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Wednesday, November 12, 2014 7:49:00 PM

We do our best to help our patients get the best sleep possible by treating their sleep apnea with the oral appliance. However, sometimes more is needed. Here are 10 adjustments you can consider if you are still not feeling as refreshed in the morning as you'd like.

1. Make it dark
Light and darkness are powerful cues that tell your brain it's time to rest or get you ready for a productive day. So it's no surprise that light in the bedroom (as well as light peeking in from outside) has an impact on the quality of your sleep. Dimming the lights about an hour before bedtime will help regulate your body clock and tell your brain that it's time to shift into sleep mode. At home, use room darkening shades and curtains to keep it dark at night.

2. Make it quiet
If this is a problem, sound conditioners mask noises that can disturb your sleep and create a consistent and soothing backdrop throughout the night.

3. Create a healthy environment
Controlling nighttime allergies is a great way to improve your sleep. Keep your room clean and use pillow and mattress protectors to help protect against allergens, dust mites, bed bugs, bacteria, mold and mildew.

4. Create comfort
Welcome bedtime with a mattress and pillows that are comfortable to you. It's up to you whether you have a soft or firm mattress - make that decision based on personal preference and your typical sleeping position (although side sleeping is best). The right pillow can improve the quality of your sleep. It allows you to rest comfortably in your ideal sleeping position and supports your head and neck in a neutral position, allowing for better sleep. Drift off to sleep with soft sheets and blankets that smell clean and fresh. Choose textures and colors that will soothe, like crisp cottons, luxurious down comforters, and pale, soft blues, greens or greys.

5. Keep cool
A cool room, typically between 60 and 67 degrees, makes for the best sleep.

6. Turn off electronics
Falling asleep with the TV on can interrupt your sleep. Unlike white noise, TV sounds are contantly changing in tone and volume. Store your phone and other electronic devices away from the bed. Light emitted from computer screens and other electronic devices close to bedtime can disrupt your sleep. Instead, spend the last hour before bed doing a calming activity such as reading, and try a sound conditioner or a fan if you don't like a quiet bedroom.

7. Relax and invite sleep
To help clear your mind before bed, try a breathing exercise or relaxation technique.

8. Eat sleep friendly foods
Keep your snacks light when eating at night. Try a banana and a handful of almonds, or a cup of chamomile tea. All of these foods have sleep-inducing properties. Avoid stimulants like caffeine - which can be found in everything from tea to chocolate - after 2:00pm, as the effects can linger for many hours.

9. Use relaxing scents
Include scents in your bedtime routine to help relax and unwind. Lavender is one scent that improves mood and increases relaxation. You can use scents in your bedroom that you like best, like honey, jasmine or lavender.

10. Exercise
Exercise is great for sleep. Exercise at any time of day, but not at the expense of your sleep.

Posted by R. Sam Callender DDS | 11/12/2014 11:49:00 AM



Wednesday, November 12, 2014 6:24:00 PM

As all of our patient's can attest, Dr. Callender feels very strongly about the need for his sleep apnea patients to sleep on their side. A recent article from the National Sleep Foundation highlighted the "Best Sleep Positions for Sleep Apnea Sufferers". Here is what they had to say:

Side Sleeping

Rest on one side, slightly curled with your knees bent. Use a supportive pillow for your head that keeps your spine in alignment. Side sleeping can be made better by placing a pillow between your knees.

To help you do this, you can sew a pocket or pin a sock on the back of your pajamas and place an object like a tennis ball (we recommend a whiffle ball) into it. You'll detect an attempt to lie flat on your back during the night and you can adjust back to a side sleeping position. This may also mean that it's time to check out a new mattress - a worn-out mattress is often uncomfortable for side sleeping.

Upright sleeping

Elevate your head significantly while you sleep to improve your breathing. You can use multiple pillows or even try a specially designed wedge pillow to achieve this position. Some beds offer moveable support that allows you to raise the mattress to help accommodate upright sleeping.

