Prospective multicenter cohort study of obstructive sleep apnea (OSA) patients treated with a custom-made mandibular repositioning device (MRD)

Notes from Dr. Norman Blumenstock
This recent French study shows the benefits of oral appliance therapy.

August 22, 2014 / By Marie-Françoise Vecchierini, MD

Editor's note: Dr. Marie-Françoise Vecchierini is a recent recipient of an American Academy of Dental Sleep Medicine (AADSM) 2014 Clinical Excellence Award.
Obstructive Sleep Apnea (OSA) has numerous and significant comorbidities, so its treatment is essential. Mandibular Repositioning Devices (MRD) are recommended as primary treatment for patients with mild-to-moderate OSA. Because very few studies have specifically assessed the long-term efficacy of MRDs in OSA patients who are noncompliant with continuous positive airway pressure (CPAP), my research team conducted a study on 312 patients (71% men; 53+/-12 years old), offering MRD treatment and determining the long-term efficacy of a custom-made computer aided-design (CAD)/computer-aided manufacturing technology (CAM).
ADDITIONAL READING | 'Captain, permission to come aboard' -- getting the team on-board with OSA therapy
Study participants
The inclusion criteria were severe OSA patients with an apnea-hypopnea index (AHI) >30 or patients with a 5<AHI<30 and severe sleepiness. All patients had no dental or articular contraindications, and no previous MRD treatment. From this criteria, three subgroups were identified according to AHI value (14% of patients with 5<AHI<15, 44% with 15<AHI<30, and 42% with AHI>30).
ADDITIONAL READING | Hidden dental dangers of undiagnosed obstructive sleep apnea
Research parameters
Successful treatment was defined as a decrease of at least 50% of the AHI and complete response was achieved for an AHI<5 or <10. Mean mandibular advancement was 7 +/- 2 cm, 75% of the maximum advancement, after 2+/-1 titration visits.
Results
In the three- to six-month follow-up, AHI decreased significantly from 29+/-15 to 11+/-10, 84% of patients had a ≥ 50% reduction in AHI, and AHI<10 was achieved in 63%. Among the patients with severe OSA, 60% were effectively treated and 40% were completely cured.
Additional results of the study are as follows:

• SpO2 parameters significantly improved in each subgroup of patients
• Epworth Sleepiness Scale decreased significantly from 12+/-5 to 8+/-5
• Clinical symptoms, including loud snoring, nocturnal polyuria, and libido disorders, were all improved
• Quality of life and fatigue scores improved significantly from the baselines scores
• No significant change in sleep duration but a slight improvement in sleep latency, slow wave sleep, and REM sleep duration
• The mean use of MRDs was 6.7 hours per night and 6.6 days per week
• Side effects were reported by 21% of the patients, including gum irritation or pain (9.5%), dental or periodontal pain (8%), and temporomandibular joint pain or stiffness (7%)
• The rate of occlusion change or mobility was low (2%), and 8% of the patients stopped the treatment early as a result of side effects
• By looking for predictive factors of treatment success through univariate and multivariate regression analysis, less abdominal obesity and Class II malocclusion were found among the patients
• Significant predictive factors for complete MRD effectiveness were lower AHI or higher maximal jaw protrusion capability

Conclusion
In conclusion, an MRD offers an excellent compliance rate among patients and provides significant improvement in patients’ OSA symptoms, AHI, and quality of sleep. A custom-made MRD is an effective therapy for patients with mild to severe OSA that can be used successfully in patients who refuse or are not compliant with CPAP.


Marie-Françoise Vecchierini, MD,
is a member of the American Academy of Dental Sleep Medicine (AADSM), the American Academy of Sleep Medicine (AASM), and past president of the French Sleep Medicine and Research Society. Dr. Vecchierini also received two awards at the 2013 AADSM Annual Meeting in Minneapolis for her study on the follow-up of a large cohort of OSA patients intolerant to CPAP and treated by MRD.

A good night's sleep is a matter of technicality.

Notes from Dr. Norman Blumenstock
Technology can possible help or hinder a good night's sleep.

