Sleep Apnea Therapy: Its all about the TEAM!

Sleep Disorders have dominated the health and wellness blogs and news sites for the last several years. It is time for patients and caregivers to wake up to the issues that come from sleep apnea.

More than 40% of adults in the U.S. have a disorder such as snoring, insomnia, restless leg syndrome or sleep apnea, according to recent studies. Dr. Patricio Reyes head of Neurology Veteran’s affairs hospital Phoenix AZ says in his recent experience it’s now clear that a lack of sleep “not only increases the risk of errors and accidents, it also has adverse effects on the body and brain,”. Neurological impact of sleep according to shows a clear implication in Dementia, Parkinson’s disease and Alzheimer’s disease. Yet most sleep disorders go untreated.

Derek Kennard often relates the story that until he began treatment with a sleep Herbst oral appliance he had not slept for more than 2 hours at a stretch

 Derek Kennard a former NFL center and Dallas Cowboys Super Bowl champion who was tough enough to play a championship game Derek Kennardagainst the Pittsburgh Steelers with a separated shoulder was almost brought down by sleep apnea. He just didn’t sleep well at night. Only grabbing sleep in 2 hour increments.  Kennard says his wife reported his breathing would stop, she would need to nudge him to get him breathing again. His passion for publicizing sleep diagnostics and therapy comes not only from his obvious success but from the fact that his brother a diagnosed sleep apnea patient passed away in his sleep from a heart attack. Heart problems are a recognized complication of sleep apnea. Reggie White also passed in his sleep of a heart attack.

Kennard is very aware of the large segment of the population that have sleep apnea. In his role as a school councilor, he has seen the signs and symptoms of obstructive sleep apnea in his coworkers. So this condition is not only a condition related to the bigger guys on the team.

Sleep Apnea is often associated with obesity which can create a false impression of a patient’s potential risk. Kennard’s brother was 6’4” and skinny as a rail.

Derek Kennard as Darth Vader
Derek Kennard as Darth Vader

Once his condition was identified Kennard went to a sleep Dr for a few tests. The most important test was an overnight sleep study. As part of the study he was put on CPAP. CPAP is a device that blows air up your nose and holds your airway open. This device is considered the gold standard or best in class therapy for obstructive sleep apnea. Kennard found that this was not a treatment he could tolerate.

The greatest impact Kennard’s condition had on his life was the sleepiness that came from waking every 2 hours. This sleepiness caused mood swings, concentration issues and of course drowsy driving. He reported falling asleep while driving often stopping on the way home from work for a short nap to improve his concentration.

Many Studies have been done in the sleep lab at Arrowhead Hospital “A patient who is young who is young, healthy and fit can be put them in a pre-diabetic state just by putting them on an irregular sleep schedule,” Reyes, says.

It is also shown in recent research that there is also a strong connection between sleep and the immune system, Reyes says. “People who do not sleep well have a 200 to 300 percent increased risk of actually catching a cold,”.

Dr. Rudi Ferrate a sleep Dr. from Arrowhead Hospital says i“My whole clinic is full of patients who are brought in by their spouses,”  When a patient is being initially diagnosed assessed Dr. Ferrate uses a simple questionnaire call the Epworth sleepiness scale. This is a list of 8 simple questions which have been validated to give a very accurate prediction of sleepiness.

Dr. Ferrate is a board certified sleep physician who is focused on all of the more than 94 sleep disorders from bed wetting and nightmares to sleep apnea. Sleep Apnea affects 1 in 3 adult males in the United States. Dr. Ferrate requires an objective measure of sleep quality using an at home or in hospital sleep study in order to form a diagnosis of sleep apnea.

Sleep Apnea is a term that refers to the absence of airflow either due to airway obstruction or due to neurological component in which the brain does not ask for a breath. The treatment for Sleep Apnea is continuous positive airway pressure (CPAP) device or, more recently an oral appliance like a sleep Herbst.

