There are several different options to the treatment of sleep apnea. One common treatment is behavioral therapy. Behavioral changes are an important part of treatment, and in some cases behavioral therapy may be all that is needed. Use of alcohol, tobacco, and sleeping pills should be avoided because they make the airway more likely to collapse during sleep and prolong the apneic periods. Patients who are overweight can benefit from losing weight, and even 10 percent weight loss can reduce the number of apneic events for most patients. For those with mild sleep apnea, breathing pauses occur only when they sleep on their backs. In such cases, using pillows and other devices to aid sleeping in a side position has proven beneficial.
Nasal continuous positive airway pressure (CPAP) is a common effective therapy for sleep apnea. With the CPAP, the patient wears a mask during sleep, and pressure from an air blower forces air through the nasal passages. The air pressure can be adjusted so that it is just enough to prevent the throat from collapsing during sleep. The pressure from the CPAP is constant and continuous. Variations in this therapy are available to minimize side effects such as nasal irritation, facial skin irritation, abdominal bloating, mask leaks, sore eyes, and headaches. The variations can be changing the air pressure to coincide with a person's breathing pattern. Although the CPAP has been proven a successful therapy of sleep apnea, patients regularly complain about its lack of comfort.
Fortunately oral sleep appliances and therapy have proven to be a viable alternative to CPAP. For those who are accustomed to the use of CPAP, but would rather not travel with the machine, it is possible that oral appliances can be used just as effectively. Oral appliances are also a good alternative for those individuals who are intolerant to CPAP.
Read more on Sleep Medicine
Thursday, September 30, 2010
Wednesday, September 22, 2010
Sleep Apnea Facts
Sleep apnea is a serious condition that is far more common than generally understood. It was first described in 1965, and was characterized by brief interruptions of breathing during sleep. In Greek, the word "apnea" means, "want of breath." Generally, there are two types of sleep apnea: central and obstructive. Obstructive sleep apnea is the most common type and occurs when air cannot flow in or out of the nose or mouth although efforts to breathe continue. The less common type, central sleep apnea occurs when the brain fails to send the appropriate signals to the breathing muscles that cause respirations.
In a given night, the number of involuntary breathing pauses or "apneic events" may be as high as 40 per hour. These pauses are almost can be accompanied by snoring, although not everyone who snores has this condition. In addition to snoring, sleep apnea can also be characterized by choking sensations. The frequent interruptions of deep, restorative sleep leads to early morning headaches, excessive daytime sleepiness, and irritability.
Early recognition and treatment of sleep apnea is important because it is a potentially life-threatening condition. Sleep Apnea can be associated with irregular heartbeat, high blood pressure, heart attack, and stroke. Get diagnosed, and get treatment today.
Read more on Obstructive Sleep Apnea Treatment
In a given night, the number of involuntary breathing pauses or "apneic events" may be as high as 40 per hour. These pauses are almost can be accompanied by snoring, although not everyone who snores has this condition. In addition to snoring, sleep apnea can also be characterized by choking sensations. The frequent interruptions of deep, restorative sleep leads to early morning headaches, excessive daytime sleepiness, and irritability.
Early recognition and treatment of sleep apnea is important because it is a potentially life-threatening condition. Sleep Apnea can be associated with irregular heartbeat, high blood pressure, heart attack, and stroke. Get diagnosed, and get treatment today.
Read more on Obstructive Sleep Apnea Treatment
Monday, September 20, 2010
Information Behind the CPAP Machine
The most common treatment of sleep apnea is a CPAP machine. CPAP stands for Continuous Positive Air Pressure. It uses a constant flow of air to keep the breathing passages open. A patient wears a mask that receives the airflow from a machine located next to the bed. When used efficiently, the CPAP machine has close to 100% effectiveness for sleep apnea. But, there is a 50% success rate due to patient's inability to tolerate the machine. Many complain that it is noisy, restricts movement, and causes side effects such as dry throat and raw skin where the mask is worn.
