Sleeping on the Left Side

There are many articles that discuss the benefits and hindrances of different sleep positions.  Sleep.com talks about sleeping on your back as the best position for the most restful sleep, while your stomach is the worst.  Sleeping on your side is considered the second best sleep position, and only 15% of adults sleep that way.  However, that number does not include those that choose to sleep in a fetal position – which is the most popular sleep position choice (by a landslide) at 41%.  These facts are interesting, but could the health benefits be even more specific?

One Side or the Other

A recent article references the Ayurveda school of medicine, and the benefits of sleeping on the left side as being particularly advantageous.  While the Sleep.com article recommends a loose fetal position on the left side for pregnant women, Ayurveda suggests that these benefits have a deeper meaning for more individuals than just pregnant women.  This all stems from the idea that our left and right sides act differently – almost independently of one another.  When considering our body composition from outward appearances, it may seem ludicrous.  Outwardly, we appear fairly symmetrical.  However, when one considers the internal composition of a human body, it can make more sense.

For instance, one proposed benefit of sleeping on the left side is that it improves digestion.  “Since our stomach and pancreas are located on the left side, sleeping on the same side enables them to hang naturally and function better.”  This position also allows the food to continue on its entire path undisturbed, from the stomach to the colon.  It is suggested that this can also reduce heartburn and indigestion.  Similarly, sleeping on the left side can be good for heart health, for the same reasons as stated above.  Since the heart is on the left side of the body, sleeping on the same side suggests that it may give the heart a break during sleep.

As the Sleep.com article also suggests, sleeping on the left side in the fetal position is especially beneficial for pregnant women.  It “improves circulation in your body and in the fetus, and it prevents your uterus from pressing against your liver…”  Another recommendation is to keep a pillow between the legs, to reduce strain on the hips.

Perhaps the most important benefit of sleeping on the left side is that it can help to prevent snoring.  “It keeps your tongue and throat in a neutral position and thus keeps your airways clear for you to be able to breathe properly.”  While this is a compelling reason to try sleep on one side or the other, there is not much evidence as to how the left side would be better than the right to assist with snoring.

Ayurvedic medicine is defined by WebMD as “one of the world’s oldest holistic (“whole-body”) healing systems. It was developed more than 3,000 years ago in India.  It’s based on the belief that health and wellness depend on a delicate balance between the mind, body and spirit.  Its main goal is to promote good health, not fight disease.  But treatments may be geared toward specific health problems.”

Sleep Trackers and Their Role in A Good Night’s Sleep

The Journal of Clinical Sleep Medicine has brought to light a new potential problem with regards to technology; sleep tracking with our wearable technology.  According to a recent article, “an estimated 15% of adults own a wearable fitness/sleep-tracking device, such as Fitbit or Apple Watch, and that another 50% might consider buying one.”  Though most wearable technology is marketed as fitness and movement tracking devices, the sleep tracking functionality is a selling point that has a fast-growing popularity.  So much so, the data collection has been found to cause a sort of anxiety for some users.

One patient mentioned in the article had purchased and used his sleep tracking device in hopes of encouraging better sleeping habits.  He had been having some issues with getting a good night’s sleep, and started using his tracker to fulfill his nightly goal “to achieve at least 8 hours of sleep every night.”  The suggestion is that, although the goal is noble, the sleep tracker can contribute to “a self-induced level of increasing anxiety” that the pressure of this goal can create.

While medical professionals commend users for the desire for better sleep, there is hesitation in placing too much reliance on these wearable pieces of technology.  Dr. Kelly Glazer Baron is one of the report authors, and her claim is that these trackers “don’t do a good job of estimating sleep accurately.”  In other words, these trackers are good for creating and maintaining awareness, but individuals should not live and die by the data.

Dr. Baron goes on to discuss further that this fixation on data – called “pursuing the ‘quantified self’” – can extend past simply sleep, and can cause stress.  In fact, terms such as “orthosomnia” and “orthorexia” have been coined to describe patients that are shown to have “unhealthy preoccupations” with sleep and food, respectively.  Because people are striving for their idea of proper living based on their tracked data, this causes some concern since the data has often been shown to be inaccurate.  One patient even questioned the accuracy of her sleep study in a lab due to her Fitbit showing opposing data.  Further inaccuracies include a lack in ability to “differentiate between light and deep sleep” and “reading in bed” versus sleeping.