Derek Kennard’s wife couldn’t stand his snoring, but she didn’t love listening to his CPAP machine either. Kennard was concerned that “Darth Vader machine took the sexy out of the bedroom. Kennard said to me I can’t wear thing that thing, I feel like I am drowning.

Herbst
Sleep Herbst By Gergen’s Orthodontic Lab

“Some players have such severe sleep apnea that they must use both a CPAP machine and a Herbst device to get restful sleep, but Kennard is glad that the device is adequate for his treatment.

Sleep diagnosis at home or in the sleep lab is a very important part of getting treated. This will provide an objective diagnosis for the sleep physician to evaluate your condition and suggest a treatment. There are a wide range of options for treatment. CPAP for severe cases mild to moderate cases with the sleep Herbst and in some cases positional therapies with a slumberbump body position device.

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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David Gergen leads the way for Dental Sleep Medicine

Over the course of my career I have been in relentless pursuit of dental knowledge. I have learned from the best and this gave me the tools and inspiration to build a very successful practice in Dallas. If we have ever been in a course together you know that I sit up front, I record and video every presentation. Over my 10 courses a year for the last 40 years, I have developed an extensive library of presentations, I guess in some way this collection will form a large part of my legacy (if I can ever get it catalogued properly). I mention this to frame a point that occurred to me recently.

While every presenter/educator has some knowledge and some have a great point of view, the truly great presenters and mentors in the industry are willing to take the lead. Leading is tough and requires the ability to challenge yourself raise the bar and strive to challenge the status quo but also to document the process. Harlod Gelb, Robert Rickets and Wayne Halstrom and a few others fall into this category.

I particularly want to single out a person who has done so much for me in the last 7 years. David Gergen CDT has taught me so much. Several years ago I met David when I had made the decision to establish a best in class sleep apnea practice. I had engaged a famous (infamous) educator from  Erie PA who I met at the “50 pearls of dentistry course”. I spent almost $100K to learn what was at that time brand new style of practice, Dental Sleep Medicine. This educator from Erie PA was one of the most enigmatic individuals I have ever met. Almost every direct question got more than one answer, often “what do you think?” To which I would reply “ I don’t know that’s why I asked you.” The only good part of this experience was meeting David Gergen. David came to my practice at his own cost and in a few short months got my practice back on track. I knew that I needed 3 things to get my practice on track:

  1. A Qualified Patient
  2. A reliable oral appliance that fit well at the right price
  3. I needed to get paid for the work I was doing

David rapidly got me back on track. In part his process was to get me involved with the ASBA study club. At that time it was called the Scottsdale Study Club that was where I met Dr Mark Collins, Dr Paul Van Wallegham and Dr Ken Berley they were both going through the same things I was.

David has always amazed me he is a multi millionaire and he always treats me like I am his boss. I asked him why that was. David told me that his credo is “I am always on the side of the practitioner. One case per month or 10 cases per month every practitioner is equal in my eyes”.

Within a year or so I was treating retired NFL players and their families and consulting by phone with dentists all over the country that David was introducing to the NFLPA through ProPlayer Health Alliance.

In the last 2 years I think that David has taken the lead in perhaps the biggest way yet. He is now the executive director of the American Sleep and breathing academy. This is the venue for David to share with the profession his passion for sleep apnea therapy. The clinicians who will lecture at the ASBA are all currently practicing and seeing patients on a daily basis. They all are making it work. There is no reason to answer riddles with riddles. It is simple education provided by a group that is trying to lead by raising the bar staying curious and delivering for the patients.

 

Harry Sugg DDS

Harry Sugg DDS

One of the most highly respected and advanced dentists in Dallas. He and his caring team at Wheatland Dental Care pride themselves on providing the highest quality dental care in a comfortable and state-of-the-art environment. Dr Harry Sugg understands that good dental care isn't just about your teeth, it's about how you feel. A beautiful and healthy smile can make you feel and look better. We stay abreast of the latest technology to ensure that our patients receive the best dental care possible.

