History of Sleep – The Beginning

In the age of information, it can be difficult to find a comprehensive article about almost anything. Not many people are able to find the time to read about topics that interest and effect them, so the demand for easily digestable material is high.  Recently, an article appeared in the New Yorker by a person clearly interested in the history and study of sleep, Jerome Groopman.

His article discusses many fascinating aspects of sleep, ranging from the medical industry’s lack of knowledge about sleep to what happens to a person when they do sleep.  The theme of his article is much like what we’ve discussed on our blog – the necessity of sleep, and how it’s lack can be a severe detriment to a person’s daily life. At PDSM, we wanted to take a further look at the items discussed in Mr. Groopman’s article.  Gleaning information from his article and other sources, we were inspired to create this series in hopes of offering a more comprehensive look at sleep in general, and the things that can happen because – and in spite – of it.

 

“No one has been able to declare with certainty why all life forms need sleep”

-Meir Kryger

 

Though we now know that sleep is a very necessary part of a healthy lifestyle, it’s not always been a focus in the medical world.  Mr. Groopman states “in medical school, the subject [of sleep] had been covered in only the most cursory way.” In addition to the fact that sleep specialtiy is a relative newcomer to the medical world, there is also the shift work typical of medical residents.  It makes sense that new doctors have to work long hours to get used to the pressures of being a full-time doctor. However, it is also a scary idea – being the patient of a doctor that’s been awake for 24+ hours. Although it is well known that lack of sleep causes us to be ineffective, there is some interestingly contradicting cultural and historical information to discuss regarding what exactly may be considered proper sleep.

 

In the coming months, we will take you on the informative adventure.  We will learn more from Dr. Kryger, Mr. Benjamin Reiss and Mr. A.Roger Ekirch – three gentlemen that have quite a lot to say about sleep. We will discuss what we know, what we don’t know, theories surrounding what we don’t know, how our understanding has changed through the years, and what the future may hold.  

 

“Even God needed a seventh day to rest from all that he created.”

-Jerome Groopman

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.

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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.”

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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.

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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.

Disrupted Sleep Linked to Alzheimer’s Disease

Researchers recently reported at the Alzheimer’s Association International Conference that none other than disrupted sleep may be a cause of Alzheimer’s. According to researchers from the University of California, Berkeley, disrupted sleep aids in the creation of beta-amyloid, which starts a process that ends in neurodegenerative disorders.

How it works:

Beta-amyloid are the main component of Amyloids. Amyloids are protein aggregates developing from improperly folded proteins. This leads to amyloidosis, which we believe leads to neurodegenerative disorders including ALS, Parkinson’s, Alzheimer’s, and Huntington’s disease.

Plan to Treat

There is currently no cure for the neurodegenerative diseases listed above. But with this new research, we can take precautions and decrease our likeness of getting these ill-fated and incurable diseases. Get better sleep now. Get better quality sleep.  Plan for your future and the future of your loved ones and get the best chance at a long, healthy life. Get a sleep test and find out your sleep patterns.

Sleep Apnea

According to Dr. Kristine Yaffe of the University of California, San Francisco,

‘Sleep apnea — brief interruptions of breathing that repeatedly awaken people without them realizing — caused a nearly two-fold increase in the risk [of being more likely to develop mild cognitive impairment and early memory problems that sometimes lead to Alzheimer’s].” She recommended that people at risk of Alzheimer’s be screened for sleep disorders, especially apnea, which has effective treatment.

 Are you at risk for Alzheimer’s disease? Take a look at the risk factors listed below. If you have one or more of these risks, then you should get asleep test and do what you can to prevent the disease.

  • Advanced Age
  • Family History
  • Genetics
  • Latino and African American Dissent
  • History of unhealthy living

Take a closer look at these risk factors on the Alzheimer’s Association website.

Alzheimer’s Association

After reviewing three different and extensive scientific studies on disrupted sleep and Alzheimer’s disease, The Fisher Center for Alzheimer’s Research Foundation found this: “…Poor sleep, as well as sleep apnea, is a common problem in the elderly. Just because you don’t sleep well doesn’t mean you will get Alzheimer’s disease. A sound night’s sleep, though, may be a critical component of a healthy lifestyle – and might even help to keep Alzheimer’s at bay.”

Understanding Sleep Apnea

How sleep apnea occurs, what it affects, and whom it affects will be covered in this article. Read on to gain a better understand of a disorder that millions of Americans suffer from, without knowing it.

