Patients with mild to moderate obstructive sleep apnea (OSA) may consider adjustable oral appliances (OAs), devices that fit within the mouth to prevent upper airway collapse, as an effective first-line treatment, according to two studies conducted by sleep medicine specialists from Walter Reed National Military Medical Center (WRNMMC) in Bethesda, Md.
The retrospective, peer-reviewed studies, published in the December 2011 issue of CHEST and in the current issue of the Journal of Clinical Sleep Medicine (JCSM), provide findings on OAs from the largest patient populations studied to date.The studies found that adjustable OAs are nearly as effective as continuous positive airway pressure (CPAP) treatment for patients with a mild form of 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, which requires wearing a face mask hooked to a machine each night," said Lt. Col. Christopher Lettieri, M.D., one of the studies' authors, 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." Eighteen million Americans, or 4 percent of men and 2 percent of women, suffer from sleep apnea, which can cause daytime sleepiness and has been linked to high blood pressure, heart attack, and stroke.
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 austere environments where electricity needed to run CPAP machines is not always available. In these cases, reliance on CPAP may result in duty restrictions or separation from service.
The study in CHEST, titled "Efficacy of an Adjustable Oral Appliance and Comparison to Continuous Positive Airway Pressure for the Treatment of Obstructive Sleep Apnea Syndrome," evaluated and compared results of overnight sleep studies in which patients used adjustable OAs or CPAP devices. Results were measured by the apnea-hypopnea index (AHI) score, used to assess the severity of sleep apnea based on the total number of complete cessations (apnea) and partial obstructions (hypoapnea) of breathing that last for at least 10 seconds per hour of sleep. 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 in this study compared to past reports (62.3 percent versus 54 percent).
In the JCSM study, "Comparison of Adjustable and Fixed Oral Appliances for the Treatment of Obstructive Sleep Apnea," patients were treated with either adjustable or fixed OAs and a sleep evaluation was conducted before and during treatment with the devices. Patients using adjustable OAs had a greater reduction in obstructive events (AHI), revealing that adjustable OAs had a greater efficacy than fixed devices (57.2 percent vs. 46.9 percent) among this patient cohort.
A total of 497 patients were prescribed adjustable OAs in the CHEST study and 602 patients in the JCSM study. The studies included patients who participated in an overnight sleep study at the sleep disorders center at Walter Reed National Military Medical Center.
Article by Advance for Respiratory Care & Sleep Medicine
Wednesday, December 28, 2011
Monday, December 26, 2011
Real-life testimonial: CPAP machine user converts to new, oral appliance for treatment of sleep apnea
“Dear Dr. Blumenstock:
As someone who has struggled with coronary artery disease, sleep apnea and chronic snoring for over several years, I write to express my deepest gratitude for equipping me with an oral repositioning appliance. It is truly a godsend and the clinical results have already far exceeded my hopes and expectations.
As you are aware, following triple bypass surgery in May, 2006 and a subsequent stent for a collapsed graft, my longstanding sleep apnea became an even more serious concern and threat to my health. For the second time, I tried in earnest to adapt to a CPAP machine. Struggling for weeks and never being able to keep the mask on, or adapt to that mode of treatment, I had given up on any effective means of treating the sleep apnea. It was then that I discovered you and your services at Central Jersey Dental.
As you introduced me to the potential benefits of wearing a dental device as a means of treating sleep apnea, I must confess that I was initially somewhat skeptical. But, after only a few weeks of using the device and experiencing its benefits, I am a true "convert!" My wife became immediately (and gratefully!) aware that all snoring had ceased. Consequently, we can now both sleep in the same bed with total comfort. Within days, I was also aware of better energy and less daytime sleepiness (particularly in the afternoons); what a blessing that has become. But, perhaps most important of all, I have watched my blood pressure reduce approx. 10-12 points - both diastolic and systolic.
