Snoring Isn't Sexy

ANY WONDER WHY DENTAL SLEEP MEDICINE IS NOT GAINING TRACTION WITH MDs?

noreply@blogger.com (Dr. Larry Barsh) — Tue, 03 May 2011 18:22:00 +0000

This was published in the Science section of the New York Times on May 2, 2011.

To the Editor:

I am correctly cited in Ms. Brody’s article stating that I would not get routine dental X-rays, as there is little evidence to support them in asymptomatic patients. The situation for mammography is completely different. Randomized clinical studies have shown mammography saves lives. It is unlikely to impact thyroid cancer, and the benefits of mammography clearly outweigh any risks. So, the message is clear: Get your mammogram and skip the “routine” dental X-ray if you do not have symptoms.

Carolyn D. Runowicz, M.D.

Miami

I contend we have a real problem here. Any comments?

The $20,000 Phone Call

noreply@blogger.com (Dr. Larry Barsh) — Sun, 01 May 2011 10:42:00 +0000

I don't even have to write today's blog ' Seth Godin did it for me:

The $20,000 phone call

When a homeowner decides to put his house on sale and calls a broker...

When he calls the moving company...

When a family arrives in town and calls someone recommended as the family doctor...

When a wealthy couple calls their favorite fancy restaurant looking for a reservation...

Go down the list. Stockbrokers, even hairdressers. And not just people who recently moved. When a new referral shows up, all that work and expense, and then the phone rings and it gets answered by your annoyed, overworked, burned out, never very good at it anyway receptionist, it all falls apart.

What is the doctor thinking when she allows her neither pleasant nor interested in new patients receptionist to answer the phone?

Snoring Isn't Sexy provides telephone conversation recording so members can listen to (and act on) phone calls that are costing them patients.

Beating a dead horse and other exercises in futility

noreply@blogger.com (Dr. Larry Barsh) — Fri, 29 Apr 2011 11:51:00 +0000

There was an ad for paper and actual books at the bottom of the Business Section in today's New York Times (Apr. 29, 2011).

Sure the Gutenberg Press was remarkable in its time but the Internet reaches many times more people, faster and more efficiently than the word printed on paper could ever do. Imagine what would happen in medicine and dentistry today if all medical journals were available on the Internet at minimal cost instead of having to wait a year or more for the printed version and then having to pay upwards of $40 an article if you don't subscribe.

This ad is an an advertisement out of desperation much like buggy whip manufacturers must have done when the car was introduced or by ice house owners when the refrigerator came into being.

In dentistry, we are doing the same thing today, especially in dental sleep medicine. We advertise in the newspapers, in magazines and even on the web. People do inquire about dental sleep medicine but few, if any, convert to patients despite the fact that, for the most part, treatment will be covered by medical insurance or Medicare. There is a reason this is happening!

Do you want to know what our problem is in the conversion of patients? Dental sleep medicine has been marginalized in the public press. For example, today Michael Breus PhD (the "sleep doctor" who writes for the Huffington Post who also shills for Sleepy's and has his own bed for sale) wrote another article on obstructive sleep apnea and snoring (Apr. 29, 2011).

http://www.huffingtonpost.com/dr-michael-j-breus/learning-something-new-th_b_846366.html

Not one word about oral appliances, not one. So when a patient who may be interested in oral appliances for his/her mild to moderate sleep apnea reads this, they immediately dismiss OAT.

The sad part is that we, both as individuals and as an organization, do little or nothing to combat this omission. Until we call Dr. Breus and others on this, we will never get patients to accept oral appliance therapy as legitimate therapy.

Comment on Dr. Breus' articles publicly on

twitter: @thesleepdoctor
Facebook: www.facebook.com/thesleepdoctor

I did.

But until we ALL comment, there will be no change and patients who cannot tolerate CPAP will get no treatment. There is no better time to make your voice heard, the Internet makes it possible but only if you have the courage to use it. Otherwise just keep sitting on the tack and crying about lack of patient flow and lack of patient conversion. Believe me, no one gives a damn about your radio commercial or your printed advertisement, or what I do or what any other group marketing dental sleep medicine does until people like Michael Breus, Mehmet Oz and Oprah start talking about the benefits of OAT.

The public just doesn't care what you say about yourself, they only care about what others say about what you say about yourself.

What would happen if...

noreply@blogger.com (Dr. Larry Barsh) — Sun, 24 Apr 2011 11:43:00 +0000

You absolutely must, MUST watch this. Eric Whitacre said it so much better than I ever could. Even the name of his piece is appropriate. Imagine if we had a world-wide network of dentists providing oral appliance therapy all working together - singing their individual practices but TOGETHER rather than singly.

Let's develop a "virtual choir" of dentists providing oral appliance therapy in the United States, Canada and around the world? Why not? Just think what would happen to your individual practices if we could actually pull this off.