There are ways that these trackers have benefited patients; the Sleep Review article references a sleep apnea patient that did get help with better sleep in part because of his sleep tracker.  Although these trackers can be one part of a patients’ answer, no electronic device is a substitute for the consultation of a medical professional.  For more about how our tech items can affect sleep, please see our blog post about blue light and electronics here.

Tonsillectomies and the Sleep Apnea Connection

The Mayo Clinic defines a tonsillectomy as “the surgical removal of the tonsils, two oval-shaped pads of tissue at the back of the throat – one tonsil on each side.”  Historically, this procedure was used as a tool in fighting chronic streptococcal infections.  Recent research is suggesting that the prevention of these infections “appear to go away” over time.  But more interestingly is that this procedure has been found to be beneficial to patients in other unexpected ways.

A recent Reuters article by Lisa Rappaport discusses the interesting transition of the tonsillectomy.  Still a widely common procedure, the latest research suggests that the infections the tonsillectomy was enacted to deter are sometimes only bringing short term relief.  The article mentions a Pediatrics study that claims “three years after tonsillectomies, children who had these procedures had roughly the same number of throat infections as kids who didn’t get their tonsils out.”  Ms. Rappaport goes on to intimate that the existing research failed to address the correlation between level of severity and level of benefit, which would surely effect the results of the study.

One of the authors of this most recent study – Dr. Sivakumar Chinnadurai – stated to Ms. Rappaport:

“The recognition of risks, and the knowledge that some patients’ infection rate improves over time has led to (strep) infection being a much less common indication for tonsillectomy than it was in the past.  While tonsillectomy remains one of the most common surgeries performed in the United States, the main indication for children has switched to obstructed breathing.”

It may not seem too surprising that inflamed, swollen tonsils may cause a child some difficulty breathing.  In a second study, researchers gathered data from almost a dozen previous studies that showed a clear correlation between tonsillectomy and sleep quality.  Ms. Rappaport states that “Compared to kids who didn’t get surgery, children who had tonsillectomies had greater improvements in sleep-related quality of life and in negative behaviors that are worsened by apnea…”

As with most newly found data within the medical community, these findings are not definite; they do, however, offer some hope for possible future prevention of Sleep Apnea.  As always, Pittsburgh Dental Sleep Medicine will stay aware and report on this and all other sleep related topics.

Melatonin: A Safe and Natural Sleep Aid?

Disruptive sleep can lead to some serious disruption in daily life, which is why most people that have troubled sleep are desperate to change that fact.  A rising trend in recent years has shown that people are becoming more aware of what substances they put into their bodies, which is commendable.  However, patients’ self-education and assumptions can prove to be more than slightly misguided when considered within the scope of certain medical research.  Prior to taking any over the counter supplements, it is recommended to talk to a physician.  Melatonin is a hormone that already exists in the human body, but this post intends to address some external factors that may not have been considered by the self-educating patient.

What is Melatonin?

Merriam-Webster defines melatonin as “a vertebrate hormone that is derived from serotonin, is secreted by the pineal gland especially in response to darkness, and has been linked to the regulation of circadian rhythms.”  It is important to note a few things, based on this definition.  Notice that the only reference to sleep is that it has been linked to the regulation of circadian rhythms.

It is also important to note that the substance referenced is a hormone; this is something that affects all aspects of a human body.  While the hormone is linked to sleep assistance, it is important to consider the effects of this supplement on an individual in its entirety.

 

The Science Behind It

In an article by Ginger Skinner published in Consumer Reports, she mentions that the American Academy of Sleep Medicine claims “there is not enough research to clearly demonstrate [it] work[s] – more is needed.”  She goes on to state that “melatonin and valerian…. sleep-inducing benefits of the products are minimal at best.”  While these studies suggest further research, Ms. Skinner still recommends this supplement as a temporary possible aid “for those with jet lag or those who do shift work.”

