Friday, October 30, 2009

Feel Like You Need More Sleep? You’re Not the Only One.


This week’s issue of the Morbidity and Mortality Weekly Report (MMWR) published by the Center for Disease Control and Prevention (CDC) highlights the number of Americans who perceive a problem with their sleep.

More than four hundred thousand U.S. residents answered the question "During the past 30 days, for about how many days have you felt you did not get enough rest or sleep?"

A whopping 11 percent of respondents reported experiencing insufficient rest or sleep every day for the 30 days leading up to the survey.

Receiving restful sleep is critical for maintaining a person’s overall health.

According to a 2007
study in the Journal of Clinical Sleep Medicine, sleeping less than seven hours a night can lead to physical and mental health problems, loss of productivity, and death.

Using data from the CDC report, WebMD
ranked each U.S. state to show where people get the most and least restful sleep.

West Virginia tops the chart with one in five residents feeling that they never get enough rest in a one month period.

North Dakota earned the best sleep scores, but its residents still report having 7 poor nights of sleep a month.

There are many reasons people receive insufficient sleep. Obstructive sleep apnea (OSA) is one cause.

People with OSA may sleep 7 or more hours a night, so they think that they get enough sleep. However, OSA causes a person to wake up throughout the night in order to breathe. They may not remember waking up, but these arousals can stop a person from getting restful, restorative sleep.

Sings of OSA include loud snoring and excessive daytime sleepiness.

Read more about
OSA.

Thursday, October 29, 2009

Sleep Fragmentation Linked to Fatigue


For some people, a cup of hot coffee is all they need to wake up in the morning. But for people with sleep apnea, that cup of Joe may not do the trick.

A recent
study in the journal Sleep and Breathing found that sleep fragmentation may contribute to the fatigue that is common in sleep apnea patients.

Sleep-disordered breathing causes a person’s body to stop breathing during sleep. One example, obstructive sleep apnea (OSA), occurs when the tissues in the back of the throat relax and collapse, blocking the oxygen flow.

Most pauses in breathing occur for 10 to 30 seconds, but can last for a minute or longer. These breaks can happen hundreds of times a night. When they occur, the brain wakes the body up to breathe. This pattern of arousal causes sleep fragmentation.

The researchers examined how the frequency of arousals impacted fatigue in OSA patients. Specifically, they looked at general, physical and emotional fatigue. Their research did, in fact, link sleep fragmentation to increased fatigue.

The researchers also took into account sleep architecture. This means that they examined the type of sleep each patient experienced. They found that the study participants spent most of their sleep time in lighter sleep stages, like stage one, verses deeper, restorative sleep stages, like REM sleep. This could be another reason the participants felt fatigued.

If you feel fatigued, you may suffer from sleep apnea. You should see a physician and set up a sleep study at an
accredited sleep center near you.

If you are diagnosed with OSA, there are several
treatments for this condition.

Oral appliances are a treatment option provided by dentists. Trained dentists use devices that look like sports mouth guards to help OSA patients breathe more freely at night.
Find-a-Dentist in your area.

Wednesday, October 28, 2009

How Do I Know If I Have Sleep Apnea?

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There are many signs of obstructive sleep apnea (OSA), including:

· Excessive daytime sleepiness
· Snoring: intermittent with pauses
· Awakenings with gasping, snorting or choking
· Morning Headaches
· Fragmented, non-refreshing sleep
· Decreased sex drive
· Mood and behavioral problems; irritability

OSA is a serious medical condition. It should be diagnosed at an accredited sleep center by a sleep physician.

If you are diagnosed with OSA, your sleep physician may recommend using Continuous Positive Airway Pressure (CPAP) or an oral appliance to help you breathe while you sleep.

Behavior modification, such as losing weight, quitting smoking, avoiding alcohol, or sleeping on your side, can also help decrease the severity of OSA.

The below test can help you see if you have a problem with daytime sleepiness. A score of nine or above on this test is an indication that you should see your doctor.

It is also a good idea to see you physician for advice if you snore, have been told that you awake gasping for breath, or if you fight to stay awake during the day.

The Epworth Sleepiness Scale

How likely are you to doze off or fall asleep in the following situations?
Choose the most appropriate number for each situation:

0 = would never doze

1 = slight chance of dozing

2 = moderate chance of dozing

3 = high chance of dozing

Activity

Sitting and Reading _____

Watching TV _____

Sitting, inactive in a public place (theater, meeting, etc.) _____

As a passenger in a car for an hour without a break _____

Lying down to rest in the afternoon when circumstances permit _____

Sitting and talking to someone _____

Sitting quietly after lunch without alcohol _____

In a car, while stopped for a few minutes in traffic _____

Total _____

Please feel free to print this test, fill it out and take with you to your physician.