Fortunately there are alternatives to the CPAP machine. Oral sleep appliances and therapy have proven to be a viable alternative to CPAP. For those who like the use of CPAP, but would rather not travel with the machine, it is possible that oral appliances can be used just as effectively. Oral appliances are also a good alternative for those individuals who are intolerant to CPAP. There is now a hybrid therapy with CPAP causing the air pressure of the CPAP to be lowered to a more comfortable level and to eliminate air leaks and tight masks. Finally, adjunctive usage means that there can be days off from CPAP usage like for camping and business trips. Some of the benefits of an oral appliance over the CPAP are: no uncomfortable masks or hoses, does not promote claustrophobia like the CPAP can, tolerated much better than CPAP, and no mask impression left on the face.
Dr. Blumenstock has treated many patients who have not been able to tolerate the CPAP, and seek alternative treatment. Within 4-6 treatments you can be fitted with an oral appliance, which is an effective solution for most sleep apnea cases. The biggest benefit is that you and your spouse can actually sleep in the same bed!
Read more on oral sleep appliances
Fortunately there are alternatives to the CPAP machine. Oral sleep appliances and therapy have proven to be a viable alternative to CPAP. For those who like the use of CPAP, but would rather not travel with the machine, it is possible that oral appliances can be used just as effectively. Oral appliances are also a good alternative for those individuals who are intolerant to CPAP. There is now a hybrid therapy with CPAP causing the air pressure of the CPAP to be lowered to a more comfortable level and to eliminate air leaks and tight masks. Finally, adjunctive usage means that there can be days off from CPAP usage like for camping and business trips. Some of the benefits of an oral appliance over the CPAP are: no uncomfortable masks or hoses, does not promote claustrophobia like the CPAP can, tolerated much better than CPAP, and no mask impression left on the face.
Dr. Blumenstock has treated many patients who have not been able to tolerate the CPAP, and seek alternative treatment. Within 4-6 treatments you can be fitted with an oral appliance, which is an effective solution for most sleep apnea cases. The biggest benefit is that you and your spouse can actually sleep in the same bed!
Read more on oral sleep appliances
The Best Sleep Apnea Treatment: CPAP vs. Oral Appliances: A Question of Compliance and Effectiveness
[PR-USA.net] — What is the best sleep apnea treatment? It is not CPAP, according to a recent study that showed 60% of patients abandon CPAP use. At least it is not the best treatment for the 60% of patients who abandoned it. This does not mean CPAP is not the most effective treatment, what it means is no matter how effective a treatment may be, it is a poor treatment if it is not used. Oral appliances are an extremely effective treatment for mild to moderate sleep apnea but less effective for morbidly obese patients and those with severe sleep apnea.
Oral appliances are the “Best Sleep Apnea Treatment” because patients actually use them. Compliance issues have always been the biggest problem with CPAP. Studies have shown most patients quit CPAP completely but even patients who use CPAP average only 4-5 hours/ night 4-5 nights a week. That is not the best treatment but it is better than no treatment. The best site for information on oral appliance therapy and dental sleep medicine is http://www.ihatecpap.com.
Medicare recognized how poor CPAP compliance was and now has minimum usage schedules for CPAP that will save Medicare millions of dollars because such a small percentage of patients actually utilize their machines on a regular basis.
CPAP is the “best treatment” for the 25% of patients who love their CPAP, and use it all night, every night.
Oral appliances may be less effective across a range of all patients at eliminating sleep apnea but they are much more effective at achieving patient compliance. A treatment that is used will always be superior to a treatment that is not used.
Oral appliance success can be greatly improved by titration of appliances in the sleep lab. When an appliance eliminates sleep apnea based on a sleep study it is effectively equivalent to CPAP. The issue of compliance almost always favors oral appliances but objective monitors for oral appliance use are not yet available. They probably will be available in the very near future making oral appliances a leading choice of sleep medicine physicians who care about patients desires.
The best treatment is one that works and is used. For most patients with mild to moderate sleep apnea the best treatment is an oral appliance due to much higher compliance. If compliance is equal and CPAP or appliances are equally effective than both would qualify as the best treatment. The patient can chose their desired treatment. Studies have shown the majority of patients offered a choice prefer a comfortable oral appliance over CPAP.
Some severe sleep apnea patients refuse CPAP, for those patients an oral appliance is superior to “no treatment”.
CPAP is almost always the best treatment for the morbidly obese patients but an oral appliance is still better than no treatment if CPAP is refused.
