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You are here: Home / Archives for December 2011

SomnoMed Registered to Provide United States Military SomnoDent Therapy

December 21, 2011 by SleepDT Leave a Comment


SomnoMed provides diagnostic and treatment solutions for Sleep Breathing Disorders such as Obstructive Sleep Apnea and manufactures the SomnoDent product range. The Armed Services Association has confirmed SomnoMed is registered and eligible to provide SomnoDent to the United States Military personnel.

SomnoMed, Inc., manufacturer of the world’s leading oral appliance, SomnoDent for the treatment of Obstructive Sleep Apnea announces that the Armed Services Association (ASA) has confirmed the company’s SomnoDent registration to provide United States Military personnel OSA Treatment.

This registration confirmation coincides with a recent announcement from the US Army Medical Department stating custom made oral “devices that fit within the mouth to prevent upper airway collapse, as an effective first-line treatment, according to two studies conducted by sleep medicine specialists from Walter Reed National Military Medical Center (WRNMMC) in Bethesda, Md.”

“Historically, CPAP has been the primary treatment for OSA, but only half of patients tolerate this therapy, which requires wearing a face mask hooked to a machine each night,” said Lt. Col. Christopher Lettieri, M.D., one of the studies’ authors, an Army medical director and the chief of sleep medicine in the pulmonary, critical care and sleep medicine department at WRNMMC. “This new data offers a fresh look at adjustable oral appliances as an initial treatment for OSA in both the military and civilian sectors.”

The military is interested in the SomnoDent, as alternatives to CPAP systems since some active duty service members deploy to environments where electricity needed to run CPAP machines is not always available. In these cases, reliance on CPAP may result in duty restrictions or separation from service. “Adjustable OAs would eliminate duty assignment limitations associated with CPAP, allowing Soldiers to travel to remote areas as needed,” said Lettieri.

Source: Somnomed.com

Filed Under: Uncategorized Tagged With: Articles, Blog

New Study: Sleep Disorders, Health, and Safety in Police Officers

December 21, 2011 by SleepDT Leave a Comment

In the current issue of JAMA “Journal of the American Medical Association” A large study of Police Officers in the U.S and Canada found 40% of police officers had symptoms of a sleep disorder, including sleep apnea and insomnia.

Click here to view Abstract and Full article

Officers who screened positive for those disorders were also more likely to be burned out, depressed or have an anxiety disorder. Over the next two years, they committed more administrative errors and safety violations and were more prone to falling asleep at the wheel than sound sleepers.

“In general we have this cultural attitude of, sleep is for the weak,” said Dr. Michael Grandner, from the Center for Sleep and Circadian Neurobiology at the University of Pennsylvania in Philadelphia.

“When you’re in an environment where signs of weakness are particularly discouraged, there may be a social pressure to not address sleep problems or to shrug them off,” added Grandner, author of a commentary published with the new study in the Journal of the American Medical Association.

When police officers in particular suffer from sleep problems, he said, it becomes a public health and safety problem. “It’s not just the people with sleep disorders that are affected,” Grandner told Reuters Health. “If they’re impaired, you’re at risk.”

Researchers say police departments could do more to make sure that officers with sleep disorders receive appropriate treatment, which may include sleep machines, therapy or changes in work schedules.

For the new study, close to 5,000 police officers were surveyed on sleep problems and other health topics. That included Philadelphia officers and Massachusetts state police as well as a broader range of other U.S. and Canadian cops.

The officers were on average 38 to 39 years old and most had been in the police force for more than decade.

Dr. Charles Czeisler from Brigham and Women’s Hospital in Boston and his colleagues found that 40% of the officers screened positive for at least one sleep disorder.

The most common was sleep apnea, which affected a third of cops, followed by moderate or severe insomnia and shift work disorder, which consists of sleepiness and insomnia associated with working at night.