Technology is a double-edged sword when it comes to sleep. It's been proven that one should shut off the "screens" — TV, computer, smartphones and beyond — well before hitting the sack, but sometimes, those future-forward devices hold the ticket to getting a good night's rest.

Sleep-related apps

IQ ALARM: Wakes people with an IQ test as an alarm; $.99

SLEEP CYCLE ALARM CLOCK: Tracks sleeping habits and quality, and awakens people with soothing tones; $.99

SLEEP: Sends people to sleep with soothing sounds, lullabies and relaxing music; $.99

DEEP SLEEP WITH ANDREW JOHNSON: Guided meditation; $2.99

INSOMNIA CURE: Hours of audio content and 40 pages of insomnia tips and learning tools; $2.99


Sleep time gadgets

These products are said to improve sleeping habits.

FitBit is a digital sleep tracker that analyzes sleep patterns and quality, similar to the SleepIQ Technology in Sleep Number beds. The One model tracks steps, distance, calories burned and stairs climbed during the day, but also measures sleep quality at night, according to FitBit.com. Sync the device to a computer or smartphone, and review the real-time progress. Various colors and styles are available. $99.95;www.fitbit.com.

The Snore Relief Wrist Band by Hammacher Schlemmer, though no longer available for purchase, reports that it did provide natural relief for snoring by stimulated the median nerves at the inner wrists.

"Snoring can be caused by loose soft tissues vibrating in the throat, and when the device detects snoring, it releases a signal that gently stimulates the body to shift position, stopping snoring," Hammacher Schlemmer states online.

Clinical trials for the product showed that 80 percent of participants' spouses observed a decrease in snoring after two weeks of use, leading to better sleep quality, according to the website.

Familiar with fumbling around in the dark? Senzo light switches are called "smart switches" and include infrared and radio frequency wireless communication for control. It features a built-in timer, wireless sensor, smartphone and Internet control, a remote control and a night light to easily find your way about in darkness. They can even be locked to prevent unauthorized users. For more information, visitwww.senzo.com.my.

Behind closed doors
Here's what's going on inside the bedroom, according to the 2013 Sleep Council Survey:

• 27 percent now use desktop computers/laptops to surf the Internet in the bedroom.

• 17 percent of respondents talk on the phone in the bedroom.

• 62 percent of 16 to 24 year olds like to eat in their bedrooms compared to only 22 percent of respondents overall. In fact 16 to 24 year olds like to do most things in their rooms: 28 percent do hobbies/crafts, 76 percent listen to music, and 28 percent exercise there.

• 65 percent of respondents read in the bedroom.




Source: Sleepcouncil.org

Definition of an Effective Oral Appliance for the Treatment of Obstructive Sleep Apnea and Snoring: A Report of the American Academy of Dental Sleep Medicine

Notes from Dr. Norman Blumenstock

In response to the demands of an emerging profession to set standards of care, the Board of Directors of the American Academy of Dental Sleep Medicine (AADSM) brought together leaders in the profession to develop the definition of an effective oral appliance for the treatment of sleep disordered breathing based on current research and clinical experience. On February 15-17, 2013, a consensus conference was held in Tampa, Florida. Fifteen leaders in the profession used the modified RAND/UCLA Appropriateness Method to craft an empiric definition of an effective oral appliance with emphasis on purpose, physical features and function. A definition was developed and in March 2013 was accepted by the Board of Directors of the AADSM.

The purpose of this report is twofold. First, it presents a systematic review of all available level one and two literature (based on Oxford Centre methodology) to validate the accepted definition of an effective oral appliance. Second, this report details the processes employed and clarifies inclusion and exclusion rationale.

Future research, improved methods, and innovations in biomaterials will continue to advance the profession of dental sleep medicine. This definition provides a foundation and framework to guide both future investigations and current treatment of individuals with sleep disordered breathing.

