From Body to Bank Account; Does Sleep Contribute to Success?

German researchers looked at the brain functions of “night owls” (those who go to bed late) and “larks” (those tucked in early) and found some distinct differences.

According to the report, the differences could have a huge effect on life, success, and overall personality. Dr Jessica Rosenberg of the Institute of Neuroscience and Medicine in Jülich, Germany says: “Our results show that extreme ‘late chronotypes’ (night owls) show differences in the diffusion of water molecules in areas belonging to the white matter of the brain as compared to early and intermediate chronotypes (larks).”

Reporter Áilín Quinlan writes that diffusion difference could be linked to depression in owls, who suffer a kind of ‘jet lag’ by being forced to reluctantly participate in a world of early risers which is in conflict with their natural tendency to sleep late.

“Late-nighters may find their lifestyles bring on more than a case of the blues,” writes Quinlan. “Studies carried out at the University of Western Sydney reveal that a night owl is more likely to be narcissistic and more Machiavellian in their desire to manipulate others — and may even be more inclined towards callousness and insensitivity.”

Sleep deprivation may also affect achievement, explains Dr Elaine Purcell, consultant in sleep disorder medicine at the Mater Private Hospital. “In general it is thought that larks do better in school, college or the workplace because they are on time and alert and able to absorb information whereas the night owl has great difficulty getting up in the morning and is missing early classes so they are at a disadvantage when it comes to exams,” she says.

Source: Irish Examiner

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Sleep Health Problems for Seniors

Sleep health and daytime functioning problems are common for seniors but there are some remedies. The architecture of sleep changes as people age. As people age their sleep is lighter, they get less deep sleep, and in the lighter stages of sleep, tend to have more awakenings.

Because of this, seniors tend to report more insomnia, frequent awakenings and more tiredness during the day. This, in turn, can lead frequently to daytime napping, which sets up a vicious cycle of getting less at night and tending to make up for it during the day.

While a Grandparent dozing in their chair may be a stereotypical image of a senior citizen, it’s actually a myth that seniors need more sleep; they just need better sleep. According to the National Sleep Foundation, as a general rule newborn babies need about 12–18 hours of sleep, school-age children require about 10-11 hours and teenagers could use (but hardly ever get) 8.5–9.25 hours of shut-eye. This amount then decreases even more as we near adulthood, to between 60 and 90 fewer minutes of sleeping time than an adolescent. So on average, seniors tend to need the same amount as other adults, about 7–9 hours of sleep each night, say experts. Unfortunately, with more interruptions at night, seniors may not be getting the sleep they need. What’s more, while the quantity of sleep is a good guideline, the quality of those hours of sleep is what makes the real difference.

Research has shown that sleeping too little can put both your health and safety at risk: people who don’t get enough good-quality sleep are not as productive or able to remember information as well. They have a harder time paying attention and their reaction time is slower. Because of this, there is an increased risk of motor vehicle accidents associated with people who don’t sleep enough. Health issues linked to poor sleep include higher risk of obesity, diabetes and heart problems, as well as depression.

From the Johns Hopkins Bloomberg School of Public Health, as study was recently published in Jama Neuruology addressing “Shorter Sleep Duration and Poorer Sleep Quality Linked to Alzheimer’s Disease Biomarker” which suggested that poor sleeping habits may increase an individual’s likelihood of developing or experiencing a worsening of Alzheimer’s symptoms. While it’s well known in the medical field that people diagnosed with Alzheimer’s tend to sleep poorly, their new research suggests a chicken-and-egg conundrum — that poor sleep might be a cause, rather than an effect, of the cognitive degenerative disease.

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Jazz Pharma Acquires Rights to Late Stage Investigational Compound for Excessive Daytime Sleepiness

Jazz Pharma a specialty pharmaceutical company who have successfully commercialized the drug Xyrem, is betting $397M on a new narcolepsy drug from Aerial BioPharma. They will pay out $125 million up front and up to $272 million in milestones for ADX-N05, Aerial’s mid-stage drug for excessive daytime sleepiness in patients with narcolepsy. In October, the North Carolina biotech unveiled positive results from a 93-patient Phase IIb trial and started looking around for a buyer to take the drug into Phase III. Now, Jazz plans to do just that in short order, leveraging the same expertise it used to develop the narcolepsy treatment Xyrem.

“Given ADX-N05′s demonstrated wake-promoting properties in preclinical and clinical studies, including the Phase IIb results, we believe ADX-N05 could also potentially benefit patients whose excessive daytime sleepiness stems from other causes, such as obstructive sleep apnea, where we also intend to pursue Phase III clinical trials,” Chief Medical Officer Jeffrey Tobias said in a statement.