However, if a person does find sleep assistance in these products, there are still risks to consider.  A 2015 Consumer Reports survey states “about 20 percent of melatonin users… reported next-day grogginess.”  In addition to side effects, it is also important to consider that supplements “are not closely regulated by the Food and Drug Administration.”  This means that there can be issues with consistency of the product, and also the possibility of harmful substances included in the pills.  Ms. Skinner refers to an analysis in 2013 in which valerian root studies showed lead contamination.

Ms. Skinner suggests to look for the “USP Verified” mark.  This is a certification from the U.S. Pharmacopeial Convention which confirms some safety standards (consistency of active ingredients and a clearance in relation to harmful substances).  She also recommends taking melatonin in small dosages for the first time.

Along with Ms. Skinner’s advice, we here at Pittsburgh Dental Sleep Medicine also recommend that you always consult with a physician prior to taking any sleep aids.

Circadian Rhythms, Blue Light and Your Sleep

In the last 20 years, mobile device usage has increased dramatically.  Phones, computers, and tablets/iPads are now all commonplace home items in the US.  While most of us have grown accustomed to the presence of these devices, it is important to be aware of what the increasing ubiquity of our electronic mobile devices could be doing to us as individuals.

In a recent article from New Atlas, Michael Franco asks some questions of Dr. Lakshmy Ayyar regarding these devices, and what it could be doing to our sleep.

 

 

Circadian Rhythms and Blue Light

According to dictionary.com, a circadian rhythm is defined as “A daily rhythmic activity cycle, based on 24-hour intervals, that is exhibited by many organisms.”  Dr. Ayyar stresses how critical it is to maintain a good cycle for sleep and other organ health; our bodies rely on external stimuli for this cycle to stay regulated.

Knowing this, it is necessary to note the top two most important external stimuli – daylight and darkness.  Per Dr. Ayyar,

“It is primarily light of a blue wavelength (blue light) that stimulates sensors in the eye to send signals to the brain’s internal clock.  Blue wavelengths are essential and beneficial during daylight hours as it helps us to stay alert and is known to boost performance and attention.”

She goes on to note that this blue light, while acceptable and even sometimes beneficial during daylight hours, can really confuse our circadian rhythm at night and in the evening.  Particularly LED lights, which have “peak emission in the blue light range (400-490 nm) … This essentially ‘tricks’ our brain into thinking it is daytime.” This exposure can also limit the production of melatonin, a hormone that is also critical to the success of an individual’s maintenance of his or her circadian rhythm.

 

What Can Help?

Most sleep specialists and medical professionals/outlets recommend removing exposure to blue light between one to two hours before bedtime.  If an individual has a regular bedtime schedule, maintaining this recommendation should be fairly easy.  Some people may have trouble maintaining such a schedule; in the instance of late-night deadlines and other necessary occurrences of blue light exposure, there are certain things that can be done to help limit the effects of this possibly harmful exposure.

Per Dr. Ayyar, “Studies have shown that amber colored glasses increase production of melatonin and can lead to improvement in sleep.”

In addition to amber colored glasses, there are filter applications and screen protectors that can be used and/or installed onto mobile devices that help to reduce blue light emitted.  Dr. Ayyar recommends the app Twilight for Android devices, “Night Shift Mode” on iOS devices, and “screen protector[s] such as Ocushield.”  While these are all important and helpful tips, perhaps the best suggestion of Dr. Ayyar’s is this – “It is also important to expose yourself to natural sunlight during the day as this will help to entrain the natural circadian rhythm.”

For more on the related topic of electronics and how they can affect sleep, please see the Pittsburgh Dental Sleep Medicine blog post regarding devices in children’s bedrooms.

New Study: Electronic Devices in Children’s Bedrooms

kids-and-mobile-in-bed

The use of mobile technology has changed the average American’s lifestyle considerably; we have the ability to answer most questions with just a few clicks of our touchscreen devices.  This convenience has become commonplace for most adults.  It has also become a fairly standard practice for children.  A study done by the National Sleep Foundation finds that well over half of children in the U.S. have some type of electronic mobile device in his or her bedrooms.  We use these devices for any number of reasons, varying from the alarm functionality to entertainment.

