Sleep and the City

There was an article in the Huffington Post yesterday entitled "Does Anyone in NYC Sleep Well Anymore?"

My wife and I live near the corner of 2nd Avenue and 70th Street, about half a block away from the construction site of the new 2nd Avenue subway line. City ordinances permit construction only between the hours of 7AM and 6PM. This morning at 5:17AM several large construction trucks with the backup signals on came by apparently the express purpose of dropping several heavy metal plates in the middle of the street. When I say dropping, I mean DROPPING.

When I called the city agency responsible for controlling noise, I was advised that indeed city ordinances permit construction only between the hours of 7AM and 6PM unless the construction company really truly feels that it must make noise. In that case the city will give them a variance.

I was also told that the EPA had no control over noise if they had a variance.

New York City can be a great place to live, but it is a lousy place to try to get a good night's sleep.

Forgive the rant, just really tired this AM and more than a little ticked off.

Dr. Barsh

Sleep and the City

Snoring Isn't Sexy on NPR

It's been a while since my last post and for that I apologize. Growth has been rapid at Snoring Isn't Sexy and we're averaging over 19,000 site visitors a month. Our coverage in the United States has made it easier for patients looking for an alternative to CPAP to find a qualified dentist.

The other day we were called by NPR to do an interview on oral appliance therapy. This is a welcome breakthrough after a number of years when oral appliance therapy was getting no coverage at all.

At any rate, the interview will be broadcast on Morning Edition in the Consumer health section on NPR on August 3. The interview will be available on NPR.org and, hopefully, in the Newsroom section of snoringisntsexy.com.

Please visit and comment.

Dr. Barsh

Father's Day - A perfect gift?

Father's Day is approaching and with it an abundance of ads for over-the-counter anti-snoring devices. Unfortunately many of the over-the-counter, available on the Internet "snoring cures" might give your loved one more than he expects.

Most of the OTC devices will stop snoring (as long as they stay in the mouth and as long as the jaw muscles don't hurt too much) but they will also stop the warning signs of apnea. You see one of the signals that a bed partner has that there is a serious problem with apnea is the sudden cessation of the sound of snoring itself. In an apneic episode, snoring continues and suddenly stops followed by an explosive gasp, a partial awakening and then a return to the same series of sounds. With the OTC devices those warning sounds are obliterated. Same with the nasal strips and the devices one puts in the nostrils.

And don't forget, medical research has shown a strong correlation between snoring and stroke so as my wife says "Snoring is much more than the punchline to a bad joke."

If a loved ones snores, get him or her screened by a qualified dentist or physician. His life depends on it.

Dr. Barsh

Snoring and the Brain, CPAP and Oral Appliances

In the last few days there have been three articles released in the scientific literature that have a direct effect on those suffering with sleep apnea:

Professor Rae, in Australia, published a paper that showed that changes in brain chemistry linked to obstructive sleep apnea could be compared to the changes in brain chemistry of people who have "had a sever stroke or who are dying." She found that this may be due to a lack of oxygen reaching the brain during the apneic (lack of breathing) episodes.

In a second article, Dr. Pepin and colleagues in France reported that people who suffer from excessive daytime sleepiness may continue to be sleepy during the day even when they are treated with CPAP. There was no mention of whether patients treated with oral appliances showed the same problem.

Finally, a study from Korea found that success rates of patients treated with mandibular advancement devices (oral appliances) were actually higher in patients with the worst apnea.

What these articles show is that snoring is (as my wife points out) not the punchline to a bad joke. It is a serious problem that can and must be identified and treated appropriately. CPAP is appropriate and effective therapy but it is not the final word in the treatment of sleep apnea - residual problems do exists that must be addressed and resolution sought.

And, evidence for the efficacy of oral appliance therapy continues to grow. The option for treatment with an oral appliance must be offered to all patients with sleep apnea.

Dr. Barsh

The Kentucky Derby and Dental Sleep Medicine

I just was reading the New York Times this morning. In the sports section, there's picture of Calvin Borel, the jockey who rode the winning horse in the Kentucky Derby this year. Apparently he has conducted more than 140 interviews since winning the Derby. The article covered most of the page. Now I realize that the Kentucky Derby is big-time sports but the outcome really only influences the lives of a couple dozen people at most (with the exception of those that won a few bucks betting on the winner).

Yet when it comes to talking about oral appliance therapy for obstructive sleep apnea that can save thousands of lives, improve the health of millions and save countless dollars in medical expenses - we have to fight for an interview with the press.

Something's wrong!

Dr. Barsh

Angry that you weren't told about an alternative to CPAP?

CPAP is a wonderful therapy for thousands of patients who suffer from sleep apnea, but thousands more, for one reason or another, cannot tolerate their prescribed CPAP units. It may be irritation from the mask, it may be the feeling of being tethered to a machine, or it may be a feeling of claustrophobia.

Whatever the reason, many people simply cannot tolerate CPAP and just go without therapy because they are not being told about a medically approved alternative treatment that works nearly as well and is medically approved.

