Snoring Isn't Sexy

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

2011-05-03T14:22:00.002-04:00

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

2011-05-01T06:42:00.000-04:00

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

2011-04-29T07:51:00.001-04:00

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...

2011-04-24T07:43:00.010-04:00

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

2011-04-22T07:38:00.000-04:00

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"

2011-04-03T07:24:00.001-04:00

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

2011-03-30T07:31:00.001-04:00

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

2011-03-28T10:28:00.000-04:00

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

2011-03-25T06:55:00.001-04:00

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

2011-03-23T09:44:00.003-04:00

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

2011-03-22T07:08:00.001-04:00

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?

2011-03-21T11:04:00.001-04:00

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

2011-03-11T17:19:00.005-05:00

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...

2010-05-23T08:18:00.000-04:00

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?

2010-05-14T09:44:00.003-04:00

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!

2010-05-02T18:30:00.000-04:00

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?

2010-03-28T07:19:00.003-04:00

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

2009-12-23T07:57:00.002-05:00

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

2009-12-18T06:57:00.002-05:00

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

2009-12-16T06:30:00.002-05:00

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

2009-11-28T08:21:00.008-05:00

"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

2009-07-24T07:55:00.003-04:00

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

2009-07-24T07:55:00.000-04:00

Snoring Isn't Sexy on NPR

2009-07-17T06:27:00.005-04:00

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?

2009-06-03T12:31:00.003-04:00

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

2009-05-19T07:05:00.002-04:00

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

2009-05-16T08:15:00.002-04:00

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?

2009-05-15T11:25:00.002-04:00

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

2009-05-14T12:12:00.003-04:00

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

2009-05-12T09:25:00.001-04:00

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

2009-04-28T07:12:00.003-04:00

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

Anti Snore device for sale on Amazon - Pay for Play Review Scheme

2009-04-24T11:46:00.003-04:00

We have long warned you of the problems of do it yourself snoring devices that are sold over the internet. The many reasons for not using products like these include TMJ jaw pain, tooth movement and most of all - the possibility of disguising the more dangerous sleep apnea by eliminating the snoring and gasping sounds. Now another reason to be wary has come to the forefront.

There are reports that the sales of the Anti-Snore device has been suspended from Amazon.com because of a customer report that Anti-Snore offered him a free mouthpiece in exchange for a 5 star review. You can read the entire report at The Consumerist.

Other reviews of this product complained that it caused pain and discomfort.

Please think carefully about purchasing medical devices over the Internet. Dental mouthpieces (oral appliances) are highly effective when prescribed, inserted and monitored by a qualified dentist.

We'd like to hear from you if you have had a problem with an over-the-counter dental device for snoring and sleep apnea. Please comment on this blog posting.

Dr. Barsh

Media Ignores Drowsy Driving

2009-04-23T10:17:00.002-04:00

A press release from the Johns Hopkins Bloomberg School of Public Health decried the fact that the press, while reporting the fact that young celebrities drink and drive, included minimal coverage of the public health aspect of this problem and stated that only 4% of the reports made any mention of injury or potential injury.

The same problem exists in the reporting of accidents caused by drowsy driving. While the press reports major incidents like oil spills, nuclear plant malfunctions and truck and bus crashes, it very rarely presents a full report of the thousands of accidents caused by the driver falling asleep at the wheel. In these myriad unreported accidents often there is only minor injury or property damage so the media ignores them instead of reporting the problem from a public health standpoint.

Drowsy driving is a serious problem that we at Snoring Isn'tSexy would like to bring to the attention of all those who snore or suspect they have or have been diagnosed with sleep apnea.

If you have ever fallenasleep at the wheel, tell us your story by commenting on this blog. No names are necessary - it is our attempt to bring alert everyone to the dangers of drowsy driving.

Dr.Barsh

Validation for Oral Appliance Therapy

2009-04-22T12:45:00.003-04:00

The University of Texas Health Science Center confirms that oral appliances are successful in treating patients with severe sleep apnea.

The entire press release can be read at http://www.uthscsa.edu/hscnews/singleformat.asp?newID=2976.

This is a significant breakthrough but results are limited to those appliances provided by specially educated and trained dentists and not for those appliances purchased over the internet.

Posted with permission from The University of Texas Health Science
Center at San Antonio.

Dr. Barsh

Sleep Apnea and Motor Vehicle Accidents

2009-04-22T07:20:00.003-04:00

The NTSB recently revisited a bus crash near Mexican Hat, Utah that occurred on January 8, 2008. In the accident 51 of the 53 passengers were ejected when the roof was sheared offthe vehicle. 9 people were killed and 43 others were injured.

The NTSB found that lack of adequate motorcoach occupant protection systems contributed to the accident's severity and that the driver was speeding.

One other factor that came out in the investigation was that the driver had been diagnosed with sleep apnea.

Sleep apnea leads to fragmented and inadequate sleep leading to excessive daytime sleepiness. Untreated sleep apnea has been implicated in many motor vehicle accidents and in the Chernobyl Disaster and the Exxon Valdez oil spill.

The lesson here is that if you or a loved one has fallen asleep at the wheel, see your physician or a qualified dentist and get evaluated for sleep apnea. Treatment can be non-invasive using CPAP or an oral appliance.

Dr. Barsh

Snoring and the News Media

2009-04-15T06:56:00.002-04:00

Last evening, on the CBS affiliate in New York City, Dr. Holly Phillips (the local on air doctor) presented a piece ostensibly on snoring. The story described how a CPAP unit could control snoring and renew relationships between husband and wife.

Perhaps I'm being somewhat paranoid but the title of the piece "HealthWatch: Dealing With Sleep Apnea: If Your Partner's Snoring Is Out Of Control, It Might Be Time To Have Him Or Her Try Out The A Proven Device" seemed to diss all other therapies including oral appliances which were not mentioned in the report.

Furthermore, it is highly unlikely that a CPAP machine would ever be prescribed or reimbursed for the treatment of primary snoring.

Stories like this negate the possibility that those who cannot tolerate CPAP will ever learn that there is an alternative treatment that can be lifesaving. Dentists who have taken the time and energy to study dental sleep medicine and patients who are now stabilized with an oral appliance have got to speak out.

We've got to do more

Dr. Barsh

The "We All Snore in the Same Language" Project

2009-03-29T08:55:00.003-04:00

Snoring Isn't Sexy LLC announces the launch of a new micro-site www.weallsnoreinthesamelanguage.com. The site was created in response to requests from around the globe to www.snoringisntsexy.com, for information about snoring and sleep apnea. The micro-site is currently asking users in every country to send a video greeting to demonstrate that people have more similarities than differences regardless of country, skin color, religion or sexual preference. The "We All Snore in the Same Language" Project is seeking volunteers to translate the one page site into as many languages as possible. To volunteer or for more information send an email or call (888) 203-0488.

The Internet presents an opportunity for all people who suffer as a result of snoring to connect with one another, as well as to learn about treatments for their condition. The micro-site, designed with the dual purpose of unifying and educating, welcomes submissions in all languages.

Dr. Barsh

The Secret [Sex] Life of Snorers

2009-03-26T06:51:00.006-04:00

There's an old saying "Laugh and the world laughs with you, snore and you sleep alone." It's pretty obvious that snorers end up in separate beds, often in separate rooms but what's not so obvious is that snoring which leads to sleep apnea can seriously alter both your sexuality and your ability to perform.

Our absolutely free, no sign in required, e-book The Secret [Sex] Life of Snorers walks you through the psychological, emotional and physical side effects of snoring and sleep apnea and provides a quick look at the possible solutions including one that your physician will probably not tell you about.

One caveat, if you enjoy sleeping alone - please do not DOWNLOAD and read this e-book.

Dr. Barsh

"When Economy Sours Tootsie Rolls Soothe Souls"

2009-03-24T07:57:00.003-04:00

Well folks, to follow up on its March 18th story extolling the virtues of Whoopie Pies, the New York Times has done it again with a front page story on how sugar comforts the soul in times of economic downturn. Story after story relates the comforting effect of candy during hard times and how the candy industry is reporting "rising sales and surprising profits." Not one mention anywhere of the adverse effects of increasing dietary intake of refined sugar: dental caries, obesity, diabetes, heart disease and sleep apnea.

