“Is A Dedicated Sleep Apnea Practice Right For Me?”

November 28, 2014 David Gergen CDT Leave a comment

Sleep Apnea Dentistry is perhaps the fastest growing part of my life. In my career I have always associated with the best dentists in the country. In my travels I have heard one question over and over again “Is a dedicated sleep practice right for me?”. The other question is “How will I know when to make the jump to a sleep only practice?”.

I asked Dr. Willey to write up his journey in sleep medicine, from the early days of training with Dental Sleep Medicine Pioneer and Legend Dr. Ed Spiegel. Dr. Willey let me interview him on his success and that is what he will be speaking on at the American Sleep and Breathing Academy Dental meeting in Scottsdale AZ April 10-11 www.asbadental.com . Being the person Dr. Willey is days later I received a call from him, he said ” David I want to tell a five part history from the being leading up to my lecture in Scottsdale” from the very beginning. He told me he could do it in a five part series on his personal journey, here is part one. Remember at the American Sleep and Breathing Academy Dental meeting in Scottsdale AZ April 10-11 www.asbadental.com he is going to explain how he built the largest dental sleep practice in the United States, 2.5 million a year and 106 appliances in a single month.

If I knew then…

“And what do you do for a living Joe?” “Purchasing agent for recreational pharmaceuticals” he replied with a wink and an unforgettable grin. Joe was a police officer and loved his work, and he never hesitated to share a good story of their newest hit on the streets. I had the privilege of working with Joe’s wife, Sarah, for 22 years, she was a powerhouse assistant and though patients might miss a chance

America's most successful Sleep Apnea Dentist — America’s most successful Sleep Apnea Dentist

to see me, they never missed a chance to see Sarah!

I wish I could say she was on top of her game every day, truth is, she wasn’t. She would come in with her hands wrapped around a cup of coffee as though it were her security blanket for the day. And then I would hear the same old same old, “Joe was snoring so bad last night, I hardly got a wink.” Following her comments, someone would always have something to say to make everyone laugh. This went on week after week, year after year.

And then the dreaded phone call came, “Doc, can you come- Joe died in his sleep from an apparent heart attack.” Racing to their home, I arrived and joined the many other mourners. Nothing made sense. Joe was a 40-year-old and in top physical shape. Sure, there were a few thugs who didn’t care for his career – but there was no sign of struggle or foul play. Sarah was never the same, nor I was.

Several years later, I was taking a weekend course on “Sleep Apnea.” And the pieces began to come together, all I could think of was Joe. I begin my search into dental sleep medicine with a determination to learn everything I possibly could and it wasn’t long until I knew that had I known then what I know now, Joe would most likely still be with us. From that moment on, dentistry changed for me. I began seeing my role differently and it wasn’t long until I was weaving sleep appliances in-between general dentistry and I always had a ‘win.’ Using Gergen’s Orthodontic Lab my cases were perfect, and that’s exactly what I was looking for.

I began experiencing a new fulfillment and I wanted more. Several patients that I had done a CBVT and radiologist read on were diagnosed with life threatening situations and their physicians called me to commend the find. Along the way a new group of challenges began to surface. I would look up to see my hygienist tapping her foot in the entrance of a treatment room, reminding me that I was spending too much time with ‘the sleep patient’ and it was sabotaging her schedule. Though being a multi-tasker was a natural for me, I was struggling to keep it all flowing – perio, implants, pros, cosmetics and … Sleep. The sleep patients needed much more time and focus. And I had to choose between changing a life and saving a life. So I chose. In a very short period of time, I sold my dental practice and began a dedicated sleep practice. This is what I found:

Physicians looked at me differently – I was no longer a dentist to them but a sleep specialist. (Though I could never claim this title)
In a dedicated sleep practice, I didn’t miss a single OSA or TMD diagnosis because that’s all I did.
Working within the medical model and accepting medical insurance is challenging but necessary.
Undiagnosed sleep apnea was all around me, and I realized there are a lot of “Joe’s” that needed my services.

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.

Diet, Exercise, and Good Sleep Are Keys to Brain Health

November 14, 2014 SleepDT Leave a comment

Sleep continues to wind its way into “three-legged” stool arguments when pondering the foundations of true health. Researchers are finding that diet, exercise, and sleep are all keys to lowering the risk of developing cognitive decline later in life.