Citation:

Scherr SC, Dort LC, Almeida FR, Bennett KM, Blumenstock NT, Demko BG, Essick GK, Katz SG, McLornan PM, Phillips KS, Prehn RS, Rogers RR, Schell TG, Sheats RD, Sreshta FP. Definition of an effective oral appliance for the treatment of obstructive sleep apnea and snoring: a report of the American Academy of Dental Sleep Medicine. Journal of Dental Sleep Medicine2014;1(1):39–50.

Is it just Snoring or is it Sleep Apnea?

From Dr. Norman Blumenstock:

Not everyone who snores has sleep apnea, and not everyone who has sleep apnea snores.

Posted on December 25, 2013

Not everyone who snores has sleep apnea, and not everyone who has sleep apnea snores. So

how do you tell the difference between normal snoring and a more serious case of sleep apnea?

The biggest telltale sign is how you feel during the day. Normal snoring doesn’t interfere with

the quality of your sleep as much as sleep apnea does, so you’re less likely to suffer from

extreme fatigue and sleepiness during the day.

Even if you don’t have sleep apnea, a snoring problem can get in the way of your bed partner’s

rest and affect your own sleep quality and health. But there are plenty of tips and treatments

that can help.

The following strategies can help you decipher the symptoms:

Keep a sleep diary – Record how many hours you’re spending in bed, any nighttime awakenings,

and whether you feel refreshed in the morning. Ask your sleep partner to keep track of your

snoring, including how loud and frequent it is. Also ask him or her to note any gasping, choking, or

other unusual sounds.

Record yourself sleeping – Taking a video or audio recording of yourself while you sleep can

be very informative and revealing. You can use a sound-activated audio recorder, a video camera,

or software that turns your computer into a recorder.

http://www.kaltura.com/index.php/kwidget/wid/0_vszpoipq/uiconf_id/8700151

Originally Published at:  http://www.mdadvice.com/blog/2013/12/25/is-it-just-snoring-or-is-it-sleep-apnea/

Advice About Sleep Deficiency in Midlife, Part 2

By NICOLE HIGGINS DeSMET

Published: September 18, 2013

This week’s Ask an Expert features Orfeu Marcello Buxton, a neuroscientist who will answer questions about the causes and health consequences of sleep deficiency, particularly in middle age. He researches chronic sleep deficiency in the workplace and home and how it contributes to disorders like obesity, diabetes and cardiovascular disease.

Orfeu Marcello Buxton,
neuroscientist and
sleep researcher.

 

Dr. Buxton is an associate neuroscientist the Division of Sleep Medicine in the Department of Medicine at Brigham and Women’s Hospital in Boston, as well as an assistant professor at Harvard Medical School and the Harvard School of Public Health. He received his doctorate from Northwestern University in Evanston, Ill.

Dr. Buxton notes that adults can express their priorities “in what we don’t do,” and too often sleep (along with healthy behavior) gets short-changed. But sleep, he says, is a foundation of healthy aging and a source of resilience. His research, for example, has shown that sleep restriction or disruption increases obesity and diabetes risk, by decreasing insulin secretion, increasing blood glucose levels slowing metabolism (the study is here). He has also found that characteristics of the work environment, including managers’ actions, can affect sleep (study is here).

Here are examples of some questions that Dr. Buxton is prepared to answer. (Note: Dr. Buxton is a researcher, not a physician, and he emphasizes that his responses should not take the place of recommendations from your health care provider.)

1. Why is sleep important?

2. What are some mechanisms by which sleep affects metabolism, and obesity and diabetes risk?

3. Why do we now think that work or the workplace affect sleep?

Please leave your questions in the comments section. [Update: Part 1 of Dr. Buxton’s responses can be found here.]

Snoring Is No Laughing Matter

Millions of Americans have obstructive sleep apnea and don't know it. But the disorder can have serious health consequences.

By Dr. Sanjay Gupta

If you snore at night and feel drowsy all day, then you may be one of 18 million Americans who have obstructive sleep apnea (OSA). Most people with the sleep disorder don’t know they have it, but left untreated OSA can lead to serious complications. 

“People with sleep apnea have been shown to be at a higher risk for cardiovascular diseases, particularly hypertension, stroke and diabetes,” said Thomas Roth, MD, director of the Center for Sleep Disorders and Research at Henry Ford Hospital in Detroit.

