2014 Will be the Year of Years

As I look back on the year we had in the Dental Sleep Medicine industry and especially at Gergen’s Orthodontic Lab, I really am pleased.  I know that we made a lot of progress in our business, and in the businesses of the dentists we work with.  Heck, we even made an impact for dentists that don’t work with us!

My trip to Washington D.C. for a meeting in the office of Secretary of Transportation Anthony Foxx helped to keep policy makers aware of the dangers of untreated Sleep Apnea and the effectiveness of Oral Appliance Therapy.

If you know anything about me outside of the dental lab or sleep industry, you know my affinity for Bob Dylan. So as I look forward to 2014 a line from “It’s Alright, Ma” comes to mind, “He not busy being born is busy dying.”  2013 was the 3rd year that our lab has managed to double in size, so I better get busy being born if I want to try and do it again.

The same thing goes for the dentists I work with.  In dentistry, the new year usually means that dental insurance starts over and we get a new set of visits and benefits for procedures that we used up last year, but with the sleep side it’s completely opposite.

Come January 1st every medical insurance plan in the nation resets, which means some patients will carry a $5000+ deductible. This can only make it more difficult to qualify a patient for an oral appliance. Traditionally this results in a drop in the number of sleep studies and correspondingly the number of therapies that go with them.

I brought this up in a recent conversation with Matt Kaplan of Sleep Services, and I believe their approach can help alleviate some of the financial burden that the patients face when we come back to the office in January.

When Sleep Services provide a home sleep test to a patient, they bill the patient’s medical insurance, and sometimes it can wipe out that new deductible.  Fortunately for the patient, Sleep Services is very flexible and offers payment plans for patients who end up having to pay out of pocket.  Home sleep testing services at $295 is one of the lowest that I’m aware of, but more importantly, I know that they do a good job and are the most dentist friendly sleep testing lab that I have ever worked with.

I hope that all the folks I’m lucky enough to know in this industry can look back on 2013 and see it as a success, but if you’re like me, you’re probably not ready to be busy dying in 2014. For me, when the New Year rolls around, it’s time to “Step It Up and Go”.


David Gergen CDT

David Gergen CDT

David Gergen, CDT and President of Pro Player Health Alliance, has been a nationally respected dental lab technician for over 25 years. He received the award for “The Finest Orthodontic Technician in the Country” given by Columbus Dental in 1986. He also has been appointed Executive Director of the American Sleep and Breathing Academy Dental Division, a national interdisciplinary academy dedicated to sleep training and education with over 60,000 members. David rolled out of bed on December 4, 1982 and had his career “ah ha” moment. He knew he was going to be an orthodontic technician and he knew he was going to help people all over the country to help treat their sleep disorders in partnership with their dentists. He has worked for some of the pioneers in the orthodontic and sleep dentistry fields. He was the personal technician for the likes of Dr. Robert Ricketts, Dr. Ronald Roth, Dr. A. Paul Serrano, Dr. Clark Jones, Dr. Harold Gelb, Dr. Joseph R. Cohen, Dr. Rodney Willey, Dr. Allan Bernstein, and Dr. Thien Pham. One of his proudest achievements is receiving The National Leadership award for Arizona Small Businessman of the Year in 2004.

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American Academy of Pediatrics backs CPAP plus selective Surfactants in Premies

CPAP begun soon after birth, followed by selective use of surfactants, may be an effective alternative to routine intubation coupled with prophylactic or early surfactants in preterm infants, according to a new policy statement issued by the American Academy of Pediatrics (AAP) which will be available in the upcoming January Edition of Pediatrics.

Present practice guidelines recommend use of surfactants at or soon after birth in preterm infants with symptoms of respiratory distress syndrome (RDS), however, the AAP notes that recent multicenter randomized controlled trials have shown that CPAP may be an effective alternative to prophylactic or early surfactant administration in premies with RDS.

“Respiratory support is being achieved more frequently with CPAP and other less invasive approaches, such as the technique of intubation, surfactant, and extubation,” the committee writes. Existing data also shows that mechanical ventilation can cause lung injury, especially when used in the presence of surfactant deficiency.

The AAP committee’s review of the literature, reached the following conclusions:

  • When compared with prophylactic or early surfactant therapy, early use of CPAP, coupled with subsequent selective use of surfactants, results in lower rates of bronchopulmonary dysplasia and death.
  • Preterm infants managed with early CPAP alone are at no increased risk for adverse outcomes if treatment with surfactants is delayed or is not administered.
  • Initiating CPAP early may help reduce the duration of mechanical ventilation and postnatal corticosteroid therapy.
  • Presentation of RDS in infants may vary significantly in terms of the severity of disease, maturity, and presence of other complications. For that reason, care should be individualized.
  • Because management of premies with respiratory difficulties is provided in a wide variety of settings, capabilities of the specific healthcare team need to be considered.