Tuesday, October 27, 2009

Money Doesn’t Sleep, but You Should


How much is a good night’s sleep worth?

For people with obstructive sleep apnea (OSA), it’s worth the cost of treatment.

Twenty-five to 50 percent of the 18 million Americans who have OSA do not tolerate or comply with
CPAP, the standard treatment therapy.

These people face an important question. “Should I leave my apnea untreated or try an alternative therapy?”

Untreated OSA can lead to excessive daytime sleepiness, driving accidents, heart attack, stroke, diabetes, and obesity.

According to a recent
study in the journal Sleep and Breathing, 99 percent of OSA patients are better off receiving some form of treatment.

The researchers examined the benefits of wearing a CPAP mask verses an
oral appliance (OA) in patients with moderate to severe apnea. They looked at quality of life, driving accidents, and cardiovascular health.

They found that after five years, undergoing oral appliance therapy (OAT) is more cost-effective than not getting treated.

OAT costs range from a couple hundred dollars to a couple thousand dollars. But medical fees due to untreated OSA can cost tens of thousands of dollars if not more.

OSA patients can
Find-a-Dentist near them who practices OAT. Qualified dentists are trained to fit and adjust OAs to treat this disease.

OAs look like mouth guards and are non-intrusive.

In fact, a 2007
study found that many patients who respond to both CPAP and OAs prefer the latter.

Patients can work with their dentist, doctor, and medical insurance company to try and receive coverage for an OA.

Read more about insurance coverage
here.


Monday, October 26, 2009

Reveille: Service Members at Risk for Daytime Sleepiness


A recent study in the journal Sleep and Breathing indicates that some military members are at risk for falling asleep on duty.

The study found that military members with mild to moderate obstructive sleep apnea (OSA) or upper airway resistance syndrome (UARS) may fall asleep during the day.

Excessive daytime sleepiness (EDS) can be a symptom of sleep-related breathing disorders (SBD), such as OSA and UARS.

Researchers used the
maintenance of wakefulness test (MWT) to gage each subject’s ability to stay awake in a dimly lit room. The subjects were asked to stay awake during 40 minute trials that were given every two hours.

Subjects with poor test results - almost a third of the service members - fell asleep approximately half way through each trial.

EDS can be hazardous. People who operate vehicles, machinery, or firearms – both in and out of the military – should make sure they get restful sleep.

Wakefulness and alertness help military members complete their missions safely. But deployment may make it hard for service members to treat their SBD. In combat zones, they may not be able to use CPAP, the standard treatment therapy for OSA.

Left untreated, OSA can impair cognitive functioning and mental alertness. OSA happens when a person’s airway collapses during sleep, causing pauses in airflow. This stops the person from getting enough oxygen and can lead to EDS.

Oral appliances are an alternative treatment for apnea. OSA patients who do not tolerate or comply with CPAP can wear an oral appliance to keep their airway open during sleep.

Learn more about
oral appliances.

Many dentists treat sleep apnea.
Find-a-Dentist in your area!

Sleep and Breathing is the official journal of the
AADSM.

Photo by U.S. Army IMCOM North Korea

Friday, October 23, 2009

Counting Sheep in the High Skies: Pilots Under Investigation for Napping on the Job


Articles in the Associated Press and Wall Street Journal report that the Federal Aviation Administration (FAA) and National Transportation Safety Board (NTSB) are investigating Norwest Airlines flight 188.

Flight 188 overflew its destination by 150 miles on Wednesday night.

The two pilots claimed that they missed their stop because of a heated debate. But investigators are determining if the pilots were actually catching up on their Z’s.

If sleep was the culprit for flight 188, it would not be the first time.

Safety experts say that there have been at least 10 U.S. airliner accidents and 260 deaths since 1990 due to sleep.

In 2008, two go! airlines pilots fell asleep for more than 18 minutes during a flight to Hilo, Hawaii. The captain of this plane was later diagnosed with Obstructive Sleep Apnea (OSA).

OSA occurs when a person’s airway becomes blocked during sleep. The person wakes up in order to breathe again, but may not know that they are waking up. This pattern can happen hundreds of times a night.

If left untreated, OSA can cause excessive daytime sleepiness.

Whether or not the flight 188 debacle was sleep-related, regulators are ready to crack down on untreated OSA.

Yesterday, this blog reported on the new NTSB recommendations for mandatory OSA screenings.

There are many ways to treat OSA.

An oral appliance is one option. It looks like a mouth guard and maintains a clear airway during sleep. Many dentists are trained in this treatment.

Find-a-Dentist in your area who treats OSA!

Photo by Caribb

Thursday, October 22, 2009

Waking Up Drivers to Sleep Apnea


According to a recent Associated Press article, the National Transportation Safety Board is trying to decrease the number of driving accidents related to sleepiness.