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Oral Appliance Therapy and Positional Therapy: Great in Combination

As I travel the country participating in sleep apnea conferences I often hear from sleep physicians that oral appliances do not achieve the same therapeutic success as CPAP. I find this to be an outrageous claim, arguably I have a demonstrated bias toward oral appliance given my history in the dental field. Also the fact that my original training in mandibular positioning to support the airway was with Dr Rickets and Dr Gelb (giants in the field) in the ’80’s. I witness fantastic successes every day with oral appliances in the hands of dentists trained to administer and monitor these devices.

A key feature that distinguishes the sleep oral appliance treatment from the CPAP therapy is that an oral appliance works over time with the muscles and ligaments to achieve a treated position. A sleep study is indicated after 6 months to confirm that the patient is in fact in a treated position. It is true that in some cases, the patent’s oral appliance cannot be adjusted further due to comfort issues. In these cases combination therapy is indicated. This is when the training and experience of the trained dentist and his team come into play.

Body position is a key factor in some of these sleep apnea cases. In fact a recent study indicated that for patients with positional apnea, body position therapy is as effective as CPAP in treating sleep apnea.

Comparison of positional therapy to CPAP in patients with positional obstructive sleep apnea.

When used in combination with oral appliances body position therapy can help patients achieve a great night sleep and an improved quality of life. I wrote up the article below to show what happened when my friend Mark Walczak who has severe OSA used combination therapy to treat his Positional Sleep Apnea

 

Mark Walczak: A Big Guy with Big Sleep Problem

I have been in the sleep therapy field for over 20 years. In that time I have witnessed the effect on patients of what I can only call an over reliance on CPAP therapy in treating OSA. Many of my close friends are ex NFL players like Roy Green, Carl Eller, Derrek Kennard, Markus Allen, Eric Dickerson and Mark Walczak many have tried CPAP but found themselves unable to comply with their prescribed therapy. Pro Player Health Alliance was founded to help these icons of the NFL share their experiences and perhaps help patients find therapy that will help them maintain their health and get a good nights sleep.

New Orleans Health ScreeningI am particularly struck by the story of Mark Walczak who has suffered with sleep apnea for many years. After undergoing an in lab sleep study it was shown that Mark had an AHI (Apnea Hypopnea Index) of 62. This is classified as severe sleep apnea “a big guy with a big sleep problem”. Mark was prescribed with CPAP and tried to wear it but was unable to make the therapy work for him.

Studies indicate that CPAP compliance is very low and is dependent on great coaching and highly engaged medical team that work a wide range of patient interfaces and desensitization protocols. This is all in an effort to help the patient adjust to wearing a mask at night with a column of pressurized air blowing into the airway. The sound of the devices and the effort to maintain a clean and effective device, all this combines and contributes to reduced compliance rates. Mark ended up a casualty of this process as do about 50% of patients who start the process according to recent studies.

As part of his journey to healthy sleep he met with Dr Roger Briggs DDS from Scottsdale AZ.  Dr Briggs made a Herbst sleep appliance for Mark. The Herbst appliance reduced Marks snoring and his sleep apnea to a moderate  level (AHI 17)  however it was not completely eradicated and with further testing it was shown that there was now a significant positional component. The decision was taken that a SlumberBump positional therapy device would be added to Marks sleep time protocol.

SlumberBump is a very simple device that is worn around the chest to help position the patient on their side while sleeping. Studies indicate that positional therapy is as effective as CPAP in mild sleep apnea patients.

stop-snoring-slumberbump-product-banner-0815

In combination Mark Walczak wears a Herbst mouth piece and a Slumberbump to bed and his AHI as registered with a sleep study went from untreated AHI of 62 all the way down to an AHI of  1. This took some time, and there were trained dental and sleep clinicians monitoring and guiding the process. I would say that the best part of this approach is that the patient has control over how often how much and understands their condition so much better.

I have to say oral appliance therapy in combination with body position therapy with a SlumberBump is a winner in my book.

 

 

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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