Excessive daytime sleepiness is a common symptom for patients with narcolepsy and obstructive sleep apnea (OSA).  Despite current therapies, many patients with narcolepsy and OSA continue to experience excessive daytime sleepiness2,3.  Narcolepsy is a chronic, debilitating, orphan condition that impacts approximately 157,000 people in the United States4.  Less than half of the estimated 157,000 people living with narcolepsy in the United States have been properly diagnosed and approximately 50,000 patients receive wake-promoting therapies. OSA is a serious chronic sleep disorder in which breathing repeatedly stops and starts during sleep.  People living with excessive daytime sleepiness in narcolepsy and OSA are often inadequately treated with available wake-promoting agents.  In the United States, approximately 500,000 patients receive wake-promoting therapies for excessive daytime sleepiness associated with OSA5.

 

 

References:

  1. SK has retained rights to ADX-N05 in Korea, Japan, China, Taiwan, Singapore, Indonesia, India,Philippines, Thailand, Malaysia, Vietnam, Hong Kong.
  2. NA Antic et al. The effect of CPAP in normalizing daytime sleepiness, quality of life, and neurocognitive function in patients with moderate to severe OSA. Sleep. 2011: Jan 1; 34(1):111-9.
  3. C Guilleminault et al. Problems associated with switch to modafinil – a novel alerting agent in narcolepsy.Eur J Neurol.  2000 Jul; 7(4):381-4.
  4. CR Baumann et al. Narcolepsy: Pathophysiology, Diagnosis, and Treatment.  Springer: NY 2011.
  5. SH Launois et al. Current Opinion in Pulmonary Medicine. 19(6):601-608, November 2013.

Source: Jazz Pharmaceuticals

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Treating America’s Sleepy Truckers

Reprinted with update from an article in Health and Wellness Magazine Nov, 2013

Every year in America there are nearly 500,000 commercial truck accidents, and, according to the Federal Motor Carrier’s Safety Administration, driver fatigue accounts for nearly 40% of these accidents. Obstructive sleep apnea is an incredibly frequent and treatable cause of the truckers’ fatigue, yet most truck drivers have not been tested for sleep apnea and, due to the inconvenience of common sleep apnea treatments, even fewer are being treated for their fatigue. For years this problem has remain unaddressed. However as Executive Director of the Dental Division of the American Sleep and Breathing Academy, I think our team can make our highways safer.

Also as founder and President of Pro Player Health Alliance, an organization which teams up with retired professional sports players to promote sleep apnea awareness, I have had the opportunity to help numerous former NFL players achieve a better night’s sleep. I noticed that, like NFL players, truckers endure long periods of travel and are frequently overweight, which places them at a higher risk of having obstructive sleep apnea.  In fact, according to a recent study by the Federal Motor Carrier Safety Administration, a third of American truck drivers have medium to severe sleep apnea. 

            Thus, On July 11th 2013 I, as well as Dr. Elliott Alpher and Dr. Richard Klein, met with the Department of Transportation to present ways to treat truck drivers for obstructive sleep apnea. The conventional treatment method for obstructive sleep apnea involves using a Controlled Positive Airway Pressure (CPAP) device. However these machines are bulky and require electricity, usually from large batteries, in order to function. Therefore most truck drivers, due to their frequent traveling, find CPAP devices to be very inconvenient. Furthermore, according to the American Thoracic Society, even in the general patient population, between 46% and 83% of CPAP patients will not adhere to CPAP therapy. Instead, we recommended for truck drivers the same treatment already been using for NFL players: oral appliance therapy.

Since 1981, Gergen’s Orthodontic Lab has been designing the highest quality oral appliances. Based on my experience, I feel that an oral appliance is

David Gergen and Josh Fowler celebrate another milestone

safe, affordable, easily transported, and non-electric, which makes it ideal for a trucker’s lifestyle. In the past, CPAP has been favored because of its ability to measure compliance and usage. However, with the addition of a new panel of sensors invented by Dr. Bonato, CEO of Braebon, who was also at the meeting, any of the oral appliances made with the sensor by Gergen’s can be used to measure compliance and usage. Appliances include the Sleep Herbst, EMA, Respire, TAPs and the newest addition invented by Steven Harkins, the Twilite Appliance which has successfully treated over 300 patients.

