In my practice, depending on what the Sleep Study indicates, recommendations for additional consultation or treatment will follow. Snoring that does not carry with it other health concerns can be treated with an oral appliance. Apnea if present can be treated in a number of ways depending on the severity identified on the overnight study. Oral appliances certainly are one option that can be explored.

The goal: Healthy airways and maybe save a few marriages along the way!

To learn more about Oral Appliances for Sleep Apena Treatment, consider reading some of my other recent blogs:

Tags Dr Donald Tanenbaum, Sleep Apnea, sleep apnea treament, sleep studies at home, sleep study, sleep study at home, Snoring, snoring treatment

Sleep Apnea Snoring

Treatment for Sleep Apnea May Assist in Weight Loss

While on a recent airplane flight to Chicago, I was unfortunately sitting across from a young man around thirty years old who was sleeping fitfully. From his outward appearance he was not overly tall, likely about 5’11” but clearly overweight particularly in the midsection.

With each breath came a snoring (or roaring) sound accompanied occasionally by a gasp for air. It was clear that this young gentleman had the appearance of obstructive sleep apnea and one can only wonder about his future if he did not address this problem with weight loss or medical intervention.

This scenario of young men and women snoring excessively is played out daily across America and the reason most of the time is obesity. Though there are many individuals that snore and develop obstructive sleep apnea, due to large tonsils and small airways due to thin necks and set back lower jaws, the problem is most commonly seen in overweight people.

For these individuals their calorie intake continues to exceed the calories they burn with the end result of fat being deposited in the neck and airway along with their midsections. Once established these patterns of weight gain are hard to reverse taking tremendous self control and discipline.

The end result unfortunately is not only a disturbed bed partner and daytime fatigue but new evidence suggests that a persistent obstructive sleep apnea condition can weaken the body’s immune system and increase the risk for cancer, as the results of a recent study published in the American Journal of Respiratory and Critical Care Management suggests.

What is also interesting is that once an obstructive sleep apnea problem has been established with the associated oxygen deficits while sleeping, there is also a disruption of the delicate hormonal balance that controls appetite and hunger patterns.

As a result it has been shown that moderate to severe obstructive sleep apnea conditions often impair weight loss efforts despite caloric control and increased exercise. As a result of this reality, a great number of patients in our office are using oral appliance therapy while sleeping and as a result are breathing better and losing the weight that they were unable to previously shed. As an end result, their improved airway capacity will most certainly reduce their risk of cancer in the future and help all of us rest peacefully on our next airplane flight.

Tags Donald Tanenbaum, Obstructive Sleep Apnea, Sleep Apnea, Snoring

Sleep Apnea

Sleep Apnea Treatment Improves Heart Function

In a previous blog post, I discussed how CPAP (Continuous Positive Airway Pressure) and custom oral appliances could be used to facilitate night-time airflow into the lungs, preventing snoring and aiding mild to moderate sleep apnea.

Researchers in England have found a new development in sleep apnea treatment. A CPAP breathing machine can improve heart function and may even prevent heart failure.

According to a new study, published by the American Heart Association, researchers at England’s University of Birmingham used echocardiogram exams to study heart structures and function in sleep apnea patients before and after CPAP therapy.

Patients were broken into three groups:

Group One: Patients with High Blood Pressure
Group Two: Patients with Obstructive Sleep Apnea
Group Three: Healthy Control Group

The lead researcher, Gregory Lip, found asymptomatic sleep apnea patients had measurable heart damage. The observable structural and functional changes found in moderate to severe sleep apnea patients were found to be akin to those suffering from high-blood pressure.

All three groups were treated across six months with CPAP. After a second round of echocardiograms, much of the heart damage had been reversed in several major areas:

Reduced thickness of the heart muscle wall
Improvement in cardiac function
Loosening of the cardiac chambers

Given the therapy’s role in improving overall heart health, sleep apnea patients should consider CPAP treatment regardless of cardiac problems. This could translate to a major reduction in stroke and risk for other heart-related diseases.

If you suffer from sleep apnea and are considering CPAP as treatment please do not hesitate to contact me. Learn more about Dr. Tanenbaum here.

Tags CPAP, Donald Tanenbaum, Obstructive Sleep Apnea, Sleep Apnea, Sleep Apnea and Heart, Sleep Problems

Sleep Apnea Snoring

Is Snoring Causing Your Child’s Behavioral Problems?

In very young children and even in infants, sleep-inhibiting breathing such as sleep apnea, mouth breathing, and even snoring may affect more than just a healthy night’s sleep.