There are patients who are severe and/or morbidly obese and the “best treatment” is actually combination treatment of an oral appliance and CPAP combined. A mask retained by the teeth instead of straps may be considerably more comfortable for many patients and lower pressure from combined use makes CPAP easier to tolerate.
The best treatment may be CPAP but with a custom made nasal mask that is made from an impression of the patients face similar to how dentures are made. Custom masks combined with oral appliances are a new entry in the field coming from airway management.
Cleanliness is of major importance with both CPAP and oral appliance treatments. Dirty masks and hoses can lead to sinus infections, bronchitis and pneumonia while poor oral hygiene with an oral appliance can lead to periodontal disease. Dr Shapira advise all patients to keep their masks and hoses scrupulously clean. It is vital to be just as thorough in cleaning oral appliances and in maintaining oral hygiene care when wearing an oral appliance. They are not well suited for patients who do not regularly brush their teeth.
What is the best CPAP mask for patients who utilize CPAP? Studies have shown that different masks and machines usually do not increase patient compliance but they do increase comfort for patients who actually use CPAP. Other studies have shown that patients’ usage of CPAP initially predicts long term compliance with CPAP. Patients who reject CPAP initially rarely embrace CPAP use in the long term. What is the best CPAP mask? A mask the patient actually uses. This will be very patient specific.
What is the best type of CPAP machine? There is standard CPAP machines that come in many styles and shapes. The industry has done a good job of making CPAP machines quieter and smaller. BiPAP machines have lower pressure during expiration that reduces claustrophobic feelings in some patients and often eliminates the sensation of drowning on air. Ramping is a gradual increase in pressure allowing patients to fall asleep prior to pressure increasing. Humidification and heated hoses are also increasing patient comfort. Unfortunately all of these advances have not been shown to increase overall patient compliance.
Servo-ventilation machines are more efficient and effective in treating central sleep apnea, which is a neurological condition where the brain “forgets” to breathe.
The best sleep apnea treatment is always patient specific. The 60% of patients who do not tolerate CPAP will likely find comfortable oral appliances are the best treatment.
A small minority of patients do not tolerate CPAP or oral appliances. The best treatment for these patients may be surgery.
What is the best sleep apnea surgery? The morbidly obese and extremely severe sleep apneics may find that a tracheotomy is the best treatment. Patients breathe through their throat bypassing the pharyngeal blockages. Most patients do not want a trach.
Soft palate surgery is almost never the best sleep apnea treatment. UP3 or Uvulopalatopharyngealplasty is painful and has very high morbidity but more importantly rarely eliminates sleep apnea and patients still require CPAP or oral appliance therapy. Pillars, somnoplasty, LAUP or laser-assisted uvuloplasty are less painful but still ineffective in treating most apnea patients completely.
Maxilo mandibular advancement is extremely effective but is major surgery where the upper jaw (maxilla) is cut loose from the skull and often split in pieces, the lower jaw (mandible) is sectioned into 3 pieces and the hyoid bone is sectioned in pieces and then the patient is wired shut for six weeks. This surgery is often very successful. A geniohyoid surgery is less invasive only splitting the lower jaw in pieces and advancing the chin and tongue. While it is effective in patients with severely recessed lower jaws (weak chin) in most patients it is the “Jay Leno” surgery creating his unique profile.
For severely obese patients with severe sleep apnea bariatric surgery may be the best sleep apnea treatment.
It is also possible to do several tongue reduction surgeries that vary in effectiveness. Dr Shapira suggests that patients attempt CPAP and/or Oral Appliances before considering surgery. Patients with blocked nasal airways frequently improve with partial turbinectomies and correction of deviated septums but while helpful this will usually not eliminate sleep apnea.
Dr Shapira reminds patients of the famous quote: “There is no disease or disorder known to man that can’t be made worse by sticking a knife in it.” This does not mean to avoid surgery cautions Dr Shapira but rather to approach any surgery with caution and consider the possible problems associated with surgery.
Information on the dangers of sleep apnea, sleep apnea treatment and comfortable oral appliances is available at http://www.ihatecpap.com.