Needless to say, my cardiologist and primary care physician are delighted with this development and assure me that it bodes extremely well in curbing further cardiac disease and enhancing my longevity. While I cannot say enough for these clinical enhancements in my life, I also want to take this opportunity to share my deep appreciation for the many ways you and your staff have treated me as a "whole person" throughout this process, continually providing helpful education, personal care and emotional support in introducing me to this invaluable new intervention and treatment.
If I can ever be of any help in "coaching" or supporting other patients as they are introduced to the oral repositioning device, please do not hesitate to call upon me. Again, many thanks for introducing me to this invaluable, effective means of treating sleep apnea and for your ongoing care.”
- Rev. Donald Stiger
Somerset, NJ
As someone who has struggled with coronary artery disease, sleep apnea and chronic snoring for over several years, I write to express my deepest gratitude for equipping me with an oral repositioning appliance. It is truly a godsend and the clinical results have already far exceeded my hopes and expectations.
As you are aware, following triple bypass surgery in May, 2006 and a subsequent stent for a collapsed graft, my longstanding sleep apnea became an even more serious concern and threat to my health. For the second time, I tried in earnest to adapt to a CPAP machine. Struggling for weeks and never being able to keep the mask on, or adapt to that mode of treatment, I had given up on any effective means of treating the sleep apnea. It was then that I discovered you and your services at Central Jersey Dental.
As you introduced me to the potential benefits of wearing a dental device as a means of treating sleep apnea, I must confess that I was initially somewhat skeptical. But, after only a few weeks of using the device and experiencing its benefits, I am a true "convert!" My wife became immediately (and gratefully!) aware that all snoring had ceased. Consequently, we can now both sleep in the same bed with total comfort. Within days, I was also aware of better energy and less daytime sleepiness (particularly in the afternoons); what a blessing that has become. But, perhaps most important of all, I have watched my blood pressure reduce approx. 10-12 points - both diastolic and systolic.
Needless to say, my cardiologist and primary care physician are delighted with this development and assure me that it bodes extremely well in curbing further cardiac disease and enhancing my longevity. While I cannot say enough for these clinical enhancements in my life, I also want to take this opportunity to share my deep appreciation for the many ways you and your staff have treated me as a "whole person" throughout this process, continually providing helpful education, personal care and emotional support in introducing me to this invaluable new intervention and treatment.
If I can ever be of any help in "coaching" or supporting other patients as they are introduced to the oral repositioning device, please do not hesitate to call upon me. Again, many thanks for introducing me to this invaluable, effective means of treating sleep apnea and for your ongoing care.”
- Rev. Donald Stiger
Somerset, NJ
Wednesday, December 21, 2011
Sleep Apnea Treatment May Lower Heart Risks
Study: CPAP Can Lower Many Risk Factors for Heart Disease, Stroke
By Salynn Boyles
WebMD Health News
Dec. 15, 2011 -- In addition to improving sleep, an effective treatment for sleep apnea can also improve blood pressure and other risk factors for heart attack, stroke, and type 2 diabetes, new research shows.
Continuous positive airway pressure therapy, or CPAP, helps patients with sleep apnea breathe better during sleep by pushing air into the nose through a mask to keep airways open.
The treatment has been shown to improve daytime sleepiness and reduce blood pressure, but its impact on heart disease, stroke, and diabetes risk factors that are common in patients with sleep apnea has not been well understood.
Results from a study published in the Dec. 15 issue of the New England Journal of Medicine suggest that CPAP is associated with a lower risk for metabolic syndrome, a cluster of symptoms that increase the risk for heart disease, stroke, and diabetes.
Researcher Surendra K. Sharma, MD, PhD, of the All India Institute of Medical Sciences in New Delhi tells WebMD that along with weight loss and lifestyle modification, treatment with CPAP may be an important way to lower heart attack, stroke, and diabetes risk in patients with sleep apnea.