Why is this of importance?

An editorial piece written for the Journal of American Medical Association (JAMA) Pediatrics by Drs. Czeisler and Shanahan suggests that children (like adults) fall prey to the alluring appeal of near-constant streaming content, which can lead to a fear of missing out.  This information – coupled with the increased responsibility of school work and extracurricular activities during the school year – is showing some potentially alarming statistics in regards to the American child’s sleep patterns.

We here at PDSM have come to understand some of the important correlations between lack of sleep and several illnesses, including obesity, Type 2 diabetes risk, lack of ability to focus, poor mood, lowered immunity, anxiety and depression.  These studies suggest that the symptoms of poor sleep can be more than doubled with children.  One idea in the JAMA Pediatrics editorial piece suggests that sleep loss and attention-deficit/hyperactivity disorder have almost exact symptoms; which raises the concern of our children suffering unnecessarily.

Another publication in JAMA Pediatrics suggests a link to screen-based electronic devices as being a cause for lack of sleep in children between the ages of 6 and 19.  The main outcomes of the study included “inadequate sleep quantity, poor sleep quality, and excessive daytime sleepiness.” Perhaps the most interesting piece of evidence was shown in the data revealing that the devices did not even have to be in use to cause sleep disruptions in a majority of the children studied.

While there is still more research required to determine the effects of electronics in the bedroom on a person’s sleep habits, the latest children studies mentioned above suggest that parents should be more vigilant regarding the usage of mobile devices before and during bedtime.  Creating a family spot for mobile devices to charge overnight is one way to eliminate this potential threat.  Another idea is creating a phone-off time, about an hour before bed time.  This can help the child to calm down before bed time, which can assist in more restful sleep.

For further reading, check out our additional sleep tips at the PDSM blog.

 

 

Pittsburgh Sleep Apnea Dentist

PittsburghSleepApneaDentist-PDSM

Are You Looking For a Sleep Apnea Treatment?
If you’re located in or near the Pittsburgh area, you’re in luck! There just so happens to be an experienced and highly qualified team of sleep medicine dentists in four areas in and around the Pittsburgh region.

Pittsburgh Dental Sleep Medicine (PDSM) was created by Dr. Robert Rogers, a pioneer in dental sleep medicine. He was founding president of the Sleep Disorders Dental Society, which is now known as the American Academy of Dental Sleep Medicine (AADSM). The AADSM was the first ‘national professional society dedicated exclusively to the practice of dental sleep medicine.’ It now has over 3,000 members.

Dr. Rogers has been treating sleep apnea in the Tristate area for over 25 years. He started the Pittsburgh Dental Sleep Medicine Network and now treats sleep apnea out of the main office in Wexford, PA, while also traveling all over the United States giving lectures on sleep apnea and oral appliance therapy. Most recently, he patented a multi design appliance that is used at all PDSM locations. He works with 3 other dentists in the Pittsburgh area who he personally trained in the treatment of Obstructive Sleep Apnea: Dr. Michael Fazzini, DDS, DABDSM, FAGD, Dr. Christopher Mascio, DMD, and Dana Mascio, DMD.

The Pittsburgh Dental Sleep Medicine Network treats obstructive sleep apnea (OSA) with oral appliances. Oftentimes, oral appliance therapy is a treatment option for OSA sufferers who cannot tolerate cumbersome continuous positive airway pressure CPAP treatment. Oral appliances fit in the mouth like a sports mouth guard, and are custom made. They support the jaw and open the pharynx to keep the airway open during sleep. (Learn more about oral appliances here)

PittsburghSleepApneaDoctor

The Pittsburgh Dental Sleep Medicine Network has 4 locations in the Pittsburgh area including Wexford, Downtown Pittsburgh, Monroeville and Burgettstown. Make an appointment at any of our locations by calling 724-935-6670.

Learn more about oral appliance therapy at Pittsburgh Dental Sleep Medicine by reading the following articles:

Top Oral Appliances

List of Best Oral Appliances

Oral appliances are a treatment option for the sleep disordered breathing condition known as obstructive sleep apnea (OSA). This option is ideal for patients who cannot tolerate Continuous Positive Airway Pressure (CPAP). Oftentimes, individuals suffering from sleep apnea try CPAP as a treatment for their sleep apnea, and then cease using their device, and thus, stop treating their sleep apnea. In this article, we will compare features of some of the most popular oral appliances available.