PUBLIC INTEREST IN TREATING SNORING AND SLEEP APNEA

noreply@blogger.com (Dr. Larry Barsh) — Fri, 22 Apr 2011 11:38:00 +0000

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!

Seth Godin just wrote "The worst voice of the brand is the brand"

noreply@blogger.com (Dr. Larry Barsh) — Sun, 03 Apr 2011 11:24:00 +0000

One sentence stood out:

When a doctor rips off Medicare, all doctors are less trustworthy.

Interesting comment that can be applied directly to those of us who practice dental sleep medicine.

How well do we represent the profession in dealing with patients who snore and have obstructive sleep apnea? Do we claim to have a unique appliance that no one else has? Do we advocate over-the-counter appliances that research has proven ineffective? Have we taken sufficient continuing education to actually know what we are doing when we treat sleep apnea? Do we present ourselves to sleep physicians in a way that is beneficial to ALL dentists who work in this field? Do we deal honestly with Medicare?

Is dental sleep medicine just a "profit center" to replace cosmetic patients lost to the recession or are we seriously approaching the field in order to help people?

I can't answer any of these questions for you, you can only do that yourself. But remember your actions reflect on ALL dentists in the field and on dentistry in general.

Larry

WTF? Twitter and Snoring and Sleep Apnea

noreply@blogger.com (Dr. Larry Barsh) — Wed, 30 Mar 2011 11:31:00 +0000

There are a number of well-meaning folks on Twitter who purport to be experts on snoring and sleep apnea. These people seem to Tweet about every article that has either the word "snoring" or "sleep apnea" in the headline.

This morning there were between 5 and 10 tweets about an article located at http://bitURL.net/bcd2.

This article contained sentences like

Buying this inexpensive device is a very good way to tell if this device helps you rattle when it is right for you by your dentist is taken into account.

Have you tried your dentist know ? that it is quite possible that the snoring problem is due to your jaw placement rather than some loose tissue or an enlarged uvula is this?

Questions and Answers Ask the experts your health related questions here … Ask 200 characters AV8 have this damn virus! Once you finally get to be able to scan the super anti-spyware, stopping my computer twice! It is capable of 120 pieces, then find out * Phew *. Now what?

It's pretty obvious that this is a computer-generated link farm page.

To those Tweeters that repeat this stuff and promote it - PLEASE READ THE ARTICLES BEFORE YOU TWEET ABOUT THEM... unless you too are just computer-generated programs.

No wonder serious dental sleep medicine is having a problem

noreply@blogger.com (Dr. Larry Barsh) — Mon, 28 Mar 2011 14:28:00 +0000

An article just came across the wires this AM at a site called articlesbase.com. The site is, of course, the kind of trash that Google is trying to get rid of with its new algorithm but its potentially dangerous to those who practice dental sleep medicine seriously. The article is designed to garner ad links without any regard for the validity of content.

The title of the article is "How Cosmetic Dentists Can Help You to Get a Good Night's Sleep...Literally." The article goes to to describe three methods of how a cosmetic dentist can help:(1) CPAP (2) Pillar procedure (3) Surgical excision. While a dentist can perform the Pillar procedure and an oral surgeon can excise excessive tissue - CPAP is outside dental licensure. There are also few, if any, cosmetic dentists who will undertake surgery on the soft palate or pharyngeal area.

The article is bogus but potential patients are able to read this.

The article goes on to state:

However, not every kind of treatment can be good for every patient. If your neighbor underwent surgery, for instance, you may be better off getting a CPAP machine. Make it a point to consult with your cosmetic dentist about suitable options before you go ahead with any kind of treatment.

Finally, choose the cosmetic dentist carefully and only after extensive research. Check out the reputation he (or she) has online prior discovering their attitude towards you during you initial in office examination. Additionally, make it a point to discuss the expenses before you decide to go ahead with the treatment. Procedures in cosmetic dentistry can be expensive, but will never burn a hole in your wallet. If a particular treatment package seems to be a little too expensive, ask for alternative options.

You are in luck if you live in or around Carrollton, TX. Cosmetic dentists here are some of the best in the entire state of Texas. Schedule an appointment with one of the reputable dentists in your area and those sleepless nights will soon be a thing of the past.

We've all got to become aware of what's going on in order to protect our patients and the field of dental sleep medicine.

Now here's something really scary about where dentistry is heading

noreply@blogger.com (Dr. Larry Barsh) — Fri, 25 Mar 2011 10:55:00 +0000

On the web page of TheWealthyDentist.com ( a group whose name distresses me anyhow especially in an era of foreclosures and unemployment) there's a survey " Do you consider oral cancer screenings to be an important part of your job?"

The survey responses that are offered are:

Do you consider oral cancer screenings to be an important part of your job?
Yes! This is an essential role for dentists.
I offer screening, but other services I offer are more important to me.
No, oral cancer screening is not a regular part of the dental care I offer.

This scares me on several levels.

First, even asking the question whose answer should obviously be "yes" indicates that even performing a screening as basic to a patient's well-being as an oral cancer screen is open to question in today's dental environment is a sign of a declining professionalism.

