Living with Sleep Apnea

Living with sleep apnea can be a real challenge, not only for the sufferer but the for the loved ones who share the same bed and/or room.

Family members or bed partners are usually the first ones to notice the snoring. They are normally the first ones to recognize their loved one stops breathing while sleeping. It is essential for people with sleep apnea to get medical help. Sleep apnea sufferers are at higher risk for car crashes, work-related accidents, and other medical problems due to their sleepiness.

Even though some people learn to sleep through someone else's snoring, it is important to recognize a condition like sleep apnea that could be life threatening. Living with sleep apnea is not the only option.

Call Dr. Blumenstock today to find out which solutions we may have for you. Now accepting Medicare and Medical Insurance.

The Battle for Oral Appliance Legitimacy | Sleep Diagnosis and Therapy

The Battle for Oral Appliance Legitimacy

If you’re living in a fox hole, CPAP is highly inconvenient. Army physicians took this simple truth and turned it into a study that has buoyed the case for adjustable oral appliances.
CPAP compliance can be challenging under ideal conditions. Add the dust, sand, and lack of electricity under combat conditions, and therapy adherence can be virtually impossible.
Major Aaron B. Holley, MD, FACP, ran an ICU unit in Afghanistan for 6 months where he treated combat-related injuries. He saw the harsh Arab landscape firsthand, a place where proper sleep is not a priority. Even in cases of clearly identified sleep apnea, most troops could not afford to give up pack space for CPAP devices and batteries.
Back home at Walter Reed National Military Medical Center (WRNMC), Bethesda, Md, Holley and Lt Col Christopher J. Lettieri, MD, FACP, FCCP, FAASM, continued their work to improve sleep for veterans. They believed that if oral appliances (OAs) were as effective as they were convenient, they could ultimately contribute to a stronger fighting force.
Lettieri, Holley, and additional colleagues attempted to find the answer to this question, ultimately publishing research in the December 2011 issue of CHEST. The study, titled Efficacy of an Adjustable Oral Appliance and Comparison With Continuous Positive Airway Pressure for the Treatment of Obstructive Sleep Apnea Syndrome, confirmed excellent results among mild to moderate sleep apnea sufferers.
Accidents and Explosions
Not surprisingly, the quality of sleep among soldiers can be a shambles during combat deployment. Explosions and less-than-ideal sleeping arrangements are unavoidable, but combined with sleep apnea can be even worse. “We know that most injuries are not battle related,” says Lettieri, a co-author of the study. “We have accidents, and if soldiers are sleep deprived, they are going to lack focus and be more prone to accidents.”
It’s a problem on U.S. roadways, but the stakes are even higher when lethal machinery is mixed in. “If you are driving a 40-ton tank around, you can’t afford to make bad decisions,” adds Lettieri, program director, Sleep Medicine Fellowship, WRNMC. “Research shows that chronic low-level sleep deprivation impairs reasoning, decision-making, and slows reaction time. You don’t want that in a combat-deployed troop.”
Beyond the obvious benefits of reduced accidents and convenient placement in a ruck sack, they found that even post traumatic stress disorder (PTSD) may be affected by poor sleep. “We have all these guys coming back with PTSD, and we broke it down into guys who were injured, and those who were not,” explains Lettieri. “Among guys who did not sustain a combat injury, almost universally they had some underlying sleep disorder.”
“When I was over there, we were sleeping next to an air field,” adds Holley. “It’s the nature of deployment that you don’t get a fixed and regular sleep schedule. Even if you take out PTSD and the anxiety of being subjected to mortars and rockets, you still have a situation where people are getting disturbed and fragmented sleep at best.”
Between 2004 and 2006, the Walter Reed sleep clinic gave out oral appliances and CPAP to service men and women on active duty. “When they went to a place without electricity, it would cause problems and sometimes even prevent some people from being able to go overseas,” explains Holley. “The dusty dirty environment made CPAP too difficult to keep clean. Filters in the machines were frequently going down and having problems.”
Large Pool Yields Better Findings
Armed with findings from one of the largest patient populations to date, Army researchers found that adjustable OAs are nearly as effective as CPAP treatment for patients with mild to moderate OSA, and are more effective than fixed oral appliances—particularly in patients with moderate to severe OSA.
“Historically, CPAP has been the primary treatment for OSA, but only half of patients tolerate this therapy,” says Lettieri, an Army medical director, and the chief of Sleep Medicine in the Pulmonary, Critical Care and Sleep Medicine Department at WRNMMC. “This new data offers a fresh look at adjustable oral appliances as an initial treatment for OSA in both the military and civilian sectors.”