Posted by R. Sam Callender DDS | 11/12/2014 10:24:00 AM



Thursday, April 17, 2014 11:08:00 PM

There is growing awareness and therefore growing concern regarding undiagnosed sleep disorders in pilots. The US House of Representatives passed a bill that would require that a specific rulemaking process be followed before regulations could be changed regarding the screening and treatment of pilots for obstructive sleep apnea. The goal of the bill is to help create policy changes that will help identify more effective and less intrusive ways of identifying at risk pilots in order to keep everyone flying safely. This issue was reported by Sleep Review Magazine.

Posted by R. Sam Callender DDS | 4/17/2014 4:08:00 PM



Wednesday, February 06, 2013 11:31:00 PM

Recently a study was presented at the 70th Annual Scientific Meeting of the American College of Gastroenterology which showed that out of 81 patients with documented sleep complaints, 26 percent had acid reflux. Of those who suffered with reflux, 94 percent of the recorded reflux events were associated with arousal from sleep or awakening.

Posted by R. Sam Callender DDS | 2/6/2013 3:31:00 PM



Tuesday, May 29, 2012 3:45:00 PM

Sleep apnea has been in the news recently, here is an article that ran in the New York Times May 20, 2012 by Anahad O'Connor that we thought was note worthy:

Two new studies have found that people with sleep apnea, a common disorder that causes snoring, fatigue and dangerous pauses in breathing at night, have a higher risk of cancer. The new research marks the first time that sleep apnea has been linked to cancer in humans.

About 28 million Americans have some form of sleep apnea, though many cases go undiagnosed. For sleep doctors, the condition is a top concern because it deprives the body of oxygen at night and often coincides with cardiovascular disease, obesity and diabetes.

"This is really big news", said Dr. Joseph Golish, a professor of sleep medicine with the Metro Health System in Cleveland who was not involved in the research. "It's the first time this has been shown, and it looks like a very solid association", he said.

Dr. Golish, the former chief of sleep medicine at the Cleveland Clinic, said that the cancer link may not prove to be as strong as the well-documented relationship between sleep apnea and cardiovascular disease, "but until disproven, it would be one more reason to get your apnea treated or to get it diagnosed if you think you might have it."

In one of the new studies, researchers in Spain followed thousands of patients at sleep clinics and found that those with the most severe forms of sleep apnea had a 65 percent greater risk of developing cancer of any kind. The second study, of about 1,500 government workers in Wisconsin, showed that those with the most breathing abnormalities at night had five times the rate of dying from cancer as people without the sleep disorder. Both research teams only looked at cancer diagnoses and outcomes in general, without focusing on any specific type of cancer.

In both studies, being presented in San Francisco this week at an international conference organized by the American Thoracic Society, the researchers ruled out the possibility that the usual risk factors for cancer, like age, smoking, alcohol use, physical activity and weight, could have played a role. The association between cancer and disordered breathing at night remained even after they adjusted these and other variables.

Dr. Mitesh Borad, a cancer researcher and assistant professor of medicine at the Mayo Clinic who was not involved with the studies, called the findings "provocative" but said more research was needed to confirm the association. The studies were observational, and other, unknown factors may account for the correlation between sleep apnea cancer.

Recent animal studies have suggested that sleep apnea might play a role in cancer. When mice with tumors were placed in low-oxygen environments that simulate the effects of sleep apnea, their cancers progressed more rapidly. Scientists speculate that depriving mice of oxygen may cause their bodies to develop more blood vessels to compensate, an effect that could act as a kind of fertilizer for cancer tissue and cause tumors to grow and spread more quickly.

The researchers wondered whether a similar relationship might exist in people with sleep apnea. in whom throat muscles collapse during sleep, choking off the airway and causing gasping and snoring as the body fights for air. Severe sleep apnea can produce hundreds of such episodes each night, depleting the body of oxygen.