In the past 30 days, the New York times has had no less than 19 stories about the risk of diabetes. One story published today is entitled "Awareness: Calculator Gives Risk of type 2 Diabetes." The article references another article that states "Nearly two-thirds of the United states population is overweight."

The story may have merit but by giving it a positive tone, it is essentially condoning an increased consumption of sugar. The article neither belongs on the front page nor should the bias be positive.

Anyone else feel this way?

Dr. Barsh

Too Sexy for CPAP

2009-03-20T16:23:00.005-04:00

Now don't get me wrong, I am in no way minimizing the importance of CPAP. CPAP is still the first choice for treating obstructive sleep apnea. The problem is that compliance is low. (Compliance is the adherence to the time and pressure setting recommended for a patient to utilize the CPAP unit.) Sometimes lack of compliance is discomfort, sometimes air leakage, sometimes a claustrophobic feeling and sometimes it's just emotionally unsettling.

There are a growing number of couples whose sexuality has been disrupted by sleep problems and even by their solutions. Lack of adequate sleep leaves many too tired for sex, others are so annoyed by a bed partner's snoring that even the thought of sexual intimacy is out of the question. Men who suffer from obstructive sleep apnea can even have physical problems with erectile dysfunction.

For some the CPAP unit itself is the turn-off. The tubing and hum from the machine are a deterrent to sexual intimacy. Comments like "It's like sleeping with DarthVader" and "the most unromantic device ever" can be found in social networking sites all over the Internet. And yet, many physicians fail to offer an alternative.

The only advice offered by physicians usually amounts to "Suck it up and wear the CPAP!" Dr. Michael Breus states at his blog "Certainly you can think of a million reasons - other than a CPAP machine - for why you're not feeling randy. You're simply not trying hard enough (no pun intended)."

Why, when there is an alternative, one that has been researched and approved,one that effectively manages the airway and one that is readily accepted by patients who cannot tolerate CPAP - is it not offered by most of the medical community?

If you feel that you are "Too Sexy for CPAP" ask your physician to refer you to a dentist who has received post-doctoral education in dental sleep medicine for an evaluation to determine if you are a candidate for oral appliance therapy. The dentist you are referred to will work with your physician to find the most appropriate therapy for you.

Dr. Barsh

Can ENT surgeons provide oral appliance therapy for snoring and sleep apnea?

2009-03-19T10:44:00.002-04:00

Recently, I have heard of more and more instances where an ear, nose and throat surgeon is constructing and managing an oral appliance for snoring and sleep apnea. But is an ENT surgeon qualified to diagnose and treat problems of the teeth, supporting structures (gums, bone, periodontium), bite (occlusion) and TMJ (temporomandibular joint) that may develop from an oral appliance? My answer is a resounding "NO"!

Oral appliances are held in place by the teeth - teeth that are periodontally sound, teeth without decay, teeth with stable restorations. The ability of teeth to sustain the demands placed on them by an oral appliance that holds the lower jaw in a forward position can only be determined by a dentist. ENT surgeons do not receive that type of education or training nor are they experientially qualified to make that judgment.

In addition, there are times when even the best oral appliance causes a bite change or discomfort in the temporomandibular joint. Here again, even the finest ENT surgeon has neither the training nor the experience to determine the cause of the problem and the proper treatment of that problem so that essential oral appliance therapy can continue.

Just as the dentist is not qualified to diagnose sleep disorders, ENT surgeons should not attempt therapeutic modalities in an area where they have received neither training nor had experience.

Dr. Barsh

Obesity and the New York Times

2009-03-18T07:53:00.006-04:00

It's probably me but at a time when the United States is in the midst of an obesity epidemic in both adults and children, when obesity related sleep apnea and diabetes run rampant is it responsible of the New York Times to headline Whoopie Pies in the Dining Section?

Today's New York Times (March 18, 2009) has an above-the-fold, full color illustration of a cake dish with a mother's hand lifting the lid and a child's hand reaching for one of the sugar and white flour laden "treats." I've been called a curmudgeon before and will be again but I find this immensely distressing. Now we all love a sugary treat but we have been counseled by physicians to restrict their intake. A report online today in The Lancet stated that " A body mass index (BMI) above the normal range is associated with an increased risk of mortality..."

The story from the front page of the Dining Section continues several pages later with an illustration of a 3-4 year child eating one of the "treats" and is accompanied by a recipe that includes 1 cup of brown sugar, 3/4 cup of white sugar and nearly a pound of butter. The recipe is included ostensibly so that Moms can make this sugary, fat-loaded treat for their already overweight, sedentary kids.

Obesity, sleep apnea, diabetes - problems that affect millions of children and adults in this country and cost the health care system billions of dollars. C'mon New York Times, act responsibly.

Dr. Barsh

Excessive Daytime Sleepiness in the Over-70 crowd

2009-03-16T06:50:00.002-04:00

Grandpa always napping during the day? A new study published in Stroke reports that otherwise healthy elderly people who say that they regularly feel sleepy during the day have a 33% increase in the risk of death compared to those who were not sleepy.

This increase in risk of mortality was true regardless of age, weight, previous cardiovascular disease and in those who snore loudly and those who do not.

Daytime sleepiness, whether it is from work, sleep loss or sleep apnea - the health consequences are all the same: risk of high blood pressure, diabetes, obesity, heart attack and stroke.

At this time, medical school includes only about an hour of education on sleep and dental school includes no education on sleep. That leaves it up to you to bring up the subject of sleepiness with your physician or dentist and to be sure the reasons for daytime sleepiness are explored and treated.

Do you have a family member that snores?

2009-03-14T06:52:00.002-04:00

Of course you do. Everyone does.

Snoring can be an indication of a serious medical problem known as sleep apnea in which breathing during sleep starts and stops.

You are much more likely to notice the problems associated with sleep apnea than your husband, wife, boy friend, girl friend or favorite uncle or aunt because they are probably not aware that they stop breathing during sleep. In addition to serious medical problems like heart disease, high blood pressure, stroke, diabetes, and obesity you may notice complaints of morning headaches and dry mouth or sore throat in the morning. You may notice that your friend or relative has memory problems, learning problems, personality changes, irritability, feeling depressed, inability to concentrate and mood swings - all of which may indicate that they are having a problem with sleep apnea.

Your physician and many dentists, especially the ones associated with Snoring Isn't Sexy, are able to confirm the existence of a problem with sleep apnea.

Dr. Barsh

Sleep disorders go unrecognized

2009-03-12T13:36:00.002-04:00

Last week was National Sleep Awareness week. Somewhere between 50 - 150 million people in the United States alone have some sort of sleep disorder... and fewer than 5% have been diagnosed.

While there are many types of sleep disorder, snoring and obstructive sleep apnea, are the most prevalent. Snoring and sleep apnea can be the cause of daytime drowsiness, irritability, headache and acid indigestion. They can also account for the more serious medical problems of stroke, high blood pressure, obesity, depression, heart disease, diabetes and even erectile dysfunction.

If you have been told that you snore, have been told that you stop breathing and gasp for air during sleep, have high blood pressure and feel tired during the day even after a full night's sleep you should check with your physician or specially trained dentist to see if you are suffering from obstuctive sleep apnea.

Heavy Snoring is a Cause of Stroke

2009-03-09T12:37:00.003-04:00

For those who may think that snoring is a joke, a scientific article published in the journal Sleep refutes that premise.

The article written by Lee et al is entitled Heavy Snoring as a Cause of Carotid Artery Atherosclerosis. Dr. Lee and the other authors state " Heavy snoring significantly increases the risk of carotid atherosclerosis, and the increase is independent of other risk factors including measures of nocturnal hypoxia and obstructive sleep apnea severity."

What this means is that heavy snoring increase the risk of building up plaque in the arteries that supply the brain increasing the likelihood of stroke. It also says that this risk is separate and apart from any risk caused by decrease in oxygen to the brain at night and how severe the sleep apnea is.

Dr. Lee went on to say "Considering the high prevalence of snoring into the community [included in the study], these findings have substantial public health implications for the prevention of carotid atherosclerosis and the prevention of stroke."

In other words, snoring is no joke - see a sleep specialist or a dentist who has received continuing education in sleep medicine.