Wise food choices and lots of exercise are a good base, along with learning new material and keeping socially connected—but another key element of brain health is good sleep.

We may take sleep for granted, but research suggests this is not a passive process, a board-certified neurologist who practices at Sutter Pacific Medical Foundation in San Francisco. There is a growing consensus that sleep is linked to learning, memory, nerve cell remodeling and repair. Evidence also suggests lack of sleep can contribute to mood and immune disorders, as well as to a decline in overall health.

According to Madison, some studies suggest that factual memories are consolidated in slow and REM sleep, based on changes at the molecular and cellular level within our brains as nerve extensions are branched, modified and reinforced. “These delicate processes can be disturbed by chemical changes in the body related to stress, pain, hormones, medications and aging, to name a few,” she writes. With aging, there is evidence that many people develop sleep disorders and experience sleep fragmentation, with slow wave and REM sleep broken up by shallower cycles.

Source: Dr. Catherine A. Madison in www.sfgate.com

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Sleep Research

ADLs for Elderly Decline with Poor Sleep

November 14, 2014 SleepDT Leave a comment

It may not be a “co-morbidity,” but difficulty with an activity of daily living (ADL) constitutes a decline in the quality of life for elderly people. According to the article “Sleep-Disordered Breathing and Functional Decline in Older Women“, older women with sleep disordered breathing were found to be at greater risk of decline in the ability to perform daily activities, such as grocery shopping and meal preparation.

The findings come courtesy of a study led by researchers at the Johns Hopkins Bloomberg School of Public Health and the University of California, San Francisco. The study was published in the online edition of the Journal of the American Geriatrics Society.

The study found that women with an AHI on the moderate to severe side, with 15 or more breathing disruptions per hour of sleep, had a 2.2 times greater odds of decline in daily activity functions during the evaluation period, which averaged five years between baseline evaluation and follow-up.

“Because sleep-disordered breathing can be treated effectively, it is possible that treatment could help prevent decline in important areas of functioning that allow older adults to remain independent,” says Adam Spira, PhD, an associate professor in the Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health and the study’s lead author in the online MedicalXPress. “As is often the case, more research is needed to investigate this possibility.”

“The researchers say they believe it is the low blood-oxygen levels caused by sleep-disordered breathing that cause the trouble with daily tasks, and not sleep fragmentation, which is also increased by sleep-disordered breathing,” says Medicalxpress. “The authors note that women who reported no difficulties with daily activities during their baseline evaluation, but a moderate-to-high AHI, had a somewhat higher risk of reporting deterioration in daily- activity function in the follow-up evaluation. No links between sleep-disordered breathing severity and decline in mobility were observed.”

Click Here for Abstract

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Sleep Research

The Most “Under-Appreciated” Health Problem in America? Sleep

November 14, 2014 SleepDT Leave a comment

Heavyweight media outlets The Huffington Post and The Oprah Winfrey Network (OWN) have been pumping out strong statements in recent weeks, and it backs up what sleep publications have been trumpeting for years: sleep matters to health. A recent Huff Post article quotes celebrity physician Mehmet Oz, MD, MBA, saying that sleep is nothing less than the “single most under-appreciated health problem in America.”

The article even poses the provocative question—What’s more important? An hour at the gym or an extra hour of sleep? Dr. Mehmet Oz, starring in the new series “Surgeon Oz” on OWN, says there is a definitive answer. “I feel pretty passionately about this,” he says. “If you have the choice between an extra hour of sleep or an extra hour of working out, you sleep.”

Although exercise has enormous value, says Oz in the #OWNSHOW video, he points out that “people who don’t sleep, gain weight. People who don’t sleep have immune problems and a whole slew of other problems. Why deal with that?”

The sleep hygiene advice is well known by members of the sleep industry, but Oz’s reach to consumer audiences is vast, particularly with the new backing by Oprah Winfrey. As far as how many hours of sleep are needed each night, Dr. Oz says in the Huff Post that it’s cut and dry. “95 percent of people need somewhere between 7 and 8 hours,” he says. “On average, women need 7 to 7.5 hours, while men – who are needier, need 7.5 to 8.”