Second, use of the word "job" rather than "profession" connotes a lowering opinion of dentists themselves as part of a health care team.

Finally, if oral cancer screening is open to question what chance do we have to convince dentists to perform the very essential screening for sleep apnea?

For years, I have fought a losing battle over the use of the terminology "doctors and dentists" rather than "physicians and dentists" since we are, or least used to be, doctors. The survey convinces me that I will never win this battle and that dentistry will continue to decline as a valuable profession in the minds of the public.

How sad!

The Borgias and Dental Sleep Medicine

noreply@blogger.com (Dr. Larry Barsh) — Wed, 23 Mar 2011 13:44:00 +0000

There was a half page advertisement in today's New York Times Dining section. The ad read

MACY'S CULINARY CHEF TODD ENGLISH PREPARES AN ORIGINAL DISH INSPIRED BY THE SHOWTIME ORIGINAL SERIES THE BORGIAS!

Now correct me if I'm wrong but wasn't Lucretia the chick with the ring that flipped open to dispense poison? Is it really a good marketing ploy to prepare an original dish based on a family that chose poison as a signature statement?

What does this have to do with dental sleep medicine? Well, there's one company marketing dentists who provide oral appliance therapy for snoring and sleep apnea by using a boil-and-bite appliance that anyone can buy over-the-counter for $9.95 as a "trial" appliance.

Those of us in the field know full well that while these devices may reduce or eliminate snoring they are far from medically acceptable therapeutic devices for treating sleep apnea. And, in addition, may have a whole range of side effects including:

This is a temporary device; it is not intended for use for more than the time determined by the prescribing Provider or if complications occur. Some complications may include soreness in the teeth, soreness in the jaws, tooth damage, existing restoration damage, facial muscle and TMJ pain, TMJ dysfunction and temporary and/or permanent bite changes. These specified complications are not intended to include all possible complications that may occur. By agreeing to participate as a patient in the [name removed] program you are agreeing that you will not hold the prescribing Provider , [names removed] liable or responsible to you, to your spouse or to any other person for physical or emotional injury, or for monetary damages, in the event one or more complications occur as a result of your participating in the[name removed] program and your use of the non-custom anti-snoring dental device provided to you as part of your participation in the [name removed] program.

(Quotation from that company's disclaimer - name of company removed intentionally)

Is subjecting medically ill patients to a device that can actually cause harm not the same marketing concept as using the Borgias to promote an original recipe? Will an OTC device really be able to predict success or failure with a well-designed, custom appliance?

It's up to you, it's your practice...

Perception is the problem

noreply@blogger.com (Dr. Larry Barsh) — Tue, 22 Mar 2011 11:08:00 +0000

Blogger Ken Terry (http://www.bnet.com/blog/healthcare-business/hospitals-8217-latest-money-making-idea-helping-people-sleep-better/2739) posted an article yesterday entitled "Hospitals’ Latest Money-Making Idea: Helping People Sleep Better."

In the post, Mr. Terry states

Milder forms of sleep apnea can be cured through the use of a continuous positive airway pressure (CPAP) mask. But in more severe cases, surgery to remove obstructive tissue may be indicated. This could be another moneymaker for hospitals as they identify additional cases of obstructive sleep apnea.

The words "sleep apnea can be cured" in the article are linked to the description of sleep apnea at the Mayo Clinic (http://www.mayoclinic.com/health/sleep-apnea/DS00148/DSECTION=treatments-and-drugs) that discusses therapies for sleep apnea.

Among the therapies listed are oral appliances.

#

Oral appliances. Another option is wearing an oral appliance designed to keep your throat open. CPAP is more effective than oral appliances, but oral appliances may be easier for you to use. Some are designed to open your throat by bringing your jaw forward, which can sometimes relieve snoring and mild obstructive sleep apnea.

A number of devices are available from your dentist. You may need to try different devices before finding one that works for you. Once you find the right fit, you'll still need to follow up with your dentist at least every six months during the first year and then at least once a year after that to ensure that the fit is still good and to reassess your signs and symptoms.

While this statement is still not a glowing appraisal of how oral appliances are therapeutic devices, the Mayo Clinic still lists them as an option that Mr. Terry has chosen to ignore.

Those of us in dental sleep medicine still have work to do educating the public as well as the press as to the role that dentistry can play in treating obstructive sleep apnea.

Snoring Isn't Sexy feels that this can be more readily accomplished as practitioners working together than as individual competing offices working at odds with one another.

How do you want to market your dental sleep medicine practice?

noreply@blogger.com (Dr. Larry Barsh) — Mon, 21 Mar 2011 15:04:00 +0000

If you are a dentist who provides oral appliance therapy for snoring and sleep apnea and wishes to work within a PROFESSIONAL marketing plan, Snoring Isn't Sexy can help you promote your practice and your services in an ethical, highly effective way that reflects positively on your practice and is acceptable to referring physicians.