Dr Ira L Shapira is an author and section editor of Sleep and Health Journal, President of I HATE CPAP LLC, President Dato-TECH, and has a Dental Practice with his partner Dr Mark Amidei. He has recently formed Chicagoland Dental Sleep Medicine Associates. He is a Regent of ICCMO and its representative to the TMD Alliance, He was a founding and certified member of the Sleep Disorder Dental Society which became the American Academy of Dental Sleep Medicine, A founding member of DOSA the Dental Organization for Sleep Apnea. He is a Diplomate of the American Board of Dental Sleep Medicine, A Diplomat of the American Academy of Pain Management, a graduate of LVI. He is a former assistant professor at Rush Medical School’s Sleep Service where he worked with Dr Rosalind Cartwright who is a founder of Sleep Medicine and Dental Sleep Medicine. Dr Shapira is a consultant to numerous sleep centers and teaches courses in Dental Sleep Medicine in his office to doctors from around the U.S. He is the Founder of I HATE CPAP LLC and http://www.ihatecpap.com Dr Shapira also holds several patents on methods and devices for the prophylactic minimally invasive early removal of wisdom teeth and collection of bone marrow and stem cells. Dr Shapira is a licensed general dentist in Illinois and Wisconsin.
Source: http://www.shiftworkdisorder.com/the-best-sleep-apnea-treatment-cpap-vs-oral-appliances-a-question-of-compliance-and-effectiveness-101439.html
Oral appliances are the “Best Sleep Apnea Treatment” because patients actually use them. Compliance issues have always been the biggest problem with CPAP. Studies have shown most patients quit CPAP completely but even patients who use CPAP average only 4-5 hours/ night 4-5 nights a week. That is not the best treatment but it is better than no treatment. The best site for information on oral appliance therapy and dental sleep medicine is http://www.ihatecpap.com.
Medicare recognized how poor CPAP compliance was and now has minimum usage schedules for CPAP that will save Medicare millions of dollars because such a small percentage of patients actually utilize their machines on a regular basis.
CPAP is the “best treatment” for the 25% of patients who love their CPAP, and use it all night, every night.
Oral appliances may be less effective across a range of all patients at eliminating sleep apnea but they are much more effective at achieving patient compliance. A treatment that is used will always be superior to a treatment that is not used.
Oral appliance success can be greatly improved by titration of appliances in the sleep lab. When an appliance eliminates sleep apnea based on a sleep study it is effectively equivalent to CPAP. The issue of compliance almost always favors oral appliances but objective monitors for oral appliance use are not yet available. They probably will be available in the very near future making oral appliances a leading choice of sleep medicine physicians who care about patients desires.
The best treatment is one that works and is used. For most patients with mild to moderate sleep apnea the best treatment is an oral appliance due to much higher compliance. If compliance is equal and CPAP or appliances are equally effective than both would qualify as the best treatment. The patient can chose their desired treatment. Studies have shown the majority of patients offered a choice prefer a comfortable oral appliance over CPAP.
Some severe sleep apnea patients refuse CPAP, for those patients an oral appliance is superior to “no treatment”.
CPAP is almost always the best treatment for the morbidly obese patients but an oral appliance is still better than no treatment if CPAP is refused.
There are patients who are severe and/or morbidly obese and the “best treatment” is actually combination treatment of an oral appliance and CPAP combined. A mask retained by the teeth instead of straps may be considerably more comfortable for many patients and lower pressure from combined use makes CPAP easier to tolerate.
The best treatment may be CPAP but with a custom made nasal mask that is made from an impression of the patients face similar to how dentures are made. Custom masks combined with oral appliances are a new entry in the field coming from airway management.
Cleanliness is of major importance with both CPAP and oral appliance treatments. Dirty masks and hoses can lead to sinus infections, bronchitis and pneumonia while poor oral hygiene with an oral appliance can lead to periodontal disease. Dr Shapira advise all patients to keep their masks and hoses scrupulously clean. It is vital to be just as thorough in cleaning oral appliances and in maintaining oral hygiene care when wearing an oral appliance. They are not well suited for patients who do not regularly brush their teeth.
What is the best CPAP mask for patients who utilize CPAP? Studies have shown that different masks and machines usually do not increase patient compliance but they do increase comfort for patients who actually use CPAP. Other studies have shown that patients’ usage of CPAP initially predicts long term compliance with CPAP. Patients who reject CPAP initially rarely embrace CPAP use in the long term. What is the best CPAP mask? A mask the patient actually uses. This will be very patient specific.