Awake In America Replaces Equipment To Treat Sleep Apnea Lost In Hurricane Ike

2008-09-15T11:09:00.002-04:00

There is an urgent need to help victims of Hurricane Ike replace lost and damaged CPAP units as a result of Hurricane Ike. The entire story can be found at Medical News Today. Please consider a donation.

Dr. Barsh
Snoring Isn't Sexy

Snoring Separately and ED

2008-09-13T08:41:00.004-04:00

According to CNN - 23% of married couple sleep apart and requests for two master bedrooms in new homes are growing. Snoring, in addition to being causally related to stroke, destroys relationships. Many psychologists warn that sleeping apart can spell trouble in a relationship.

Snoring also can be a sign of sleep apnea. With many sleep apnea sufferers, erectile dysfunction (ED) can be a problem. Recent research indicates that ED can result from periods of oxygen deprivation associated with sleep apnea. Although the research was conducted on animals, there is a strong possibility that this relationship exists in humans as well.

It is, therefore, quite possible that ED is a sign of sleep apnea which has been linked to high blood pressure, cardiac problems, stroke, diabetes and depression. If you snore heavily, have been observed to stop breathing during sleep, have high blood pressure and feel sleepy during the day even after a night's rest, before you pop the little blue pill think about having a sleep study.

You could not only be saving your marriage but also saving your life.

Dr. Barsh
SnoringIsntSexy.com

Snoring, Diabetes and Physicians

2008-09-05T13:05:00.002-04:00

DiabetesHealth.com released a statement today that said

Despite the fact that 94 percent of doctors are aware of the association between sleep apnea and diabetes, only 47 percent of them screen for the condition in their patients with diabetes. As a result, about 85 percent of sleep apnea cases among diabetics go undiagnosed.

Dentists are probably worse than physicians in this regard. If you are a patient with diabetes, ask your dentist why such an important relationship of diseases goes unnoticed in his/her office. For the most part, dentists see their patients more frequently than physicians see theirs and it would be a simple matter for a dentist to ask a few simple questions about sleep-breathing problems especially where dentistry can play such an active role in the management of these problems. Again from DiabetesHealth.com:

Dental Device (a.k.a. oral appliance, intraoral device, or mouthpiece):
Breathe through your nose. Now move your lower jaw forward. Does the back of your throat feel a bit more open, making it a little easier to breathe? A dentist or orthodontist can custom make a device for you to wear at night that will keep your lower jaw and/or tongue forward.

Help us get the word out about the relationship of sleep apnea and diabetes, ask about screening at your dentist's office.

Dr. Barsh

Snoring Isn't Sexy

Still think snoring is a joke?

2008-09-01T19:04:00.004-04:00

Snoring has always been considered a joke. "Two snorers walk into a bar...." You can finish the rest of the story, I'm sure.

Television advertising promotes the ability to stop snoring by sticking things on the outside of your nose, sticking things in the inside of your nose, spraying stuff in your throat, and by taking a boil and bite mouth device to pull your jaw forward (by the way, it's illegal in the United States to sell these over the counter). And, in fact, most of these WILL stop the snoring but do you really want to?

Huh? you say - of course I want to stop the snoring, why shouldn't I? As it turns out there is a good reason not to do it yourself. A scientific article released in the Sept. 1 issue of the prestigious journal Sleep shows that snoring is indeed an independent risk factor for the development of hardening of the arteries in neck - known as carotid atherosclerosis - that can progress to a point where it is associated with a stroke.

We know that snoring can also be a warning sign of sleep apnea as well especially if one's bed partner notices cessation of breathing at intervals during sleep. Stopping the snoring eliminates the warning sign and creates what is know as a silent apneic. Sleep apnea is associated with heart disease, stroke, diabetes, high blood pressure, depression, excessive daytime sleepiness, erectile dysfunction and even death during sleep from factors related to apnea.

So for a couple of reasons, stopping the snoring without medical or dental intervention can be a bad idea. It's your decision of course but before you decide, stop and take a few moments to think of the possible consequences - the point is not to just stop the sound of snoring, the point is to eliminate the obstruction that causes the snoring and to increase oxygen flow through the partially obstructed airway.

Dr. Barsh
Snoring Isn't Sexy

Driving on Labor Day Weekend

2008-08-23T08:14:00.002-04:00

It's hard to believe but Labor Day is only one week away. Despite high gas prices, it's estimated that more than 30 million Americans will be driving this Labor Day weekend.

Most people are aware of the dangers of drinking and driving, but few are aware of the dangers of sleepiness and driving. The 2008 Sleep in America Poll found that

64 percent of drivers who work at least 30 hours per week report they have driven a
vehicle while feeling drowsy in the past year, and more than one-third, 36
percent, have actually fallen asleep at the wheel. Sleep-related crashes
are most common in young people, especially men, shift workers, commercial
drivers, and people with untreated sleep disorders. NHTSA conservatively
estimates that 100,000 police-reported crashes are the direct result of
driver fatigue each year. This results in an estimated 1,550 deaths, 71,000
injuries, and $12.5 billion in monetary losses each year.

Be sure to get adequate sleep before any road trip this coming weekend and if you have been told that you snore, have had your bed partnhttp://www.blogger.com/img/gl.link.gifer tell you that you stop breathing during sleep, know that you have high blood pressure and that you are tired despite sleeping 7 - 8 hours at night - get yourself checked out for sleep apnea. For more information, visit snoringisntsexy.com

Have a great weekend and drive safely.

Dr. Barsh

Want to Look Better and Live Longer? First, Stop Smoking

2008-08-16T08:49:00.003-04:00

In the August 14 issue of the New York Times in the style section (where we all get our medical news apparently), there was an article that plastic surgeons are refusing to do face lifts for men and women who smoke. Hmmm... approaching a life endangering habit from a cosmetic point of view. Very much the same way we at Snoring Isn't Sexy.com approach snoring and sleep apnea.

While we are on the subject of smoking, two recent scientific articles point to the dangers of smoking and sleep apnea.

In February, 2008 an article was published in the Proceedings of the American Thoracic Society:

...obstructive sleep apnea is also being recognized as an independent risk factor for several clinical consequences, including systemic hypertension, cardiovascular disease, stroke, and abnormal glucose metabolism.
Factors that increase vulnerability for the disorder include age,male sex, obesity, family history, menopause, craniofacial abnormalities, and certain health behaviors such as cigarette smoking and alcohol use.

And in March in Sleep Medicine, Dr. Peretz Lavie published an article that stated that smoking interacts with sleep apnea to increase risk of heart disese:

There is a synergistic effect between cigarette smoking and sleep apnea on some of the biochemical cardiovascular risk markers. Patients with severe sleep apnea who smoke are at a greater cardiovascular risk than smokers with mild-moderate sleep apnea and patients who do not smoke.

We recommend quitting smoking at any age for any reason but if you smoke and have sleep apnea, you are at risk.

Quiet Now!

Dr. Barsh

New Website You might be Interested In

2008-08-08T07:15:00.002-04:00

There's a new web site that features a video diary Dr. Jonathan Lown's experience of living with CPAP that may develop into a resource that you want to keep your eye on over the next few months. The site features the ability to use what they call a "Still Sleepy Tracker" that apparently you can download and develop your own diary of sleepiness. The site is at StillSleepy.com.

While the video diary is interesting, there are a couple of problems that I find with the site.

First, there is no way to contact the developer of the site. When you visit any medical site, it is imperative that you be able to contact the web developer. As I mentioned in an earlier blog, many sites that offer medical information where, in fact, developed with the sole purpose of attracting search engines and cashing in on the advertising in the side bar.

Second, the site is actually a commercial for a pharmaceutical called Provigel. While there is a cost associated with development and maintenance of a web site, there is a serious conflict of interest at the site.

Third, the "Still Sleepy Tracker" is nothing more than the Epworth Sleepiness scale without attribution. While being able to measure daytime sleepiness it is not diagnostic for sleep apnea. It measures only one factor - daytime sleepiness - which could be due to a variety of reasons.

Finally, the video diary contains a video of a Dr. Jonathan Lown but fails to provide any background information as to whether Dr. Lown is a physician or a PhD. When you visit a medical information site, you should always be able to be able to access information about the medical authority featured on the site.