The American Academy of Sleep Medicine (AASM) gives these stats on drowsy driving:

· 80,000 people fall asleep at the wheel each day
· 250,000 motor vehicle accidents are sleep-related each year
· 20 percent of all serious driving injuries are due to sleep

The Board wants all truck and bus drivers and merchant ship pilots to be screened for Obstructive Sleep Apnea (OSA). Similar recommendations for airline pilots and train operators came out earlier this year.

OSA can be fatal. It raises a person’s risk for daytime sleepiness and driving accidents.

The AASM estimates that two percent of women and four percent of men have OSA. But truckers have OSA more often than the general population.

A study by the Federal Motor Carrier Safety Administration (FMCSA) found that more than 28 percent of truck drivers have sleep apnea.

There are many ways to treat OSA. Dentists trained in dental sleep medicine can treat OSA with oral appliances. Find-a-dentist near you!

Image by Max Duggan

Wednesday, October 21, 2009

Sawing Logs: Snoring May Signal Sleep Apnea


A news segment on Ozarks First reports on the benefits of Oral Appliance Therapy (OAT).

The
video shows Sleep Apnea patient Lucille Willnett getting fitted for an oral appliance at her dentist’s office and explains why she decided to try OAT.

Willnett went for a
sleep test when her husband started sleeping in a separate room because of her loud snoring.

Snoring occurs at all ages and in both genders. According to the
American Academy of Sleep Medicine, an estimated 30 million, or 1 in 8 people snore.

Snoring can be harmless, but loud, frequent snoring can also be a sign of Obstructive Sleep Apnea (OSA).

OSA occurs when a person’s airway collapses during sleep, causing a pause in airflow. Oxygen stops going to the brain, so the brain wakes the person up to breathe – often causing the person to make loud gasping or choking sounds.

Willnett’s sleep test showed that she did in fact have OSA.

If left untreated, OSA can increase a person’s risk for heart attack, stroke, driving accidents and other
problems.

Willnett’s physician had her try
CPAP, the standard treatment therapy. But Wilnett did not tolerate CPAP and often took her mask off during the night without realizing it.

Because she did not use her CPAP mask all night, Willnett’s OSA was not being effectively treated.

Instead, her dentist, Dr. Tyler Buzbee, fitted her with a device similar to a retainer or mouth guard.

Willnett’s oral appliance moved her lower jaw slightly forward, giving her a healthy level of airflow and a good night’s rest.


Do you or your bedpartner snore loudly at night?

Find-a-dentist who treats snoring and sleep apnea in your area!

Tuesday, October 20, 2009

Promising Results for Tongue Retaining Devices


A study in the Oct. 15 issue of the Journal of Clinical Sleep Medicine (JCSM) found that tongue retaining devices (TRD) performed similarly to mandibular advancement devices (MAD) in OSA patients.

TRD and MAD are two common types of oral devices used in dental sleep medicine.

A TRD holds the tongue in a forward position using suction. This suction keeps the tongue from collapsing during sleep and obstructing a person’s airway.

A MAD maintains the lower jaw in a protruded position during sleep. This protrusion maintains an open airway and pulls the tongue forward.

The JCSM study involved 84 patients who had mild, moderate or severe Apnea. Patients took one sleep test, or polysomnography (PSG), without a TRD and one sleep test wearing a TRD.

Both tests measured the patients’ Apnea-Hypopnea Index (AHI).

AHI is an average that represents the number of complete breaks in breathing (apneas) and partial breaks in breathing (hypopneas) that occur per hour of sleep.

In the study, an AHI of 10 to 15 indicated mild OSA. An AHI of 15 to 30 indicated moderate OSA. And an AHI of more than 30 indicated severe OSA.

Based on AHI, full or partial success was obtained in 71 percent of the cases. The mean AHI of the patients went from 38 to 14 with the TRD.

When OSA patients have a lower AHI, they breathe better and wake up fewer times during the night.

Photo courtesy of Lazard DS et al. The tongue-retaining device: efficacy and side effects in obstructive sleep apnea syndrome. J Clin Sleep Med 2009;5(5):431-438.

Monday, October 19, 2009

Dental Sleep Medicine: The Basics Part II


In 1991, eight dentists founded the American Academy of Dental Sleep Medicine (AADSM). At that time it was called the Sleep Disorders Dental Society.

These dentists wanted to treat sleep-related breathing disorders (SBD), such as snoring and
Obstructive Sleep Apnea (OSA).

More dentists became interested in treating these problems over time.

Today, the AADSM has over 1,750 members
from 31 countries. These dentists are trained to safely and effectively treat snoring and OSA.