Oral appliances are another option to treat sleep apnea that is less intrusive, portable, and comfortable. They are very effective as a treatment option for OSA patients due to higher retention rates. Oral appliances are used like a mouthguard or retainer, and function by advancing your lower jaw while you sleep, and opening the space behind your tongue to increase airflow and stop any blockage.

At Pittsburgh Dental Sleep Medicine, we carry a multitude of different devices so our patients have options, and have a higher chance of finding the ideal dental device for their unique situation. All of the oral appliances we create or supply are custom fit to your mouth, and have received FDA clearance. Read more about our most popular devices below to learn about the various features of the devices, and how they differ from one another.

PittsburghDentalSleepMedicine-Oral Appliance-MicrO2

The MicrO2 oral appliance is made by Prosomnus, a division of MicroDental Laboratories. This device is designed to offer a large amount of tongue space, and also gives the wearer the ability to open and close their mouth during wear. The unit is designed to be both small and comfortable, while holding the jaw in a slightly forward position to open the airway, like the other devices listed below.

PittsburghDentalSleepMedicine-Oral Appliance-HerbstAdvance

PittsburghDentalSleepMedicine-HerbstAdvance-Mechanism

The Herbst Advance™ oral appliance is made by SomnoMed®. The device is designed to have a high level of performance and give the patient more control. The device features a visual calibration indicator (pictured right), which is where the lower and upper sections of the device connect. The calibration indicator empowers both us and the patient with the ability to adjust the appliance as necessary, and simultaneously tells us when the device is fully extended. This appliances has a longer range of advancement at 8mm than most oral appliances that have a standard range of 5mm. The Herbst Advance™ is covered by Somnodent 2-3 year warranty against manufacturer defects.

View Source

PittsburghDentalSleepMedicine-Oral Appliance-NarvalCC

The Narval™ CC oral appliance is created by ResMed. This dental device is one of the lightest devices on the oral appliance market. It is developed to be discreet and comfortable while being effective. One feature worth mentioning for this device is that you can talk and drink with it, as well as close your mouth and breathe through your nose with it, unlike most other devices. This device connects in the back corners, where the lower and upper sections of the device fit into one another, as you can see in the image above. ResMed states that the Narval™ is “a solution so comfortable, you’ll never want to go a night without it.”

View Source

PittsburghDentalSleepMedicine-Oral Appliance-MedleyGold

The Medley Gold appliances represent a revolutionary development in oral appliance therapy. As the name implies, the Medley series of appliances can change into any one of 3 different design types without having to remake the appliance itself (2 of 3 pictured above). A rigid nylon link connector is very comfortable and effective for the vast majority of patients. However, a stretchable, elastomeric strap is available for patients with sore jaw joints. In addition, a Herbst-type rod/sleeve mechanism can be utilized when indicated.

PittsburghDentalSleepMedicine-Oral Appliance-TAP3

TAP stands for Thornton Adjustable Positioner. This device functions differently than other devices in how the upper and lower sections connect in the front area as you can see in the image above. This device utilizes a front connector as “a hook mechanism attached to the upper tray which fits into a socket attached to the lower tray and positions the lower jaw forward.” This design allows for more range of motion laterally than other devices.

View Source

For more information about sleep apnea and oral appliances, browse through all of our blogs, or check out the blogs listed below:

If you would like to schedule an appointment for an oral appliance consultation at one of our 4 locations in and around Pittsburgh, give us a call at 724-935-6670. We have locations throughout Western Pennsylvania in Wexford, Monroeville, Downtown Pittsburgh, and Burgettstown.

The Rogers’ are Featured in Sleep Review Magazine!