According to a recent New York Times article, a study conducted by Karen Bonuck, PhD., at the Albert Einstein College of Medicine at Yeshiva University found that sleep-inhibiting breathing starting in infancy and early development is causing more than just problems with sleeping and staying awake during the day. This longitudinal study tested 11,000 children (controlling for future behavioral problems caused by events such as maternal smoking and prematurity) found a definitive link between children with sleeping problems during early development and later behavioral problems.

Sleep-inhibiting breathing leads to a poor night’s rest for your child potentially providing their brain with too little oxygen or too much carbon dioxide. This could seriously affect the prefrontal cortex area of the brain which is directly linked to behavioral decision-making.

Parents need to pay attention to their child’s breathing at night, even as early as infancy. A good night’s sleep restores what a developing brain has lost during the day.

If you feel your child is having a problem with snoring, sleep apnea, or mouth breathing, do not hesitate to contact me. Learn more about Dr. Tanenbaum here.

Tags Child Sleep Apnea, Child Snoring, Donald Tanenbaum, Sleep Apnea, Sleep Apnea Behavior, Snoring

Sleep Apnea Snoring

Snoring and Weight – Yes, There Is a Connection

My patients often ask me about the relationship between snoring and weight gain. Snoring undoubtedly can be a result of obesity, and obesity can also be a result of snoring. Confused?

Fact: Obesity Causes Snoring

More than 30% of Americans are considered obese, which is having a BMI (Body Mass Index) of 30 or more. Excess weight, regardless of its amount or origin, has many effects on your breathing, and in many cases causes snoring.

Though it may feel like all the weight you’ve gained is stored in one or two areas, extra layers of fat actually distribute themselves all over your body! When excess is deposited around the throat and neck area, it can narrow the airway, causing airflow turbulence leading to that annoying snoring sound. Also, as you gain weight, fat displaces muscle tissue and you lose muscle tone. As a result the soft palate and other soft tissue in the throat become floppy and snoring levels rise.

Causes of Snoring

Body fat around the throat and neck
Loss of muscle tone in the throat and soft palate region
Obstructed nasal passages
Large tongue

Sleep Apnea and Obesity

Along with snoring, individuals who are overweight are more likely to develop sleep apnea. Sleep apnea is a serious medical condition characterized by periods during sleep when your breathing stops completely. As a result your brain is aroused and you wake up. Sometimes breathing can stop for up to 10 seconds! These stoppages in breathing can happen as many as 100 times a night leaving you exhausted in the morning and at risk for heart problems.

Fact: Snoring Causes Obesity

Believe it or not, snoring could actually be the cause of your weight gain or your inability to lose weight.

Nightly snoring prevents you from getting a good night’s sleep, leaving you feeling tired and run-down during the day. This lack of energy can keep you from going on that pre-work run or makes you choose the elevator over the stairs. The bottom line is that the weight you’ve gained is a result of sleep deprivation.

In addition in a University of Chicago study, young and healthy students were deprived of sleep for six nights in a row. The sleep deprivation resulted in measurable metabolic changes, one of which was increased hunger and appetite! As your body relies on the energy it gets from a good night’s sleep, if you aren’t getting enough sleep, your body will crave the energy from somewhere else: usually your refrigerator!

Clearly there is a direct relationship between snoring , a poor nights sleep and overeating!

Is There a Snoring Remedy?

If you’re an overweight snorer, the first step is to try to lose weight. But, if you are so sleep deprived that weight loss is impossible, other options are available. Thousands of suffering snorers (and their partners) have seen extraordinary results from using an oral appliance at night.

Using a custom-made oral appliance (mouth guard) overnight keeps your jaw forward, making air flow into your throat easier. Oral appliances can be used alone, with a CPAP mask, or as an alternate sleep device when using the CPAP becomes monotonous. Most people find that using an oral appliance greatly reduces and even eliminates their snoring.

Please share this article with anyone you care about (or his/her partner) who is dragging around during the day because of a snoring problem at night.

Dr. Donald Tanenbaum has been practicing in New York City and Long Island for over 20 years. He is uniquely qualified to diagnose and treat Sleep Apnea, facial pain, TMJ and TMD problems, muscle pain disorders, nerve pain disorders, tension headaches, and snoring. Learn more here

Tags Obesity, Oral Appliances, Sleep Apnea, Snoring

Sleep Apnea Snoring

Oral Appliance Saves Marriage

Post author By Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain
Post date August 24, 2011
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Recently, a 52 year old female patient told me about her experience with CPAP. She has a history of loud and disruptive snoring, which ultimately caused her husband to sleep in a separate bedroom.

After being evaluated at a sleep lab, she was diagnosed with mild to moderate Obstructive Sleep Apnea (OSA) and was prescribed a CPAP device. Thanks to the CPAP, her snoring was gone, but her husband still slept in the next room–he refused to get into bed with Darth Vadar. Now it was the cumbersome CPAP mask was causing her love life to suffer.