Furthermore even the sleep apnea screening process can be made simpler and more portable by using new technology which could record data from off-site locations such as a hotel room or even the cab of a truck. With the availability of this new portable technology, I believe that truckers deserve the same treatment that we have been delivering to NFL players for years.

            The Department of Transportation agreed with our presentation and the government responded. On October 15th 2013 a major step was taken toward making America’s highways safer when President Obama signed into law H.R. 3095, which requires screening all commercial truck drivers for sleep apnea. Screening for sleep apnea will make thousands of drivers aware of the cause for their drowsiness and will encourage them to pursue treatment.

            Still, there are more workers in the transportation sector who could be helped by sleep apnea screening and oral appliance treatment, including train operators and pilots. For example, a most recent event in Brooklyn unfortunately involved a train engineer falling asleep at a turn, derailing and flipping the train. Sleep apnea was later to be believed as the cause of this accident, although sleep test results have not been confirmed to date. However, Dr. Klein best captures the importance of October’s decision by saying, “Last year over 200,000 people on the roadways in this nation lost their lives due to sleepy drivers and now American roads will be safer and drivers can feel more confident in their safety.”

David Gergen

Since he received the award for The Finest Orthodontic Technician in the country given by Columbus Dental in 1986, 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. Harold Gelb, Dr. Robert Ricketts, Dr. Ronald Roth, Dr. A. Paul Serrano, Dr. Clark Jones, Dr. Arthur Gaus, Dr. Joseph R. Cohen and Dr. Edward Spiegel.  He has also taught orthodontic technicians at Arizona Institute of Technology for dental and medical careers.  David has also been active on the Arizona State University Sports and Medicine team since 1991.  He also received in 2012 a lifetime achievement award by the Gelb Academy as America’s greatest Orthodontic technician of all time. David can be reached at www.Gergensortho.com

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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Modern Gizmos Infringing on Good Sleep?

Most people have heard the sage advice to keep TVs out of the bedroom. Instead, the bedroom should be for sleeping and not sleeping when the mood strikes.

What about keeping the smart phone, tablet, or laptop away from the mattress? As it turns out, scientists at no less than Harvard Medical School have found that specific wavelengths of of light can suppress the slumber-inducing hormone melatonin in the brain.

“We have biologically shifted ourselves so we can’t fall asleep earlier,” said Charles A. Czeisler, a professor of sleep medicine at Harvard Medical School in an article in The Denver Post. “The amazing thing is that we are still trying to get up with the chickens.”

According to the Post, the result is less sleep, and less time for the body to recover. In the U.S. alone, revenue from clinics treating sleep disorders expanded 12 percent annually from 2008 to 2011, reaching $6 billion, according to IBISWorld. Drowsy drivers cause 1,550 fatalities annually, the National Department of Transportation estimates, and insomnia-related accidents in the workplace cost $31.1 billion annually, a study last year found.

“Sleep is in a battle for our time with work life, social life and family life,” said David Hillman, a sleep specialist at the Sir Charles Gairdner Hospital in Perth, Western Australia, and the chairman of the Sleep Health Foundation. “For a lot of us, it comes off a poor fourth in that battle.”

While the noisy ping of a nocturnal e-mail or text message can interrupt sleep, staring at the gadgets’ screen late at night may be more detrimental, according to researcher Czeisler, who is also head of sleep medicine at Boston’s Brigham and Women’s Hospital. It comes down to the body’s circadian rhythm, which has been affected ever since the invention of the electric light.

Source: Denver Post

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Top 10 Healthcare Buzzwords for 2014

Whether you call it lingo, jargon, or nomenclature, there is no denying that health care professionals often speak their own language. Cheryl Clark, senior quality editor at HealthLeaders Media, narrowed it down to 14 buzzwords for 2014, and we at Sleep Diagnosis and Therapy have trimmed it to a tidy top 10.

1) High Outliers

Some 158 “high outlier” hospitals were singled out by the Office of Inspector General in a November report because on average, $1 out of every $8 they received from Medicare came in the form of outlier payments. For 13 of these hospitals, outlier payments amounted to more than $1 in $5, because the hospital received charges rather than what Medicare typically pays for a patient with that diagnosis.

The report said the disparity “raises concerns about why charges for similar patient-care cases vary substantially across hospitals,” and called for “increased scrutiny” from the Centers for Medicare & Medicaid Services. CMS agreed.

2) MSPB

“MSPB” or Medicare Spending Per Beneficiary sounds obtuse, but it translates to money for your hospital. It is a ratio indicating how much any one facility’s Medicare beneficiaries cost the government over a span of time from three days before admission to 30 days post discharge. Unfair, some industry groups complain. How can they control what services patients receive outside their walls?