OSA, the most common form of sleep apnea, occurs when muscles in the back of the throat relax, disrupting a person’s breathing while they’re asleep. Central sleep apnea, a rarer form in which the brain doesn’t send signals to the muscles that control breathing, affects less than 5 percent of people and is usually the result of another condition such as Parkinson’s disease or stroke.

Anyone can have OSA, but there are several risk factors. Being overweight can lead to fat deposits around the upper airway that obstruct breathing. A recent study found that the obesity epidemic may be responsible for a 55 percent jump in sleep apnea cases over the past 20 years.

“Weight loss can be helpful in reducing the severity of sleep apnea or even curing it with mild forms of the condition,” said Ashish Adlakha, MD, director of the Middlesex Hospital Comprehensive Sleep Disorders Center in Middletown, Conn.

Age and gender are factors: Most sleep apnea patients are over age 60, and men are twice as likely to have it as women. People with naturally narrow throats, or who develop enlarged tonsils or adenoids have a greater risk; as do people who smoke or drink alcohol.

Sleep apnea is more than a mere annoyance, and it can lead to potentially life-threatening health conditions. “When a person has chronic sleep deprivation and they’re waking up a lot during the night, there are frequent drops in blood oxygen levels, which trigger the response of the systemic nervous system,” said Dr. Adlakha.

These “stresses to the nervous system and low oxygen levels have a big impact on blood pressure and a person’s cardiovascular system and metabolism,” said Tucker Woodson, MD, director of the Froedtert Hospital/Medical College of Wisconsin Sleep Disorders Program in Milwaukee.

Recent studies suggest sleep apnea may be responsible for up to 60 percent of hypertension cases that don’t respond to medication. The condition has also been linked to increased risk of sudden cardiac death.

Research has shown that sleep apnea patients have a greater likelihood of suffering from other diseases, including type 2 diabetes, chronic kidney failure, and asthma.

“A big challenge for sleep medicine doctors is knowing what’s associated or related to the sleep apnea versus what’s causing the sleep apnea itself,” said Dr. Woodson. “That’s often the case with obesity, and sometimes hypertension.”

Lifestyle changes such as weight loss, exercise, and quitting smoking and drinking are recommended for anyone with OSA. More serious cases can be treated with a device known as a Continuous Positive Airway Pressure (CPAP) machine that delivers air pressure to keep airway passages open. The patient has to wear a mask while sleeping, which can be an annoyance; and the air pressure can cause dry mouth and nose.

“It’s a big problem in trying to treat the disease because people don’t use it correctly or as much as they’re supposed to,” said Dr. Roth.

Another treatment option is wearing a mouthpiece, similar to a dental mouth guard, to correct jaw or tongue problems and keep the throat open. In severe OSA cases where no other treatment proves effective, there are surgical options to relieve airway blockages.

“The biggest reason we treat sleep apnea is to improve a person’s quality of life, as it can make almost any other condition a person has worse,” said Woodson. “If you’re not sleeping well, good health is hard to come by.”

Originally Published At:  http://www.everydayhealth.com/sanjay-gupta/snoring-is-no-laughing-matter.aspx

Dr. Norman Blumenstock - Awarded the 2013 Distinguished Service Award by the American Academy of Dental Sleep Medicine

DISTINGUISHED SERVICE AWARD 2013

Norman Blumenstock, DDS

Norman T. Blumenstock, DDS,

earned his dental degree from

Columbia University College

of Dental Medicine, after

earning his bachelor’s degree

from Brooklyn College. Prior

to entering private practice,

he served a general practice

and Medical Center in New York

City. He is proud to have earned

both Fellowship and Mastership

awards from the Academy of General Dentistry.

For the past 25 years, he has focused on dental sleep medicine.

Since 1991, Dr. Blumenstock has attended the weekly sleep

clinic sessions at the medical school where he is currently

appointed to the Medical Department as an Assistant Clinical

Professor at UMDNJ - Robert Wood Johnson Medical School.