The military is interested in the potential of adjustable OAs, also called mandibular advancement devices, as alternatives to CPAP systems since some active duty service members deploy to remote environments where electricity is not always available. In these cases, reliance on CPAP may result in duty restrictions or separation from service. “Adjustable OAs would eliminate duty assignment limitations associated with CPAP, allowing soldiers to travel to remote areas as needed,” adds Lettieri.
The study in CHEST evaluated and compared results of overnight sleep studies in which patients used adjustable OAs or CPAP devices. Researchers found that a significantly higher percentage of patients using an adjustable OA experienced successful reduction of their AHI score to below five apneic events per hour, compared to past reports (62.3% versus 54%).
In most research trials of oral appliances, patients receive oral appliances after they have already failed with CPAP.  It amounts to a selection bias because patients have already failed, and researchers often never really know why they failed. “We thought our data set was unique because a fair proportion of our patients did not fail CPAP since they were given both at the same time,” explains Holley. “The problem with doing this in the real world is you run into cost limitations. It is not cheap to do either of these therapies individually, never mind giving both to everyone up front. This is true in the military or civilian world.”
Changing Perceptions
Holley contends that physician “CPAP followers” are fairly devoted, tending to favor the humidification features of the modality. “Some docs are comfortable with what they are comfortable with, regardless of the evidence, even when it is compelling,” laments Holley. “It takes time to change people’s minds. How much will change with this study is hard to say. I would hope we have at least shifted the thought process and debate so that pulmonologists like me are more likely to not automatically go to CPAP for mild to moderate. It really does work just about as well as CPAP for people who have mild to moderate disease.”
Lettieri and Holley believe the study will (and should) contribute to a shift toward considering OAs earlier in the patient experience. More comparisons with CPAP are necessary, but Holley admits it can be difficult to level the playing field. “CPAP is electronic with a smart card that records compliance,” he says. “We know exactly how well it’s working. The struggle with studying oral appliances is that you must rely on self reporting from patients as to how much they use it. We can prove that oral appliances work, but the next thing to prove is if patients actually wear them more than CPAP. We suspect they do, but we have yet to prove it.”
Building the case is something that Lettieri is content to do. As a 40-year-old physician in a relatively young field, he has seen awareness grow exponentially, and he has helped the military change its perceptions. At Walter Reed, the size of the sleep lab has doubled in recent years and the staff has tripled. Consults have gone from 70 per month to often 70 in a day.
In a culture where sleep deprivation is part of the culture, Lettieri admits that raising awareness has not always been easy. “When I enlisted, the recruiting slogan was ‘We do more by 9:00 a.m. than most people do all day,’” he muses. “We get up early and operate at night. There is a sleep-when-you-can mentality. Americans as a whole keep shortening their average sleep time at night. Since the 1970s, we have about 1.3 hours less per night. The military is even worse.”
SIDEBAR: Military Intelligence
As program director of the Sleep Medicine Fellowship at Walter Reed National Medical Center, Bethesda, Md, Lt Col Christopher J. Lettieri, MD, FACP, FCCP, FAASM, has seen the evolution of sleep medicine. In a culture where sleep deprivation is often considered a badge of honor, the 40-year-old Lettieri has succeeded by educating top brass and soldiers alike with a powerful message: Well-rested soldiers are more effective in the field of battle.
Nowadays, the sleep lab at Walter Reed is a full-fledged sleep disorders center that is recognized as a center of excellence. In addition to pulmonologists, neurologists, pediatricians, and even psychiatrists are applying for fellowship training. Sleep Diagnosis & Therapy sat down with Lettieri to talk about the explosion in sleep awareness and the implications for the military.
How tough is it to get proper rest in the military?
Lettieri: If you are talking about deployment, your sleep quality gets worse because you go from the relatively quiet environment to sleeping among a bunch of other people. There is more noise, radios, helicopters, explosions, and the constant stress.
Is sleep apnea more or less common in the military population?