CMS disagrees. On authority of the PPACA, the agency gave this measure a 20% weight in the equation determining whether hospitals receive incentive payments under value-based purchasing starting this Oct. 1. The formula is designed to make sure hospitals monitor and guide their physicians to not duplicate expensive imaging tests and to move patients to home care rather than skilled nursing care when appropriate.

3) Flipping Healthcare

Healthcare should be flipped, that is, delivered in a way that’s convenient for patients, not their providers, says Institute for Healthcare Improvement president and CEO Maureen Bisognano, who used the phrase in her National Forum keynote last month.

The idea, borrowed from education ( “flipping the classroom,”) is that healthcare should be provided in a way that meets what the patient wants, and providers should be allowed to teach caregivers what they need and that caregivers should listen.

That could mean providing care to the patient in the home, for example getting the patient a new chair that reduces risk of injury, rather than treating the consequences of injury.

“We need to flip from focusing on the medical condition to focusing on the patient,” Bisognano says.

4) Financial Harm

Patient harm is usually considered a medical intervention that hurts the patient, such as administering a contraindicated medicine. But with medical debt now the biggest reason for bankruptcies, some doctors admonish their colleagues to look out for healthcare that may cause “financial harm” and stress to the patient.

Providers should appreciate financial harm as a real quality and safety issue, and screen for this with the same fervor with which they try to prevent central line infections, these physicians argue.

Writing in JAMA, hospitalists Christopher Moriates and Vineet Arora, and OB/GYN Neel Shah all involved with the Costs of Care project to reduce unnecessary healthcare spending, also say providers should take responsibility for knowing how much certain services actually cost. “In my view, financial harm is a real form of harm,” Shah says.

5) Billing Optimization

Also known as “documentation improvement” or “documentation integrity.”

In the last month, we’ve heard numerous physicians and hospital executives talk about the push from their accounting departments to document—legally of course—complex comorbidities that will generate a more lucrative reimbursement. This is especially important with declining revenue from loss of incentive payments and disproportionate share funding, readmission penalties, and upcoming financial cuts for hospitals with rates of higher hospital-acquired conditions.

Better documentation also may impact risk adjustment equations that may help a hospital’s score on certain public reports, reflecting that their patients are indeed sicker than their competitors’ patients.

6) Servant Leader

Robert Wachter, MD, chief of both medical service at UCSF Medical Center and of the Division of Hospital Medicine, says that while the phrase “servant leader” is not that new, it is the latest catch phrase heard within the C-suite. “It describes a leader who is there to serve the employees and the company, rather than be a larger-than-life, Lee Iacocca type,” he says.

References around the Web suggest such a person is an executive who provides his or her teams with the resources they need, from staffing to sophisticated electronic health record systems, to support through respect and recognition.

7) Choosing Wisely

Imagine each physician specialty and primary care society comes up with a list of five procedures or tests that their own members should avoid, and discourage if their patients request them. Keep in mind these services would have produced revenue and may have been performed under the assumption that more care is better care, however marginally beneficial.

That’s exactly what the American Board of Internal Medicine Foundation has accomplished with its Choosing Wisely campaign, which ABIM officials say is “revolutionizing” healthcare. The initiative seeks to inform providers and patients on evidence based practice in an effort to avoid harm, needless interventions and waste, and reduce cost.

The effort began in 2011 and 2012 with nine practice organizations, but took off in 2013 with some 46 primary and specialty societies putting in their lists of five or more procedures, and more expected in 2014.

8) The Hospitalization Toxic

You’ve heard the expression, “the treatment was successful, but the patient died,” right? Yale-New Haven Hospital’s Center for Outcomes Research and Evaluation director Harlan Krumholz, MD, has noticed the worrisome “Post-Hospital Syndrome” phenomenon, which he described last January in the New England Journal of Medicine.

After patients are appropriately treated for their condition and discharged, they “have heightened risks of myriad conditions, many of which appear to have little in common with the initial diagnosis,” he believes.

Krumholz refers to this as “the hospitalization toxic,” a combination of new metabolic disorders, pneumonia, gastrointestinal maladies, mental illness, and other problems that often bring the patient back to the hospital within 30 days.

He postulates that sleep deprivation, multiple medications, inactivity, and monotonous hospital surroundings, especially in the intensive care unit, may be contributing factors.

Associated words to describe this sequence include “deliriogenic” and “SICU psychosis.”