The committee also recommends, “If it is likely that respiratory support with a ventilator will be needed, early administration of surfactant followed by rapid extubation is preferable to prolonged ventilation.”


Source: Medscape and AAP

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Better Sleep for More Birdies?

In a sports-obsessed American culture, linking better sleep to sports performance could well open up new markets among coaches and athletes. A new study bolsters the possibility with findings that suggest that treating obstructive sleep apnea (OSA) with CPAP improves golf performance in middle-aged men.

Results show that up to six months of treatment with CPAP therapy was associated with significant improvements in self-reported excessive daytime sleepiness and sleep-related quality of life. Participants treated with CPAP therapy also experienced a significant drop of 11% in their average handicap index, a standardized formula that estimates a golfer’s skill level.

Among the more skilled golfers who had a baseline handicap index of 12 or less, the average handicap index dropped by 31.5%. Participants attributed their enhanced performance to factors such as improved concentration, endurance, and decision making.

“The degree of improvement was most substantial in the better golfers who have done a superior job of managing the technical and mechanical aspects of golf,” said principal investigator and lead author Dr. Marc Benton, senior partner at Atlantic Sleep & Pulmonary Associates and medical director of SleepWell Centers of NJ, Madison, N.J.  “With the cognitive enhancement afforded by successful treatment of their sleep apnea, they saw measurable improvement early and more significantly than those who were less skilled.”

The study results appear in the Dec 15 issue of the Journal of Clinical Sleep Medicine, which is published by the American Academy of Sleep Medicine. Objective data reporting shows that average utilization of CPAP therapy by participants in the treatment group was 6.3 hours per night for 91.4% of the nights, which is a much higher compliance rate than is typically reported.  The results suggest that the potential for improved golf performance may have played a motivational role in increasing treatment compliance.

“An important aspect of providing high quality, patient-centered care is to identify the unique factors that motivate individual patients to comply with treatment,” said American Academy of Sleep Medicine President Dr. M. Safwan Badr.  “Effectively treating sleep apnea with CPAP therapy can yield numerous physical, cognitive and emotional benefits, all of which can be great motivators for patients when they begin treatment.”

Source: JCSM

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Focus on Job Performance in Battle for Sleep Patients

Do sleep-deprived office workers affect profits? They may not be behind the wheels of multi-ton trucks, but sleepy workers who affect the bottom line are fast becoming a concern as modern medicine heads into 2014.

The largely uncharted territory of corporate America is looking for an edge, and reducing instances of sleep apnea could give them that extra push. No one will die in mangled wreckage if an accountant does his job poorly, but the consequences of an error-riddled audit could add up to dollars lost on the bottom line. Poor sleep affects every job, and every job adds up to a massive pool of opportunity.

How best to tap into that opportunity is the question on the minds of sleep lab directors and sleep physicians throughout the country. The consequences of poor performance for employees in the nation’s corporations is not insignificant, and the right marketing pitch could add up to lucrative referral streams flowing from the cubicles of America.

Research companies call them “wellness programs” or “outcome-based incentive and engagement programs.” In the wake of the Affordable Care Act, the shape of such programs is still in doubt, but possible models could include on-site/near-site primary care delivery—perhaps even sleep tests administered right there at the office work site. Many companies would be willing to pay out of pocket if long term benefits could be proven.

If such programs are covered as a benefit and/or perk, employee response could well be positive. After all, employees are used to cost-cutting measures that inevitably reduce benefits. Adding a “better sleep program,” to existing employee wellness packages could reverse the trend—leading to increased loyalty or even helping to attract better talent.

Industry innovators believe the key to convincing managers to make such an investment is to convince them that better sleep equals increased productivity. With new studies coming out virtually every week linking sleep to countless comorbidities, such an equation is entirely accurate.

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Two New Masks Hit the Market

Pennsylvania-based giant Philips Respironics has what company officials are calling the industry’s first and only gel pillows mask, which brings the comfort and sealing power of gel to nasal pillows. The Nuance mask is the latest in a series of new masks from Philips.

“With its sleek design and better seal, Nuance represents the new choice for better sleep therapy for clinicians, home care providers and patients,” says John Frank, senior vice president, general manager, Sleep and Respiratory Care, Philips Home Healthcare Solutions. “It is part of our comprehensive portfolio of masks and services designed to address some of the challenges facing home care providers today.”

