A Cautionary Tale: For Physicians, Dentists and Regulatory Boards

Recently, I saw a patient in my dental sleep clinic referred by his general Dentist. He was originally referred to a Sleep Physician that arranged an in-lab sleep study, establishing a moderate level of sleep apnea (Overall AHI = 19, Lateral AHI = 12). After demonstrating intolerance to CPAP, he visited the Sleep Physician requesting to try an oral appliance, something he read about on the Internet. The Sleep Physician flatly refused to provide him with a referral and insisted that he wear CPAP.
Continue reading A Cautionary Tale: For Physicians, Dentists and Regulatory Boards

John Viviano B.Sc. DDS Diplomate ABDSM

John Viviano B.Sc. DDS Diplomate ABDSM

John Viviano B.Sc. DDS Diplomate ABDSM; from Mississauga ON Canada,obtained his credentials from U of T in 1983, he provides conservative therapy for snoring and sleep apnea in his clinic, Limited to the Management of Breathing Related Sleep Disorders. A member of various sleep organizations, he is a Credentialed Diplomate of the American Board of Dental Sleep Medicine, and has lectured internationally regarding management of Sleep-Disordered Breathing and the use of Acoustic Reflection. Dr Viviano has also conducted original research, authored articles and established protocols on the use of Acoustic Reflection for assessing the Upper Airway and its Normalization. For more info or to contact Dr Viviano click: SleepDisordersDentistry.com Website SleepDisordersDentistry LinkedIn Discussion Group

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Clinicians Seek Consensus on Vertical for Oral Appliance Therapy

H. Ball DDS,  D. Klauer DDS, D. Rawson DDS, L. Priemer DDS, T. Soileau DDS, S. Lamberg DDS, T. Morgan DMD, S. Carstensen DDS, D. Marangos DDS, E. Elliott DDS, J. Viviano DDS, K. Thornton DDS, D. Tache DDS

The newly formed LinkedIn Discussion Group, “SleepDisordersDentistry” had an open discussion on the impact of Vertical for oral appliance therapy. Here is a consensus for all to ponder.

What was asked,

“What I would like to see discussed here is the importance of vertical; some swear by it and others never vary vertical. Yet, everyone seems to have a similar success rate; or do they? I am sure there are some “Pearls” by those that vary vertical that could help those that don’t vary vertical to help them understand when it is helpful. I started with this subject because there seems to be two sides on this issue and I think both sides could benefit by sharing their clinical experiences here.”

What was said,

Literature Consensus:

The literature suggests that vertical should be kept to a minimum due to the potential for a negative impact on the airway caused by the jaw rotating back with increase in vertical (Cistuli). It was also pointed out that since the jaw opens and closes along an arc, if you increase vertical in some of the “fixed position appliances” you are actually increasing protrusion, and the benefit may actually be from an increase in protrusion rather than an increase in vertical. (H. Ball, S. Lamberg)
Continue reading Clinicians Seek Consensus on Vertical for Oral Appliance Therapy

John Viviano B.Sc. DDS Diplomate ABDSM

John Viviano B.Sc. DDS Diplomate ABDSM

John Viviano B.Sc. DDS Diplomate ABDSM; from Mississauga ON Canada,obtained his credentials from U of T in 1983, he provides conservative therapy for snoring and sleep apnea in his clinic, Limited to the Management of Breathing Related Sleep Disorders. A member of various sleep organizations, he is a Credentialed Diplomate of the American Board of Dental Sleep Medicine, and has lectured internationally regarding management of Sleep-Disordered Breathing and the use of Acoustic Reflection. Dr Viviano has also conducted original research, authored articles and established protocols on the use of Acoustic Reflection for assessing the Upper Airway and its Normalization. For more info or to contact Dr Viviano click: SleepDisordersDentistry.com Website SleepDisordersDentistry LinkedIn Discussion Group

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Men’s Disconnect with Sleep and Health

Most people underestimate how long they can survive without food. Prisoners that have gone on hunger strikes live around 60 days before their demise. Although there is not a lot of data on how long humans can survive without sleep, researches agree that it is considerably less. In studies the longest lifespan of sleep deprived rats was only 11 days.

We know that men outnumber women when it comes to those that suffer sleep disorders. These disorders are killers. The challenge for those concerned for us is to get us to act on the lifesaving  treatments for these nighttime disorders. But should you deprive us men our dinners, you will most likely see us go into an immediate survival mode and take action to nourish our poor starving bodies. It would seem very unnatural to state that we will take care of this another day when it’s more convenient.