9) Moral Hazard

Used mainly in economics, this term applies to a situation in which a person is more likely to take a risk because he or she won’t be affected by the costs of a negative consequence. The phrase is now being applied to healthcare in a variety of ways, one of which refers to people with health issues or a risky lifestyle who choose not to buy health coverage because the individual mandate penalty they’d pay through taxes the following year is less than their premiums.

If they eventually need expensive healthcare, society and providers along with government funding borne by society, will bear that cost.

10. Second Victim

Just as a patient and family members suffer from a medical error, the healthcare provider who makes that mistake is a second victim, often riddled with destabilizing shame, perhaps ridicule from co-workers, and an impaired ability to remain effective.

Soon we’ll have guidance from the Joint Commission on the need for hospitals to create appropriate guidelines and rapid response systems for healthcare providers involved in adverse events and the training and certification those programs should have to appropriately intervene.

Second victim advocate and Johns Hopkins research center director Albert Wu, MD, says that the creation of more understanding healthcare environments can encourage personnel involved in such incidents to report medical hazards. Doing so not only minimizes their own suffering, but helps assure those same errors don’t happen again.

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Vegas Consumer Electronics Show Bridges to Sleep World

It should be no surprise that the “smart” revolution is hitting the world of sleep. As reported by BBC News, the Consumer Electronics Show in Las Vegas is set to roll out the Aura “smart sleep” system from a company called Withings.

Reporter Leo Kelion reveals that one part of the device slides under the mattress to study the dozing owners while another screens their bedroom environment. It is the first of more than a dozen sleep-related gadgets set to be launched at the Las Vegas event.

The Aura system consists of three parts:
1) a soft padded sensor that is slipped under the mattress which the firm says is able to record body movements, breathing cycles and heart rates;
2) a device that should be placed next to the bed that includes sensors to study noise levels, room temperature and light levels. In addition it contains a clock, a speaker that plays alarm sounds and a circular LED (light-emitting diode) lamp; and
3) A smartphone app that controls the system and provides feedback about the sleepers’ night.

“The light changes colour from blue to yellow and red across the course of the night on the basis of research that different light wavelengths can affect the secretion of hormones,” writes Kelion. “Philips’ rival Wake-up Light lacks the mattress sensor but can charge a smartphone. Studies have suggested that blue light stimulates melanopsin – a pigment found in cells in the eye’s retina, which send nerve impulses to parts of the brain thought to make a person feel alert.”

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Juggernaut of The Jaw

 

David Gergen rolled out of bed on September 12, 1981, and had his career “aha” moment. Gergen knew he was going to be an orthodontic technician, and he knew he was going to help people all over the country. Since then, he has built one of America’s most successful dental labs in Phoenix, Arizona, revolutionized the sleep industry through oral appliances and special programs, and was once voted top dental laboratory technician in the country.

For more than 20 years in Phoenix, Gergen spent the fall coaching POP Warner football and/or high school football. Most of the important lessons of his life were learned either watching football legends, creating challenges for himself on the field, or teaching children the values of courage and teamwork on the field.

It comes as no surprise that Gergen, father of nine children, would focus a good deal of his professional life to helping children achieve their goals. Gergen is a certified dental technician, and some would say a master technician that children and adults have relied on for excellent results.

In his professional life, Gergen worked to straighten teeth for cosmetic reasons, and to help create functional oral structures for patients with severe trauma or developmental issues. Recently, attention has turned to the effects of poor jaw position on children. “A small airway often forces children to breathe through their mouth and posture their head forward resulting in rounded shoulders and back problems,” explains Gergen. “Continuing this position over many years will create permanent changes in posture. Poor breathing habits can result in heart and lung problems in later life.”

After 30 years of establishing better jaw and tooth function through orthodontics, Gergen decided that he was going to focus on the airway. His pediatric sleep appliance is a direct result of all of this experience and experimentation. Despite the growing evidence, Gergen laments that, “Some clinicians still believe that oral appliances are ineffective. As a dental sleep industry, I don’t think we’ve done a good enough job educating the public and physicians.”

P55 57 ls 1 Juggernaut of The Jaw

Gergen’s pediatric sleep appliance is worn on the child’s upper and lower teeth, and gives dentists an opportunity to guide the growth of patients’ teeth— more importantly, the jaw and the airway. Expansion of the upper jaw will create more room for the tongue to posture forward and open the airway.