Dr. Barsh
Snoring Isn't Sexy

Sleep Apnea and increased risk of death (continued)

2008-08-04T07:05:00.003-04:00

Several other points need to be made in relation to this study:

The increased risk of death that was associated with severe sleep apnea was reduced when patients were treated with CPAP
Milder forms of sleep apnea did not seem to increase the risk of death
CPAP improved the symptoms of sleep apnea and may reduce the risk in severe case

Dr. Terry Young talks about the study:

Two points become very clear as a result of this study:

First - if you snore heavily and have stopped breathing during sleep, get evaluated for sleep apnea. I know I've said this before but it's worth repeating!

Second, if you are a dentist, whether you choose to work with colleagues to manage patients with sleep apnea or not, it is your obligation to screen all patients that you treat for sleep apnea. You screen now, or if not should screen, for oral cancer and high blood pressure and you encourage smoking cessation - add one minute to your examination and ask 4 short questions:

Do you snore loudly?
Do you often feel tired, fatigued or sleepy during the daytime?
Has anyone observed you stop breathing during sleep?
Do you have or are you being treated for high blood pressure?

(The STOP Questionnaire, Frances Chung)

Dr. Barsh

People with Sleep Apnea have a high risk of death

2008-08-01T08:05:00.002-04:00

A study was released in the Journal Sleep that showed that people with severe sleep apnea have a much higher mortality risk than people without sleep apnea.

From eScience News:

A study in the August 1 issue of the journal Sleep shows that people with severe sleep apnea have a much higher mortality risk than people without sleep apnea, and this risk increases when sleep apnea is untreated. Results show that people who have severe sleep apnea, which involves frequent breathing pauses during sleep, have three times the risk of dying due to any cause compared with people who do not have sleep apnea. This risk is represented by an adjusted hazard ratio of 3.2 after controlling for age, sex and body mass index. When 126 participants who reported regular use of continuous positive airway pressure (CPAP) therapy were removed from the statistical analysis, the hazard ratio for all-cause mortality related to severe sleep apnea rose to 4.3.

"We found that both men and women with sleep apnea in the general population - not patients - mostly undiagnosed and untreated, had poorer survival compared with persons without sleep apnea, given equal BMI, age and sex," said principal investigator and lead author Terry Young, PhD, professor of epidemiology at the University of Wisconsin-Madison.

According to Young, most previous studies of sleep apnea and mortality have involved patients referred for a clinical sleep diagnostic evaluation; the mortality risk for sleep apnea in the general population has not been previously reported.

This is serious business folks.

If you snore, have been observed to stop breathing and then gasp and choke while asleep, have high blood pressure and feel tired during the day SEE YOUR PHYSICIAN OR SLEEP MEDICINE DENTIST for an evaluation.

No joke - let's go a little further with a recommendation, if you snore loudly and regularly see a sleep medicine dentist or a physician - it's your life.

Dr. Barsh

Sleep Apnea and Your Bottom Line

2008-07-28T06:36:00.004-04:00

Obstructive sleep apnea affects over 18 million people in the United States alone. These people can suffer from heart disease, high blood pressure, diabetes, stroke and depression. Additionally, when untreated, sleep apnea causes excessive daytime sleepiness leading to accidental injury and lost productivity.

It has been estimated that employees wth untreated sleep apnea can increase employer's healthcare costs by $2000 to $5000 annually in physician visits, medication costs and increased hospitalizations. Employees with sleep apnea are more likely to have an accident at work, perform less well than their non-drowsy counterparts and are absent more frequently than other employees.

Sleepiness has been implicated in such major disasters as Chernobyl, Exxon Valdez and Bhopal.

If your business employs drivers it has been calculated that drivers with sleep apnea have an up to 15 fold increase of motor vehicle accidents which can be reduced or eliminated with proper treatment.

What can you do? First, the dentists associated with Snoring Isn't Sexy(tm) are well versed in screening, and if appropriate as decided in joint consultation with the patient's physician, treating the problem with an oral appliance.

Second, many dentists associated with Snoring Isn't Sexy(tm) will be adding sleep apnea screeners to their new web sites in the fall of 2008. Although these screeners are not at the dentists' web sites as yet, you can have your employees screened free of charge at our sister site's screener at Quietsleep.com.

Finally, if there are no dentists in your area that provide screening and treatment of snoring and sleep apnea, please let us know and we will do everything we can to point them to the proper continuing education.

It's your employees' health and your bottom line. Please help us, help you!

Dr. Barsh

Sleep Apnea and Heart Attack Risk

2008-07-23T07:29:00.005-04:00

A new study from the Mayo Clinic and reported in the Journal of the American College of Cardiology suggests that heart attacks that occur between midnight and 6AM are associated with sleep apnea.

"If a patient has a heart attack that wakes him or her from sleep, then it may be important to look for sleep apnea in them," said Dr. Virend Somers, one of the investigators.

More information on this study can be found at medpage today.

If you have sleep apnea or have had a heart attack that has awakened you from sleep, it's critical that you review this information.

Dr. Barsh

Validity of Medical Content - Your Responsibility!

2008-07-20T07:21:00.007-04:00

Lately there are a plethora of blogs purporting to be information about snoring and sleep apnea but which are, in reality, articles from content farms or sales pitches for products couched in the form of what may or may not be valid content. The key is usually in the last paragraph "About the Author."

For example, a site called Find Diseases Directory has an article by Suzy Hughes with "Information on Central Sleep Apnea". In it Ms. Hughes recommends use of Ambien to treat central sleep apnea.

Another site, has an identical article by Suzy Hughes on Central Sleep Apnea. As does artipot.com.

The fact that the drug "Ambien" is misspelled in each of these articles as "Ambient" should lead readers to suspect that the content is not exactly valid.

The problem is not the content but rather exactly who "Suzy Hughes" is. When you search Google for Suzy Hughes and "unique content" you are taken to a site named Uber Articles. It turns out that Uber Articles is a site that provides content for blogs and web sites designed not to produce valid content but rather to produce content designed to attract search engines and with that search engine optimization the dollars from Google Advertising.

"Who else wants Totally Unique Content for their websites and newsletters - Absolutely FREE?"

The search engines are bored with seeing the same old articles again, and again, and again - So why not give them something unique?

They will love you for it - and as a result your search engine rankings - and your visitors - will soar. In fact, this is the single most effective way to get the top spots in the search engines. It costs nothing, so why not get started right now?

Using our powerful, secret, Unique Article Wizard™, we are able to deliver literally thousands of unique versions of selected articles - all you need do is cut and paste the article into your web page or ezine, knowing that, at most, there will be only one or maybe two identical versions anywhere on the internet. You are even free to use these articles offline (naturally all on- or off-line use is subject to our terms and conditions).

If you prefer, you can even sign up to receive unique articles direct to your inbox - formatted, for your convenience, in both fixed length (60 characters), and free-flow text. Again, no one else will receive an article identical to the one you receive.

The site is not interested in validating content but rather producing content on a grand scale in areas from dating to World of Warcraft.

My recommendation is that if you ever come across a blog or web site that has a link back to Uber Articles, you take the information offered with a grain of salt knowing it was created for the sole purpose of attracting search engines to a site and not to provide health information.

As ever, the web is a great source of information but it is unregulated. Anyone can post anything on the web - valid or invalid. Content is a commodity, search engine placement is a commodity. Medical information on the web is a valuable way to educate yourself about disease and treatment but it is your responsibility to validate the source of that content yourself and, before deciding on treatment, discuss that treatment with your physician or dentist.

Dr. Barsh

About.com, Snoring, Dentists

2008-07-16T11:00:00.004-04:00

I don't know how many of you read About.com but last month they published an article entitled "Is Snoring a Problem? See your Dentist." We at Snoring Isn't Sexy(tm) and Quietsleep(r) would like to applaud their efforts and thank them for mentioning dentistry as an option in the field of sleep medicine.

But at the same time we'd like to correct a few inaccuracies in the article.

First a pet peeve of mine personally. About.com refers to doctors and dentists. While this is in common usage, it's blatantly incorrect. Dentists ARE Doctors. We received our degrees after four years of intensive education and training, many of us went on to receive post-doctoral degrees and many had internships and residencies. We encourage the proper usage of physician and dentist. Please...