Lettieri: Sleep apnea is common in general, and it’s common in the military. Even though we tend to be younger and more physically fit, we still have a lot of sleep apnea.
Why is that?
Lettieri: Some of it is anatomic, but a lot of it has to do with chronic low level sleep deprivation. You lose your ability to maintain tone of your upper airways. Back when I was a fellow, I did a research study called, “Obstructive Sleep Apnea Syndrome: Are We Missing an At Risk Population.” Across America, most people thought about sleep apnea in the 55 year-old overweight guy snoring in your waiting room. But really you see it in younger, thinner people. And if you don’t think about it, you’re going to miss the diagnosis.
Are physicians outside of the sleep realm starting to think about sleep apnea outside of the stereotypical patient categories?
Lettieri: With some of my prior research, and in a lot of the lectures I do now, I am trying to get people to think about it in the less typical person, such as the younger girl with chronic headaches and depression. Or the young guy who has unexplained fatigue and ADHD. I’ve always thought we had a lot of it in the military because of this chronic low level sleep deprivation.
Are there examples among fit combat soldiers?
Lettieri: We have had young, active duty guys who get diagnosed with sleep apnea. If it is toward the earlier part of the war, what do you do with them? You cannot bring CPAP in the theater with you. If you’re living in a fox hole, where are you going to plug it in?
Are CPAPs possible at the larger bases?
Lettieri: Even with the more mature theaters we have now, where everybody has laptops plugged in and lamps, you still can’t plug in a CPAP. The Central Command that runs the war said you can’t bring it.
So what do you do now? You’ve got a young guy, and if you tell him he has sleep apnea, he may be out of a job. The alternative is oral appliances.
When did oral appliances emerge as a viable alternative?
Lettieri: A couple of years ago, when we started this, oral appliances were largely considered an alternative to CPAP. You could consider oral appliances if they had a really mild disease, or really hated CPAP.
What do you with young guys who have severe disease?
Lettieri: You can’t say, ‘Well you’re out of the army.’ So we pushed the envelope way beyond what was accepted, because we didn’t want anyone to be forced out of the Military because of sleep apnea” At one point, we had more experience with oral appliances than most of the country combined. We had to get this message out, so we published two papers almost back to back.
Why did you focus so much on the oral appliances?
Lettieri: We did it largely to conserve the military fighting strength. On one hand, we want to find alternatives to CPAP, because while it is great, lots of people don’t like it.
Across the country, it’s a constant battle with better adherence. You can say that with all medical care, but the difference with CPAP is it has an integrated compliance monitoring device. So we look at this thing and we can tell exactly when the person used it. Some people abandon therapy, and roughly only half of people on CPAP have regular use of their therapy. That’s terrible.
CPAP may be great, but if people aren’t going to use it, we’ve got to have another treatment option. For us on a more personal note, we also have to maintain the fighting strength. We must be able to send people into combat.
You don’t diagnose sleep apnea, and then let soldiers go out with an untreated medical disorder. That is not good for anybody. In that case, you are taking very sleepy people and putting them in harm’s way, and you’re going to see more accidents.
How effective are oral appliances?
Lettieri: Nothing’s perfect by any means, but even half of the people with severe disease got what we considered to be adequate therapy. It depends on where you draw your line in the sand.
“We use strict criteria for what we consider to be effective therapy.  It would be hard to argue with this criteria, so most people would have to agree that adjustable oral appliances work.” If we realize that only half the people are actually using their CPAP anyway, then you’re no worse off. Even if CPAP were completely effective, half the people are not going to use it.
What do you think of non adjustable or fixed devices?
Lettieri: The problem is that you get one shot to fix them. We found that they are OK, but only for really mild disease. Anyone with moderate to severe, you need adjustable. And these are ones you can titrate, just like you do when adding a higher dose of a medication or a range of pressures with CPAP. Adjustable ones ought to be used, and are probably more cost effective in the long term because more people get adequate therapy.
What do you think of tongue control devices?
Lettieri: These are essentially suction bulbs affixed to your tongue that pulls your tongue forward. They really don’t work well—maybe for very mild disease they can be adequate. Most patients find them uncomfortable and they are not used much in clinical practice.

