Sleep Apnea & Multi-Modal Transportation Conference in Baltimore

Dr. Blumenstock has attended the Sleep Apnea & Multi-Modal Transportation Conference in Baltimore on November 8-9, 2011. This event was sponsored by the American Sleep Society to promote and find solutions for transportation safety.

What are the alternatives to CPAP?

How effective is a treatment if you simply don’t use it? Studies show that up to 60% of sleep apnea patients abandon CPAP use. For this reason, Dr. Blumenstock has dedicated his practice to providing remedies to those who suffer from snoring and sleep apnea, offering a variety of oral appliances that are often more appealing and user-friendly than the CPAP. These appliances can be more effective, as patients find them more comfortable and easier to use.

Consider the wide variety of oral appliances offered by Dr. Blumenstock below (see photos), and make an appointment for your own consultation:

· SomnoMed

The SomnoMed MAS is a custom-made device, consisting of upper and lower dental plates with a unique patented fin-coupling component, which allows normal mouth opening and closing. An optional part provides incremental and adjustable levels of lower jaw advancement, which improves the effectiveness and comfort level of treatment as the jaw is moved only as far as is required to alleviate snoring and reduce apnea.

· Elastic Mandibular Advancement Appliance (EMA)

The EMA - Custom appliance is a simple, patient-friendly oral appliance created for noninvasive treatment of snoring and OSA. The primary treatment mechanism of opening the bite and gently moving the mandible forward is achieved with the use of interchangeable elastic straps that offer varying degrees of mandibular advancement. The flexibility of these elastic straps provides unsurpassed lateral movement and overall TMJ comfort. The 2 mm thick pressure formed bases offer orthodontic retention (resulting in no tooth movement) and maximum anterior tongue space because there are no projections in the palate.

· The Thornton Adjustable Positioner (TAP)

A custom-made adjustable oral appliance that is worn while sleeping. The appliance holds the lower jaw forward, preventing the tongue and soft tissue of the throat from collapsing into the airway. It is easily adjusted by the patient, as well as the patient’s spouse or significant other. The adjustment handle acts as a snoring volume control. As snoring is reduced, the airway is opened.

· Dorsal Appliance

Originally designed as a nighttime TMD splint, the Dorsal Appliance has evolved into one of the most popular choices for snoring and obstructive sleep apnea. The two piece construction allows for patient comfort and lateral jaw movement. The Dorsal fins on the mandibular appliance interface with inclines built into the buccal of the upper appliance to dictate a specific mandibular position. The appliance is traditionally fabricated with adjustable screws in the maxillary appliance to allow for further mandibular advancement. This appliance can be fabricated in a variety of materials including acrylic, dual laminate or thermal splint material.

· Silent Nite SL

Silent Nite SL positions the lower jaw forward using special S-shaped connectors that are attached to upper and lower trays. These trays are comprised of a soft inner layer with a hard outer layer that is durable and BPA-free. The new, improved connectors are stronger than those found on the original Silent Nite and are easily interchangeable by the patient. This intraoral appliance is indicated for patients with a minimum of eight teeth per jaw and a body mass index (BMI) of 30 or less.

· The SUAD™ Device

The SUAD™ Device is a premium dental sleep appliance developed for the treatment of snoring and obstructive sleep apnea. It is an effective, comfortable, and durable alternative to CPAP therapy or corrective surgery. By simply wearing The SUAD™ Device while sleeping, your lower jaw (mandible) will be moved forward into a comfortable position, allowing relaxation of the tissues at the back of your throat and ensuring the base of your tongue does not collapse and block your airway, giving you a safe and soundless sleep.

· Herbst, Herbst Telescopic, and SAUD Appliance

The Herbst appliance has been proven to be effective on chronic snoring and mild to moderate obstructive sleep apnea sufferers. This appliance allows patients to move laterally and vertically without disengaging the appliance. Also, if it is determined that the initial position does not provide the anticipated relief of the condition, the mandible can easily be moved forward by two options of adjustability. The Herbst is traditional hardware with limited range of adjustment. The Herbst Telescopic version allows greater flexibility of adjustment. The more robust SAUD version is made for the heavy grinder who might break other appliances.

· Oasys Sleep Appliance

The Oasys Appliance has a built-in nasal dilation so it works in a similar manner to Breathe Right Strips. The Oasys Oral/Nasal Airway System is the first dental device to be reviewed by both the dental and ENT divisions of the FDA. It has been approved as a dental device for treatment of snoring and sleep apnea through mandibular repositioning and also as a nasal dilator for reduction of nasal resistance and improved nasal breathing.

· Tongue Retaining Device (TRD)

The TRD is lab-constructed flexible polyvinyl material adapted to the general contours of the teeth and dental arches. It does not depend on teeth for retention. Rather, the tongue is held forward by the negative pressure created in the vacuum bulb on the front of the appliance.

The dental alternative to CPAP

From Sleep Apnea Video featuring Dr. Norman Blumenstock

Snoring can be described as gasping or snorting at night. These physical responses are actually forms of choking. While you sleep, your throat becomes relaxed and/or the weight of your tongue may block your throat. Your body’s method of self-preservation is to give you a shot of adrenaline to wake you up to stop the choking. Hence, the stop-and-start process of snoring, which may actually be sleep apnea or hypopnea, and can have severe health effects.