Oral appliances are small dental mouthpieces that hold the jaw in a forward position splinting the airway during sleep. Now I'm not referring to those over-the-counter devices that are being sold(illegally) over the Internet but to well-researched therapeutic appliances that are provided by dentists who have received special post-doctoral education and who work closely with their patients' physicians. The published research documents the efficacy of these appliances.

So don't be angry, just find a qualified dentist and get treated.

Dr.Barsh

The Voices of Sleep Apnea

There is a well presented blog written by Tara Parker-Pope at the New York Times web site. The link is http://well.blogs.nytimes.com/2009/05/14/the-voices-of-sleep-apnea/. It's worth reading and commenting on especially if you have been treated successfully with an oral appliance.

Millions of people with undiagnosed and untreated sleep apnea suffer from heart disease, stroke, high blood pressure, diabetes, obesity and excessive daytime sleepiness without knowing the cause.

Obstructive sleep apnea has been causally related to many medical problems. While the conventional treatment for sleep apnea is a medical device known as CPAP (continuous positive air pressure delivered through a nasal tube) many people cannot tolerate this device.

Now there is a medically approved treatment known as oral appliance therapy that is delivered by specially trained dentists. This is not to be confused with the over-the-counter devices seen on the Internet or advertised on television. Oral appliance therapy is a treatment that has been approved by the American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine.

Dentists will work directly with physicians to determine if this therapy is appropriate for use for the individual patient and monitor the continuing therapy until therapeutic results are achieved.

The practice parameters for oral appliance therapy were published in the February 2006 issue of the journal Sleep. THe abstract is available at http://www.ncbi.nlm.nih.gov/pubmed/16494092.

For more information, please visit http://www.snoringisntsexy.com

Dr. Barsh

Attention Family Physicians

It has been estimated that nearly half of the American population snores and yet snoring, which has been linked causally to carotid artery atherosclerosis , is still considered no more than a social nuisance. Obstructive sleep apnea (OSA), which affects 20 million people in the United States alone, has been causally related to heart disease, hypertension, stroke, diabetes, obesity, sexual dysfunction and excessive daytime sleepiness. With obesity reaching epidemic proportions, the numbers will increase dramatically in the years to come.

Because of the medical ramifications of snoring and sleep apnea, recognition and management of snoring and OSA are the responsibility of every member of the health professions. Family physicians and family dentists, individually and working in concert, have a unique relationship with their patients – that being a close personal relationship that is not shared by any of the specialties. This interpersonal bond carries with it a special responsibility to recognize the medical and social problems of snoring and sleep apnea.

While continuous positive air pressure (CPAP) is still the primary treatment modality for OSA, dentistry now offers an accepted alternative in the form of an oral appliance for those patients who would rather not use CPAP and/or those who tried but cannot tolerate the CPAP.

A practice parameters paper was published in the journal Sleep in 2006 that stated

Oral appliances (OAs) are indicated for use in patients with mild to moderate OSA who prefer them to continuous positive airway pressure (CPAP) therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP. Until there is higher quality evidence to suggest efficacy, CPAP is indicated whenever possible for patients with severe OSA before considering OAs. Oral appliances should be fitted by qualified dental personnel who are trained and experienced in the overall care of oral health, the temporomandibular joint, dental occlusion and associated oral structures. Follow�up polysomnography or an attended cardiorespiratory (Type 3) sleep study is needed to verify efficacy, and may be needed when symptoms of OSA worsen or recur.

Oral appliance therapy (OAT) provided by a dentist who has received post-doctoral education in sleep medicine involves the use of a custom designed dental mouthpiece, much like an orthodontic appliance, worn during sleep. Oral appliances maintain the mandible in a forward position to prevent the collapse of the tongue and pharyngeal soft tissue maintaining airway patency during sleep.

Family physicians play a primary role in the management of care for their patients.
Hopefully this blog post will provide additional information that will be useful in managing treatment options for patients who snore, have observed cessation of breathing during sleep, are hypertensive and who exhibit excessive daytime sleepiness.

Dr. Barsh

Choice of Dentist to Treat Snoring and Sleep Apnea

We often get requests at Snoring Isn't Sexy for a dentist to treat snoring and sleep apnea with an oral appliance. Just yesterday I had a request for a dentist in a city on the East Coast. Since we did not have a dentist in Snoring Isn't Sexy in that city, we referred her to a Diplomate of the American Board of Dental Sleep Medicine who was not a member of Snoring Isn't Sexy.

She called his office but upon finding out that he was not a participant in her insurance plan she called a dentist who accepted her medical insurance. But accepting an insurance plan is not sufficient reason to choose a dentist for this very specific treatment. While any dentist can legally provide an oral appliance for sleep apnea, it does not mean that they are qualified to do so.

We have provided some guidelines for choosing a dentist at snoringisntsexy.com. Plese read these over before selecting a dentist to provide oral appliance therapy.

Dr. Barsh