DEPRESSION, BURNOUT, ANXIETY

Officers with a sleep disorder were more than twice as likely as healthy sleepers to report depression, emotional exhaustion or burnout and anxiety disorders on their original surveys.

On follow-up questionnaires sent out over the next two years, they were also 40 to 60% more likely to report making serious administrative errors, falling asleep while driving or committing a fatigue-related error or safety violation during work.

Poor sleepers reported more citizen complaints and more often showed uncontrolled anger toward a suspect or citizen.

“You have people who are sleep deprived, which means that their ability to make good decisions, to respond effectively, to drive emergency vehicles well … all of those things are impaired,” said Bryan Vila, a criminal justice professor who studies sleep and performance in cops at Washington State University in Spokane but wasn’t involved in the study.

The researchers noted that being heavy increases the risk of sleep apnea, and that almost 80% of the officers they surveyed were overweight or obese.

Czeisler said the lowest rates of both sleep apnea and overweight and obese conditions were in Massachusetts state cops, and that that’s no coincidence.

Those officers get one hour paid exercise time for every work shift, he told Reuters Health, and undergo regular fitness tests that simulate chasing a suspect or dragging a victim, with a bonus in pay if they pass.

“It’s an impressive program and perhaps a model for the nation,” Czeisler said.

HEALTH AND SAFETY ISSUES

Putting in measures to catch sleep disorders early could help prevent future health and safety consequences, researchers say. Those could include on-the-job screening in police departments, according to Czeisler, and making sure cops with sleep problems get help.

“We have great treatments for sleep disorders, we have great screening tools, the technology is there,” Grandner told Reuters Health. Sleep apnea can be treated with a breathing machine and mask used at night, and behavioral therapy is often the first line of treatment for people with insomnia, he said.

Czeisler said next up is a study funded by the Federal Emergency Management Agency to look at sleep disorders in firefighters.

Source: JAMA

Filed Under: Uncategorized Tagged With: Articles, Blog

Editorial

December 20, 2011 by Randy Clare Leave a Comment

I have been involved in the diagnosis and treatment of sleep apnea for over 20 years. My first foray into the industry was with the Silencer in 1993. At that time I had no dental background and the practice of dental sleep medicine was just beginning.  Since that time, I have been involved with all aspects of the diagnostics and treatment of sleep disorders.  I am spending more and more of my time these days in the dental arena.  I am very impressed with the diligence and commitment of the dentist when it comes to working hard to understand all aspects of sleep medicine.

 

I believe the most misunderstood relationship in the practice of dental sleep medicine is the relationship between the dental lab and the dentist in building oral appliances for the patient.  What is often lost in the discussion of sleep medicine is that each oral appliance is made by hand, by a technician trained in the fabrication of dental devices, to the specification requested by the dentist.

 

I first witnessed this relationship while Dr. Wayne Halstrom developed the Silencer and his “lab man” Loris Campagnolo (then with Space Maintainers) developed the techniques that became the Silencer system. Here we are 20 years later and Loris is still working with Dr. Halstrom now in his own lab called Echelon in Burnaby British Columbia. When you ask Dr. Halstrom about the Silencer he often refers to the trials of finding materials and developing easily teachable and transferable techniques, all with the help of a highly skilled technician from which to bounce ideas. The Silencer has grown over the years to be a widely used oral appliance in the treatment of OSA. The durability of the device is well known and it is available from some of the best dental technicians in the country, Johns Dental Lab, Burbank Dental and Gergen’s Orthodontic lab to name a few.

 

The educational requirement of both the dentist and the technician have really evolved in the last several years. Dental sleep treatment is now recognized as first line OSA therapy and is easily accepted by the medical community. The challenges the dental community face in providing these devices have shifted from appliance and dental procedure issues to issues of practice management, medical insurance and patient qualification. 