Source: Doctoroz.com

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Sleep Research

Analysis: A Bad Night’s Sleep Helps…Nothing

November 14, 2014 SleepDT Leave a comment

With celebrity physician Dr. Oz recently proclaiming that poor sleep is the “single most under-appreciated health problem in America,” the business and clinical practice of sleep medicine seems poised to explode. Sleep awareness has arrived like the Beatles in 1960’s America, or Taylor Swift on the red carpet at the VMAs.

Like so many “overnight” successes, awareness has actually built gradually, with study results published week after week in relatively obscure journals. The message comes in different forms, but it all comes down to an inescapable conclusion: chronically bad sleep goes way beyond daytime sleepiness, affecting virtually every aspect of health.

Does bad/shortened sleep help anything? It might help procrastinating college kids make tight deadlines, or propel high-tech start-up mavens to stunning IPOs, but for the vast majority of people, the answer is poor sleep has zero benefits. And over the long haul, poor sleep (ravaged by sleep apnea) can lead to a long list of co-morbidities. These real health problems can take years off of the average human’s life expectancy.

It sounds melodramatic, but it’s the truth. Major consumer magazines, Oprah Winfrey, and the New York Times are firmly on the sleep bandwagon, and they are not jumping off. For sleep centers, CPAP providers, and sleep physicians, it all adds up to opportunity.

Fortunately, this opportunity (and its inevitable financial rewards) is nourished by helping patients. There is no snake oil element to satisfying the demand for sleep apnea relief—through CPAP, oral appliances, and surgical alternatives. Far from being threatened by diverse treatments, ethical providers know that free-flowing referral streams, based on patient need, will help all concerned.

Long-time sleep clinicians are no doubt reading all the hype with an “I told you so” grin, and these grizzled veterans are well positioned to take advantage of increased awareness. If they continue to put patient needs first, the new age of sleep could have considerable legs.

Source: Sleep Diagnosis and Therapy Journal

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Sleep Research

Night Owl Nonsense? New Study Suggests Four Sleep Types

November 13, 2014 SleepDT Leave a comment

As reported in Atlantic.com, scientists in Russia are proposing that there are actually four chronotypes beyond the late (owls) and early (larks) risers. Instead, there are people who feel energetic in both the mornings and evenings, as well as people who feel lethargic all day.

In a study detailed in the journal Personality and Individual Differences, biologist Arcady Putilov, and his colleagues at the Siberian Branch of the Russian Academy of Sciences, asked 130 people to stay awake for 24 hours. The subjects filled out questionnaires about how awake they felt, their sleep patterns, and how well they had functioned during the previous week.

“The results showed that among them were 29 larks, who showed higher energy levels at 9 a.m. than at 9 p.m., and 44 owls, for whom the opposite was true,” writes Olga Khazan for The Atlantic. “The owls also went to bed about two hours later, on average, than the larks. But the rest of the group fell into neither of these patterns.”

As BPS Research Digest puts it: There was a “high energetic” group of 25 people who reported feeling relatively sprightly in both the morning and evening; and a “lethargic” group of 32 others, who described feeling relatively dozy in both the morning and evening.

The next big question is, writes Khazan with tongue firmly in cheek: “What bird names to assign these two new groups. Lazy Bird and hummingbird? The albatross and the peregrine falcon?”

Source: The Atlantic

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Professional Education

Dar Radfar DDS Teaches Medical Reimbursement Best Practices, for Dentists

November 7, 2014 David Gergen CDT Leave a comment

Dr. Dar Radfar took a few courses in dental sleep medicine by the so-called experts of industry. Like so many others, he burst onto the scene and in his first month, he sent Gergen’s Orthodontic Lab eight

Dar Radfar DDS New Breed of Sleep Apnea Dentistry Lecturer

cases. However, of those eight cases he was only paid on two due to the lack of knowledge and effort of a certain medical billing company, which I will not name. After countless insurance claims being denied or delayed, Dr. Radfar decided every time he got a claim denied he would pick up the phone and call the insurance company. He asked questions, spoke to a “peer” medical doctor, supervisor after supervisor, tallied up all they said, and came up with some conclusions. He realized a key common denominator kept coming up – a doctor’s chart notes play a pivotal role in medical billing as do diagnosis codes. Certain key phrases and words will need to be written to have a higher chance of getting paid. His chart notes are extremely precise, detailing all comorbidities, findings, reasons, and the list goes on. He even discovered that the type of sleep equipment used based on the insurance plan makes a difference on whether the oral appliance gets paid on, even though everything else indicates a necessity He switched medical billing companies and being the practitioner that he is, began working hand in hand with the medical billing company.