The article stated that

However, if the sleep study rules out obstructive sleep apnea, or if the apnea is still very mild, then you might consider a visit to your dentist. A dentist can supply you with a dental appliance that can help you control your snoring. A dental appliance is a small plastic device that fits in the mouth. You wear it at night and it prevents the collapse of throat tissues that cause the snoring. These devices are easy to use and inexpensive. They are fitted to the individual patient and require no surgery.

While this is partially true, oral appliances have been approved for snoring and sleep apnea and as an alternative to CPAP when patients cannot tolerate the CPAP device. The statement issued in a parameters report from the American Academy of Sleep Medicine states

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 over- all care of oral health, the temporomandibular joint, dental occlusion and associated oral structures.

Practice Parameters for the Treatment of Snoring and Obstructive
Sleep Apnea with Oral Appliances: An Update for 2005
SLEEP, Vol. 29, No. 2, 2006

Secondly, as far as appliances are concerned, the article in About.com mentions only two:

One such device is the Snore Guard. Snore Guard looks like an athletic mouthpiece. You wear it while you're sleeping and it prevents the jaw and tongue from dropping back to obstruct the air passages. It allows you to breathe easier, and keep breathing so you get a more restful sleep.

Another such appliance is called Silent Nite. These devices are flexible, small, thin, and quite comfortable to wear. Your dentist will determine from a questionnaire and from impressions of your upper and lower arch just what shape your Silent Nite should take. Snore prevention devices have proved successful in more than 85% of cases, while other treatment, such as surgery or drugs have a success rate of less than 50%.

While both appliances are still available to dentists, neither, in my opinion, is an adequate choice to treat a disease as serious as obstructive sleep apnea.

Better choices for treatment of snoring and sleep apnea are the TAP, Somnomed MAS, Adjustable PM Positioner, Klearway, and many others. Full description of many oral appliances are available at Quietsleep.com. Your dentist who is trained in dental sleep medicine will be able to guide you in which appliance is best for your problem and your mouth. But remember, it's really not about which appliance, treatment of both snoring and sleep apnea is about the therapy.

Dr. Barsh

Benign Snoring?

2008-07-15T07:29:00.002-04:00

In a post on his blog today, a dentist Dr. Paavanj, discussed snoring and sleep apnea and its relationship to dentistry. In it Dr. Paavanj stated:

Can snoring be a sign of medical problems? If so, is there a particular type of snoring that signals the need to seek help?

A. Primary snoring has been reported in a few studies to have some link to hypertension, stroke and coronary artery disease.

However, there is a significant amount of debate about the health consequences of just snoring. The general consensus is that snoring is a benign condition. The intensity or loudness of the snoring has nothing to do with any health consequences.

While current thought may lead to controversy over whether snoring itself is a benign condition, there really shouldn't be but it takes redefining what snoring really is.

Obstructive sleep apnea is complete blockage of the airway in the pharyngeal (throat) area, snoring is partial obstruction and can be defined as obstructive hypopnea. This means there is, in snoring, a decreased amount of oxygen inspired with each breath which, in turn, can precipitate many of the same problems as apnea.

Since snoring can be a warning sign of sleep apnea and especially snoring accompanied by observed cessation of brathing, it's best to not treat any snoring as benign but to consider it as a wake up call (sorry for the pun) to visit a sleep physician or trained sleep medicine dentist for evaluation.

Snoring benign? Well maybe as far as the insurance companies are concerned but not as far as your health is concerned

Dr. Barsh

PURE SLEEP and other do-it-yourself "cures"

2008-07-13T09:19:00.008-04:00

There is a mail-order device that is advertised heavily on TV that purports to be an FDA-cleared device appropriate for snoring. The device is called PURESLEEP and was invented by a dentist, Dr. Douglas Fenton.

According to the PURESLEEP web site:

" PureSleep is an FDA-cleared prescription dental device and uses a technique called 'mandibular repositioning' which has been clinically validated through years of research and testing. For the first time ever, it is available without a visit to the dentist or physician. That translates into savings of more than 80% off the price a dentist would charge!"

(If the manufacturer is reading this post, I would appreciate it if he would comment and post the FDA Clearance number and registration date because I could find no reference to the PureSleep Device at the FDA web site.I will happily retract the comments about FDA approval if the FDA reference material is provided)

Even so, the statement "prescription dental device" implies that a dentist must prescribe the appliance which clearly is refuted by the statement "available without a visit to the dentist or physician."

The web site goes on to state:

"PureSleep is an FDA-cleared prescription dental device, now available for the first time without visiting a physician or dentist. To determine if it is appropriate to prescribe PureSleep to you, it is necessary to answer a few simple questions on this website or by calling an automated voice response system, using the toll-free number below -- any time, day or night. In either case, your answers to these questions will be recorded, and if appropriate, PureSleep will be prescribed to you and your order will be shipped."

(THE FDA states: Intraoral devices to treat snoring and/or obstructive sleep apnea are prescription devices unless adequate directions for use (21 CFR 801.5) are developed and FDA clears a 510(k) specifically for over-the-counter (OTC) distribution.)

The questions, as posted on the web site:

"PureSleep is an FDA-cleared, prescription device. Because of this, you must be at least 18 years old to purchase or use PureSleep. Furthermore, before we can provide you with a PureSleep device, we will need to ask you some questions about your health. The Pure Sleep Company is not liable for any damages or injuries resulting from false or erroneous information provided by you.
Are you at least 18 years old?
Do you agree to the terms and conditions?

The questions continue:

Have you ever been diagnosed with central sleep apnea?

Do you have chronic asthma, emphysema, or any other severe respiratory disorder?

Do you have loose teeth, abscesses, or severe gum disease?

Do you have full dentures, or are you presently undergoing orthodontic treatment?

Have you had a dental implant within the last year? Note that crowns, caps, and bridges are not dental implants.

Have you been diagnosed with temporomandibular disorder -- sometimes called TMD or TMJ?

Does it hurt when you open your mouth wide or yawn?

Does it hurt when you chew, or use the jaws?

Does it hurt when you are not chewing or using the jaws?

Is your jaw pain worse on waking?

Do you have pain in front of the ears or ear aches?

Do you have jaw muscle (cheek) pain?

Do you have pain in the temples?

Do you have pain or soreness in the teeth?

Do your jaw joints make noise so that it bothers you or others?

Do you find it difficult to open your mouth wide?

Does your jaw ever lock closed so you cannot open it?

Does your jaw ever lock open so you cannot close it?

Do you have a problem with your bite being uncomfortable?

Having answered all questions in the negative, I was taken to the following screen:

Great! Your responses to the questionnaire indicate that it would be appropriate for you to use the PureSleep stop snoring solution.

You have the option of making two payments of $29.95 ($59.90 total) plus $7.95 for shipping and handling. However most of our customers prefer the ease and convenience of a single payment - and you can still take advantage of our risk-free 30-day Money Back Guarantee.

To purchase PureSleep, simply select a payment option below and then click the "Continue" button below. Your order will then be transfered to our secure shopping cart where you can complete your purchase.

I prefer the ease and convenience of a single payment.
I prefer to make two payments.

PLEASE NOTE: There is not one question that attempts to determine whether or not the purchaser may have obstructive sleep apnea. And yet the device is supposedly cleared just for snoring. Even if relevant questions were asked, every reputable scientific article states that history alone cannot make the diagnosis of sleep apnea and that it must be confirmed with a sleep study.

Let us realize that even if this device was approved for over-the-counter sale as an anti-snoring mouthpiece, people most likely to purchase it are loud snorers and are often likely to have overlying mild to severe sleep apnea.

Big problem!

Sleep apnea is a serious medical problem that can lead to heart disease, stroke, high blood pressure, diabetes, motor vehicle accidents due to drowsing off while driving and even erectile dysfunction. Even though the device may control the snoring, it may not adequately treat sleep apnea leaving you open, in extreme cases, for death while you sleep.

There are no easy answers in medicine or dentistry. If you have sleep apnea or even if you snore heavily with pauses in breathing at night (observed by your bed partner), have high blood pressure and if you are tired during the day you should be evaluated by a sleep physician or dentist trained in sleep medicine.

PLEASE DON't DO IT YOURSELF. It's not a joke. If you find that you need an oral appliance have it constructed by a dentist who has been trained in this therapy. Often your medical insurance will cover the charges.