Sleep Apnea, CPAP, and the Heart
More than18 million adults in the U.S. have sleep apnea, according to the National Sleep Foundation, and a significant percentage of them are overweight or obese.
Other than weight loss, CPAP is considered the most effective nonsurgical treatment for patients with moderate to severe sleep apnea.
The new study included 86 patients with sleep apnea, including 75 who had metabolic syndrome.
Study participants were treated with either CPAP or a fake therapy for three months, followed by a month of no treatment and three additional months of the opposite treatment.
Before and after each phase of the study, researchers recorded the participants’ blood pressure, blood sugar, blood fats called triglycerides, hemoglobin A1c levels, neck artery thickness, abdominal fat, and insulin resistance, which measures the body's ability to use insulin efficiently.
When compared to the fake therapy, three months on CPAP was associated with significantly lower blood pressure, total cholesterol, triglycerides, and LDL cholesterol, the so-called bad cholesterol.
Treatment with CPAP was also associated with a significant decrease in abdominal fat and body mass index (BMI).
It was also associated with a significant decrease in hemoglobin A1c values, which indicate average blood sugar levels over the past two to three months. And 1 in 5 patients with metabolic syndrome before starting CPAP treatment no longer had the condition after three months of treatment.
Lack of Sleep and Chronic Disease
Sleep specialist Meir Kryger, MD, of the Yale University School of Medicine and the VA Connecticut Health System, tells WebMD the findings highlight the growing recognition that sleep disturbances play a significant role in chronic disease.
Kryger is a board member with the National Sleep Foundation.
“It is now clear that patients with heart disease or a metabolic disease like type 2 diabetes should be asked about their sleep habits, and they should be treated if they have sleep apnea,” he says.
Cardiologist Tara Narula, MD, of Lenox Hill Hospital in New York City, says sleep issues have not been a major focus in cardiology in the past. But she says this is changing.
“We are seeing more and more studies linking sleep disorders and stress to [heart disease and stroke risk],” she tells WebMD. “This study suggests that a simple, effective treatment for sleep apnea may help reverse the abnormalities that lead to heart attack and stroke.”
While CPAP may be simple and effective, Kryger acknowledges that most patients don’t like wearing a mask while they sleep.
But he adds that CPAP technology and masks have improved dramatically over the last few years. Most new machines are even able to monitor how often the treatment is used and how well it is working.
By Salynn Boyles
WebMD Health News
Dec. 15, 2011 -- In addition to improving sleep, an effective treatment for sleep apnea can also improve blood pressure and other risk factors for heart attack, stroke, and type 2 diabetes, new research shows.Continuous positive airway pressure therapy, or CPAP, helps patients with sleep apnea breathe better during sleep by pushing air into the nose through a mask to keep airways open.
The treatment has been shown to improve daytime sleepiness and reduce blood pressure, but its impact on heart disease, stroke, and diabetes risk factors that are common in patients with sleep apnea has not been well understood.
Results from a study published in the Dec. 15 issue of the New England Journal of Medicine suggest that CPAP is associated with a lower risk for metabolic syndrome, a cluster of symptoms that increase the risk for heart disease, stroke, and diabetes.
Researcher Surendra K. Sharma, MD, PhD, of the All India Institute of Medical Sciences in New Delhi tells WebMD that along with weight loss and lifestyle modification, treatment with CPAP may be an important way to lower heart attack, stroke, and diabetes risk in patients with sleep apnea.
Sleep Apnea, CPAP, and the Heart
More than18 million adults in the U.S. have sleep apnea, according to the National Sleep Foundation, and a significant percentage of them are overweight or obese.
Other than weight loss, CPAP is considered the most effective nonsurgical treatment for patients with moderate to severe sleep apnea.
The new study included 86 patients with sleep apnea, including 75 who had metabolic syndrome.
Study participants were treated with either CPAP or a fake therapy for three months, followed by a month of no treatment and three additional months of the opposite treatment.