This year marks 30 years as an attending staff member at

the Dental Department of Robert Wood Johnson University

Hospital, where he shares his dental sleep medicine knowledge

with dental residents. He is Dental Director at the 14-bed Capital

Health Center for Sleep in the Hamilton-Trenton, NJ area. In

addition to memberships in the Academy of General Dentistry,

American Dental Association, New Jersey Dental Association,

and Middlesex County Dental Society, Dr. Blumenstock is a

charter member of the American Academy of Dental Sleep

Medicine (formerly the Sleep Disorder Dental Society in 1991)

and has been credentialed by the American Board of Dental

Dr. Blumenstock’s recent involvement with the American

Academy of Dental Sleep Medicine includes writing

examination questions for the American Board of Dental

Sleep Medicine written test, participation in the task force for

structuring the facility accreditation process and subsequently

serving as Chairman for the facility Accreditation Committee.

He also serves on the Ethics Committee and has participated in

the consensus committee for formulating the definition of an

oral appliance for dental sleep medicine.

Medicare Coverage is available for Sleep Apnea Oral Appliance Treatment

Top News

New Oral Appliance Coverage Determination Released

In late November, the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) released a new local coverage determination for oral appliances. The policy, effective for claims with dates of service on or after January 3, 2011, states that a custom fabricated mandibular advancement oral appliance (E0486) used to treat obstructive sleep apnea is covered if certain criteria are met.

“The policy is a great step forward for both patients and providers. Choices in treatment are a must and treatment can now be personalized,” said Steve Moore, VP of sales and marketing for Airway Management Inc. “To say that everyone should have CPAP is like saying that everyone should wear the same type of shoes. Given the growing awareness that many people are not compliant with CPAP therapy, a second treatment option should increase the number of people who are successfully treated for obstructive sleep apnea.”

According to the policy:
A custom fabricated mandibular advancement oral appliance (E0486) used to treat obstructive sleep apnea (OSA) is covered if criteria A - E are met.

A. The patient has a face-to-face clinical evaluation by the treating physician prior to the sleep test to assess the patient for obstructive sleep apnea testing.

B. The patient has a Medicare-covered sleep test that meets either of the following criteria (1 or 2):
1. The apnea-hypopnea index (AHI) or Respiratory Disturbance Index (RDI) is greater
than or equal to 15 events per hour with a minimum of 30 events; or
2. The AHI or RDI is greater than or equal to 5 and less than or equal to 14 events per
hour with a minimum of 10 events and documentation of:
a. Excessive daytime sleepiness, impaired cognition, mood disorders, or
insomnia; or
b. Hypertension, ischemic heart disease, or history of stroke.

C. If the AHI >30 or the RDI >30 and meets either of the following (1 or 2):
1. The patient is not able to tolerate a positive airway pressure (PAP) device or
2. The treating physician determines that the use of a PAP device is contraindicated.

D. The device is ordered by the treating physician following review of the report of the sleep
test. (The physician who provides the order for the oral appliance could be different from the
one who performed the clinical evaluation in criterion A.)

E. The device is provided and billed for by a licensed dentist (DDS or DMD).

If all of these criteria (A-E) are not met, the custom fabricated oral appliance (E0486) will be denied as not reasonable and necessary.

“Patients can now have a custom appliance as first line treatment without the requirement to “fail” PAP therapy first,” Moore said. “If the patient has an AHI/RDI >30 events/hour, the treating physician must state that the patient is intolerant to PAP or that PAP therapy is contraindicated.”

Moore also pointed out that “strict requirements for devices must be met and only custom appliances that advance the mandible into a treatment position will qualify for payment. Custom appliances must be adjustable by the patient and advance the mandible in 1 mm increments,” Moore said. “Non-custom (boil and bite) appliances and tongue retaining devices are deemed medically unnecessary.”