As in all things caveat emptor - it's your health and your life.

Dr. Barsh

Drowsy Driving and Snoring

2008-07-11T13:10:00.002-04:00

The National Sleep Foundation estimates that “drowsy driving” claims 1,500 lives and accounts for at least 100,000 auto accidents each year. Drowsy driving is almost as much a road hazard as alcohol related accidents. Truck drivers are especially subject to this problem because they live a sedentary lifestyle and have a high incidence of sleep apnea.

Sleep breathing disorders, including snoring and obstructive sleep apnea, are associated with heart disease, high blood pressure, stroke, mood disorders, motor vehicle and job-related accidents. There are accounts of employees being accused of on-the-job drunkeness when, in actuality, the problem was treatable sleep apnea.

You owe it to yourself, especially in these trying times when jobs are scarce, to talk to your physician or dentist about excessive daytime sleepiness and/or drowsy driving. A CPAP machine or, alternatively, a mouth device may solve your problem, save your job and even save your life.

Dr. Barsh

All Dentists Should Screen Their Patients for Snoring and Sleep Apnea

2008-07-07T09:07:00.004-04:00

18 million people in the United States alone suffer from sleep apnea, untold millions more snore. As a country we are experiencing an epidemic of obesity which can be a precursor of sleep apnea. Both snoring and sleep apnea are related to heart disease, stroke, high blood pressure, depression, diabetes, erectile dysfunction and accidental injury or death due to drowsy driving.

Dentists are in an ideal position to ask a few simple questions (Do you snore loudly? Have you ever been told you stop breathing during sleep? Do you have high blood pressure? Do you tend to drowse off during the day?) and, if the patient answers in the affirmative, to either refer or initiate management for sleep apnea.

Easy, quick - maybe two minutes of time - to improve the health of their patients.

Ask your dentist to become involved.

Dr. Barsh

Wal-Mart: The New Determinant in Medical Care

2008-06-25T08:40:00.008-04:00

Ladies and Gentlemen - we have a problem. I don't care if you are a physician, a dentist or a patient you've got to read an article in today's New York Times entitled "High Medicare Costs, Courtesy of Congress."

The article discusses the fact that as of July 1, companies will have to submit bids to compete with one another if they want to continue selling products to Medicare. While on the surface this may seem to be an excellent cost-cutting idea, low bid medical care is a dangerous precedent for several reasons. First, because it equates the quality of all devices with a similar function. For example, one of the items on the list (Chart is not available online) is CPAP. Currently Medicare pays $105 a month for a CPAP, the proposed cut will bring the monthly cost down to $67 a month. There's no distinction, in this chart, between CPAP, BiPAP, DPAP, humidfied units etc. it's just called CPAP. Will you get the device you really need?

Dangerous precedent - second reason for worry: we are on the verge of a national health care system. When will a Wal-Mart model be advocated for ALL health care? When will your doctor be forced to bid for the right to treat you? When will ALL doctors be forced into fields of medicine and dentistry that are not covered by a national health system in order to earn a decent income?

A recent press release emphasizes the possibility that more doctors and more research dollars will be spent on non-covered services than on those that are within the realm of government coverage:

"Rejuvenating newly identified fat compartments in the facial cheeks can help reduce the hollowed look of the face as it ages, according to new research by plastic surgeons at UT Southwestern Medical Center...'This anatomic fat cheek compartment completely changes how we look at facial aging,' said Dr. Rod Rohrich, chairman of plastic surgery at UT Southwestern and lead author of the study. 'The process to correct facial aging is now dramatically changed as well. No longer do we remove fat without pre-op analysis or merely lift the cheek; we must now lift and fill the face to restore a natural youthful, unoperated appearance.'

The research is part of an ongoing project among UT Southwestern plastic surgeons to better map fat compartments in the face and body.

'Research to identify specific fat compartments for surgeons to target helps provide more predictable results in the ongoing fight against facial aging,' Dr. Pessa said."

The appearance of facial aging as opposed to the health of individuals covered by Medicare... hmmm... let's figure out where the best medical minds would be more appropriately applied. But then again, cosmetic surgery is not and will not be covered by any government health care agency.

Think I'm being paranoid?

Another article in today's New York Times is titled "House Votes to Block Cut in Doctor's Medicare Fees." Again on the surface, a noble effort. But blocking a cut would reduce federal payments to Medicare Advantage plans that many retirees depend on for health care.

Doctor's fees, under Medicare, are ridiculously low anyhow - the projected increase of 1.1 percent in fees is not going to keep any physician in the system. With or without further cuts in compensation, many of the country's docs are opting out of Medicare. Personally, my wife's gynecologist and my cardiologist have opted out of Medicare and I have no option even of paying more for insurance in order to be able to utilize their services. Our internist was unable to continue rent payments to her landlord which forced her to close her private office and seek employment elsewhere.

With the thrust by both political parties to provide a national health plan that covers everyone (again, a noble goal) how far away are we from a medical system in which no bright individual wants to enter the field of medicine? How many excellent physicians, surgeons, dentists (who will sooner or later be forced into the system as well) will opt for cosmetics rather than treating your apnea, your heart disease, your diabetes?

And while we're on the subject, oral appliances for the treatment of snoring and apnea are considered durable medical equipment as well and are billed for under medical insurance. Will you be able to continue with your doctor's choice of appliance, or will you, under the new Medicare and National Health insurance, be forced to use a simple, ineffective boil and bite appliance because Wal-Mart sells them cheaply?

I don't know the answers but I know that we, as patients, physicians and dentists, need to start asking tough questions of our elected officials on both a national and local level. We've got to regain control of what was once the best medical care anywhere in the world.

Wal-Mart cannot be the shining star of health care to which we, as a country, aspire.

Dr. Barsh

Breathe Right Strips

2008-06-17T06:35:00.004-04:00

An article in today's Miami Herald discussed the efficacy of Breathe Right Strips. As you know these strips "opens your nose to: reduce snoring, relieve nasal congestion."

"The FDA approved the strips in 1996 for temporary relief of breathing difficulties related to a deviated nasal septum. The Mayo Clinic recommends nasal strips to prevent or quiet snoring." according to the article.

The author went on to state "Evidence is mounting that these strips can help snorers. It's worth a try, especially because there are no adverse effects."

True, dilating the nose to allow freer air passage has no adverse health effects per se but snoring can be a sign of obstructive sleep apnea. Dr. Chung and her colleagues at the University of Toronto defined and validated 4 questions to ask patients about to undergo anesthesia for general surgery. The four questions: snoring, tiredness during the day, observed cessation of breathing during sleep and high blood pressure.

Stopping the snoring does not stop obstructive sleep apnea which occurs because of obstruction in the throat behind the tongue but may just silence and eliminate several of the warning signs of apnea - snoring and observed cessation of breathing.

The lesson to be learned from this - quieting snoring is a double edged sword in people who may have obstructive sleep apnea. If the snoring is heavy, constant and punctuated by periods of silence then the best advice is to consult a sleep physician or a specially trained dentist especially in a person who is overweight, has a large shirt collar size and has high blood pressure.

Dr. Barsh

60 Minutes Tackles Sleep

2008-06-16T07:26:00.003-04:00

Last evening, June 15 2008, CBS dedicated most of their program to the Science of Sleep. Leslie Stahl investigated the correlation of sleep and health.

For those of you who may have missed the show, Snoring Isn't Sexy has added the two segments of the show to the web site. You can access these clips at www.snoringisntsexy.com/scienceofsleep.cfm.

The segment on Drowsy Driving in Part 1 is well worth reviewing. Sleep deprivation occurs not only when people do not get enough hours of sleep at night but also during sleep apnea when patients awaken frequently to breathe.

Part 2 discusses the relationship between sleep deprivation and obesity, heart disease, stroke and diabetes.

Although this show does not specifically address the problems of sleep apnea, most of the mental and health problems with sleep deprivation are applicable to sleep apnea as well. Be sure to watch the segment on noise and delta waves. This is identical to what happens during sleep apnea.

It turns out that sleep deprivation affects sexuality and performance as well so we weren't kidding when we said "SNORING ISN'T SEXY."