“The simple shape and construction of the lower appliance will help stage the growth of the child’s teeth allowing the dentist to control the growth rates of the teeth for maximum cosmetic and palliative effect,” enthuses Gergen. “One of the best parts of the treatment is that all the time this growth is being controlled, the jaw is held slightly forward creating an open airway leading to better and deeper sleep patterns.”

What is the Expected Roll out for the Remainder of 2013?

Gergen has been working with Hall of Fame NFL great Mike Haynes, whose son is Pop Warner age and grinds his teeth in his sleep. This is what drove Gergen to come up with the first pediatric sleep appliance.

Mike Haynes is no stranger to health issues from his experience with prostate cancer and concussions. Both Gergen and Haynes know the value of an oral appliance worn during the day, or while playing a sport. Proper jaw position has been shown to improve agility, performance, and strength.

We got our CE mark and we are beginning our launch in Europe. We received our 510k approval in May. Our game plan now is that we are going to launch in Europe, and then toward the end of summer we’ll be launching in the U.S. By the end of this year, and going into 2014, we plan to be at full scale.

The concept of jaw position as a fundamental piece of sports performance is not new. Dr. Harold Gelb introduced this concept in his early work in the 1970s. The culmination of his work in improved performance was the 2000 Baltimore Ravens who triumphed over the New York Giants to win Super Bowl XXXV.

Every player on the team wore a custom oral appliance that positioned the jaw in Dr. Gelb’s Jaw position called the Gelb 4/7 position. Since that time, professional sportsmen all over the world have been adopting a daytime mouth guard to protect them from injury and improve their performance.

In a 2012 dental conference in Las Vegas, Dr. Gelb paid Gergen a high compliment, saying, “David Gergen is the finest technician ever to live. He is heads and tails above the competition.” Gergen was honoring Dr. Gelb for his 65th year in dentistry at the presentation, and Dr. Gelb also mentioned, “There are two legends in this room.”

“To say that David Gergen is a juggernaut of the jaw is to describe the part that is most obvious to all,” adds Rudi M. Ferrate, MD, DABSM and Sleep medicine specialist. “The part most people miss at first is the strength of his character, his passion for excellence, and his humble desire to help as many people as possible. He could easily sit back and enjoy the fruits of his business, but instead he spends his time and resources promoting education and awareness about sleep disorders. He is single handedly the most important force bringing sleep physicians and sleep dentists together and now is using his skills and reputation to bring everyone else on board—from legislators to sports legends.”

Improvement on Many Levels

Children undergoing standard orthodontic care have noticed their grades improve, sometimes dramatically. In the past, this would have been attributed to improved self-image or a growth spurt. Today, experts have measured the improved sleep patterns and the increase in airway size that comes from a better jaw position. These patients breathe better at night, and wake up more able to deal with the demands of the day.

When Gergen decided to change the world of sleep medicine, it seemed like something outside the realms of possibility. How could a certified dental lab tech from Arizona manifestly change the sleep industry? It began by assembling a winning team and deciding to help people treat their sleep disorders in partnership with their dentists.

In August 2011, Gergen’s first training program in sleep was presented to a group of 25 doctors in Sonoma, Calif. He continues to hold special seminars and educational meetings. In a market where there are companies running dental sleep medicine programs every week, each successive Gergen’s Orthodontic Lab program has gotten better in one really significant
way: the team.

Gergen’s Orthodontic Lab’s team is achieving a seasoned balance that makes these meetings better. Each educator has his specialty. Each topic is covered thoroughly without overreach that comes from trying to extrapolate data points to gloss over the unknown or unknowable. When Gergen was Arizona’s most successful POP Warner football coach, he learned that individual efforts often do not make the grade, and it is teams that win.

Gergen’s new meetings will be remembered as the first time that retired NFL players used their celebrity status to introduce the urgent need for sleep diagnosis and therapy to the general public.

He could easily sit back and enjoy the fruits of his business, but instead he spends his time and resources promoting education and awareness about sleep disorders.

“Pro Player Health Alliance was created to treat the sleep health needs of retired NFL players,” explains Gergen, “while at the same time raising awareness of sleep apnea as a silent killer.”

Dr. Archie Roberts, founder of the NFL HOPE program and retired NFL player, has been one of Gergen’s keynote speakers. Roberts established the much higher incidence of OSA and heart disease in the general population. He asked Gergen to be the sleep apnea director in the program they’re launching at the Mayo Clinic in Scottsdale, Arizona, on August 14, 2013.