It’s no surprise that women in general are willing to admit when they are in poor health and less likely to die because of it. If you look at drugs that Big Pharma push in advertising to the male demographic, it would appear that the erectile disorder drugs are the big money makers over heart and hypertension drugs. Once again, showing that we men often lose focus on the one area that is most important, living.

So in an act to remind men of some of the dangers of sleep I will list some sleep disorder trivia

  • Humans can survive longer without food than without sleep
  •  Heart disease, diabetes, and obesity have been linked to chronic sleep loss
  •  Over 70 million Americans suffer from a sleep disorder
  • Those that have less sleep than the average person have shorter lives
  •  Sleep deprivation leads to higher inflammatory proteins in blood
  •  65% of Americans lose sleep because of stress
  •  A snoring person wakes their bed partner an average of 20 times per night with an average of 1 hour of sleep loss each night
  • Oh, did I mention that erectile dysfunction is often associated with sleep disorders?
Jeremy Andra, RPSGT, RST

Jeremy Andra, RPSGT, RST

Mr. Andra is well known throughout the western United States for bringing sleep programs from initial startup to full operational capabilities by opening approximately 100 sleep facilities. Mr. Andra has been involved in sleep medicine since 1990 when he started one of the first sleep labs using computerized digital systems and one of the earliest portable EEG services in the market. Later, he was involved in large drug research studies as well as evaluating and field testing various medical devices needing FDA approvals including auto technologies with major PAP companies. Mr. Andra then added the dental sleep medicine as a part of his focus. He developed a dental tool named the “Andra Gauge” that is now sold internationally. The Andra Gauge has won Medical Innovation Awards and Dental Products Report had it in their “Top 10 Most Wanted Products”. As a regular on the sleep industry speaking circuit, Jeremy Andra is known for bringing both medical and dental professionals together to create successful business and patient models for Sleep Medicine. Mr. Andra now serves as Product Manager and Business Development Manager for Cadwell Laboratories.

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Why won’t my TMJ splint help me sleep better? I can’t sleep!

 

  • What is “TMJ”?
  • What is sleep apnea?
  • Is a splint for my top teeth better than a bottom splint?
  • What should I ask my dentist if I don’t sleep well?

The nights that you’re not sleeping and/or waking up feeling amazing may be that your TMJ problem is a symptom and not the true problem. Most patients (and sadly most doctors) see TMJ as the problem and everything else as a symptom of “TMJ disorder”. If you were in an accident and damaged your muscles, nerves, spinal column, etc you may simply have TMJ disorder. TMJ disorder can occur when your muscles are not working properly and are unbalanced. This can cause the muscles of your shoulders, neck, and head to become over worked and stay tight. This “tightness” causes the TMJ symptoms you may be experiencing. A “bad back” certainly can cause this. I have to wear my own TMJ splint every time I cut firewood. Yeah I know. Bend your knees and lift with your legs and not your back. So maybe you’re not sleeping because you have knots also called trigger points in your muscles causing you pain in the middle of the night??? Or maybe that’s not it.
Continue reading Why won’t my TMJ splint help me sleep better? I can’t sleep!

Tony Soileau DDS

Tony Soileau DDS

Dr Tony is a general dentist from Lafayette, Louisiana. He was born and raised in Pine Prairie, Louisiana. His practice focuses on restorative, cosmetic, and family dentistry as well as sleep apnea treatments other than a CPAP and TMJ. Dr Tony graduated from LSU School of Dentistry in New Orleans in 1994. He has been president of his local dental society and is an associate professor at LSU School of Dentistry. He has been a faculty member of the Institute of Oral Art and Design (IOAD) in Tampa, Florida and the Pacific Aesthetic Continuum (PAC~Live) in San Francisco. He is a member of the ADDA, LDA, ADA, AGD, AACD, and has his Fellowship in the Academy of Comprehensive Esthetics. He has published over 50 articles on cosmetic dentistry. In addition to being a published author he has and continues to lecture both nationally and internationally on cosmetic dentistry as well as treatment of sleep apnea.