In one study, a team at the University of Wisconsin School of Medicine and Public Health examined data on state workers taking part in the long-running Wisconsin Sleep Cohort, who since 1989 have undergone extensive overnight sleep studies and other measures of health about every four years. The landmark project was one of the first to reveal the widespread occurrence of sleep apnea in the general population.

The researchers found that the more severe a person's breathing problems at night, the greater the likelihood of dying from cancer. People with moderate apnea were found to die of cancer at a rate double that of people without disordered breathing at night, while those in the severe category died at a rate 4.8 times that of those without the sleep disorder.

"That is really striking", said Dr. F. Javier Nieto, one of the study's authors and chairman of the department of population health sciences at the University of Wisconsin. "It could be something else, but it's hard to imagine that something we didn't control for is causing this".

In  the second study, researchers with the Spanish Sleep Network took a slightly different approach, looking not at cancer mortality among apnea patients, but at the incidence of cancer. They used a measure called the hypoxemia index, which looks at the amount of time the level of oxygen in a person's blood drops below 90 percent at night.

About 5,200 people were followed for seven years, none of whom had a cancer diagnosis when the study began. The researchers found that the greater the extent of hypoxemia, or oxygen depletion, during sleep, the more likely a person would receive a cancer diagnosis during the study period.

People whose oxygen levels dropped below 90 percent for up to 12 percent of the total time they were asleep, for example, had a 68 percent greater likelihood of developing cancer than people whose oxygen levels did not plummet at night, said study author Dr. Miguel Angel Martinez-Garcia of La Fe University and Polytechnic Hospital in Spain. As time spent without oxygen increased, so too did the cancer risk.

Although the study did not look for it, Dr. Martinez-Garcia speculated that treatments for sleep apnea like continuous positive airway pressure, or CPAP, which keeps the airways open at night might reduce the association.

The Wisconsin study also did not specifically look at the impact treatment for apnea on survival, either, but when people who were being treated with CPAP were removed from the analysis, the cancer association became stronger, "which is consistent with the hypoxemia theory," Dr. Nieto said. "I would say that this is one more instance that shows that sleep apnea can have profound impacts for people's health", he added. "Not breathing while you're sleeping is a serious problem".

Posted by R. Sam Callender DDS | 5/29/2012 8:45:00 AM



Wednesday, May 02, 2012 3:57:00 PM

The following update came from the Sleep Group Solutions:

Sleep Group Solutions teams up with former NFL superstars to tackle sleep apnea by raising awareness through seminars.

We remember the NFL #1 Draft pick JaMarcus Russell for the Oakland Raiders back in 2007. His mediocre performance on the field was later linked to sleep apnea. Sleep Group Solutions and Dr. Harry Sugg are teaming up with former NFL Linemen Derek Kennard and Nate Newton to raise awareness of sleep apnea through a series of events titled "Tackle Sleep Apnea".

On April 26th 2012 Derek Kennard and Nate Newton made sure to let the NFL Draft hopefuls know about sleep apnea, as well as their former NFL teammates and the public. Hitting close to home, Derek spoke about the importance of seeking treatment if you have any of the symptoms of sleep apnea such as snoring, high blood pressure, hypertension, diabetes, etc. Dr. Sugg, a dentist in Dallas Texas is among a small group of dentists who offer treatment for snoring and sleep apnea. Sleep Group Solutions teaches dentists such as Dr. Sugg how to screen and treat sleep apnea through Oral Appliance Therapy. "The first Tackle Sleep Apnea event went even better than anticipated. So much support by the media, as well as the NFL was a great way to show the public just how dangerous sleep apnea is. All of us supporters are eager to plan the next public awareness event", Rani Ben-David said on the event.

