Friday, April 22, 2011


Despite the fact that we, as health care professionals, understand that snoring and sleep apnea are life-threatening, cardiovascular-related conditions, the public seemingly does not. This is yet another illustration of the 80:20 rule in action.

20% of the estimated 20 - 40 million people who suffer with sleep apnea in the United States have been diagnosed and treated (successfully or not). The other 80% have no doubt heard of sleep apnea and know about the problems of snoring but yet do not seek treatment or follow through when they find a source of treatment.

In dental sleep medicine, it is relatively easy to get patients to call a dental office and inquire about options for treatment and yet the conversion rate from inquiry to treatment is exceptionally low despite the fact that both private medical insurance and Medicare often cover the cost of care.

If cost is removed from the equation, we could assume that a reason for patient hesitancy is concern about the treatment itself. Yet neither CPAP nor oral appliances are invasive and getting fitted for either is not an ordeal in itself. So what is the answer?

The only answer that I can see is patient apathy. 80% of the public does not perceive the problem of snoring and sleep apnea to be significant enough to bother spending the time involved in diagnosis and ultimate treatment. Most of the time, a CPAP unit requires an overnight stay in a hospital environment wired to a PSG. Even the home sleep study requires patient involvement for diagnosis. And then there's the nightly nuisance of the CPAP itself, for a disease state most patients do not perceive as important.

In the case of oral appliance, a sleep study is also needed and then there is the succession of dental appointments to get a device that the patient again has to insert and care for - all for a condition that 80% of patients do not perceive as important. After all - there is no pain, no bleeding, no swelling - "sure it may cause a problem down the road but right now I've got other things to do."

We live in a "give-me-a-pill-for-that" society where immediacy is the answer. We do not yet have that answer. The diagnosis and treatment of snoring and sleep apnea require a degree of patient involvement that they are reluctant to commit to. We need to do a better job of public education, we need to do a helluva lot less intra-specialty squabbling, we need to do far less condemnation of the other specialty's therapeutic regimen. In other words, if we are ever to get the public to accept care for this serious medical syndrome; we need to present a unified approach. Early diagnosis and treatment of sleep apnea could save the American health care system millions (if not billions) of dollars in the treatment of associated diseases but despite this we continually pit CPAP against oral appliances against surgery.

Do patients perceive care of sleep apnea as a necessity? Do physicians really think that dentists are a valuable source of alternative treatment? Do dentists advertise a sure-fire "cure" for snoring and apnea? Do vendors claim that their procedure, device, surgical approach is the only treatment that works?

We are all guilty, we are all responsible. The public is suffering!


Blogger Jack Hadin said...

Great post...thanks for sharing....


August 12, 2012 at 2:33 AM  

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