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.

Pittsburgh Sleep Apnea Dentist

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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)

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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.

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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.

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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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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.

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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.

What Sleep Apnea Treatment to Try When CPAP Just Doesn’t Work For You

CPAP (Continuos Positive Airway Pressure) Patient

When it comes to treatment options for sleep apnea, Continuous Positive Airway Pressure, or CPAP, is often times the first option presented to patients. CPAP functions by use of a mask connected to tubes that send pressurized air through the nasal passages and/or mouth to the patient. This treatment creates an influx of air that opens the collapsed airway, and allows for unimpeded breathing. Unfortunately, CPAP is also the sleep apnea option that is often least tolerated by patients. When the machine is used properly and consistently, it works very well. The problem is, that wearing a mask to sleep every night is a daunting task, and more often than not, patients fail to comply with the directives and fail to wear the mask to sleep each night. The mask also causes other problems, such as trouble falling asleep, discomfort, inability to sleep in certain positions, leaky masks, dry mouth/nose, and other issues.

So what should you do if CPAP isn’t for you? Oral appliance therapy is an excellent option. Instead of bulky tubes, machine noise, and claustrophobia inducing masks, oral appliances look like a retainer and are simply placed in the mouth during sleep.

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Oral appliances, like CPAP masks, come in a variety of designs to create options for patients. The oral appliance is placed in the mouth much like an orthodontic retainer or an athletic mouth guard. It is utilized during sleep to prevent the collapse of the tongue and soft tissues in the back of the throat so that the breathing passages stay open during sleep. As you can tell by the image above, oral appliances are much less cumbersome than CPAP masks. This alleviates many of the issues associated with CPAP, and makes oral appliances a more viable option for patients who can’t tolerate CPAP.

At Pittsburgh Dental Sleep Medicine, we help select the best oral appliance for you with our selection of oral appliance options. We then fit the appliance to you by using information about your tooth alignment, jaw joint, and bite to make a custom oral appliance that fits your unique oral cavity. You can read more about our process and oral appliance therapy on the Pittsburgh Dental Sleep Medicine webpage: Oral Appliance Therapy – Overview.

Regardless of the pros and cons of using either CPAP or oral appliance therapy as treatment options for sleep apnea, the important decision is deciding to treat the problem. Sleep apnea gone untreated leads to increase risk of other dire consequences like heart attack, stroke, high blood pressure, diabetes and depression, to name a few. If you haven’t been diagnosed with sleep apnea but suspect you might suffer from it, see your family physician and voice your concerns. Your physician will then provide a formal diagnosis based on a medical sleep study. (Learn about Sleep Study Options.) After that, make an appointment with Pittsburgh Dental Sleep Medicine if you are located in Southwest PA by calling  724.935.6670, or find a dental sleep specialist near you by contacting the American Academy of Dental Sleep Medicine (www.aadsm.org, click on “Find a Dentist”).  The important part is getting your sleep apnea treated. So find a sleep apnea treatment that works for you and start feeling well rested. Get on the road to healthiness and happiness today.

Treating Sleep Apnea is Now As Easy As Using a Remote Control

Inspire Therapy is new technology that works inside the body to treat obstructive sleep apnea (OSA), rather than with a CPAP mask or outer body device. It is a small, implanted system that senses breathing patterns and delivers mild stimulation to maintain an open airway during sleep. The inspire system consists of a small generator, breathing sensor lead, and stimulation lead, that are all controlled by a small remote. The patient turns the device on when going to bed and it keeps the airway open, which stops apneas from occurring throughout the night.

The Inspire system stops the airway from being blocked and apneas from occurring by sensing breathing patterns and delivering mild stimulation to key airway muscles. This keeps the airway open at the soft palate, and tongue base, where blockage usually occurs.

inspire therapy sleep apnea treatment diagram

Inspire Therapy became FDA approved in May of 2014. It has undergone clinical testing and review. In the STAR clinical trial, patients experienced a 68% reduction in apneas and significant improvements in quality of life and daytime functioning, as well as 85% of bed partners reporting no or soft snoring.

Inspire Therapy is for patients who have undergone a sleep study and been diagnosed with OSA and have an Apnea-hypopnea index (AHI) of 15 or more. AHI is the number of apnea and hypopnea events occurring per hour of sleep. This means that Inspire Therapy is meant for sleep apnea patients who have either moderate or severe sleep apnea.

If you or a loved one has OSA and you want to learn more about Inspire Therapy as an option after other options have failed, find the nearest doctor that can help you on the Inspire website.

Stay tuned for more information on Inspire Therapy to be posted soon.

Will New Sleep Technology Help Shed Light on Sleep Apnea?

There are major changes happening on in the world of sleep technology, and some surprising new players to boot. These innovative new gadgets are neither console, smart device, nor wearable technology. The new technology is contactless, and different from any sleep tracking technology ever seen before.

In October of this year, ResMed partnered with Apple to unveil the S+. The product is now available for purchase in all Apple stores and in the apple online store. It integrates with Apple HealthKit.  S+ is the worlds first non-contact sleep sensor. S+ is a system combining a bedside sleep monitor, smart phone app, and web-based app. The system helps you track your sleep patterns, and better understand them with personal feedback and suggestions that can help you improve your sleep.

S+ has some intriguing features, such as one of its many programs, ‘Relax to Sleep’. Relax to Sleep synchronizes specially designed sounds with your breathing, gradually slowing it down with your breath to help you fall asleep more easily. Find out about more of ResMed’s S+ by watching the S+ video.

S+ by ResMed

Coincidentally, Nintendo also unveiled its plan to enter the market of non-contact sleep sensors. It is called ‘Quality of Life’.

Similar to the S+, the product will sit by a user’s bed and track their sleep habit. As it so happens, this soon to be second non-contact sleep sensor is also being created in partnership with ResMed. However,  “Nintendo says their unique position of knowing how to properly gamify things will be essential in getting users to adopt their own product.” However, exactly how Nintendo sets its QOL product apart from the S+, will have to be a mystery until more information is released.

The importance of these innovations is that they are happening. Why this sudden interest in Sleep health? Who will buy and use these sensors? What will happen when people learn about their quality of sleep? What’s next?

This interest and these new technologies with a focus on the user may be exactly what us dental sleep medicine dentists have been waiting for. These new products will make people aware of their sleep patterns, and hopefully help them understand their sleep quality, and how bad or good it is.

As Nathaniel Branden said, “The first step towards change is awareness.”