Posted by R. Sam Callender DDS | 5/2/2012 8:57:00 AM



Monday, March 12, 2012 9:43:00 PM

We came across an interesting article in the February/March 2012 edition of Neurology Now which linked obstructive sleep apnea (OSA) with  cognitive problems due to the decrease in blood oxygen saturation at night. A study done at the University of California, San Francisco, showed that OSA might contribute to dementia. The drops in blood oxygen (hypoxemia) which occur with sleep apnea puts a strain on all the tissues and organs of the body, especially the brain which uses about 20% of the body's oxygen supply! The study showed that those who experience repeated nighttime hypoxemia were more likely to develop dementia. The study also indicated that cognitive impairment might be partially reversible in some cases if treated. Another noteworthy part of this study is that all the patients tested were women and all were experiencing only mild to moderate OSA. So if mild OSA can contribute to dementia, think of what severe sleep apnea does to the brain!

More information can be found at www.neurologynow.com

Posted by R. Sam Callender DDS | 3/12/2012 2:43:00 PM



Wednesday, February 29, 2012 11:05:00 PM

New research has been published by the Agency for Healthcare Research and Quality regarding the effectiveness of diagnosis and treatment of sleep apnea in adults, we thought we'd pass it along to you. The report highlighted the seriousness of treating severe sleep apnea because of it's association with diabetes and other chronic diseases.

The full report can be found at www.effectivehealthcare.ahrq.gov/apnea.cfm.

Posted by R. Sam Callender DDS | 2/29/2012 3:05:00 PM



Wednesday, October 05, 2011 6:24:00 PM

The following article was featured in the July/August 2011 edition of Sleep Review: The Journal for Sleep Specialists and we thought we would pass the information along to you. The article was written by Barry Krakow MD.

   More than 30,000 individuals die by suicide each year in the United States. For every death by suicide, there are 10 - 25 nonlethal attempts. Lifetime prevalence indicates 5% of the population reports a suicide attempt, 4% a plan, and 14% ideation. Although suicide is the 11th leading cause of death in the United States, recent research reveals a number of risk factors that may be targeted to prevent fatalities.
   In our field of sleep medicine, research points to sleep disturbances as significant risk factors for suicidal ideation and behaviors. Deverity of global insomnia has been identified as a significant - and, importantly, modifiable - short-term risk factor for suicide. Hypersomnia and poor sleep quality have both been predictive of eventual death by suicide. Suicidal individuals report significantly higher rates of nightmares, especially when the patient is suffering from depression. Other sleep disturbances have been implicated as potential suicide risk factors, including lower sleep efficiency, longer sleep latency and sleep-disordered breathing.
   The knowledge that sleep problems may provoke or worsen suicidal thoughts creates a clinically important opportunity for sleep physicians, because patients with both sleep problems and suicidal ideation may seek treatment at sleep centers, particularly if their experiences with psychiatrists or other therapists have not fully resolved their mental health concerns. In such circumstances, mental health patients may suffer from lingering insomnia or nonrestorative sleep due to ineffective psychotherapy or psychotropic medications. If insomnia persists, they may turn their attention toward solving their sleep problems by seeking help from a sleep specialist. And sleep centers and providers would then have the change to detect and provide early intervention for these patients before their suicidal ideation progresses to suicidal behaviors or completed suicides.
   Until recently, research had not been conducted on the prevalence of suicidal ideation in patients seeking treatment at sleep medical centers. In 2010, we collaborated with experts in the field of suicide research at Florida State University (Drs Thomas Joiner and Jessica Ribeiro) to evaluate a large database of sleep patients who sought treatment at Maimondies Sleep Arts & Sciences, a community-based sleep center that specializes in the treatment of mental health patients with sleep disorders. Our results were published in the Journal of Affective Disorders in January 2011.
   From our database of 1,584 patients, we discovered that 13% (n = 211) of the entire sample reported suicidal ideation; and more than a third of these patients or 4.5% of the total sample reported a degree of suicidal ideation consistent with apparent clinical risk.
   Statistically, a very large number of common sleep factors were associated significantly with suicidal ideation including:

  • Poor sleep quality
  • Lighter sleep
  • Insomnia severity
  • Awakenings at night
  • Sleep onset latency
  • Prolonged time in bed
  • Wake time after sleep onset
  • Lower sleep efficiency
  • Daytime fatigue and sleepiness
   Additonal interesting associations were parasomnias such as nightmares, acting out dreams and disruptive sleep behaviors. Also, psychophysiological conditioning such as excessive time monitoring behavior or "losing sleep over losing sleep" was associated with the severity of suicidal ideation. Even something as simple as a poor sleep environment was associated with suicidal ideation.
   To further analyze all these factors, we then controlled for depressive symptoms in our sample, because suicidal ideation is so strongly linked to depression. With this analysis, a number of sleep factors still correlated significantly with suicidal ideation or showed a trend toward significance, including greater chronicity of sleep problems, poor sleep quality, daytime fatigue, lighter sleep, prolonged time in bed and nightmares. So, even though the effects of depressive symptoms were removed from the analysis, these sleep symptoms remained in association with suicidal ideation.
   Now, this type of research cannot prove these sleep factors cause suicidal ideation or lead to completed suicides. However, the pervasiveness of these associations strongly suggests that intervention research is needed to learn whether treatment of these sleep problems would result in a decrease in suicidal ideation. Research programs are currently in the proposal stages to the Military Suicide Research Consortium to investigate whether sleep treatments such as cognitive-behavioral therapy for insomnia (CBT-I) or imagery rehearsal therapy (IRT) for nightmares can be effectively administered to military personnel who suffer from suicidal ideation.
   At Maimonides Sleep Arts & Sciences, we use Dr. Joiner's DSI-SS scale (Depression Severity Index - Suicide Subscale) of four brief questions on suicidal thoughts and behaviors. If patients are identified with elevated scores, we contact them to find out whether they are currently undergoing counseling. If not, we help them make arrangements to begin work with a therapist. In rare instances in the clinic, we have also helped suicidal patients initiate preliminary actions (eg, removal of a gun from the home; third-party monitoring of medications) in conjunction with their therapists. Most importantly, we aggressively treat their sleep problems in the belief that enhanced sleep quality will improve mental health symptoms.
  In summary, suicidal ideation appears to be fairly common in treatment-seeking sleep patients. Prevalence rates will likely vary depending on the type of sleep medical center and the population it serves. It seems plausible that evidence-based treatments of sleep disorders would lower suicidal risks, mostly in the area of decreased suicidal ideation. In fact, a recent case study showed that auto-CPAP treatment in an elderly sleep apnea patient dramatically eliminated suicidal ideation. Thus, the sleep center may prove to be an important research venue or early intervention site for this deadly and common mental health problem.

Posted by R. Sam Callender DDS | 10/5/2011 11:24:00 AM



Wednesday, October 05, 2011 4:50:00 PM

An article featured in the Denver Post this summer addressed the link between sleep apnea and dementia. Here's what the article had to say:

   Older women with sleep apnea have twice the risk of developing dementia as those without the breathing disorder, according to a study published Tuesday, but the data weren't conclusive as to why.

   The findings indicate that people with sleep apnea should be screened for cognitive problems, said Kristine Yaffe, an author of the study in JAMA: the Journal of the American Medical Association.

   Potential cognitive decline "is another reason why you want to be medically followed carefully and possibly treated" for sleep apnea, said Dr. Yaffe, who is a professor of psychiatry, neurology and epidemiology at the University of California, San Francisco.

   Sleep apnea, in which sufferers stop breathing as many as hundreds of times a night, commonly results from a blockage of the airway during sleep. The disorder is estimated to affect 10% to 20% of middle-aged and older adults, according to a recent report by the federal Agency for Healthcare Research and Quality.

   The study published Tuesday followed 298 older women who all started off testing cognitively normal. They had a mean age of 82 and were followed for an average of five years. Over that time, the women who had sleep apnea were twice as likely to develop memory decline or other symptoms of dementia.

   When a person stops breathing during sleep, blood-oxygenation levels fall. When it reaches a certain low, the body wakes itself and begins breathing again. To get a diagnosis of sleep apnea, such episodes must occur five or more times per hour. Typically a person with sleep apnea isn't aware this is happening but feels tired upon waking despite getting many hours of sleep.