Dr. Radfar doesn’t see himself as an expert though. He believes that we are just practitioners who have more experience in the field of dental sleep medicine but that doesn’t mean we know everything. For the last 2 years, he has actually been educating other dentists through seminars that have either sold out or come close to it with people asking him “Is that all I have to do?” Well it’s not as easy as it sounds, clearly. Otherwise, everyone would be making an average of $7,000 per patient per oral appliance as Dr. Radfar informed me he does.

Dr. Radfar’s philosophy is simple, we, as practitioners did the work, why are we not getting paid in a timely matter? He spends an hour on this topic during his seminars and provides details on what the chart notes need to look like in order to win the battle against insurance companies. Because of this attention to detail, time and time again we see him get paid thousands of dollars per patient. He explained to me how he has been on hold, gotten into verbal arguments, asked for direct fax lines and emails, spoken to one supervisor one day and another one another day, just to get two different answers to the same question. He calls insurance companies weekly trying to figure out how he, and any dentist, who takes his seminar can reduce insurance denials and profit from treating sleep apnea.

So what does he do differently than other dentists practicing dental sleep medicine? Sure, he’s getting more new patient consults from medical doctors in the community, whom he has connected with, but ultimately getting reimbursed at the highest level from medical insurance is what Dr. Radfar truly spent his time perfecting. It’s never all about the money – quality patient care, and providing a service that saves lives provides ultimate satisfaction.

Dr. Radfar, who is also a diplomate of the American Sleep & Breathing Academy Dental Division, is now doing over twenty cases per month and receiving handsome reimbursement on all of them. He is out there teaching other dentists the proper procedures so that they can avoid the headaches associated with dealing with medical insurance. That’s the funny thing about these so-called expert trainers; the guys doing the training aren’t actually the ones doing the work. Sleep apnea is a serious medical condition, and the treatment of it can prevent multiple diseases, including death. Medical insurances should provide coverage for a diagnosed sleep apnea patient, as any patient treated should ideally live a healthier life with less medical expenses down the line. Dentists have the right to screen and treat their patients, and they have the right to get reimbursed at any level they feel provides value for what they have found and helped treat. So what’s saving someone’s life worth? Well Dr. Radfar believes you cannot put a price on life!

David Gergen CDT opened his family-owned Gergen’s Orthodontic Lab in Phoenix, AZ in 1986 and now employees over 80 people. David Gergen 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 received a lifetime achievement award by Dr Harold Gelb Academy as Americas greatest Orthodontic technician of all time, in 2012. He has worked for some of the pioneers in the orthodontic and sleep dentistry fields. Gergen and his father John Gergen began Gergen Orthodontic labs in 1984 and have grown it into one of the most respected labs in the country. One of his proudest achievements is receiving The National Leadership award for Arizona Small Businessman of the Year in 2004. David is the Dental Director of the American Sleep and Breathing Academy and he has also taken a spot at Tufts University teaching seminars for the Continuing-Ed program on Dental Sleep Medicine.

David Gergen CDT

Building Better Athletes With More Sleep

November 7, 2014 SleepDT Leave a comment

Those rigid curfews enforced by sports coaches for decades may indeed have scientific backing. In an article entitled “Building Better Athletes with More Sleep,” The Atlantic takes the national obsession with athletic performance and applies it to sports.

“For us humans, sleep is completely crucial to proper functioning,” writes Mark McCluskey. “As we’ve all experienced, we’re simply not as adept at anything in our lives if we don’t sleep well. Without proper sleep, whether it’s a short-term or long-term deficit, there are substantial effects on mood, mental and cognitive skills, and motor abilities. When it comes to recovery from hard physical efforts, there’s simply no better treatment than sleep, and a lot of it.”