 

Once again, the “Lab Man” is not far away. David Gergen C.D.T. of Gergen’s Orthodontic Lab has taken it upon him self to assemble advance courses in sleep dentistry that will give the dentist the tools to understand the requirements of dental sleep medicine outside of the standard dental issues of occlusion, impression technique and appliance selection.  Gergen focuses his courses on all the next steps after the Dr. has begun the practice of dental sleep medicine. Gergen has often told me that, “ the biggest mistake a dentist can make is to assume that sleep medicine is just like tooth whitening or Invisilign”.  The relationship between the dentist and the lab is taken very seriously at Gergen’s Orthodontic lab  “If the dentist is not successful we will never be successful”.

 

Reports from the Gergen’s courses have been excellent. Dr. Gerbholtz from Denver CO attended the meeting in Sonoma CA and had this to say “I left Sonoma with a new passion and a good working business model that actually made sense and worked. Where before I was seeing only 2 to 6 patients each month, I am now seeing 20 to 24 patients each month after Sonoma”. I found that the focus on internal marketing for the dental practice really paid off for some practices. Dr. Michael Van Leeuwen of Salt Lake City UT reports “I am now seeing three times the number of patients and they are all getting are sleeping better with the modified sleep Herbst appliance”.  My inspiration for this article came from the following quote from Dr. Harry Sugg of Dallas TX. “The in-depth presentations led to a much greater understanding of how we can help our patients with finding solutions to their sleep issues. So many of our questions were answered regarding insurance billing and coding, some we hadn’t even thought of.

“We were floundering before we went to Sonoma, and we had twelve cases in ten months’ time and where we were having problems due to the learning curve in insurance procedures. In just two short months, we now have over forty cases through. We took five staff members that received technical instruction, but more importantly, much more administrative understanding. Due to the detailed explanations given by Dr. Rod & Donna Willey we have been able to help many more patients. They have been tireless in assisting us to reach others with this information. “

 

 

In summary, if you are considering the practice of sleep dentistry or are looking for a dental team to treat your patient, take some time and develop the relationship. Understand that each therapy is customized to the patient and there is a whole team of highly trained individuals working behind the scenes making sure that everyone in the process has an excellent outcome.

 

Gergen’s Ortho provides the following sleep appliances- Sleep Herbst, the Silencer, EMA, TAP website is www.gergensortho.com The next course is in Las Vegas http://gergensortho.com/las-vegas-sleep-symposium

 Randy Clare is a mentor for the following  dental sleep study clubs www.scottsdalestudyclub.com www.sandiegostudyclub.com

 

Filed Under: David Gergen

Compumedics Another Milestone: EEG Contract Win with Yale University

December 20, 2011 by SleepDT Leave a Comment

Compumedics Limited (ASX:CMP) today announced another significant milestone of being awarded the contract to supply EEG equipment for the Neurology Department at Yale School of Medicine, Yale University, USA.  Under the contract Compumedics will supply its latest EEG products comprising the new Compumedics NEUVO® Long-Term EEG Monitoring (LTEM) system, Grael®HD, Profusion EEG 4 and Curry® NS7 software.  The systems are to be used for routine clinical EEG and surgical monitoring.  This purchase represents another major milestone in Compumedics’ strategic entry into the global $250 million p.a. LTEM/neurology market.

The sale, with an order value of more than AUD1 million, will see the installation of Compumedics’ latest EEG products into Yale University and follows several other significant EEG orders in the USA in the first half of FY2012. The NEUVO® LTEM systems can record a minimum 64 individual channels of high-density EEG data on a single patient for days or weeks at a time.  The Grael®HD system provides high definition EEG signals while the Siesta®802 remains the industry’s most compact wireless EEG recording device.  Compumedics’ digital amplifier technology and breadth of EEG diagnostic offerings is state-of-the-art and provides Compumedics with a unique point of differentiation from competing offerings. Compumedics’ products provide higher quality brain recordings and more precise brain analysis than alternatives, helping to improve patient outcomes.