Originally Published At ... http://www.sleepdt.com/the-battle-for-oral-appliance-legitimacy/

Sleepwalking is fairly common, study finds

Links to depression, OCD, apnea seen

By Janice Lloyd USA TODAY

   To sleep: perchance to sleepwalk, ah, that is not unusual after all, finds a study Monday in Neurology.

   About 30% of adults in the USA have experienced nighttime wanderings, and those with sleep apneas, psychiatric disorders, depression or obsessive-compulsive disorders are at higher risk, finds the study of 19,136 Americans ages 18 and older. Antidepressants, sleeping pills and certain other medications can increase the risk, but they appear to bring on events in people with a history of sleepwalking.

   “I would like to correct the impression that sleepwalking is rare,” says study author Mau-rice Ohayon, professor of psychiatry and behavioral sciences at the Stanford Sleep Epidemiology Research Center. “This is a huge number of people.”

   Participants were asked in phone surveys about their sleep habits, general health, medications and mental disorders. People who wandered at night at least once during the year were more likely to have a family history of sleepwalking — and often tread on quality sleep for household members. Ohayon says that’s how most know of their somnambulism. “Their partners will wake up in the morning and tell them about it. It can be very disruptive to others, while the person walking at night can be quite unaware.”

   Ohayon says this is the first study to look at how many people sleepwalk, how often, and why. Men and women are just as likely to do it. Other findings:

   u30% of all respondents have sleepwalked.

   u3.6% of those sleepwalked at least once in the past year.

   u2.6% had between one and 12 episodes in the past year.

   u1% had two or more episodes in a month.

   “I think this study shows we don’t recognize nighttime wandering as often as we should,” says neurologist Jan Brandes of Vanderbilt University in Nashville. “We need to encourage people to keep track of their sleep and tell their physician if they do.”

   She adds that no studies have determined longtime health implications of sleepwalking, “but most of us would say going to bed at 10 and waking up at 6 — rather than roaming the house — would be the ideal.”

   People with depression were 3.5 times more likely to sleepwalk; those with obsessive-compulsive disorder, four times more likely.

   Most sleepwalking occurs during deep sleep, according tothe National Institutes of Health.

   Bottom line, Ohayon says: It needs to be identified and treated because of the risk of injury, the importance of a good night’s sleep and disruption to others. “You can’t have anyone, especially older people, wandering around because they could fall and hurt themselves,” he says.


Originally Published At ... http://ee.usatoday.com/SUBSCRIBERS/LandingPage/LandingPage.aspx?href=VVNBLzIwMTIvMDUvMTU.&pageno=Mw..&entity=QXIwMDMwMQ..&view=ZW50aXR5

Sleep lessens effect of genes on weight

Study compares the BMIs of twins

By Nanci Hellmich USA TODAY

   Sleeping more may help you fight a genetic predisposition to gain weight, a new study says.

   “The less sleep you get, the more your genes contribute to how much you weigh. The more sleep you get, the less your genes determine how much you weigh,” says lead author Nathaniel Watson, a neurologist and co-director of the University of Washington Medicine Sleep Center in Seattle.

   Research has shown the connection between sleep and weight before, but this study looks at the role of genetics.

   Watson and his colleagues analyzed self-reported data on height, weight and sleep duration of 604 pairs of identical twins and 484 sets of fraternal twins in the University of Washington Twin Registry.

   People were considered to get short sleep if they slept less than seven hours a night, normal sleep was seven to 8.9 hours, and long sleep if they slept nine hours or more. The average age of participants was about 37 years; average sleep duration was 7.2 hours a night.

   Among findings published online today in the journal Sleep from the American Academy of Sleep Medicine:

   uThose who slept longer at night had lower body mass index (BMI), based on weight and height, than those sleeping less.

   uPeople who slept less increased their genetic risk of an elevated BMI, Watson says.

   uFor twins averaging more than nine hours of sleep, genetic factors accounted for about 32% of weight variations; for those sleeping less than seven hours, genetic factors accounted for 70% of weight variations. For those sleeping seven to nine hours, 60% of the variation was the result of genetic factors. Other factors that affect BMI include environmental ones.

   Both sleep need and BMI are inherited traits, Watson says. “But we see differences in how much twins weigh based on their sleep duration,” he adds.

   He says researchers don’t know which genetic pathways involving weight are influenced by sleep, but they might include those involving hunger, satiety, fat storage, metabolism or other physiological functions.