Clinicians and providers have the ability to provide a high performance minimal contact mask for greater patient satisfaction. Nuance features an all-fabric frame and headgear that enhances patient comfort and causes fewer red marks. Nuance Pro’s gel-padded frame holds the mask in place during sleep and reduces the need for re-adjustment.

Over at InnoMed Technologies Inc, a new full face mask called the Aspen made its debut with designers touting the product as compact, quiet, lightweight, and affordable—all with a forehead pad featuring a SoftTouch Wrap.

“With competitive bidding and declining reimbursement rates, we felt it was important to round out our product portfolio as a company to remain competitive with companies such as ResMed, Fisher & Paykel Healthcare, and Philips Respironics,” states Ron Richard, CEO of InnoMed Technologies.

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FAA Rejects “Rulemaking” Process, Will Implement Strict OSA Screening

The Aircraft Owners and Pilots Association (AOPA) is reporting that the FAA will move forward with implementing mandatory screening and testing for obstructive sleep apnea, despite opposition from the pilot and aviation medical communities.

During a webinar last week, the Federal Flight Surgeon said the FAA would require aviation medical examiners to calculate body mass index (BMI) for all pilots. Those with a BMI of 40 or greater would have to be screened and, if necessary, treated for obstructive sleep apnea (OSA).

“The AME may issue a medical certificate at the time of the examination; however, the FAA will follow up with a request for additional evaluations, including a sleep study and evaluation by a board-certified sleep specialist,” wrote Elizabeth A. Tennyson of the AOPA. “Pilots who don’t undertake the evaluation within 60 days would face receiving a letter of disqualification. Over time, the FAA would lower the BMI requirement, compelling more pilots to be screened by a sleep specialist. The FAA currently lists 5,000 pilots with a BMI of 40 or greater and more than 120,000 who qualify as obese with a BMI of 30 or higher.”

Much like the trucking industry, AOPA and others have objected to the new testing requirements, saying they force AMEs to venture into predictive medicine, “rather than focusing on their mandate of determining the likelihood that a pilot will be medically incapacitated at some point in the duration of the medical certificate.”

The AOPA has argued that such a significant change should go through the more stringent “rulemaking process” to allow public input and the opportunity to explore less intrusive and less costly methods for addressing concerns about sleep disorders. Instead of “rulemaking,” the FAA is using its regulatory powers to implement the new guidelines.

Source: AOPA

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CPAP and Better Blood Pressure Connection Bolstered in Latest Study

People with sleep apnea and hard-to-control high blood pressure may see their blood pressure drop with appropriate CPAP treatment according to a recent study from Spain.

Sleep apnea has been linked to high blood pressure in past studies, and in the latest study from Polytechnic University Hospital in Valencia, Spain, participants who used CPAP for 12 weeks reduced their diastolic blood pressure and improved their overall nighttime blood pressure.

“The prevalence of sleep apnea in patients with resistant [high blood pressure] is very high,” said lead researcher Dr. Miguel-Angel Martinez-Garcia. “This [sleep apnea] treatment increases the probability of recovering the normal nocturnal blood pressure pattern.”

Patients with resistant high blood pressure should undergo a sleep study to rule out obstructive sleep apnea, Martinez-Garcia said, and “If the patient has sleep apnea, he should be treated with CPAP and undergo blood pressure monitoring.”

The studyEffect of CPAP on Blood Pressure in Patients With Obstructive Sleep Apnea and Resistant Hypertension“, published in the December issue of the Journal of the American Medical Association, was partly funded by Philips-Respironics, maker of the CPAP system used in the study. Dr. Gregg Fonarow, a spokesman for the American Heart Association and professor of cardiology at the University of California, Los Angeles, stated that most patients with hard-to-control high blood pressure also suffer from sleep apnea.

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“Close to three out of four patients with resistant [high blood pressure] have been found to have obstructive sleep apnea, and this sleep apnea may contribute to the difficulty to control the blood pressure in these patients,” he said.

“Whether these improvements in blood pressure can be sustained in the long term and will translate to improved health outcomes will require additional studies.”

Source: JAMA

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Consumer Press Keeps Home Sleep Testing in the Spotlight

From the Washington Post to the Saratogian News, consumer press outlets are continuing a push to boost awareness of sleep disorders. In a summary of the latest articles, several sleep situations are outlined with home sleep testing proposed as the most convenient diagnostic solution.

The first anecdote documents a chronic snorer, pointing out that snoring may be a sign of sleep apnea, a disorder that raises the “risk of heart disease and diabetes.” In years past, diagnosing the problem meant spending the night at a sleep lab hooked up to monitors. Home testing, is “a simpler, cheaper and more convenient route…that works as well for many patients as the varieties used in sleep labs.”