Sleep apnea is defined by a repeated cessation of breathing that occurs during sleep. An apnea, or pause in breath, can last anywhere from a few seconds to a few minutes in length, and happens at least 5 times per hour by definition. The apnea occurs because the pharynx (upper airway) becomes obstructed, which prevents the air (oxygen) from entering the lungs. When an apnea occurs, the body increases blood pressure and heart rate to wake the person experiencing the apnea just enough to start breathing again and clear the airway. The person may not wake up long enough to register the momentary disruption in their sleep. However, the repetitive drops in blood oxygen and the resulting sleep deprivation is associated with a host of medical problems.sleep apnea diagrams Pictured left: normal pharynx. Pictured right: Collapsed airway during sleep.

Sleep apnea occurs for a multitude of reasons; including the relaxing influence of sleep and the gravitational effects of the supine (back sleeping) position. Individuals with thick trunks or necks, excessive weight, and older males, also have an increased risk of suffering from sleep apnea.

Sleep apnea is an elusive disorder for one simple reason: apneas happen during sleep. This makes the problem less obvious to those who suffer from it, and more difficult to diagnose. Sleep apnea does however have some tell-tale symptoms that can clue you that you have or may have the disease. Mainly, snoring and frequent daytime sleepiness are strong signs that you may be suffering from sleep apnea, and should undergo a sleep study.  Other effects of sleep apnea are behavioral changes, such as; moodiness, depression, belligerence, decreased attentiveness and ambition. Other effects are slowed reaction time and vision problems.

Sleep apnea can be observed by bed-partners sleep partners or by its effects on the person suffering from sleep apnea. Gone untreated, sleep apnea can lead to health complications including diabetes, heart conditions, stroke, and more.

 

If your bed-partner snores, momentarily stops breathing during sleep and then abruptly starts again, or if you snore, feel tired and less ambitious and don’t know why, you may be suffering from sleep apnea. Get a sleep test. Find out which kind of sleep test to get here: Home Sleep Test versus In-Lab Sleep Study. If you have sleep apnea, get it treated and get better quality sleep while living a healthier, happier life. MotionX 24/7

If you aren’t quite ready to submit to an at Home Sleep Test or In-Lab Sleep Study, then perhaps you should look into a sleep monitoring application for your phone, like MotionX 24/7. And make sure you let us know how it worked for you on our facebook page!

Home Sleep Test versus In-Lab Sleep Study, Which is the Best Option For You?

in-lab sleep study image

Home Sleep Test versus In-Lab Sleep Study

What do you do after your physician or dentist evaluates you as someone who should be studied for sleep apnea or another sleep related disorder? Get a sleep study. But which kind is right for you? Let’s take a look at the differences in the studies and weigh the pros and cons.

In-Lab Sleep Study

For an In-Lab Sleep Study, the patient stays overnight at a sleep center or hospital. The sleep studies administered there records brain waves, the oxygen level in your blood, heart rate, breath, eye and leg movements. A sleep specialist then analyzes the results and determines if you have a sleep disorder. There are a few types of sleep studies that can be done In-Lab:

  • Diagnostic overnight Polysomnogram (PSG): This study monitors breathing patterns, blood oxygen levels, heart beat rhythms as well as limb movements. The test monitors sleep stages and cycles. This study helps determine if patients are suffering from disorders like sleep apnea, periodic limb movement disorder, narcolepsy, REM sleep behavior disorder, and helps identify unusual sleep behaviors, and unexplained chronic insomnia.
  • Diagnostic daytime multiple sleep latency test (MSLT): The MSLT test measures sleep latency, which is the time that elapses from the beginning of a daytime nap period to the first signs of sleep. This test is used primarily to diagnose narcolepsy. The test monitors brain waves, muscle activity, and eye movement.
  • Continuous positive airway pressure (CPAP) Titration: After sleep apnea has been discovered, patients try a night or partial night with CPAP treatment to determine the necessary CPAP pressure to stop the apneas from occurring and regulate breathe.

Typically, a PSG is conducted, and the results will determine whether the patient needs to take the other tests listed.

The idea of sleeping at a sleep center or a hospital may create anxiety and deter a patient from proceeding with a sleep study.  Lucky for them (or you), sleep studies can be conducted in the home.

Home sleep test image

Home Sleep Test

Insurance carriers push for home sleep studies because in comparison to in-lab PSG, they are more cost efficient. Medicare now approves in home sleep studies and since most private insurers adopt their practices, most insurers currently accept home sleep studies in combination with a clinical evaluation, as an acceptable -if not preferred method of diagnosis.