Before and after each phase of the study, researchers recorded the participants’ blood pressure, blood sugar, blood fats called triglycerides, hemoglobin A1c levels, neck artery thickness, abdominal fat, and insulin resistance, which measures the body's ability to use insulin efficiently.
When compared to the fake therapy, three months on CPAP was associated with significantly lower blood pressure, total cholesterol, triglycerides, and LDL cholesterol, the so-called bad cholesterol.
Treatment with CPAP was also associated with a significant decrease in abdominal fat and body mass index (BMI).
It was also associated with a significant decrease in hemoglobin A1c values, which indicate average blood sugar levels over the past two to three months. And 1 in 5 patients with metabolic syndrome before starting CPAP treatment no longer had the condition after three months of treatment.
Lack of Sleep and Chronic Disease
Sleep specialist Meir Kryger, MD, of the Yale University School of Medicine and the VA Connecticut Health System, tells WebMD the findings highlight the growing recognition that sleep disturbances play a significant role in chronic disease.
Kryger is a board member with the National Sleep Foundation.
“It is now clear that patients with heart disease or a metabolic disease like type 2 diabetes should be asked about their sleep habits, and they should be treated if they have sleep apnea,” he says.
Cardiologist Tara Narula, MD, of Lenox Hill Hospital in New York City, says sleep issues have not been a major focus in cardiology in the past. But she says this is changing.
“We are seeing more and more studies linking sleep disorders and stress to [heart disease and stroke risk],” she tells WebMD. “This study suggests that a simple, effective treatment for sleep apnea may help reverse the abnormalities that lead to heart attack and stroke.”
While CPAP may be simple and effective, Kryger acknowledges that most patients don’t like wearing a mask while they sleep.
But he adds that CPAP technology and masks have improved dramatically over the last few years. Most new machines are even able to monitor how often the treatment is used and how well it is working.
Monday, December 19, 2011
Sleep apnea patients avoid treatment: CPAP device intolerance
Despite the growing number of Americans who suffer from sleepless nights, snoring, and serious medical consequences (estimated at over 15 million Americans), studies show that sleep apnea sufferers are avoiding treatment, and running serious health risks in the process.
Although the CPAP machine has proven itself to be almost 100% effective at treating sleep apnea, scientists are discovering that the catch phrase that goes along with that statistic is “if used properly”. It’s common knowledge that data can be interpreted in many ways, and often is misleading. In the case of the CPAP machine (continuous positive airway pressure machine), the numbers don’t lie. It is hands-down the most effective machine for treating sleep apnea, if it can be used as intended. To illustrate the point, check out the photo under “CPAP machine” on the “treatments” page on Dr. Blumenstock’s web site: http://www.sleep-apnea-dentist-nj.info/sleep_apnea_treatments.htm. If you have not looked, I will describe it for you here: a cousin to the World War II gas mask, with a band strapped around the head and neck, a plastic mask similar to those worn by hospital patients, connected to a large, fairly rigid plastic tube, all leading to the machine itself, which must be placed beside the bed and is about the size of a small humidifier. Though sleep apnea patients suffer from sleepless nights and oxygen deprivation, it’s hard to imagine that their quality of sleep is much improved when strapped to such apparatus, and it is doubtful that they don’t wake just as often by discomfort and hampered movements due to the cumbersome parts of the machine. Some patients complain that it also produces noise and chafes the skin intolerably.
Perhaps this explains the new CPAP machine effectiveness data: 50% or less. While many Americans are just beginning to realize that their “snoring problem” is really a more problematic health issue, with serious, long-term ramifications, it seems that the traditional, or most common remedy (the CPAP machine), is frequently ineffective or intolerable. Do not despair! This is one of the reasons that Dr. Blumenstock invests his time in maintaining an internet presence, with up-to-date information and solutions. It’s important for sleep apnea sufferers to understand that there are other treatments, and many patients are finding relief for the first time in years, based on advances in Dental Sleep Medicine.