“The driver for all of this is cost and convenience. Lab tests are labor-intensive and costly,” said Safwan Badr, president of the American Academy of Sleep Medicine, in the article. “Insurance companies sometimes insist on home studies first. But patients would be much better off if insurers would allow doctors to use their best judgment.”

The report calls home testing part of a trend toward do-it-yourself exams that include a growing array of tests for genetics, fertility, blood cholesterol levels, thyroid stimulating hormone, urinary tract infections and more.

“Sleep specialists say they expect more people to opt for home tests as insurers continue seeking to cut costs. Home sleep tests cost up to $300 or more, while hospital-based lab tests can reach $1,500 or more,” writes Ungar. “Some doctors, though, suggest that while home tests have a place, particularly among relatively health patients with strongly suspected sleep apnea, they are not as thorough as lab tests, don’t provide as much data, sometimes miss less clear cases of apnea and can’t detect other problems such as narcolepsy or restless leg syndrome.”

Source: Washington Post


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Train Derailment Highlights Deadly Consequences of Poor Sleep

If the engineer at the controls of the ill-fated Metro-North train in the Bronx had worn a CPAP the night before, could the tragic derailment have been avoided? Inside the world of sleep medicine, the question rages in light of several media outlets reporting that the engineer may have fallen asleep.

DNA info reported that engineer William Rockefeller “all but admitted he was falling asleep” as he was commandeering the train. When he finally woke up, he was going 82 mph on a curve that demanded about 30 mph. The derailment killed four people and injured many others.

In the apparent absence of drug and alcohol impairment, lack of sleep lands squarely in the spotlight. An analysis from a report published in the Huffington Post concluded that train operators are actually one of the most likely groups to experience sleep-related job performance issues.

The National Sleep Foundation conducted a poll of 800 transportation workers and 300 non-transportation workers, asking whether sleepiness affects job performance at least once a week. Train operators were the group most likely to admit this, at 26%, followed by pilots, at 23%. Meanwhile, just 17% of non-transportation workers reported that sleepiness affected job performance in the last week.

“For transportation workers, it’s a 24-hours-per-day industry, which means there are always going to be people working under shifts that are not conducive to getting adequate sleep,” Thomas J. Balkin, the chief of the department of behavioral biology at the Walter Reed Army Institute of Research and chairman of the National Sleep Foundation, previously told HuffPost. “Unfortunately, the nature of the work makes it very dangerous to be sleepy.”

Source: Associated Press

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National Business Aviation Association Aims to Enforce “Rulemaking” Process for Sleep Apnea

Taking a page from the trucking industry playbook, the National Business Aviation Association (NBAA) is supporting legislation that would compel the Federal Aviation Administration (FAA) to follow established “rulemaking” processes for sleep apnea screening of pilots.

The so-called “rulemaking” procedure makes it more difficult for federal entities to establish regulations. According to www.aviationpros.com, NBAA leadership thanked a key U.S. House of Representatives panel for approving legislation that would require the rulemaking processes.

The legislation, HR 3578, was introduced on Nov. 21 by Rep. Frank LoBiondo (R – NJ), chairman of the Transportation Committee’s Aviation Subcommittee. The bill responds to a new policy, first reported in a November 2013 FAA newsletter, that the agency would soon begin subjecting pilots with a body mass index of 40 or greater to OSA screening.

“It was later revealed that the agency would require pilots to bear the significant costs of getting tested for OSA (as much as $5,000, according to some sources), and obtaining the requisite equipment to treat the condition, if necessary,” writes the NBAA. “The FAA has suggested that this policy would eventually apply to all pilots, regardless of the class of medical certificate or the operation in which the pilot flies.”

LoBiondo’s bill seeks to ensure “that any new or revised requirement providing for the screening, testing, or treatment of an airman…is adopted pursuant to a rulemaking proceeding.” With the approval by the House Transportation Committee, the bill now moves to consideration by the full House of Representatives.

“We thank the co-sponsors of HR 3578, and all the members of the full committee, for their prompt, bipartisan action on this matter, and we look forward to prompt passage of the bill by the full House,” said NBAA President and CEO Ed Bolen. “As the FAA considers unilateral implementation of a policy of this magnitude, the proposal should be subject to transparency, in part through commentary from affected parties, as well as analysis of its data-driven justification, costs, benefits and other important criteria. This bill will ensure that these important considerations are made before the proposed OSA requirement is allowed to take effect.”

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