Carl Eller, Larry Fitzgerald, Warren Moon, Roy Green, Dave Krieg, Isiah Robertson, Eric Dickerson, Mike Haynes, Tony Dorsett, Matt Blair, Chuck Foreman, and Derrek Kennard were all excellent football players, and some have been inducted into the Hall of Fame. They are all sleep apnea patients who are contributing to the field of sleep medicine and sharing their experiences with the general public.

The results are more diagnostic tests and, hopefully, reversing the trend of undiagnosed sleep apnea. Mike even asked Gergen recently to make an agility guard for his son to help him with his football performance. He also asked Gergen to have his son looked at for pediatric sleep.

With long-time friend, Dr. Elliott Alpher, Gergen met with the Secretary of the Department of Transportation, and his cabinet, on behalf of the Trucker’s Union, to begin using his oral appliance, made with a micro-recorder manufactured by Braebon. The micro-reader can monitor commercial
truck drivers’ compliance.

On the horizon is an upcoming Pro Player Health Alliance event in New York, a presentation with Dr. Brad Eli during sleep symposium at the Super Bowl (scheduled for February 2, 2014 in East Rutherford, NJ), and a seminar in Las Vegas with Dr. Brock Rendeau. “Rendeau is one of North America’s most sought after clinicians, and without a doubt one of the most creative speakers on the topic of functional orthodontic treatment,” says Gergen.

Gergen will remain at the center of these programs. He will be building teams, asking hard questions, and the sleep industry will be better for it.

David Gergen At a Glance• CDT and president of Pro Player Health Alliance and Gergen’s Orthodontic Lab;

• Honored as “The Finest Orthodontic Technician in the Country” by Columbus Dental in 1986.

• Executive Director of the dental wing of the American Sleep and Breathing Academy, a national interdisciplinary academy dedicated to sleep training and education with over 60,000 members.

• Personal technician for 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.

• Winner of the National Leadership award for Arizona Small Businessman of the Year in 2004.

P55 57 ls 3 11 Juggernaut of The Jaw

 

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Beyond Trucking: Expanding Opportunity Via Corporate Wellness Programs

 

Sleep professionals have heard about the trucking industry ad nauseum. Meanwhile, members of the general public also care about truckers because they justifi ably fear sleepy drivers guiding multi-ton vehicles on the nation’s highways.There is undeniable opportunity in the trucking industry, but a once promising landscape has been muddied a bit by the powerful trucking lobby that will make offi cial rulemaking about sleep apnea increasingly diffi cult. Beyond the realm of trucking, boating, fl ying, and various transportation industry jobs, is a largely uncharted territory of corporate America.

No one will die in mangled wreckage if an accountant does his job poorly, but the consequencesof 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 insignifi cant, and the right marketing pitch could add up to lucrative referral streams fl owing from the cubicles of America.

Research companies call them “health and productivity strategies” 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- ite/near-site primary care delivery—perhaps even sleep tests administered right there at the office work site.

If such programs are covered as a benefi t and/or perk, employee response could well be positive. After all, employees are used to cost-cutting measures that inevitably reduce benefi ts. 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.

 

The post Beyond Trucking: Expanding Opportunity Via Corporate Wellness Programs appeared first on Sleep Diagnosis and Therapy.

Baker Banks on the Future

 

When David Baker left his post as head of the largest sleep diagnostics company in the world, the veteran of more than two decades in the sleep business was far from done. Instead, Baker marshaled his considerable experience to start a new company called SleepImage®, based on the product of the same name.

Now serving as president and CEO of the Colorado-based company, Baker sings the praises of proprietary cardiopulmonary coupling (CPC), a technology that measures sleep quality through breathing and heart rate patterns known to control stable, healthy sleep versus unstable, unhealthy sleep.

Putting time, resources, and expertise behind the CPC concept came after considerable research that began seven years ago when Baker reconnected with Robert Thomas, MD, at the Harvard-affiliated Beth Israel Deaconess Medical Center. Thomas showed considerable enthusiasm for CPC, and the two men discussed the possibilities.

Rather than using EEG to evaluate the phasic transitions of sleep through the night, Thomas looked at biometric signals, ultimately selecting heart rate variability and breathing effort. By coupling these systems together, he could determine how someone was sleeping through the night and establish an objective, quantitative measure of sleep.

“When you are sleeping normally with no outside influences, your biorhythms are normal and synchronized,” explains Baker. “Dr. Thomas makes the analogy of an orchestra where everything is playing in tune. The totality of the music is clear and rhythmic. If one of the instruments is not in rhythm, it’s noticeable.”