Sleep Review Magazine May 2016

We are excited to announce that we are currently featured in the May 2016 issue of Sleep Review Magazine! Learn the story of Rob Rogers, DMD, DABDSM, and Mary Beth Rogers, a ‘dream team’ in this well written article that reviews the couple’s major contribution to the world of sleep medicine and oral appliances. Within it, learn the origins of the American Academy of Dental Sleep Medicine (AADSM), the hurdles of oral appliances the Rogers’ have overcome, and their ongoing role in the sleep medicine industry. The article starts with a glimpse into the early days of sleep medicine and how it peaked the Rogers’ interest:

“When Rob Rogers, DMD, DABDSM, graduated from the University of Pittsburgh School of Dental Medicine and launched his dental practice, now the Pittsburgh Dental Sleep Medicine Network, the field of dental sleep medicine did not exist. Sleep medicine itself was still a relatively young science. And when Mary Beth Davis (now, Mary Beth Rogers), vice president and director of administrative services for the Pittsburgh Dental Sleep Medicine Network, graduated from the University of Pittsburgh with a Bachelors of Science in education, the American Academy of Dental Sleep Medicine (AADSM) did not exist. Indeed, the American Academy of Sleep Medicine (AASM) had just been founded the year before in 1975. But the winds of change could be heard—including in the childhood home of Mary Beth.”

Dr. Rogers and Marybeth Rogers of Pittsburgh Dental Sleep Medicine

Delve further into the new era of sleep medicine and see how the Rogers’ helped position oral appliances as an appropriate first-line treatment for obstructive sleep apnea (OSA) by reading the full Sleep Review Magazine article, “A Dream Team: Rob Rogers, DMD, DABDSM, and Mary Beth Rogers” on the Sleep Review website.

Did you learn something new about the Rogers, or the AADSM from reading this article? Be sure to leave us a comment below to let us know what you think or what you learned.

The Sleep Apnea / Cardiovascular Connection

Sleep apnea is extremely common in patients with cardiovascular disease. It is well known that when sleep apnea is left untreated, medical comorbidities are likely including; cardiovascular complications such as hypertension, heart attack, stroke, A-Fib, and endothelial dysfunction. Understanding the relationship between these two serious maladies and how to impact the ongoing negative cycle by treating OSA can help your patients improve their cardiovascular health.

 

Blood Pressure During Sleep

Sleep should be a time when the body regenerates, and recovers from the stress of waking hours. In normal sleep and breathing, blood pressure and heart rate remain below waking levels on average. For individuals without sleep apnea, sleep and normal breathing has a relaxing effect on the cardiovascular system. However for sleep apnea sufferers, disrupted breathing has a negative effect on the cardiovascular system that may result in an increase in blood pressure, cardiac dysrhythmias, endothelial dysfunction and more. The mechanisms triggered by sleep-disordered breathing can carry over into waking hours.

 

Sleep Apnea and Hypertension

Intermittent desaturations at night are associated with release of stress hormones (catecholamines) that cause vasoconstriction and elevated blood pressure. Studies have shown that this elevation in catecholamine then persists during the daytime resulting in systemic hypertension.

Patients with sleep apnea are also at risk for cardiac rhythm disturbances especially ventricular arrhythmias and atrial fibrillation as well as myocardial ischemia.
Untreated Sleep Apnea can lead to hypertension, cardiac Arrhythmias, Stroke, Myocardial ischemiaIt is estimated that 80% of Americans with sleep apnea are undiagnosed. Sleep apnea affects more than 20 million unaware Americans. This is why we urge health care practitioners such as yourself to keep sleep health at the forefront during patient interaction. Treating sleep apnea in individuals who also have cardiovascular issues has been proven to improve co-morbidities like hypertension and arrhythmia.

 

Start with Sleep Health

When assessing your patients, it is useful to inquire about quality of sleep, presence of snoring, observed apneas, awakening from sleep gasping and daytime hypersomnolence.  Urge your patients to get a sleep test when appropriate, and begin managing sleep apnea if indicated.

Please use our website as a resource, both for yourself, and for your patients. We have many blog articles to help understand sleep apnea, treatment options, the effects of sleep deprivation, sleep study information, and more. Our goal is to help your patients get treated if they suffer from sleep apnea, and improve their quality of life starting with improving sleep health.

This blog was co-written by Dr. Rogers, DMD, DABDSM, and Dr. Bijwadia, MD.