   Scientists have known for years that sleep deprivation increases levels of a hunger hormone and decreases levels of a hormone that makes you feel full. The effects may lead to overeating and weight gain.

   The new findings are another good reason to be sure you get enough sleep every night, says sleep expert Jodi Mindell, a psychology professor at Saint Joseph’s University in Philadelphia: “If you’re trying to lose weight, getting enough sleep gives you a fighting chance.”


Originally Published At ... http://ee.usatoday.com/SUBSCRIBERS/LandingPage/LandingPage.aspx?href=VVNBLzIwMTIvMDUvMDE.&pageno=MjU.&entity=QXIwMjUwMw..&view=ZW50aXR5

Snoring Isn’t Sexy Member, Norman Blumenstock, DDS Presents Lecture on Snoring and Sleep Apnea to New York 3rd District Dental Society Meeting

Norman Blumenstock, DDS whose dental practice is located in Monroe Township, NJ, presented a lecture entitled “It’s Not Just Snoring or Obstructive Sleep Apnea” to members of the Third District Dental Society of New York and their staff. Dr. Blumentsock’s lecture emphasized dentistry’s role in the recognition and management of sleep breathing disorders.

Snoring Isn't Sexy

Teaching dentists about sleep apnea is important because dentists are in a position to screen for this serious disease.

New York, NY (PRWEB) May 07, 2012

Norman Blumenstock, DDS whose dental practice is located in Monroe Township, NJ, presented a lecture entitled “It’s Not Just Snoring or Obstructive Sleep Apnea” to members of the Third District Dental Society of New York and their staff. Dr. Blumenstock’s lecture emphasized dentistry’s role in the recognition and management of sleep breathing disorders.

Dr. Blumenstock’s lecture provided attendees with the information needed to learn when snoring might be just an annoyance and when it might be the sign of a life-shortening condition know as obstructive sleep apnea. He taught attendees how to screen patients who should be referred to sleep physicians for sleep testing and diagnosis. The lecture included a discussion on the pathophysiology involved in snoring and sleep apnea and how oral appliance therapy works to stabilize the upper airway during sleep.

Dr. Blumenstock is uniquely qualified to teach this subject. He is a charter member of the Sleep Disorder Dental Society and has been credentialed by the Academy of Dental Sleep Medicine (formerly the Sleep Disorder Dental Society). He is a Diplomate of the American Board of Dental Sleep Medicine and a member of the American Academy of Sleep Medicine. Dr. Blumenstock is an Assistant Clinical Professor at UMDNJ – Robert Wood Johnson Medical School and on the staff at the Dental Department of Robert Wood Johnson University Hospital where he evaluates patients who snore and have sleep apnea and would benefit by the use of an oral airway appliance. He serves on staff at the Capital Health Center for Sleep in Hamilton/Trenton.

“Teaching dentists about sleep apnea is important because dentists are in a position to screen for this serious disease,” said Dr. Blumenstock. “With further extensive education they can be proficient in treating patients with this disorder. It’s extremely rewarding to be able to teach dentists to provide a service that can substantially improve the health and quality of life of patients.”

The Third District Dental Society serves dentists in six counties of New York (Albany, Rensselaer, Columbia, Greene, Ulster and Sullivan). The mission of this society is to cultivate and promote the art and science of dentistry and to improve the oral and dental health of the public. Membership consists of 470 dentists.

About Snoring Isn't Sexy, LLC

Snoring Isn't Sexy, LLC was founded in 2008 by Laurence I. Barsh, DMD, a dentist who has been involved with sleep medicine since 1992 and who now devotes full time to educating the public about dentistry's role and responsibility in the recognition and management of snoring and sleep apnea. Dr. Barsh and the dentists associated with Snoring Isn't Sexy, LLC feel strongly that management of sleep-breathing disorders is a shared responsibility of both the medical and dental professions.

Snoring Isn't Sexy, LLC consists of independently owned and operated affiliated offices. Visit SnoringIsntSexy.comfor a directory of all participating dentists or our dedicated Facebook page athttp://www.facebook.com/findsleepapneadentist.

Dr. Blumenstock can be reached for comment at his office at 410 Spotswood Englishtown Rd., Monroe Township, NJ by phone at 732-251-7766, by e-mail to nblumenstock(at)gmail(dot)com or on Facebook. His practice web site ishttp://www.snoredentist.com.