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Why Your Dental Practice Should Be Blogging

As a dentist, did you know that blogging can make all the difference with your practice? Yes, it really can! When you think of a blog you might think of the latest gossip column or sports digest, but blogs can cover an array of topics across all areas–from businesses to personal use. It is our nonstop goal to maintain a full practice and a practice full of patients who are invested in improving their health with your dental expertise. Let’s talk about how you can get there with blogging.
Continue reading Why Your Dental Practice Should Be Blogging

Mayoor Patel, DDS, MS

Mayoor Patel, DDS, MS

Dr. Patel received his dental degree from the University of Tennessee in 1994 and then completed a one year residency in Advanced Education in General Dentistry (AEGD). He also earned a Masters in Science from Tufts University in 2011. Additionally he served as an Adjunct Clinical Instructor at the Craniofacial Pain Center at Tufts Dental School from 2011-2014. Dr.Patel also serves as Adjunct Clinical Instructor in the Department of Oral Health and Diagnostic Sciences at the Georgia Regents University, College of Dental Medicine in Augusta Georgia (formally Medical College of Georgia). He is one of five dental professionals in Georgia to be Board certified in Dental Sleep Medicine (DABDSM). Additionally, he is the only Dental Practitioner in Georgia and in the southeast to be triple-boarded in Craniofacial Pain, Orofacial Pain and Dental Sleep Medicine.

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Bob Rutan’s Notebook: Carl Eller Still a Game Changer

Hi there,

Traveling across the NW and Western states this summer in the RV

Remzzzs Game Changer
Remzzzs Game Changer

and towing the car, we’ve had many adults approach us nearly everyday asking questions like, “Is this Carl Eller’s car… is Carl in the car…or why do you have Carl Eller on your car?”  But this is the first child to walk up and talk with Bob…and of course Bob always tells the story of RemZzzs® and how Carl Eller is wearing it and living a healthier, more active life!

We thought you’d fin the  encounter interesting & heart-warming…
                                                   ~~~~~~~~~~~~
At a campground where we stayed overnight in Bozeman, MT,  an adult and young boy approached Bob while he was busy washing the Jeep (wrapped with Carl Eller’s “Game-Changer” campaign graphics!)
Carl Eller Game Changer
Young Carl Eller fan

Wearing his bright purple Vikings sweatshirt and a big smile, the boy exclaimed that he knows all about Carl Eller being one of the “Purple People Eaters” and that he is a big fan!  He asked for a picture to be taken next to Carl. Bob gave him his card and and asked permission to post the picture online.  Later, Bob received a “Thank you” text giving permission to post the picture on social media.  It said, “Of course. Mike Berumen is from Billings, MT.  He is a great fan and would like in any way to connect with the accomplished guys of the game.”

Check out our video about Carl Eller and his experience using RemZzzs® with his CPAP therapy!  Carl is an NFL Hall of Famer who played with the MN Vikings in the 60-70s.  He was one of the legendary “Purple People Eaters!”  Carl’s NFL career spanned from 1964-79

Bob Rutan

Bob Rutan

Inventor of RemZzzs® CPAP Mask Liners, the innovative solution for CPAP mask discomfort, air leaks and non-compliance. RemZzzs® was listed as one of the top ten finalists of the 2015 Medtrade Spring Innovative Products Awards, sponsored by Homecare Magazine. In March 2007, his wife was struggling to continue CPAP therapy for her moderate-to-severe OSA (obstructive sleep apnea), and Robert was desperate to find an answer for her. After much thought and prayer, he awoke one night with the idea of a fabric gasket to stop air leaks and increase comfort. By Jan. 2009 this “idea” became a reality when RemZzzs® became available online as the first-of-a-kind mask liner accessory. RemZzzs® is sold nationwide online and via Home Medical Supply stores. Internationally, distributors in Australia, Europe and Canada sell to their respective markets. Robert Rutan holds a patent on the product in the USA, Australia, Canada, China, Israel, and Mexico; with patent pending status in EU and several other countries. Mr. Rutan travels across the USA, speaking, presenting and demonstrating the use of RemZzzs® to doctors, nurses, sleep techs and individuals. His passion is to help people find success with their CPAP therapy.

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ResMed Narval CC Case Study: Size Matters!

My beautiful trout picture
My beautiful trout picture

One of the most intriguing features of the ResMed Narval CC is its small footprint. I find most patient’s transitioning from an acrylic appliance frequently comment on both the small size and the increase in comfort, as compared to their previous appliance. But what about new patients to Oral Appliance Therapy, where do they stand on this issue?

Sleep Herbst
Left Patient Herbst, Right Sample Herbst

Recently, I made a Herbst appliance for a patient that had many crowns that he was thinking of replacing in the future, but was not ready to act on. He had a very severe level of apnea (AHI = 36, 62 in supine position) and could not tolerate CPAP at all, even after trying several masks. So, we decided to proceed with an appliance that would be more forgiving when adjusting around future crowns, even allowing for a full reline if necessary; the Herbst.
Continue reading ResMed Narval CC Case Study: Size Matters!