There are many options and many companies that can help you market your dental sleep medicine practice. Marketing to those who have been diagnosed and treated but cannot tolerate their prescribed CPAP is one route. There are hundreds of patients who fit this category and like other companies, Snoring Isn't Sexy markets to these patients. But only about 15% of those who have sleep apnea have been diagnosed, fewer have been treated and still fewer are unhappy with their CPAP unit.

At Snoring Isn't Sexy, we believe that dentistry has an obligation to educate the 85% of patients with undiagnosed sleep apnea, that snoring is a critical sign of sleep apnea. We also believe that working as a team with our physician colleagues in a highly professional manner is the best route to providing the care our mutual patients deserve.

One of our competitors requires member doctors to provide free consultations to patients and requires that members provide an over-the-counter type appliance for 7 days to see if oral appliance therapy works for the patient. Snoring Isn't Sexy does NOT feel that we should interfere with your practice decisions but there are a couple of caveats to this approach.

Free consultations, in our opinion, demean the professionalism of our marketing. After all how many primary care physicians, sleep physicians or cardologists offer a free consultation? These are the professionals with whom you will be working if you elect to make dental sleep medicine part of your practice.

As you know, over-the-counter appliances are not an indication of how well a custom device will work. There are few scientific articles whether they are safe to use or even effective (1,2). And from our competitor's own web site,the over-the-counter devices (boil and bite) which are the same as those available on the Internet that they recommend, apparently even under supervision, can cause serious side effects. Their disclaimer clearly states:

This is a temporary device; it is not intended for use for more than the time determined by the prescribing Provider or if complications occur. Some complications may include soreness in the teeth, soreness in the jaws, tooth damage, existing restoration damage, facial muscle and TMJ pain, TMJ dysfunction and temporary and/or permanent bite changes. These specified complications are not intended to include all possible complications that may occur. By agreeing to participate as a patient in the [name removed] program you are agreeing that you will not hold the prescribing Provider , [names removed] liable or responsible to you, to your spouse or to any other person for physical or emotional injury, or for monetary damages, in the event one or more complications occur as a result of your participating in the[name removed] program and your use of the non-custom anti-snoring dental device provided to you as part of your participation in the [name removed] program.

If you would rather maintain strict professionalism and would rather not involve your practice in these potential problems, then Snoring Isn't Sexy should be your marketing company.

If you have taken continuing education courses, have a serious interest in treating sleep-breathing problems, and intend to or are working toward Board Certification with the American Board of Dental Sleep Medicine, please take a few minutes to either drop us an email or call 888.203.0488. Our phones and email are available 24 hours a day, 365 days a year so write or call at your convenience. If we're not available to speak with you immediately, we'll call you back at your convenience - just let us know the best time and phone number.

Our goal is to provide patients with a directory of the most well-qualified and well-educated dental sleep medicine practitioners in the United States and world-wide. If you feel you qualify and want to learn more, please fill out the form below to learn what we offer to help you save lives and health.

1. Tsuda, H., F. Almeida, et al. (2010). "Side effects of boil and bite type
oral appliance therapy in sleep apnea patients." Sleep and Breathing 14(3):
227-232.

2. Vanderveken, O. M., A. Devolder, et al. (2008). "Comparison of a custom-made
and a thermoplastic oral appliance for the treatment of mild sleep apnea."
Am J Respir Crit Care Med 178(2): 197-202.

Evolution and Google Algorithms

noreply@blogger.com (Dr. Larry Barsh) — Fri, 11 Mar 2011 22:19:00 +0000

A couple of articles came across my desk this morning that on first look appear to be totally unrelated to how dental practices that provide oral appliance therapy for snoring and sleep apnea can flourish. These articles, on close examination, are critical to marketing DSM.

The first articles from the New York Times thus morning (March 11, 2011) discussed the separation of humans from apes.

"Early human groups, according to the new view, would have been more cooperative and willing to learn from one another than the chimpanzees from which human ancestors split about five million years ago. The advantages of cooperation and social learning then propelled the incipient human groups along a different evolutionary path...

Group selection could possibly act at the level of the tribe, Dr. Hill said, meaning that tribes with highly cooperative members would prevail over those that were less cohesive, thus promoting genes for cooperation...

Because humans are unusually adept at social learning, including copying useful activities from others, a large social network is particularly effective at spreading and accumulating knowledge."

Since its inception in July of 2008, Snoring Isn't Sexy has always advocated the advantages of working together to promote a common cause as opposed to a number of individual practices that market individually often in competition with one another. Collaborative marketing not only offers the advantage of shared costs but also validates the existence of a new service. Collaborative marketing under a single "brand" name also provides the advantage of recognition across a large geographic area. Imagine if you will the advantages of being in a global network in a mobile society.

The second article related to the efficacy of individual web site search engine optimization in light of Google's new Panda algorithm.