Dr. Barsh

Sleep Apnea Increases Risk of Death

2008-06-13T06:42:00.002-04:00

Terry Young, PhD found, in an 18 year long study at the University of Wisconsin, that people with severe sleep apnea had a 3.2 fold increase in risk of death from any cause comared with people whose sleep breathing was normal. Another study found that sleep apnea also increases the risk for cardiovascular disease.

CPAP may reduce the risk of death in people with severe sleep apnea. Oral appliance therapy was not included in the study.

The message is clear, however: first, dentists and physicians must be more aware of the possibility of sleep apnea in their patients, and, second, you must take responsibility for your own health as well. If you have been told that you snore heavily, stop breathing at times during sleep, have high blood pressure and a shirt neck size of 17 inches or more for men, 16 inches or more for women - it is imperative that you tell your physician or dentist and ask to be referred for a sleep test.

Dr. Barsh

17th Annual American Academy of Dental Sleep Medicine

2008-06-09T15:27:00.002-04:00

Over 650 dentists attended the 17th Annual American Academy of Dental Sleep Medicine.

The Academy has been offering continuing education in the sleep medicine field for dentists in working with oral appliance therapy for patients who snore and suffer from obstructive sleep apnea.

The lecturers presented information on Cardiovascular Complications of Sleep Apnea, The Relationship Between Obstructive Sleep Apnea-Hypopnea and Obesity, Airway Imaging, Dynamic and Static Evaluation of the Upper Airway and Its Role in Obstructive Sleep Apnea Management, and Efficacy of Oral Appliance Therapy as an Adjunct to CPAP.

It is critical that when you choose a dentist to treat your obstructive sleep apnea that you ensure that your choice has received the proper education and training.

Dr. Barsh

Beddie Buys

2008-06-05T15:14:00.005-04:00

What good is your Hastens Sangar if you can't manage to fall asleep or stay asleep? For that matter, how much can a drowsy, cranky person enjoy any of life's luxuries?

SLEEP. It's not just a fashion statement, a trendy marketing topic or a hot media story. While all of the preceding are true; we can't discount the reality: it's essential for human survival, sanity and health.
In this economy, even people who can afford high-end items are judicious about how they allocate their money. If you go for the designer handbag, perhaps you'll cut back on the thrice-weekly blow-outs. Likewise, the same balancing act might go into the acquisition of nocturnal niceties.

SNORING. Most people do it; and the majority doesn't even know. It's insidious and robs you of the potential to function at the top of your game. It's a one-two punch of being symptomatic (and maybe indicative)of Sleep Apnea, as well as being a hazard unto itself.

So back to that European bed...the one in which you find yourself awakening repeatedly throughout the night. Put the buyer's remorse on the shelf for a moment - and consider the fact that you might have a health problem. Then, give yourself a pat on the back for coming across this post because chances are, a relatively small appliance made by your dentist (and quite possibly reimbursed by your insurance company) will curtail or even STOP the snoring. Check out http://www.snoringisntsexy.com/. Sweet dreams!

Snoring Doesn't Cut It in Relationships

2008-05-31T11:10:00.006-04:00

Snoring Isn't SEXy AND THE CITY

The new movie "Sex and the City," based in part on writer Candace Bushnell's book of the same name, is a romantic comedy about four female friends living in New York City featuring dialogue about romance and sexuality.

Imagine that Miranda's relationship with Steve has gone down the hopper because Steve snores loudly and has been sleeping in a different room. Samantha has moved to L.A. with Smith who has a successful television career but has packed on pounds , stops breathing frequently at night and is now taking Viagra. Carrie's wedding plans with Big are in doubt because Big just had a heart attack (he awoke at 4:30 AM with chest pains and was rushed to the hospital) and has been advised not to have sex for a couple of months. Meanwhile Charlotte, who thought everything was perfect, was driving to work, fell asleep, and is now recuperating from the accident.

Just a little different scenario for the movie would ensue if any of the girls or the men they sleep with snore or have sleep apnea.

Snoring and Obstructive sleep apnea can ruin both relationships and health. Think about it.

Dr. Barsh

Over the Counter snore Appliances

2008-05-28T16:14:00.001-04:00

A plethora of the so-called boil and bite appliances are available on the Internet. These devices claim to "cure" snoring and apnea. Most are not FDA approved and are illegal in the united States.

While some will no doubt stop snoring, this will not treat your apnea and may actually increase the problem causing the apneic incidents to become worse.

Please remember that sleep apnea has serious medical consequences including heart disease, high blood pressure, stroke and diabetes.

It's always best to visit a qualified dentist or sleep physician.

Dr. Barsh
Larry Barsh, DMD
Snoringisntsexy.com
Quietsleep.com

Dental Sleep Medicine - The need for a new specialty in dentistry

2008-05-16T07:06:00.002-04:00

Dentistry has several specialty classifications : oral surgery, orthodontics, prosthodontics (crown and bridge) and endodontics (root canal). These specialties were developed in response to the need for specialized additional education in these areas of dentistry.

Today, with dentistry's increasing role in the recognition and treatment of sleep-breathing disorders, there is a need for a new specialty - that of dental sleep medicine. While basic training in dentistry is required, a comprehensive knowledge of sleep medicine would benefit those entering this field and make interaction with physician colleagues more productive. Dental sleep medicine is as unlike general, restorative dentistry as is the specialty of oral surgery and requires as much medical background.

The amount of knowledge required to practice dental sleep medicine is growing at an exponential rate that is difficult to fit into a standard dental school curriculum. For now, self-directed study with continuing education courses is probably sufficient but as the sheer volume of patients with sleep apnea expands, as we learn more about the medical ramifications of this disorder and as home sleep studies become more accurate, specially trained sleep-breathing dental specialists will be asked to assume more of the diagnostic and therapeutic roles.

Choosing a dentist for oral appliance therapy, for now, is in the hands of the individual.
The dentist you choose to treat your problem with sleep disordered breathing must be properly educated and with adequate experience. Legally, any dentist can treat snoring and/or sleep apnea with an oral appliance, however, that does not mean that every dentist has the necessary experience and training to provide proper therapy. Because no special qualifications are required it is your responsibility to choose your dentist wisely.

A qualified sleep-disorders dentist should have:

Appropriate knowledge of sleep medicine
Adequate training in oral appliance therapy
Years of experience with many different appliance types
Solid relationships with local sleep labs and sleep physicians
Current knowledge of emerging trends
Ability to derive maximum insurance benefits for you
A team approach with other professionals
A proven follow-up system to ensure healthy results long-term
In-depth knowledge of oral appliance research

Where's the damn outlet?

2008-05-09T11:00:00.004-04:00

I don't know about you but I can't afford to fly business class.

Now, fortunately, I don't need a CPAP but I've flown on enough 12 to 14 hour overnight flights to be aware of the amount of snoring and choking and gasping that occurs in coach. Despite the fact that coach seats don't recline there's still a lot of people who have problems with apnea on these flights. There may be electrical outlets and room to place a CPAP machine in business/first class but space and electrical outlets are nowhere to be had in coach.

Once off the plane and into a hotel room, another set of problems becomes evident when you travel with CPAP. Have you ever tried to find an outlet near the bed where you can plug in your CPAP machine? Heck, I often can't find an outlet to recharge my cell phone without moving furniture to say nothing about forgetting the plug adapter for European and Asian countries.

Oral appliances designed to control obstructive sleep apnea are an (almost) ideal solution for travel and, often, can be used as an alternative to CPAP at home for those who find the CPAP mask confining.

Problem is that sometimes something breaks. And it usually breaks at the worst possible time in the worst possible location. Most dentists know little about oral appliances used to treat obstructive sleep apnea and physicians know even less.

As oral appliance therapy for snoring and sleep apnea becomes more and more prevalent, it becomes more and more important for dentistry to establish a network of dentists who have been trained and are knowledgeable about oral appliance therapy. It's the goal of Snoring Isn't Sexy to develop a global network of well-educated and well-trained dentists who can provide oral appliance therapy and act as a resource to the traveler everywhere in the world.

Dr. Larry Barsh

Men's Hair Color vs. Heart Disease and Hypertension

2008-05-08T17:38:00.005-04:00

The bad news: it looks like subtracting just a little bit of gray is way more important than talking about a serious health problem.