John Viviano B.Sc. DDS Diplomate ABDSM

John Viviano B.Sc. DDS Diplomate ABDSM

John Viviano B.Sc. DDS Diplomate ABDSM; from Mississauga ON Canada,obtained his credentials from U of T in 1983, he provides conservative therapy for snoring and sleep apnea in his clinic, Limited to the Management of Breathing Related Sleep Disorders. A member of various sleep organizations, he is a Credentialed Diplomate of the American Board of Dental Sleep Medicine, and has lectured internationally regarding management of Sleep-Disordered Breathing and the use of Acoustic Reflection. Dr Viviano has also conducted original research, authored articles and established protocols on the use of Acoustic Reflection for assessing the Upper Airway and its Normalization. For more info or to contact Dr Viviano click: SleepDisordersDentistry.com Website SleepDisordersDentistry LinkedIn Discussion Group

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3 Steps for Marketing Your Dental Sleep Medicine Office

A dental sleep medicine expert offers advice on how best to introduce yourself, why it’s important to understand medical insurance billing, and pointers on growing your web presence.

You have decided to expand your practice with dental sleep medicine, so now what? By incorporating dental sleep medicine into your practice, you have already taken the first big step in improving your dental office and the services you offer. Your next step should be putting together an active marketing plan. Whether you go through a large marketing company or a freelancer, creating an effective marketing strategy can make all the difference.
Continue reading 3 Steps for Marketing Your Dental Sleep Medicine Office

Mayoor Patel, DDS, MS

Mayoor Patel, DDS, MS

Dr. Patel received his dental degree from the University of Tennessee in 1994 and then completed a one year residency in Advanced Education in General Dentistry (AEGD). He also earned a Masters in Science from Tufts University in 2011. Additionally he served as an Adjunct Clinical Instructor at the Craniofacial Pain Center at Tufts Dental School from 2011-2014. Dr.Patel also serves as Adjunct Clinical Instructor in the Department of Oral Health and Diagnostic Sciences at the Georgia Regents University, College of Dental Medicine in Augusta Georgia (formally Medical College of Georgia). He is one of five dental professionals in Georgia to be Board certified in Dental Sleep Medicine (DABDSM). Additionally, he is the only Dental Practitioner in Georgia and in the southeast to be triple-boarded in Craniofacial Pain, Orofacial Pain and Dental Sleep Medicine.

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Economic Impact of Obstructive Sleep Apnea

While attending a recent Post Falls, ID Chamber Business Fair, the powers that be placed our practice right across the way from a health insurance company. Some call it chance, but I call it destiny.
The vice president of the health insurance company was up from headquarters visiting our area and decided to stop by his booth at the Expo.

Just as an aside- Believe it or not, I actually like going to expos. Not only do I go to promote my practice and the Dental Sleep Medicine in my practice, I go to interact with the community. My staff and I always have fun.
Continue reading Economic Impact of Obstructive Sleep Apnea

Erin Elliott DDS

Erin Elliott DDS

ERIN ELLIOTT, DDS, is in private practice in Post Falls, Idaho, where she provides general and cosmetic dentistry, short-term orthodontics, and dental sleep medicine. Dr. Elliott is an active member of the American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine, as well as a diplomate and sitting co-President of the American Sleep and Breathing Academy. She has authored several articles and lectured extensively on dental sleep medicine.

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ApneaRx Eases Patient Concerns- The Predictor Device®

Over the last 20 years there has been an ever increasing use of oral appliances for the treatment of obstructive sleep apnea (OSA) and sleep disordered breathing (SDB). In Scandinavian countries the preferred interventional therapy for the mild to moderate sleep apnea patient has been an oral appliance due to improved patient compliance. Only when the patient has severe sleep apnea or when there are other clinical factors to consider is CPAP recommended. In the United States the American Academy of Sleep Medicine (AASM) has recommended Oral Appliance Therapy as a first line therapy for mild to moderate OSA since 2006.
In America the dominance of CPAP therapy is quickly surrendering

Nox T3 by CareFusion
Home Sleep Test with ApneaRx

Continue reading ApneaRx Eases Patient Concerns- The Predictor Device®

Randy Clare

Randy Clare

Randy Clare brings to Sleep Scholar more than 25 years of extensive knowledge and experience in the sleep field. He has held numerous management positions throughout his career and has demonstrated a unique view of the alternate care diagnostic and therapy model. Mr. Clare's extensive sleep industry experience assists Sleep Scholar in providing current, relevant, data-proven information on sleep diagnostics and sleep therapies that are effective for the treatment of sleep disorders.

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