“A major update by Google of how it ranks sites has affected 12% of search results and halved many sites’ visitor numbers. Named the Farmer or Panda Update it’s only affecting US Google results as I write but if you’re outside the US it is coming to you soon.

The aims of Panda are noble: to remove poor quality sites from the top of Google’s results pages. Or as Matt Cutts, Google’s head of spam, puts it in a blog post announcing Panda:

‘This update is designed to reduce rankings for low-quality sites—sites which are low-value add for users, copy content from other websites or sites that are just not very useful. At the same time, it will provide better rankings for high-quality sites—sites with original content and information such as research, in-depth reports, thoughtful analysis and so on.’

The last thing Google wants is searchers being unhappy with what they find. They might try another search engine if that happens.

Few people other than the low-quality sites’ owners and their investors will have a problem with that.

But all major Google updates leave ‘collateral damage’ behind them: sites that just don’t match the target or deserve to be penalized [sic]. Google are aware of this and so have asked those with “a high quality site that has been negatively affected by this change” to let them know about it here.

• A high % of duplicate content. This might apply to a page, a site or both. If it’s a site measure then that might contribute to each page’s evaluation.

• A low amount of original content on a page or site.

• A high % (or number) of pages with a low amount of original content.

• A high amount of inappropriate (they don’t match the search queries a page does well for) adverts, especially high on the page.

• Page content (and page title tag) not matching the search queries a page does well for.

• Unnatural language on a page including heavy-handed on-page SEO (‘over-optimization’ to use a common oxymoron). Eg, unnatural overuse of a word on a page.

• High bounce rate on page or site.

• Low visit times on page or site.

• Low % of users returning to a site.

• Low clickthrough % from Google’s results pages (for page or site).

• High % of boilerplate content (the same on every page).

• Low or no quality inbound links to a page or site (by count or %).

• Low or no mentions or links to a page or site in social media and from other sites.

If any of these factors is relevant to Panda, it is unlikely that they will be so on their own.

Combinations of factors will be required to get ‘Panda points’ (and points do not mean prizes in this game). Panda points will be added up. Cross a threshold (Panda’s redline) and you are ‘blocked’.

‘Blocked’ is Matt Cutts’ word, used in that Wired interview: “Whenever we look at the most blocked sites, it did match our intuition and experience”. This suggests that …

… if a site gets defined as low quality then a penalty is applied (it is ‘blocked’).

Google have since said that ‘low quality content on part of a site can impact a site’s ranking as a whole.’

The way this sounds to me is that each individual dental site will have to review its search engine optimization plan to be sure it fits within Google’s (secret) algorithm. None of us can be really sure how this is going to affect our web sites but it is still apparent that sites with original content, sites that keep updating content and sites with numerous INCOMING links are still going to rank high in referral from Google searches.

SnoringIsntSexy.com has ranked high in Google searches on many different keywords and phrases. We update content at the site on almost a daily basis by providing an RSS Feed containing links to articles about snoring and sleep apnea. SnoringIsntSexy.com has an admirable number of incoming links but we always can use more so we have adding widgets for any dental sleep medicine site and links from two new iPad and iPhone apps.

Combining the information from the article about man’s separation from apes and the update about Google’s new ranking algorithm convinces me that we are on the right path with Snoring Isn’t Sexy – collaborative marketing and shared knowledge combined with a single site to which multiple sites are attached is the way to go.

Comments please?

Thanks

Larry

Gossip Columns are abuzz with the news...

noreply@blogger.com (Dr. Larry Barsh) — Sun, 23 May 2010 12:18:00 +0000

While certainly not the most significant medical news of the day, gossip blogs and "celebrity" web sites are reporting that Kevin Jonas and his new wife have been married only 5 months and are already sleeping in separate beds.

While considered as an insignificant joke among most of these "journalists," snoring can be sign of the serious medical problem - obstructive sleep apnea. Even though a diagnosis of sleep apnea is unlikely, one would think that someone close to the pop star would insist that a sleep study be performed.

Even without the more serious diagnosis, treatment of primary snoring is relatively simple with an oral appliance without the possible voice-altering effects of a surgical procedure.

As dentists who provide oral appliance therapy for snoring and sleep apnea, we need to do more to educate the public of our role in the recognition and management of sleep breathing disorders.

As always your comments are appreciated.

Dr. Barsh

Are professional truck drivers being denied adequate medical treatment for sleep apnea by the very regulatory agencies charged with their protection?

noreply@blogger.com (Dr. Larry Barsh) — Fri, 14 May 2010 13:44:00 +0000

In an online news release today on the Occupational Health & Safety web site (ohsonline.com), there was an article that stated:

For commercial motor vehicle drivers with obstructive sleep apnea (OSA), effective treatment lowers health care costs and disability rates, reports a study in the May Journal of Occupational and Environmental Medicine, the official publication of the American College of Occupational and Environmental Medicine (ACOEM)....