We made her an oral appliance to use nightly as an alternative to the CPAP. Presently, husband and wife are happy again.

Tags CPAP, Obstructive Sleep Apnea, Oral Appliances, OSA, Sleep Apnea, Snoring

Sleep Apnea Snoring

What is CPAP?

Post author By Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain
Post date August 22, 2011
No Comments on What is CPAP?

CPAP, or Continuous Positive Airway Pressure, is the primary therapy used to manage a condition called Obstructive Sleep Apnea (OSA). As the airway narrows during sleep in individuals with OSA, the CPAP device is designed to provide a constant flow of compressed air under pressure to keep the airway open.

Often called the most effective nonsurgical treatment for obstructive sleep apnea, wearing a CPAP mask at night can improve the quality of sleep. Nightly use of the CPAP machine can also reduce high blood pressure, daytime sleepiness and snoring.

Though the CPAP machine can provide great results, it is NOT the right solution for everyone. As a matter of fact, many people find CPAP to be uncomfortable, preventing them from falling or staying asleep. As a result, according to the American Sleep Apnea Association, 60% of CPAP users discontinue use within one year because of discomfort or side effects.

Drawbacks of CPAP include:

• Can cause excessive dreaming and nightmares
• The mask often causes skin irritation
• The mask or nasal attachments often slip out of position while sleeping, diminishing the effectiveness of the device
• The airway hoses can wrap themselves around the wearers head
• The mask creates a sense of claustrophobia
• The machine is loud and can disrupt you or your sleep partner

Alternative to CPAP

An alternative to a CPAP machine is a custom fitted oral appliance which can be used to prevent snoring and to treat mild to moderate sleep apnea. Scientific studies have shown that properly constructed and adjusted oral appliances have the capacity to consistently facilitate nighttime air flow into the lungs thereby reducing the risk of stroke and high blood pressure developing in individuals with this medical condition.

An oral appliance works one of two ways. The first and most commonly utilized type of oral appliance repositions the jaw forward, carrying the tongue out of the airway . This type of appliance attaches directly to the teeth of the upper and lower dental arches. With the tongue forward the patency of the airway increases. The second type which is infrequently used is called a tongue retaining device. This appliance attaches only to the tongue and via a suction mechanism, the tongue is pulled forward out of the mouth. The end result is typically a sore tongue and a restless nights sleep.

The Perfect Marriage

As any one treatment over the course of many years can become monotonous we continue to advocate the use of both oral appliances and CPAP in patients that seek our advice. Whether a fixed schedule of alternating between the oral appliance and the CPAP is established or whether the oral appliance is just worn when traveling for work or on vacation, many of our patients have benefitted from this scenario. As over the long term oral appliances have been shown to have a better than 70% compliance they have therefore become an important component of managing OSA and socially disruptive snoring.

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Tags CPAP, Obstructive Sleep Apnea, Oral Appliances, Sleep Apnea, Snoring

Sleep Apnea Snoring

Beware! The Snore Patrol Has Arrived at Your Hotel

Recently, I read in the news that a large hotel chain is making a focused effort to identify which of their nightly guests’ snoring is disrupting the sleep of others. Corridor monitors are instructed to identify the sources of snores and to knock on the doors, waking the inhabitants from their sound, but disruptive, sleep. Once identified, these sound offenders will be asked to relocate to a different part of the hotel if they are planning to stay several days. The hotel is also installing soundproof walls and purchasing soundproof headboards to silence the symphony of snores.

To those of us involved in the world of sleep, snoring has been of long concern. Not only has snoring been cited as a top reason why partners sleep apart, but the disruptive character of snoring actually diminishes the quality and quantity of your partner’s sleep. Imagine sleeping next to someone who continued to talk all night long as you attempted to fall or stay asleep. Impossible? In fact, many snorers snore at a decibel level of normal conversation, while the snoring of some has been rated to be as loud as a jackhammer!

A Simple Oral Appliance May be the Solution to Your Snoring Problem

Fortunately, there is a great solution to snoring both at home and when traveling. Though being available for years, oral appliances have only just begun to get the attention they deserve. These devices, when made by a dentist, have been shown to stop or reduce snoring on a predictable basis and are extremely comfortable to wear. As approximately 30-50% of snorers have a condition called Obstructive Sleep Apnea, oral devices are often used to treat this serious medical problem. In many cases, oral appliances can be used instead of a facemask at night and offer a portable alternative to the facemask apparatus at home while traveling.

Oral appliances that stop snoring will allow you to once again sleep with your partner…and to help you avoid the embarrassment of being awakened by hotel Snore Police.

You can read the article I referred to above here.

Tags Crown Plaza, Obstructive Sleep Apnea, Oral Appliances, Sleep Apnea, Snore Patrol, Snoring