The AADSM offers educational
courses, an Annual Meeting, and a journal to ensure that dentists know the latest information in Dental Sleep Medicine (DSM).

Many AADSM members become Diplomates of the
American Board of Dental Sleep Medicine (ABDSM). They represent the highest level of expertise in DSM.

The
American Academy of Sleep Medicine (AASM) recently published guidelines for the treatment of Sleep Apnea. These guidelines say that OAT is indicated for mild to moderate OSA patients if they prefer it to CPAP, cannot tolerate CPAP, or are unable to use positional therapy or weight loss to control their apnea.

Oral appliances (OAs) are also recommended for severe OSA patients if they cannot tolerate CPAP.

Every OSA patient has specific needs. Dentists are trained to select which OA is right for his or her patient and adjust it for the best results.

OAT takes time. A dentist will continue to monitor a patient’s treatment and may ask the patient to go for a follow-up
Sleep Study to ensure that the OAT is working.

OAT is a safe option for OSA patients who do not tolerate CPAP. As well as for those who prefer it to CPAP.

DSM has become more popular in recent years. But OAT is not new.

In 1934, Pierre Robin reported the first use of an OA to reposition the mandible. Since then, the study and practice of DSM has boomed.

Friday, October 16, 2009

Dental Sleep Medicine: The Basics Part I


18 million – This is the number of Americans who suffer from Obstructive Sleep Apnea (OSA).

People with OSA stop breathing for 10 to 30 seconds, sometimes for one minute or longer. This pause in breathing can happen hundreds of times a night, often causing excessive daytime sleepiness.

If you’ve never heard of dental sleep medicine (DSM), it is a focus of dentistry that addresses OSA.

DSM is the management of sleep-related breathing disorders (SBD), such as snoring and OSA, with Oral Appliance Therapy (OAT) and upper airway surgery.

OAT involves the fitting and adjustment of oral appliances (OAs), which look like mouth guards and are worn at night. These devices reposition the lower jaw and tongue forward to keep an open airway.

OAT should be performed by qualified dentists. Surgery can also treat SBD and should be done by qualified surgeons.

Continuous Positive Airway Pressure (CPAP) is the standard treatment therapy for OSA. But 25 to 50 percent of patients do not tolerate this option. OAT is a safe and effective alternative to CPAP.

SleepEducation has a great blog post on OSA treatments.

OSA is a serious medical condition and must be diagnosed by a physician. Diagnosis is based on the results of an overnight
sleep study.

It is important to treat OSA. If a person does not treat their OSA, they may be at risk for high blood pressure, heart attack, stroke, diabetes, obesity and driving accidents.

Signs of OSA include snoring loudly and making choking, gasping or snorting sounds during sleep. Not surprisingly, an OSA patient’s spouse is often the one who notices that there is a problem.

Find-a-Dentist in your area who practices DSM!

Wednesday, October 14, 2009

National Healthcare Reform Addresses Children’s Oral Health


A Kaiser Health News article reports that Congress is trying to boost the number of children in the U.S who receive dental care.

Children’s Dental Health Project developed a chart to compare how different healthcare proposals would tackle this issue.

Children’s oral health drew national attention in 2007 when Deamonte Driver, a 12 year old boy, died from bacteria that spread from his teeth to his brain. Deamonte was on Medicaid and unable to find the dental help he needed.

Since Deamonte’s death, children’s oral health has received more attention from policy makers. A recent report states that for each child without medical insurance, there are more than two children who do not have dental insurance.

Because 95 percent of dental insurance is managed separately from medical insurance, some people believe that dental health is not a necessity.

That is not the case. These two forms of healthcare often go hand-in-hand. In some areas, like sleep medicine, dentists and doctors work together to help their patients.

Dentists are playing a larger role in children’s healthcare by screening for sleep-related breathing disorders, such as Obstructive Sleep Apnea
.

Sleep Apnea can affect children who are obese or have large tonsils or an abnormal jaw. OSA is a serious condition that blocks a child’s airway while they sleep. Because they can not breathe, children wake up throughout the night.

Signs of OSA include loud snoring, headaches, irritability and daytime sleepiness.

Find-a-Dentist in your area who treats OSA.

Disclaimer

The Official Blog of the American Academy of Dental Sleep Medicine (AADSM) is intended as an information source only. Content of this blog should not be used for self-diagnosis or treatment, and it is not a substitute for medical care, which should be provided by the appropriate health care professional. If you suspect you have a sleep-related breathing disorder, such as obstructive sleep apnea (OSA), you should consult your personal physician or visit an AASM-accredited sleep disorders center. The AADSM, and the American Academy of Sleep Medicine, as the managing agent of the AADSM, assume no liability for the information contained on the Official Blog of the AADSM or for its use.