On average, treatment for OSA led to “over $6,000 in total health plan and disability cost savings per treated driver,” the researchers noted. Total costs decreased by 41 percent in drivers treated for OSA (compared to an eight percent decrease in untreated drivers)....

Sleep apnea is an important preventable cause of motor vehicle accidents, and studies have found that treatment for OSA can lower the accident rate. Screening and treatment for OSA has recently been recommended for commercial motor vehicle drivers.

For truckers with sleep apnea, CPAP is the preferred and approved treatment of choice for sleep apnea. But despite the fact that many people cannot tolerate CPAP and despite the fact that CPAP is not always available in trucks or other places where truckers can sleep, oral appliance therapy is NOT an approved method of treatment because of the inability to document compliance with therapy.

This issue arose at the recent Sleep Apnea Truckers Conference held in Baltimore on May 11 - 12.

The problems with CPAP use for a trucker range from inability to tolerate the mask and unit, power supply problems, altitude problems, humidification and heat problems, water sloshing in the humidification chamber while partner is driving,anti-idling laws and problems with cleaning the unit. None of these problems apply to oral appliances and yet their use is not approved.

Patients are considered to be complying with CPAP usage if they wear their CPAP unit for a total of only 4 hours out of every 24 hour period. Is this sufficient for effective treatment? Does 4 hours of use reduce excessive daytime sleepiness to an acceptable level? Yet oral appliances are not approved since their compliance cannot be measured even though research has shown that oral appliances are often better tolerated and worn longer than CPAP.

So if a trucker cannot tolerate CPAP or if it is impossible to utilize the CPAP properly for the above reasons that truck driver cannot be offered an oral appliance simply because compliance cannot be measured.

The other reason for not using oral appliances is, as one speaker at the SATC meeting put it, the fact that oral appliances are not effective in severe sleep apnea.

Following this logic, for example, a driver with an AHI of 60 that cannot use CPAP for one reason or the other is best left uncertified, medically ill and unable to earn a living despite the fact that an oral appliance might only reduce his/her AHI to 20 and because appliance use cannot be quantified. Even if a patient who uses an oral appliance can be documented to show improvement by sleep study, this is not considered adequate evidence of compliance.

Oral appliances have been proven to be an effective treatment for obstructive sleep apnea and have been approved for use in mild to moderate sleep apnea. There is research to show that they are useful in some cases of severe sleep apnea as well.

To simply dismiss their use on the basis that compliance cannot be measured or that they are not as effective in severe sleep apnea as CPAP is dismissing a therapy can can save lives.

Your comments would be appreciated.

Dr. Barsh

It's Your Responsibility!

noreply@blogger.com (Dr. Larry Barsh) — Sun, 02 May 2010 22:30:00 +0000

At Snoring Isn't Sexy, we can't say this often enough but it's up to you to ensure that the dentist you choose for oral appliance therapy has had the education and training he or she needs to provide this service effectively and safely.

With the exception of the Tufts Dental School graduate program, dental sleep medicine is not taught in dental schools so all the training is acquired in continuing education courses.

Snoring Isn't Sexy provides some guidelines at its web site (http://www.snoringisntsexy.com/choosedentist-onecolumn.cfm) but in addition be sure to ask about the training that the doctor has had and be sure the appliance used has been FDA approved.It's way to easy for a dentist to "invent" an appliance and claim that s/he is the only one who has this appliance available.

Do not be mislead by a doctor who claims to treat only snoring, there is no way to determine if you just snore or have sleep apnea without a sleep test. Be sure your dentist works with qualified physicians who will examine you personally. Over the Internet health histories are not worth the kilobytes used to generate them.

Oral appliance therapy is an effective, comfortable way to solve sleep breathing problems but like any other medical treatment it is not always 100% effective and can have adverse side effects.

Dr. Barsh

Will oral appliances be taxed as well?

noreply@blogger.com (Dr. Larry Barsh) — Sun, 28 Mar 2010 11:19:00 +0000

A bit of distressing news came across my desk this AM.

Ask Mike Amory where it hurts and the owner of a medical equipment supply business points to the health care reform signed into law last week.

The money to pay for a portion of the nearly $1 trillion overhaul package is coming out of the pockets of him and other business owners facing new taxes on the medical devices. The law imposes a $20 billion excise tax over 10 years on manufacturers of the power wheelchairs, sleep apnea, respiratory and other equipment sold at Amory Medical Associates.

[Emphasis added]

Since oral appliance therapy has been classified as a DME, does this mean that there will be a tax on an oral appliance as well?

We will just have to wait and find out.

Dr. Barsh

Choosing a dentist for Oral Appliance Therapy

noreply@blogger.com (Dr. Larry Barsh) — Wed, 23 Dec 2009 12:57:00 +0000

I know I've talked about this before but as more and more dentists start to provide oral appliance therapy for snoring and sleep apnea, it becomes more important that you, the patient, become more and more aware of the necessity to choose a dentist for this therapy with care and consideration.