When we started SnoringIsntSexy.com, we figured that the name of the site would attract some of the "Style" Editors by introducing a medical problem as a lifestyle issue (especially with recent research linking snoring and sleep apnea to erectile dysfunction) but it looks like we may have been somewhat misguided.

The New York Times Style section this morning had a full page discussion of how men can restore "gray locks to a comely mix of salt and pepper." Never mind that snoring and sleep apnea can lead to heart disease, stroke, diabetes, depression and accidental injury and death, people seem to be more concerned with their appearance than with their health. One gentleman was quoted as saying "In my business, if you're over 40 you're too old..." I guess that just the right touch of gray makes up for excessive daytime sleepiness and inability to concentrate.

Snoring and sleep apnea are lifestyle issues as well as being causally related to serious disease problems. What is seemingly more important than ensuring one's health is "Fooling That Thief, Time. With a Change of Locks." The article goes on "But [gray hair] has also been associated with death, health problems, diminished mental abilities and loss of sexual potency, said Victoria Sherrow, the author of ' Encyclopedia of Hair: A Cultural History.' "

Hey, that's really funny because research has proven that snoring and sleep apnea really are associated with death, health problems, diminished mental abilities and loss of sexual potency!

I urge editors and writers to take a close look at a problem that affects the quality of life and the health of more than 18 million men, women and children in the United States alone and that of untold millions more who snore. Just maybe, with the right approach, we can save lives and millions of dollars a year in unnecessary health care expenditures.

Dr. Larry Barsh

Medical Information on the Web

2008-05-07T07:35:00.003-04:00

As a dentist and founder of SnoringIsntSexy.com and Quietsleep.com, I am continually searching the web for new and vital information to keep the sites up-to-date and valuable for patients. Neither site is intended as medical advice (you should always see your own physician and dentist) but they are intended rather to keep you informed.

I am, however, continually frustrated, when attempting to research a bit of information, by sites that require one to subscribe to a journal or pay an outlandish fee (usually $40 or $50) for a pdf copy before being able to read that scientific article.

I am aware, of course, that it takes dollars to bring a journal to print. But withholding information to doctors (whether physician or dentist) that can be critical to their patient's care is simply unconscionable. It is critical to our patients' well being that a free flow of information be available.

Journals should adopt what is basically a web model in thousands of other instances and let free article access be supported by advertising. I'm not asking for access to an entire month's publication but rather to a single article on a particular current topic.

Any other opinions on this?

Dr. Larry Barsh

Epworth Sleepiness Scale

2008-05-05T07:15:00.002-04:00

One of the questionnaires that most dentists rely on when taking a history for sleep apnea is called the Epworth Sleepiness Scale. The Epworth Sleepiness Scale measures the likelihood that one will fall asleep inappropriately under a variety of daytime conditions but does not specifically test for sleep apnea. So when answering the questions on the test, be aware that many problems including sleep apnea will lead to a positive result.

"Excessive daytime sleepiness (EDS) is commonly assumed to be the result of disturbed or inadequate sleep" wrote Dr Edward Bixler and colleagues at Penn State University. Bixler studied other possible causes of excessive daytime sleepiness and found that EDS is also associated with mood disorders as well as metabolic factors like obesity and/or diabetes. Depression was found to be the biggest risk factor followed by BMI, age, typical sleep duration, diabetes and smoking.

Patients with a high Epworth score should be evaluated by their physician whether or not sleep-disordered brething is present.

Dentistry and Sleep-Breathing Disorders

2008-04-26T12:28:00.004-04:00

It has been estimated that in the United States alone 18 million men, women and children suffer from sleep apnea. Millions more snore. Of these 18 million, approximately 85% are not aware of their problem despite the fact that the average life span of an untreated sleep apneic is years shorter than for the rest of the population. Both snoring and obstructive sleep apnea have been implicated causally and otherwise in cardiac disease, myocardial infarction, irregular heart beat, hypertension, diabetes, stroke, depression, and erectile dysfunction to say nothing about vehicular and occupational accidental injury, death and planetary pollution. At a time when, in the United States, presidential candidates and the public clamor for the adoption of universal health care, the increased medical costs associated with untreated sleep apnea are estimated to be in the billions a year.

Oral appliance therapy has been accepted as an alternative or supplement to CPAP in some instances and yet the public and many dentists remain unaware of the vital role of the dentist as part of the healthcare team for the recognition and management of snoring and obstructive sleep apnea.

Dentists who have chosen to become involved in the recognition and management of snoring and obstructive sleep apnea are exceptional in their viewpoint and in their dedication to learning. Those physicians who recognize the important contribution dentistry can make and have accepted these dedicated practitioners as part of the treatment team are to be applauded. Dental schools whose forward-looking faculties have chosen to include the study of sleep-breathing disorders are to be commended.

There is, however, more that needs to be done.

Dentistry must assume its full role as a healthcare profession in the 21st century. It is no longer enough to be consumed with only the appearance and health of the oral cavity. The ability to recognize potential stroke victims by panoramic radiograph and to recognize the relationship of periodontal disease to cardiac disease have already mandated a new vision for dentistry. To that mandate we must add, at the very least, the screening for obstructive sleep apnea.

In the May, 2008 issue of the journal Anesthesiology , Chung et al propose a series of 4 questions to be asked of every patient about to undergo surgery under general anesthesia. Dr. Chung and her team propose the STOP questionnaire:
S: Do you snore loudly?
T: Do you often feel tired, fatigued or sleepy?
O: Has anyone observed you stop breathing during sleep?
P: Do you have or are you being treated for high blood pressure?

If you answer "yes" to two or more questions, then you have a high probability of having obstructive sleep apnea. For a more in-depth assessment, please visit the Ares Screener at Quietsleep.com.

This questionnaire should be part of every practicing dentist's initial medical history and asked again at reevaluation appointments. It is essential that these questions also precede every administration of oral or IV sedation in-office.

If your dentist doesn't ask you these questions, point him or her to this site or to Quietsleep.com for more information on the way he or she can protect your health and the health of loved ones.

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?

Snoring and the Brain, CPAP and Oral Appliances

The Kentucky Derby and Dental Sleep Medicine

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

The Voices of Sleep Apnea

Attention Family Physicians

Choice of Dentist to Treat Snoring and Sleep Apnea

Anti Snore device for sale on Amazon - Pay for Play Review Scheme

Media Ignores Drowsy Driving

Validation for Oral Appliance Therapy

Sleep Apnea and Motor Vehicle Accidents

Snoring and the News Media

The "We All Snore in the Same Language" Project

The Secret [Sex] Life of Snorers

"When Economy Sours Tootsie Rolls Soothe Souls"

Too Sexy for CPAP

Can ENT surgeons provide oral appliance therapy for snoring and sleep apnea?

Obesity and the New York Times

Excessive Daytime Sleepiness in the Over-70 crowd

Do you have a family member that snores?

Sleep disorders go unrecognized

Heavy Snoring is a Cause of Stroke

Awake In America Replaces Equipment To Treat Sleep Apnea Lost In Hurricane Ike

Snoring Separately and ED

Snoring, Diabetes and Physicians

Still think snoring is a joke?

Driving on Labor Day Weekend

Want to Look Better and Live Longer? First, Stop Smoking

New Website You might be Interested In

Sleep Apnea and increased risk of death (continued)

People with Sleep Apnea have a high risk of death

Sleep Apnea and Your Bottom Line

Sleep Apnea and Heart Attack Risk

Validity of Medical Content - Your Responsibility!

About.com, Snoring, Dentists

Benign Snoring?

PURE SLEEP and other do-it-yourself "cures"

Drowsy Driving and Snoring

All Dentists Should Screen Their Patients for Snoring and Sleep Apnea

Wal-Mart: The New Determinant in Medical Care

Breathe Right Strips

60 Minutes Tackles Sleep

Sleep Apnea Increases Risk of Death

17th Annual American Academy of Dental Sleep Medicine

Beddie Buys

Snoring Doesn't Cut It in Relationships

Over the Counter snore Appliances

Dental Sleep Medicine - The need for a new specialty in dentistry

Where's the damn outlet?

Men's Hair Color vs. Heart Disease and Hypertension

Medical Information on the Web

Epworth Sleepiness Scale

Dentistry and Sleep-Breathing Disorders

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