Central Jersey Dental Sleep Medicine is proud to provide medical benefits for Sleep Apnea Treatment, to those patients who meet the Medicare qualifications. Visit our website for additional information on Sleep Apnea Treatments and Alternatives to CPAP at www.SnoreDentist.com. Call our office at 732-251-7766 to schedule an appointment with Dr. Norman Blumenstock, to find out if you qualify for benefits through Medicare or your personal insurance plan.

Oral Appliances 101

There are many ways to treat sleep apnea. Besides using a CPAP machine or lifestyle change, oral appliances are an excellent option. Oral Appliance therapy is the selection, design, fitting and use of a specially designed oral appliance. When worn during sleep, it maintains an opened, unobstructed airway in the throat. Oral appliances that treat snoring and obstructive sleep apnea are devices worn in the mouth, and are similar to orthodontic retainers or mouth-guards. They have several advantages over other forms of therapy. Oral appliances are comfortable, easy to wear and care for. They are small and convenient, making them easy to carry with you when you travel. Treatment with oral appliances is a smart non-invasive solution.

After referral from a physician, you can make an appointment to receive a thorough oral examination by Dr. Blumenstock. He will then discuss all options, advantages, limitations, and consequences of an oral appliance. After you are fitted with the oral appliance that should work best for you, we’ll take any needed time to adjust the appliance to a comfortable and effective position. If you suffer from sleep apnea, make an appointment with us today!

Dr. Blumenstock and Sleep Apnea

Did you know that Dr. Blumenstock is your dental sleep expert in New Jersey and surrounding areas? He has taken hundreds of hours of postgraduate education, as well as his 20-year plus focus on sleep medicine. He is passionate about what he does and can help improve your overall health.

Central Jersey Dental Sleep Medicine cooperates with medical doctors to make sure your individual situation is fully addressed with an objective medical assessment. Dr. Blumenstock and his staff work with physicians and specialists such as neurologists, pulmonologists, and ENT physicians to help with this initial medical assessment.

Snoring and obstructive sleep apnea are medical problems, and should be treated by qualified professionals. We have your best interest in mind.

Once you receive a referral from a physician, you will obtain a thorough oral examination by Dr. Blumenstock. From there the best plan for your specific situation will be discussed and implemented.

Our services do not end there, however, we recommend a follow-up evaluation to ensure your satisfaction and to objectively document the effectiveness of the therapy. Are you ready to sleep better and wake up feeling refreshed? Give us a call for more information on how you can get started.

Read more on oral appliance therapy for sleep apnea in NJ

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

Sleep Apnea: How and When to get Treated

It’s estimated that as many as 15 million people suffer from sleep apnea, it is more prevalent in men than women. If you snore, already been diagnosed with sleep apnea, use a CPAP machine or suffer from any symptoms of sleep apnea, then you are a good candidate for treatment.

Some symptoms of sleep apnea include: depression, dry mouth, falling asleep while driving or working, gasping or choking during sleep, general tiredness during the day, irritability or anxiety, restless sleep, and snoring with pauses in breathing. If someone suspects they may have sleep apnea, a sleep study (polysomnogram) should be done. This study will accurately measure what happens during sleep and how severe the problem is.

If left untreated, disturbed and interrupted sleep can cause a wide variety of problems, ranging from minor to very serious. Lack of sleep makes one drowsy during the day. Sleep apnea sufferers also complain of fatigue most often. But, that is just the beginning. Sleep apnea can be linked to the following health risks: cardiovascular disease, diabetes, hypertension, inability to lose weight, stroke, poor quality of life, and slowed metabolism or weight gain. All of which should be taken very seriously.

One way to treat sleep apnea is through oral sleep appliances and therapy. These have proven to be a viable alternative to CPAP. Research has shown that the tongue is really one of the major factors contributing the blockage of the throat and airway. By using an oral appliance and gradually repositioning the lower jaw forward, the tongue also moves forward opening the airway and creating better muscle tone in the oral pharyngeal area.

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, no mask impression left on the face, far more convenient for travel, airports, and much more.

If you or a loved one has any symptoms of sleep apnea, it is important to address and receive treatment. It will better the quality of your sleep, and your life.

Read more on Sleep Apnea Dentist in NJ and Sleep Apnea Treatments