Every dentist legally can provide this therapy but this does not mean that every dentist is qualified to do so. Treating snoring and sleep apnea - both problems with serious medical consequences - with a dental device is not dentistry. It is medicine and has to be approached differently than restoring a decayed tooth or replacing a tooth with a dental implant.

Remember that oral appliance therapy is not part of any undergraduate dental school curriculum at this time. Tufts Dental School is the only school (so far) that offers a post doctoral course in dental sleep medicine. This means that most education in this field is provided by continuing education course which, unfortunately, do vary in quality. No organization rates the quality of the courses or the qualifications of the presenters so it is up to you to question the dentist you select to provide this treatment.

I would like to refer you to the web page we have written on this subject as a guideline to choosing a dentist.

Happy Holidays

Dr. Barsh

The Internet and Medicine

noreply@blogger.com (Dr. Larry Barsh) — Fri, 18 Dec 2009 11:57:00 +0000

In an article today on Medpage Today by Lauren Cox of ABC Medical News Unit describes the 10 Top Medical Advances of the Decade. Among them was"Doctors and Patients Harness Information Technology."

She writes

Patients may not even think of it as they sign in with a pad and pen, then sit in the waiting room while the nurse pulls their file. But doctors say the Internet and information technology has actually changed the way they practice medicine for the better. Even doctors need to look things up from time to time.

"Early in practice, if I had a clinical question to research, I had to go to the library, pull out multiple years of the Index Medicus, look up the topic, write down the references, go to the stacks and pull the volumes of journals, find the article, read the article, go to the copy machine and make a copy& if I were lucky, I would have my answer in about four hours," said John Messmer, MD, associate professor at the Penn State College of Medicine in Hershey.

"Now I can be on rounds and in five minutes have more information on the topic than I need& on my iPod Touch, I can look up a medication, check the formulary to see if it's covered, check for interactions with a patient's other meds and double-check details of the pharmacology of the med plus quickly review the problem I am treating, and I don't even have to go online," said Messmer.

Information technology has also, to some degree, made life safer for the patient. Once admitted to a hospital, they get a bar code which matches their blood samples and their IVs.

"The ways in which computer systems are improving hospital care& are pervasive and radical," explained Margaret Humphreys, MD, PhD, editor of the Journal of the History of Medicine.

But many physicians have been reluctant to go digital because there is a significant upfront investment, which is why several of the healthcare reform measures now before Congress include provisions to underwrite some of this cost.

And with or without reform, the Obama administration has an ambitious program aimed at converting paper records to electronic health records. It has earmarked $20 billion to pay for the switch-over and named medical IT wonk David Blumenthal, MD, to serve as National Coordinator for Health Information Technology.

Snoring Isn't Sexy is proud to be able to provide information on dentistry's role in the recognition and management of snoring and sleep apnea without government or funding from commercial sources.

The information and availability of resources to help manage snoring and sleep apnea have been brought to you solely by the dentists and physicians who are members of Snoring Isn't Sexy and, thus, have been able to remain unbiased with no obligation to any outside influence.

Dr. Barsh

Insulation Isn't Sexy

noreply@blogger.com (Dr. Larry Barsh) — Wed, 16 Dec 2009 11:30:00 +0000

Tuesday, December 15, 2010

(CNN) - President Barack Obama expressed his true feelings about
insulation.

"I'm calling on Congress to provide new, temporary incentives for
Americans to make energy efficiency retrofit investment in their
homes, and we want them to do it soon," said President Obama. "I know
the idea may not be very glamorous, although I get really excited
about it. We were at the round table and somebody said insulation
isn't sexy, and I disagree. Frank, don't you think? Insulation is sexy
stuff. Here's what's sexy about it: saving money."

Obama referred to someone who said "Insulation isn't Sexy"

Hmmm... Funny that phrase was never used before in Washington. And
just a couple of days after Snoring Isn't Sexy's ad appeared in the
Wall Street Journal Supplement.

Coincidence, I think not ;-)

Larry

5 Things Every Woman Should Know About Her Man's Snoring

noreply@blogger.com (Dr. Larry Barsh) — Sat, 28 Nov 2009 13:21:00 +0000

"I'm too busy!" "It's nothing, it'll go away by itself." "I can't find a doctor I like." " My insurance won't cover it." "I DON'T SNORE!"

One excuse after another... We men are masters of avoiding a visit to a doctor's office. But whatever the excuse, a woman is often aware that her man is having medical issues long before he is willing to admit it. In the case of snoring and its serious counterpart, obstructive sleep apnea, stalling could be deadly.

So what do you need to know about your man's snoring?

1.Snoring is not his fault

Snoring results from a partial blockage of the airway during sleep. As a snorer breathes, air is forced through narrowed passages around loose tissue like the soft palate and uvula. As the air passes over these structures, noise is created much like the sound of a flag flapping in the breeze.

So snoring is an anatomic, medical noise that he can't control.