Now that Baker is conducting the moving pieces of this new company, the days are long and the travel is rigorous. All the hard work is done in an effort to spread the word about Sleep Image, a device that uses the proprietary CPC technology to gain a better picture of true sleep quality in conjunction with snore, respiratory rate, body position, actigraphy and – now – SpO2 (optional). Amazingly, the SleepImage recorder weighs less than an ounce and uses only two ECG leads.
 

Sleep Diagnosis & Therapy recently sat down with Baker to trace the roots of his enthusiasm. Opportunities are out there,and Baker is convinced that the much-talked-about occupational health and trucking industries are only the beginning. After all, he says, many industries — even sports medicine — are catching on to the benefits of well-rested employees and athletes.

There are a lot of home sleep devices these days. What makes SleepImage special and how Sensitive is it?

David Baker, president and CEO, SleepImage: It’s not just a sleep apnea detector. Most home sleep testing devices measure for apnea, but they are not measuring sleep quality. It is also different in that it is noninvasive by design, the very parameter you are trying to measure (sleep) is not affected by having it on. There’s nothing wrapped around your head or chest or up your nose that will
influence how you sleep.

SleepImage is also one of the only products I know of that looks at sleep quality through the night and will register this change over time regardless of what caused it from things like pain,
fibromyalgia and sleep apnea to a bed partner snoring, a truck making too much noise, incorrect medication, or over titration of CPAPs—even improper advancement of a mandibular device.

We have seen poor sleep turn to good sleep and vice versa, within one or two centimeters of water pressure on a CPAP, or within a mm of advancement on an oral appliance. I’d say it’s quite sensitive!

How can this product bring more patients in the fold and get them diagnosed?

Its noninvasive design, simple implementation and reasonable cost will make it a tool that can be used by Sleep Doctors, Dentists, Psychologists, Pediatricians – any clinician really – to identify sleep dysfunction as well as track the benefit of whatever sleep therapy is in place. Simply put – it is to sleep what a thermometer is to temperature, or scales are to weight. More patients suffer from sleep issues outside of SDB than SDB itself, so a larger population can now be easily identified and treated. It’s also important to note that SleepImage, because of its size, is approved for use on pediatrics.

Specifically, what are the SleepImage’s best capabilities?
It does two things very well. One – it easily identifies – fundamentally – how the patient is sleeping. Potential sleep issues (including sleep disordered breathing) are identified. Secondly, post therapy, it tells clinicians how patients are responding to treatment, whatever form that treatment may be – from adjusting medication dosage to simply improving the sleep environment. So there is the identification of an issue on the front end, then therapy is applied and we can objectively measure the tangible results on the back end. For a couple of dollars per test, clinicians can verify that the therapy is optimal and make changes until they see an improvement in sleep. Patients who benefit from therapy, versus just comply, will naturally continue with the therapy. That’s very different from any other product at this price point.

How can SleepImage help to expand the patient base and even apply the technology beyond the traditional realms?

SleepImage can move us beyond a sleep monitor to a health monitor and start linking good sleep to good health in a way that has never been done before. If you want to really understand a patient’s health, the best way of doing that is through sleep. The way I look at it is that if you are walking around, you can put pain or stress to the back of your mind, but when you’re asleep all of those issues are going to surface and you’re vulnerable because you can’t consciously stifle them.

In sports medicine, if we can improve an athlete’s sleep by 5%, does that reduce his time to run a mile by one second? We were talking to a coach from the University of Southern California before the last Olympics about swimming. The period of time before a meet is very important as to how much the team trains and when they sleep. The SleepImage recorder doesn’t disrupt sleep, which is obviously very important, so if you can understand what improves the athletes sleep, by say 5% and it takes a second off the race time that could be the difference between a Gold Medal and an “also ran”.

What has been the reaction in the dental sleep medicine community?
We’ve been very successful so far, even though it’s not yet approved by payers to justify the payment for an oral appliance. Because it’s low cost and very simple to use, many dentists use SleepImage to titrate the patient and determine the correct advancement of the lower mandible and eliminate the more expensive lab or home apnea testing. Dentists can adjust patients to the appropriate setting, then test them again in a month to make sure the device is working. This also ensures the diagnostic test after the installation of the oral appliance is successful and treatment will be covered. Subsequent follow up tests can also be done at regular checkups to ensure the device is still effective and the patient is sleeping well. SleepImage can help identify other potential issues impacting sleep, so once apnea is being treated successfully with an Oral Appliance, the test serves as a tool to create a dialogue between the dentist and the sleep physician.

 

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