If you are reading this article, odds are that you, or a loved one close to you, has been diagnosed with sleep apnea, or has symptoms of the condition. Do not rely upon word of mouth to convince you that there is no effective remedy for your suffering. Many diagnosed in the past were given the CPAP machine, and have either tolerated the machine, or given up on it in despair. New technologies have produced oral appliances and a variety of other approaches to effectively treat sleep apnea. Visit Dr. Blumenstock’s site today to learn more: http://www.sleep-apnea-dentist-nj.info/ His patient testimonials attest to his and their success!
Although the CPAP machine has proven itself to be almost 100% effective at treating sleep apnea, scientists are discovering that the catch phrase that goes along with that statistic is “if used properly”. It’s common knowledge that data can be interpreted in many ways, and often is misleading. In the case of the CPAP machine (continuous positive airway pressure machine), the numbers don’t lie. It is hands-down the most effective machine for treating sleep apnea, if it can be used as intended. To illustrate the point, check out the photo under “CPAP machine” on the “treatments” page on Dr. Blumenstock’s web site: http://www.sleep-apnea-dentist-nj.info/sleep_apnea_treatments.htm. If you have not looked, I will describe it for you here: a cousin to the World War II gas mask, with a band strapped around the head and neck, a plastic mask similar to those worn by hospital patients, connected to a large, fairly rigid plastic tube, all leading to the machine itself, which must be placed beside the bed and is about the size of a small humidifier. Though sleep apnea patients suffer from sleepless nights and oxygen deprivation, it’s hard to imagine that their quality of sleep is much improved when strapped to such apparatus, and it is doubtful that they don’t wake just as often by discomfort and hampered movements due to the cumbersome parts of the machine. Some patients complain that it also produces noise and chafes the skin intolerably.
Perhaps this explains the new CPAP machine effectiveness data: 50% or less. While many Americans are just beginning to realize that their “snoring problem” is really a more problematic health issue, with serious, long-term ramifications, it seems that the traditional, or most common remedy (the CPAP machine), is frequently ineffective or intolerable. Do not despair! This is one of the reasons that Dr. Blumenstock invests his time in maintaining an internet presence, with up-to-date information and solutions. It’s important for sleep apnea sufferers to understand that there are other treatments, and many patients are finding relief for the first time in years, based on advances in Dental Sleep Medicine.
If you are reading this article, odds are that you, or a loved one close to you, has been diagnosed with sleep apnea, or has symptoms of the condition. Do not rely upon word of mouth to convince you that there is no effective remedy for your suffering. Many diagnosed in the past were given the CPAP machine, and have either tolerated the machine, or given up on it in despair. New technologies have produced oral appliances and a variety of other approaches to effectively treat sleep apnea. Visit Dr. Blumenstock’s site today to learn more: http://www.sleep-apnea-dentist-nj.info/ His patient testimonials attest to his and their success!
Monday, December 12, 2011
This holiday season, give yourself the gift of good sleep!
There are many things available for purchase each holiday season. So many, in fact, that the shopping can be quite overwhelming. In the whirlwind of trying to get everything on the list while scouring ads for “this year’s newest and best,” all at the lowest prices, sometimes it seems impossible to make a decision. It’s always frustrating, too, to find that some hot item turns out to be dud.
Don’t let that be your experience this year. One market that we see consistently advertised each year is the “sleep better” category. Granted, there are a wide variety of items that make this claim. From pillow-top mattresses, to herbal remedies, from nasal devices, to diet plans, from black-out curtains, to relaxation cd’s, the list is really quite varied. While many of these things may have some positive effect on your sleep, some people have a much more severe situation, and only proper treatment will provide relief.
Sleep apnea: a condition that affects 20% of U.S. adults; 90% are undiagnosed.
If you have never heard of sleep apnea, but perhaps stumbled across this article because you’ve been having “sleep problems” or “snoring issues,” it’s worth taking a moment to learn more. Especially if you fall into the group of people who’ve been buying “duds” every holiday, hoping that your sleep quality will improve, but finding no relief.