The Department of Neurology at Yale School of Medicine describes itself as a research, teaching, and clinical centre devoted to improving the understanding and treatment of diseases of the nervous system.  The department is a major part of the Yale University School of Medicine and has several active clinical programs at local medical establishments.

Compumedics® equipment will help the Department of Neurology to achieve its goal of providing the highest level of patient care through state-of-the-art clinical programs, educating future leaders in the field of neurology and being at the forefront of neuroscience research within one of the world’s most prestigious universities.  The department has a long history of being a pioneer in the field of Neurology, such as establishing one of the first epilepsy monitoring units and creating one of the first stroke centres.

Dr. David Burton, Chairman and Chief Executive Officer of Compumedics Group commented,

“This contract is another important milestone for our Company. It reinforces our commitment to our customers and the patients under their care.  Compumedics has made significant investments in product development, targeting the neuro-diagnostics market to leverage its expertise in high-end amplifier design and physiological signal processing.  The world-class Yale University installation will establish a new and innovative standard for long-term EEG monitoring.   This project further underpins our strategy to grow our business across this important, but relatively new, market sector for Compumedics.  In particular, this prestigious sale to one of the world’s pre-eminent epilepsy monitoring centres validates our key growth strategy to penetrate the global LTEM market.  The LTEM market alone is more than twice the size of our existing core sleep diagnostic business.”

Source: Compumedics.com

Filed Under: Uncategorized Tagged With: Articles, Blog

Documentation of Bite Changes with OAD

December 17, 2011 by Randy Clare Leave a Comment

Dr. L. Wayne Halstrom DDS

An unwelcome but common occurrence in patients undergoing oral appliance therapy for management of sleep disordered breathing is a change in the occlusion.

Research at the University of British Columbia suggests that bite changes may be expected to occur in 14% of patients (ref).  25% of these changes may be positive while the balance present management issues and threat of litigation to the attending dentists.  Such changes are largely impossible to predict and sometimes impossible to correct without giving up the appliance and resorting to dental procedures to re-establish the patients’ customary occlusion.

Why?

Condylar angle of the fossa of the TMJ?                                               

Condylar angles:

-         vary widely from patient to patient and from side to side in individual patients.

-        Without expensive radiological examination these angles are impossible to establish.  Routine Cephalometric radiology offers insufficient information to be diagnostic.

 

Muscular responses:

-        During the initial stages of therapy muscular responses may result in the development of TMJ issues.  Patients who exhibit Bruxism will be more likely to experience some TMJ response that may include some negative occlusal outcomes.

 

Hard tissue changes:

-        There is no body of evidence that confirms that occlusal changes are a result of hard tissue changes in the TMJ that lead to irreversible changes in occlusion.

Soft tissue changes:

-        The conventional wisdom for management of jaw position in treatment of SDB has been to begin therapy at 50% of the range of motion and then titrate the appliance forward until the symptoms are resolved.  This technique may present significant threat to occlusion by stretching the ligaments that govern the positioning of the condyle of the TMJ.  In patients with a steep condylar angle a continuance of advancement of the mandible beyond the tolerance of the spacing allowed within the joint itself may result in a stretching of the ligaments.  In the authors’ experience this occurrence may be mitigated by increasing the vertical positioning of the appliance while continuing to advance the mandible.  By changing the vertical angle of advancement it has been possible to bring patients into a greater advancement both from the comfort as well as the possible mandibular extension perspective.

Tooth movement?

There is no doubt that tooth movement occurs in some cases.  There are enormous forces that may be applied by the bruxing patients which may result in some changes.  In addition the selection of materials for the appliance may play a roll.  The use of Thermoplastic materials in appliance construction will have a tendency to have the material at the back of the mouth at one temperature while at the opening of the mouth another temperature.  This would be of greater significance in patients who are subject to mouth breathing.  It may be preferable to use a fabrication technique that involves the use of hard acrylic to cover the teeth to the height of contour and an elastic material for the balance of the appliance.