   The increased risk of dementia appeared linked to the amount of time the women experienced decreased oxygen, not the total amount of sleep or the number of interruptions to their sleep. It isn't definitive from the data, however, whether oxygen deprivation caused the dementia symptoms or some other pathology was responsible for both the sleep problems and the cognitive decline. The results would likely apply to men as well but need to be replicated in that population, Dr. Yaffe said.

   The study examined women with moderate sleep apnea - 15 or more breathing stoppages per hour - so the cognitive impact among those with milder sleep apnea wasn't clear, said Amy Aronsky, medical director for the Center for Sleep Disorders in Longview, Wash., who wasn't involved with the study. However, the finding "gives further proof to the idea that untreated sleep apnea has a lot of unintended consequences", Dr. Aronsky said.

This article was written by Shirley S. Wang

Posted by R. Sam Callender DDS | 10/5/2011 9:50:00 AM



Wednesday, June 08, 2011 7:39:00 PM

We are happy to announce that we have now been accepted as a participating provider with CIGNA Healthcare to provide oral appliances for sleep apnea. Contact our office today to find out what coverage might be available with your CIGNA plan and start sleeping better tonight!

Posted by R. Sam Callender DDS | 6/8/2011 12:39:00 PM



Monday, March 28, 2011 3:42:00 PM

We are pleased to announce that we are now participating with Medicare as a durable medical equipment supplier for oral appliances!

Late last year Medicare determined that they will cover sleep apnea appliances when medically necessary. In order to establish medical necessity, the patient must have an overnight sleep study performed that documents an apnea-hypopnea index (AHI) of 15 or greater. If less than 15 but more than 5, must have documentation of excessive daytime sleepiness, impaired cognition, mood disorders or insomnia or hypertension, ischemic heart disease or history of stroke. If the AHI is greater than 30, must have documentation of CPAP trial and reason of non-compliance.

Medicare also requires a prescription to be written by the primary care physician sent to our office describing the need for an oral appliance.

Our staff can assist you in gathering all documentation required by Medicare prior to your appointment. Why not give us a call today and start sleeping better!

Posted by R. Sam Callender DDS | 3/28/2011 8:42:00 AM



Wednesday, March 02, 2011 11:20:00 PM

Thank you for checking out our blog! Our goal is to keep you up to date with the world of sleep apnea and to provide informative and helpful information. The following came to us from the American Academy of Dental Sleep Medicine:

A study done by the University of Texas Health Science Center at San Antonio published 1/14/2009 shows that dental appliances are successful in treatment of patient with severe sleep apnea.  The study used the Thornton Adjustable Positioner (TAP) and according to assistant professor Paul McLornan B.D.S in the Department of Prosthodontics, "We saw patients who began the study with severe sleep apnea end the study with very mild or no sleep apnea. They reported sleeping better, feeling more rested in the morning and altogether healthier."

Dr. McLornan said this research is vital to both the medical and dental communities.

"What we found was that many of our patients with moderate to severe sleep apnea were not adhering to standard treatment with Continuous Positive Airway Pressure (CPAP). Although the CPAP is considered to be the gold standard in treating sleep apnea and is very effective, compliance by patients is well below 50 percent. Sleep apnea is a growing and serious problem for people of all ages and all ethnic groups. If left untreated, it becomes progressively worse. People suffering from sleep apnea are at increased risk for high blood pressure, heart attacks, strokes, obesity and diabetes. It takes both dentists and medical professionals working together to control this potentially deadly disorder. The TAP gives patients another viable treatment alternative."

The American Academy of Sleep Medicine, the professional society that sets the standards for and promotes excellence in sleep medicine, now recommends that oral appliances can be the first line of treatment for people with mild to moderate sleep apnea. Dr. McLornan's study demonstrates it can be used for patients with severe problems as well.

Posted by R. Sam Callender DDS | 3/2/2011 3:20:00 PM



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