There are a great many reasons that people do not sleep well. Sleep apnea is a specific condition in which the breathing airway actually becomes blocked during sleep, cutting off oxygen to the body. One of the primary signs is snoring. The body struggling or “gasping” for air is the snoring sound that is heard, and it is not a harmless nuisance. Apnea episodes can occur from 6 to 100 times per hour, leaving people feeling exhausted when they wake up. Irritability, headaches, and impaired thinking and memory are common complaints. Unfortunately, more severe cases can lead to heart disease, stroke, depression and suicidal thoughts. Apnea sufferers are also at higher risk throughout the day, as their motor skills are impaired from lack of sleep.
If you have concerns because you have any of these symptoms, have been struggling with snoring, or feel that you’re just not getting the sleep you need, do yourself a favor this holiday season. Don’t buy another “dud”. Invest in yourself by contacting your doctor about what could be a serious condition, sleep apnea. Your family physician can help you decide whether you need to see a sleep medicine specialist. Also, read more at: http://www.sleep-apnea-dentist-nj.info/index.htm
Happy Holidays, from Central Jersey Dental Sleep Medicine! (732) 251-7766
Monday, December 5, 2011
From Central Jersey Sleep Medicine, Letter to Dr. Blumenstock (testimonials)
Dear Dr. Blumenstock:
I am writing this to let you know what a difference meeting you made in my life.
I am 48 years old. Sometime during the year of my 41st birthday I began to develop a problem with snoring that progressed slowly but by the time I was 47 the effect of the snoring on my lovely wife and children was becoming a severe aggravation. My wife Maria tried to adapt to my snoring by using ear plugs. This worked temporarily but ear plugs would get misplaced. The novelty effect of the ear plugs eventually wore off and they became a nuisance to her. Each morning my two sons would report to me about the volume of my snoring. It was very unpleasant for them. I resolved to relocate to the downstairs couch to sleep at night. While there I felt isolated from my wife and children.
I was in excellent physical condition, was not overweight, had recently completed the NY Marathon, and yet 2 sleep studies confirmed a sleep apnea and snoring problem. Because of the shape of my face and nose I was not a good candidate for a C-PAP device. Even if I was, I did not look forward lugging around a boxy electrical appliance for the rest of my life. I was getting used to feeling tired, I stopped running, and was letting myself get out of shape. After my last sleep study in December 2008 I was referred to you but hesitated to take action because I was still convinced I could work out this problem on my own. By February 2009 I was in poor physical condition. I had no more motivation to run because I burned myself out running and learned that all the running in the world could not help me eliminate the snoring. I resented sleeping on the couch away from my family. It began to “get to me,” and I was unpleasant to be with. I was becoming tempted to blame my family for my situation. Here I was blessed with a wonderful family yet I was feeling tired, resentful, and miserable all of the time.
In late March 2009 I finally decided I needed to see someone for help regarding the snoring. I made an appointment to see you in April. At the appointment I was impressed by the courtesy and professionalism of your staff. Even more important was when you and I discussed my problem. After I explained my situation you responded and I listened critically to what you had to say. By the time we were finished talking I was convinced that maybe someone like you, with your accumulated years of knowledge and experience in treating sleep apnea and the resulting issues, could help me.
By the next appointment you were fitting me with the EMA Appliance and by May I was no longer snoring. Not only did you provide me with an appliance that works and that I can carry around in a pocket but you also explained physiology of my particular problem and explained which sleeping positions would help me get the most out of the appliance. I resolved to do exactly what you told me to do. Armed with these tools I moved back upstairs with my family. I am not snoring any more. I feel refreshed when I awake each morning and once again I enjoy the sport of running. The quality of my life with my family is wonderful again and I have you to thank for it. Very truly yours, Daniel.
- Daniel T.
New Brunswick, NJ
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