 

DEFENCE MECHANISMS:

                  Informed consent?

It has been demonstrated over and over again that in spite of well documented informed consent documents the courts have maintained that a patient is not competent to understand the implications as described.

                  Records?

-        The only protection against legal implications of negative occlusal change challenges comes in the form of adequate records.  These records must include accurate measurements of mandibular range of motion capability as well as radiological support to treatment decisions. 

-        In the authors’ opinion the only way to establish the specifics of mandibular range of motion and be able at the same time to identify existing but nonsymptomatic TMJ issues is with the use of a gothic arch tracing.

 

-        The use of a gothic arch tracing technique that offers the advantages of specific measurements and inclusion of an actual hard copy tracing entered into the patients’ permanent health history can be very advantageous when confronted by an unhappy patient.  Such patients are often “egged on” by a dentist unfamiliar with, unhappy with  and unfriendly to the issues involved in treatment of the medical condition of sleep disordered breathing with a dental approach.

-        A gothic arch tracing that results in a competent bite registration is, in the authors’ opinion, imperative in the management of patients with SDB.

 

In summary, the advantage of the gothic arch tracing technique may be found in a technique that involves not only the specific forward positioning of the mandible but also a registration of Centric Relation for the patient.  By keeping the actual gothic arch tracing generated by the bite registration it is possible to at any time recreate the occlusion of a given patient.  Many patients have no real idea of what their occlusion was like prior to treatment and the resulting change.  Often it is the uninformed general dentist who initiates the patient awareness of the existence of bite change and its’ negative consequences.  This opinion in combination with an aggressive tort lawyer in the background is enough to present significant financial threat and a mountain of unwelcome irritative narrative.  By being able to specifically recreate, with the aid of a gothic arch tracing generated bite registration, the existing occlusion the treating dentist may be able to overcome the threat engendered by an unwelcome and unforeseen event. 

- Dr Halstrom has been practicing dentistry in Canada since 1960. In addition to his position as chief executive of  Dr. Halstrom Sleep Apnea and Snoring Clinics; he is also Adjunct Professor of Respiratory Therapy, Faculty of Science – Sleep Program, Thompson Rivers University. Contact Dr Halstrom at dhalstrom@drhalstrom.com

 

Filed Under: dental appliances, Uncategorized

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Editorial Board

Randy Clare
Managing Editor of SleepScholar and RespiratoryScholar
Dr. Steve Carstensen
Pankey Institute for Advanced Dental Education, American Academy of Dental Sleep Medicine.
Ruchir Patel MD
Founder & Medical Director at the Insomnia and Sleep Institute of Arizona.
Dr. John S. Viviano
AADSM Diplomate and member of various sleep organizations. Has lectured internationally on the treatment of Sleep-Disordered Breathing and the use of Acoustic Reflection.
Jeffroy Wyscarver
President, DDME Online, Sleep Lab Technology and Services for the Dental Community.
Claude Albertario
RPSGT, speaker, author and mentor in the field of sleep diagnostics with 25 yrs of management experience in one of New York's premier sleep centers.
Joseph Anderson
Co-Founder and Director of Education for Priority Health Education and Priority Scoring.
Todd Austin
Managed sleep labs and has 15 experience in sleep diagnostics and therapeutic systems. .
Marietta Bibbs
Sleep specialist and manager of Sleep and Neurodiagnostics at Morton Plant Mease Healthcare.
Bradley Eli DMD, MS
Director, San Diego Headache and Facial Pain Center / Sleep Treatment and Research Institute
Edward Grandi
Executive Director of the American Sleep Apnea Association.
Edward Michaelson MD
Board Certified in Pulmonary Medicine, Internal Medicine and Sleep Medicine
Ashley Truitt
Founder & Director of Dental Sleep Medicine Worldwide, Co-Founder of TPT Dental.

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