Sleep apnea and the sleep disorder hypopnea are closely related. With sleep apnea, your breathing airway closes between 80-100%, resulting in significantly decreased levels of oxygen in the blood. With hypopnea, there is a 50% air blockage and a 3-4% oxygen loss in the blood. With both disorders, you wake feeling exhausted or you simply don’t feel well. Snoring is the recognized calling card of sleep apnea; however, sleep apnea can be noticeable or can be silent. Some sufferers may find that their chief complaint may NOT be snoring. Instead, they cite simply feeling bad, they cannot function, can’t think, or feel like they’ve done an all-nighter. If you’re getting eight hours of sleep, but feel like you’ve only gotten two, you should consider a sleep apnea consultation.

The increased identification, diagnosis and treatment of sleep apnea do not necessarily signal that this is a new problem. It simply reflects the progress made within dentistry and the field of medicine in general. Prior to the 1980’s, the only answer to sleep apnea was a tracheotomy(!). Then, the cumbersome CPAP machine was invented and became the standby for sleep apnea sufferers. Further advances in the 1990’s led to surgery on the soft palate done by ENT doctors. Finally, oral appliances were invented, mimicking the simple concepts used in CPR: open the airways by tilting the head back (tightening the throat muscles) and pulling the jaw forward. From this non-invasive approach, a number of oral devices have been created to move the jaw forward, pulling the tongue forward and tightening the throat muscles at the same time. Sleep apnea dentists now can offer a variety of non-invasive, relatively small oral appliances that eliminate sleep apnea.

… Because of My Snoring!

“I knew something had to be done when my wife and I started sleeping in separate rooms…”

If you complete that sentence with “because of my snoring,” you owe it to yourself (and your wife!) to investigate a condition called sleep apnea. Much of our media is filled with gimmicks, hype and scare tactics, and most snorers have dismissed their condition as a common and incurable nuisance.

Perhaps you’ve already tried the latest remedy at the local drugstore in the hopes that you could find a cheap and easy solution to the nightly aggravation, but finally accepted the situation as “normal” when it didn’t work. While it’s true that snoring is fairly common, it is not correct to assume that it is benign or untreatable.

Over 12 million Americans suffer from a condition known as sleep apnea, and the #1 symptom of this condition is snoring. With sleep apnea, a person actually experiences oxygen deprivation during sleeping hours, and it can have long-term health effects. While it is common knowledge that long-term sleep deprivation is bad for your health, snorers often don’t make the connection to daytime symptoms of their serious long-term condition: difficulty with information processing, judgment, and short term memory, behavioral effects such as decreased vigilance and motivation as well as moodiness and aggressiveness.

While other sleep apnea patients suffer even more serious and acute health problems, they typically form the group of patients that are diagnosed, as their health complications force them to seek treatment.

The good news is, whether you have a mild snoring problem or diagnosed sleep apnea, effective remedies are available. Please feel free to research this topic more at our web site:

http://www.sleep-apnea-dentist-nj.info/index.htm

Or, read what our patients have to say:

http://www.sleep-apnea-dentist-nj.info/sleep_apnea_dentist_testimonials.htm

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.

Trucking Accidents Caused by Undiagnosed & Untreated Sleeping Disorders

The first thing that comes to mind when you hear about trucking accidents is road rage or weather related road conditions. Although many trucking accidents are caused by road rage and stormy weather conditions, there are an increasing number of accidents caused by sleep apnea.

According to the U.S. National Highway Traffic Safety Administration, there are 100,000 accidents caused by driver fatigue. The good news is sleep apnea can be detected through medical testing.

In addition to mandatory drug testing by trucking companies, truck drivers must undergo screening for sleep disorders, such as sleep apnea. Trucking companies that fail to comply with government regulations could be fined heavily.

Sleep apnea while driving doesn’t just affect truck drivers, it also affects motor vehicle drivers. The more people are educated about the harmful effects of sleep apnea, the fewer accidents will occur on the road.

Do you have sleep apnea?

The only way a person can tell whether or not they have sleep apnea is by getting a diagnosis from a doctor. Here are a few common symptoms of sleep apnea:

• Loud snoring (severe)
• Day-time drowsiness
• Episodes of not breathing during sleep
• Tossing and turning during sleep
• Nighttime choking
• Memory loss
• Moodiness
• Headaches (morning or night)
• Frequent urination at night
• Chest pain and sweating while sleeping

There are a variety of treatment options for sleep apnea suffers. One of the most effective treatments is the oral appliance. Oral appliances have helped many patients regain control of their sleep. There’s nothing more satisfying than getting a good nights sleep.

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.

Obstructive Sleep Apnea Can Effect On the Job Work Performance

Often times, an employer will automatically label an employee who has a poor job performance as lazy and unmotivated. That is not always the case. Did you know that untreated Obstructive Sleep Apnea (OSA) can affect a person's job performance? People who suffer from this type of sleep disorder are more likely to have a higher percentage of lateness’s and absences. They are also more likely to fall asleep on the job.

In the corporate work environment, workers who suffer from sleep disorders are more likely to make costly errors. In a blue-collar work environment, OSA is not only hazardous to one’s health; it can also be a hazard to other workers, especially if the job requires operating machinery. Many on the job injuries are a direct result of undiagnosed and untreated sleep disorders.

Study Proves OSA Can Effect Work Performance

Recently, the University of California San Francisco Sleep Disorders Center, conducted a sleep apnea study in 150 workers from various fields. All the participants were in their mid-forties. The overnight sleep study results indicated that 83 of the participants had sleep apnea. The results also concluded that work productivity suffers when employees suffer from sleep apnea and daytime fatigue.

So, what are companies doing to prevent on the job accidents and work performance issues caused by OSA? They’re educating their employees about the dangers of untreated sleep disorders.

Sleep disorders can also prevent a person from getting promoted on the job and it can even cause a person to lose their job. Once a person is treated for Obstructive Sleep Apnea, they can live a more healthy and productive life.

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.