But it's still a problem. In 2006, Rosalind Cartwright of the Rush University Medical Center found that wives could be sleep deprived due to their husband’s snoring. This puts a strain on the marriage and creates a hostile and tense situation resulting in a high divorce rate.

2.Snoring alone can cause serious medical problems

Research at the University of New South Wales in Australia this spring found that one in four middle aged men who snore are at risk for developing brain damage while they sleep. Caroline Rae, the lead author, found that snoring associated with obstructive sleep apnea caused changes in brain energy levels that mimic the changes that happens just before dying or after a stroke.

And speaking of stroke, in 2008, a research team headed up by Sharon Lee, again in Australia, found that heavy snoring significantly increases the risk of plaque build up in the carotid arteries that supply blood to the brain. Plaque in the carotid arteries is a leading cause of stroke.

3. Snoring can be a sign of obstructive sleep apnea

When the airway becomes completely blocked, it's called obstructive sleep apnea. This blockage of the airway prevents oxygen from reaching tissues throughout the body and has been implicated in cardiovascular disease, high blood pressure, diabetes, stroke, obesity, depression, excessive daytime sleepiness and depression.

It has been estimated that in the United States alone 20 million men, women and children suffer from obstructive sleep apnea. Millions more snore. Of these 20 million, only about 10% have been diagnosed despite the fact that the average life span of an untreated sleep apneic is years less than those without sleep apnea.

4.Snoring and apnea can be a cause of ED

For those men with sleep apnea, erectile dysfunction may be part of the package (no pun intended). ED may be caused by long-standing intermittent decreased oxygen levels in the blood associated with episodes of obstructed breathing. What is important is that it is possible to reverse erectile dysfunction by treating snoring and sleep apnea dramatically improving the quality of life. One study showed that Cialis may ease the problem of ED, but does not totally overcome the problem in men with obstructive sleep apnea.

Snoring may even effect a man's libido. Men who suffer from obstructive sleep apnea produce lower levels of testosterone resulting in decreased sexual activity.

5.Snoring, Apnea and excessive daytime sleepiness

When complete airway blockage occurs during an apneic episode, your man will partially awaken to start breathing. Although he won't remember this in the morning, it can happen hundreds of times a night leading to fragmented sleep. As a result, he could awake with a headache and be more tired in the morning than he was the night before and tend to doze off easily while driving and at work.

According to the National Sleep Foundation's Sleep in America poll, 60% of Americans have driven while feeling sleepy and 37% admit to actually having fallen asleep at the wheel in the past year. Each year almost 2,000 people die in crashes caused by drowsy driving, according to the National Highway Traffic Safety Administration. And thousands more are injured as a result of sleepy pilots, boat captains and truck drivers.*

So what can you do to help?

Be aware!

If your man snores and stops breathing during sleep, if he has high blood pressure and if he dozes off while driving, get him to see a sleep specialist or a specially trained dentist. Help him to lose weight, help him to stop smoking, control the alcohol consumption - but most of all - make sure he gets to someone who can help.

* SnoringIsntSexy.com has launched a survey to determine the extent of sleepiness with those who interact with the public. The survey is at snoringisntsexy.com.

Sleep and the City

noreply@blogger.com (Dr. Larry Barsh) — Fri, 24 Jul 2009 11:55:00 +0000

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

noreply@blogger.com (Dr. Larry Barsh) — Fri, 24 Jul 2009 11:55:00 +0000

Snoring Isn't Sexy on NPR

noreply@blogger.com (Dr. Larry Barsh) — Fri, 17 Jul 2009 10:27:00 +0000

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?

noreply@blogger.com (Dr. Larry Barsh) — Wed, 03 Jun 2009 16:31:00 +0000

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 Isn't Sexy

ANY WONDER WHY DENTAL SLEEP MEDICINE IS NOT GAINING TRACTION WITH MDs?

The $20,000 Phone Call

Beating a dead horse and other exercises in futility

What would happen if...

PUBLIC INTEREST IN TREATING SNORING AND SLEEP APNEA

Seth Godin just wrote "The worst voice of the brand *is* the brand"

WTF? Twitter and Snoring and Sleep Apnea

No wonder serious dental sleep medicine is having a problem

Now here's something really scary about where dentistry is heading

The Borgias and Dental Sleep Medicine

Perception is the problem

How do you want to market your dental sleep medicine practice?

Evolution and Google Algorithms

Gossip Columns are abuzz with the news...

Are professional truck drivers being denied adequate medical treatment for sleep apnea by the very regulatory agencies charged with their protection?

It's Your Responsibility!

Will oral appliances be taxed as well?

Choosing a dentist for Oral Appliance Therapy

The Internet and Medicine

Insulation Isn't Sexy

5 Things Every Woman Should Know About Her Man's Snoring

Sleep and the City

Sleep and the City

Snoring Isn't Sexy on NPR

Father's Day - A perfect gift?

Seth Godin just wrote "The worst voice of the brand is the brand"