What is the best type of CPAP machine? There is standard CPAP machines that come in many styles and shapes. The industry has done a good job of making CPAP machines quieter and smaller. BiPAP machines have lower pressure during expiration that reduces claustrophobic feelings in some patients and often eliminates the sensation of drowning on air. Ramping is a gradual increase in pressure allowing patients to fall asleep prior to pressure increasing. Humidification and heated hoses are also increasing patient comfort. Unfortunately all of these advances have not been shown to increase overall patient compliance.
Servo-ventilation machines are more efficient and effective in treating central sleep apnea, which is a neurological condition where the brain “forgets” to breathe.
The best sleep apnea treatment is always patient specific. The 60% of patients who do not tolerate CPAP will likely find comfortable oral appliances are the best treatment.
A small minority of patients do not tolerate CPAP or oral appliances. The best treatment for these patients may be surgery.
What is the best sleep apnea surgery? The morbidly obese and extremely severe sleep apneics may find that a tracheotomy is the best treatment. Patients breathe through their throat bypassing the pharyngeal blockages. Most patients do not want a trach.
Soft palate surgery is almost never the best sleep apnea treatment. UP3 or Uvulopalatopharyngealplasty is painful and has very high morbidity but more importantly rarely eliminates sleep apnea and patients still require CPAP or oral appliance therapy. Pillars, somnoplasty, LAUP or laser-assisted uvuloplasty are less painful but still ineffective in treating most apnea patients completely.
Maxilo mandibular advancement is extremely effective but is major surgery where the upper jaw (maxilla) is cut loose from the skull and often split in pieces, the lower jaw (mandible) is sectioned into 3 pieces and the hyoid bone is sectioned in pieces and then the patient is wired shut for six weeks. This surgery is often very successful. A geniohyoid surgery is less invasive only splitting the lower jaw in pieces and advancing the chin and tongue. While it is effective in patients with severely recessed lower jaws (weak chin) in most patients it is the “Jay Leno” surgery creating his unique profile.
For severely obese patients with severe sleep apnea bariatric surgery may be the best sleep apnea treatment.
It is also possible to do several tongue reduction surgeries that vary in effectiveness. Dr Shapira suggests that patients attempt CPAP and/or Oral Appliances before considering surgery. Patients with blocked nasal airways frequently improve with partial turbinectomies and correction of deviated septums but while helpful this will usually not eliminate sleep apnea.
Dr Shapira reminds patients of the famous quote: “There is no disease or disorder known to man that can’t be made worse by sticking a knife in it.” This does not mean to avoid surgery cautions Dr Shapira but rather to approach any surgery with caution and consider the possible problems associated with surgery.
Information on the dangers of sleep apnea, sleep apnea treatment and comfortable oral appliances is available at http://www.ihatecpap.com.
Dr Ira L Shapira is an author and section editor of Sleep and Health Journal, President of I HATE CPAP LLC, President Dato-TECH, and has a Dental Practice with his partner Dr Mark Amidei. He has recently formed Chicagoland Dental Sleep Medicine Associates. He is a Regent of ICCMO and its representative to the TMD Alliance, He was a founding and certified member of the Sleep Disorder Dental Society which became the American Academy of Dental Sleep Medicine, A founding member of DOSA the Dental Organization for Sleep Apnea. He is a Diplomate of the American Board of Dental Sleep Medicine, A Diplomat of the American Academy of Pain Management, a graduate of LVI. He is a former assistant professor at Rush Medical School’s Sleep Service where he worked with Dr Rosalind Cartwright who is a founder of Sleep Medicine and Dental Sleep Medicine. Dr Shapira is a consultant to numerous sleep centers and teaches courses in Dental Sleep Medicine in his office to doctors from around the U.S. He is the Founder of I HATE CPAP LLC and http://www.ihatecpap.com Dr Shapira also holds several patents on methods and devices for the prophylactic minimally invasive early removal of wisdom teeth and collection of bone marrow and stem cells. Dr Shapira is a licensed general dentist in Illinois and Wisconsin.
Source: http://www.shiftworkdisorder.com/the-best-sleep-apnea-treatment-cpap-vs-oral-appliances-a-question-of-compliance-and-effectiveness-101439.html
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