Home sleep tests are conducted in the patients’ home after a clinical evaluation determines a sleep test is necessary. The patients’ family physician, dentist, and most other medical practitioners can do a clinical evaluation. Then the patient either receives the portable monitoring device in the mail, or picks one up from the designated sleep clinic or hospital. The portable monitoring device used for the home sleep test measures oxygen saturation, heart rate, airflow, effort, as well as snoring and sleep position.

The main difference between an in-lab sleep study and home sleep test, is that an in-lab sleep study will additionally measure leg movements, sleep time, and brain waves. However most often, the deciding factor between the two options is sleeping at home comfortably versus sleeping at an unfamiliar sleep center. When the sleep disorder in question is likely sleep apnea, both options suffice, although the in-lab study will gauge the severity of the sleep apnea more precisely than the home sleep test.

 

Sources:

  1. Mayo Clinic
  2. American Academy of Sleep Medicine
  3. America Sleep Apnea Association 
  4. Web MD

Sleep Apnea: You May Have It and Not Even Know It

Man falling asleep during work hours

Most people who have sleep apnea do not know it. An estimated 18 million people suffer from sleep apnea. The reason most people are unaware that they suffer from sleep apnea is simple; it happens during sleep. Sleep apnea is recognized by others, such as sleep partners, witnessing an individual have episodes of sleep apnea. An episode occurs when the airway is blocked, and the regular breathing pattern is interrupted. This pause in breathing is called an apnea. It can last for several seconds to a minute. When an episode occurs and the airway becomes blocked, their body will automatically react, carbon dioxide will build up in the blood stream, and the brain is signaled to wake up and breathe. Apnea’s can happen more than 30 times an hour.

Diagram explaining obstructive sleep apnea

 

Symptoms of the disease are snoring, excessive sleepiness and impaired alertness. Common effects of sleep apnea are slow reaction time and vision problems. This sleep apnea cycle stops the brain from getting the sleep it needs. Constant sleep disturbance stop you from getting the quality sleep you need to be awake and alert during the day. Untreated, sleep apnea can cause dire consequences. From personality changes such as depression or irritability, to headaches, decreased sex drive, decline in mental functioning or even worse –high blood pressure, irregular heartbeats, and diabetes, heart attack and stroke.

These complications can be avoided easily -by getting tested, and treated for the disease when applicable. So get a sleep test if you, your partner, or someone you know has symptoms of sleep apnea. Luckily, there is a solution to the problem. You can stop it from cause more problems, and start getting a good quality of sleep.

I think I have Sleep Apnea: What should I do?

The best way to find out if you suffer from sleep apnea, is to complete a sleep study. A sleep study is just like it sounds, a test recording the activity of the body during sleep. For sleep apnea, Polysomnography sleep study records your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye, leg, chest and belly movements. Sleep studies can be conducted in a sleep lab, or even from home.

If you are not ready to conduct a sleep study just yet, you can also conduct some of your own tests to learn about your quality of sleep. Try answering the questionnaires below and see how you do to find out if you might want to complete a sleep study and start getting a good nights rest.

 

How does your Snore Score? 

1. Are you a loud and/or regular snorer?
2. Have you been observed to gasp or stop breathing during sleep?
3. Do you feel tired or groggy upon awakening, or do you awaken with a headache?
4. Are you often tired or fatigued during the wake time hours?
5. Do you fall asleep sitting, reading, watching TV or driving?
6. Do you often have problems with memory or concentration?

If you have one or more of these symptoms you are at higher risk for having obstructive sleep apnea. If you are also overweight, have a large neck, and/or have high blood pressure the risk increases even further.

If you or someone close to you answers “yes” to any of the above questions, you should discuss your symptoms with your physician or a sleep specialist. Or ask the American Sleep Apnea Association for more information on the diagnosis and treatment of sleep apnea. Different treatment options exist; which is right for you depends upon the severity of your apnea and other aspects of the disorder. Talk to your doctor about choices. Untreated, obstructive sleep apnea can be extremely serious and cannot be ignored.

 

 Epworth Sleepiness Scale
How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired?

0 = would never doze off
1 = slight chance of dozing off
2 = moderate chance of dozing off
3 = high chance of dozing off

Situation:
Sitting and Reading:____
Watching TV: ____
Sitting inactively in a public place (movies, theater, meeting):____
Sitting in a car as a passenger for over an hour (no break):____
Sitting and talking to someone:____
Sitting quietly after lunch (no alcohol):____
In a car, stopped in traffic for a few minutes:____

If you answered these with scores of 1 or more, give Pittsburgh Dental Sleep Medicine a call and find out if you should get a sleep study.