Most research on the effects of sleep on athletes has studied sleep deprivation, and McCluskey confirms that those effects are quite strong. “Just like the rest of us, athletes see a drop in their performance across all sorts of measurements if they are kept awake for the entire night, or even just interrupted in their sleep,” he writes. “But instead of focusing on the effects of a lack of sleep, it’s more interesting to explore additional sleep as an advantage. If an athlete gets more sleep than his or her competitors, will that lead to an edge? That’s just the question that Stanford researcher Cheri D. Mah set out to answer.”

The answer, found Mah, is that a bit more sleep could dramatically enhance performance.

Source: The Atlantic

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Transportation

AAA Drowsy Driving Numbers Signal Large Problem

November 7, 2014 SleepDT Leave a comment

The AAA Foundation for Public Safety’s long-awaited report on the effects of drowsy driving concluded that as much as 21% of crashes (from 2009-2013) in which a person was killed, likely involved a drowsy driver.

“If these proportions are applied to all reported crashes nationwide, results suggest that an average of 328,000 crashes annually, including 109,000 crashes that result in injuries and 6,400 fatal crashes, involve a drowsy driver,” wrote AAA analysts in a report released this week.

According to the National Highway Traffic Safety Administration (NHTSA), approximately 1.4% of all motor vehicle crashes in the United States, 2.2% of those that resulted in injuries, and 2.5% of all fatal crashes in years 2005-2009, involved a drowsy driver, and those crashes resulted in a total of 5,021 deaths over those years.

“However, the official government statistics are widely regarded as a substantial underestimates of the true magnitude of the problem,” writes AAA. “This study estimates that as many as 6% of all crashes in which a passenger vehicle is towed from the scene, 7% of crashes that result in any injuries, 13% of crashes that result in sever injuries requiring hospitalization, and 21% of fatal crashes involve a drowsy driver.”

Full report:

https://www.aaafoundation.org/sites/default/files/AAAFoundation-DrowsyDriving-Nov2014.pdf

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Sleep Research

Losing Sleep in Distant Lands

November 7, 2014 SleepDT Leave a comment

Travelers know jet lag all too well, but soldiers losing sleep in distant lands represents a different challenge altogether. How bad is it for members of the military? As reported in the San Antonio Express News, a new medical study determined that the Army had the highest rate of chronic insomnia among the armed services over a long decade of war.

The study showed a sharp increase among men and women as the U.S. fought in Iraq and Afghanistan from 2005 to 2013 and found those veterans were more likely to have high blood pressure and Type 2 diabetes.

“Insomnia is a common complaint in active-duty service members,” the authors of the study wrote in a report issued by the Armed Forces Health Surveillance Center. “Of those returning from deployment in Iraq and Afghanistan, 41 percent reported problems sleeping.”

According to reporter Sig Christenson, the problem is well known among troops who’ve served in the war zone since 9/11. But the study found chronic insomnia, diagnosed when symptoms occur at least three times a week for three months or more, rose sharply from 2004 through 2012.

“Researchers pored over more than a decade’s worth of medical data to reach their findings, published late last week in the Medical Surveillance Monthly Report,” writes Christenson. “Both men and women slept poorly in many cases. The Army—which bore the heaviest burden of fighting in Afghanistan and Iraq, sending soldiers to the war zone on multiple occasions—had the highest rate of chronic insomnia.”

Source: San Antonio News

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Monthly Archives: November 2014

“Is A Dedicated Sleep Apnea Practice Right For Me?”

David Gergen CDT

Diet, Exercise, and Good Sleep Are Keys to Brain Health

SleepDT

ADLs for Elderly Decline with Poor Sleep

SleepDT

The Most “Under-Appreciated” Health Problem in America? Sleep

SleepDT

Analysis: A Bad Night’s Sleep Helps…Nothing

SleepDT

Night Owl Nonsense? New Study Suggests Four Sleep Types

SleepDT

Dar Radfar DDS Teaches Medical Reimbursement Best Practices, for Dentists

David Gergen CDT

Building Better Athletes With More Sleep

SleepDT

AAA Drowsy Driving Numbers Signal Large Problem

SleepDT

Losing Sleep in Distant Lands

SleepDT

Sleep Scholar for Sleep Medicine Professionals

Sleep Scholar for Sleep Medicine Professionals

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