Sleep Apnea
Does your spouse snore?
Did you hear about the newly discovered link between snoring and bruising? The connection was made clear when one spouse admitted to the doctor that her husband's bruises were from her efforts to stop the snoring! Mystery diagnosis solved!
With 200 million snorers in the United States the odds are that everyone will have numerous opportunities to be "entertained" or annoyed by a snorer. Whether it is someone in the next tent, in the next room, or lying next to you in bed, snorers oblivious to their own plight can make life miserable for anyone trying to sleep around them.
Consider the impact of the following noises:
Snoring jokes and humor aside, snoring is no joke for those who have to put up with it. But there is a darker side associated with this annoying nocturnal sound effect.
Snoring can be very hard on marriages, causing many couples to sleep in different rooms in the house. It can have otherwise unintended consequences such as daytime tiredness, falling asleep while driving and impaired mental clarity.
As annoying and problematic as snoring is, it is only the tip of this noisy and deadly iceberg. Bellevue dentists say that snoring is the beginning of a health-disease continuum that researchers now link with many of life's most challenging diseases, and even to death itself.
As snoring deepens or persists, its cousin Sleep Apnea can raise its ugly head. Apnea is the Greek expression for "without breath" or "want of "breath". Dentists say that the numbers for this are equally staggering. With an estimated 17-20% of the population suffering from some form of sleep apnea, that means upwards of nearly 60 million Americans suffer nightly oxygen deprivation, and episodes of no breathing- which sets in play a host of risk factors connected to many troubling medical disorders.
Modern medical research has now shown that sleep apnea has terrible health consequences, nearly all of which can lead to eventual death for the sufferer. The reduced air flow lowers oxygen saturation in the blood and can lead to learning and memory problems, irritability, depression, accidents and productivity problems at work or school. Bellevue dentists say that sleep apnea is linked to such medical conditions as heart attacks and heart disease, stroke, weight gain, headaches, high blood pressure and kidney disease.
According to the National Sleep Foundation, people with untreated sleep apnea have been estimated to be three times more likely to have motor vehicle accidents. It is estimated that roughly one in four truck drivers suffer sleep apnea and experience excessive daytime sleepiness.
To be sure, oxygen is king! Without it we die. But what happens when there is subtle and chronic deprivation due to persistent nightly obstruction or narrowing of the windpipe that carries precious air to the lungs and bloodstream?
Why is this minor alteration in breathing so consequential when it comes to your health?
Consequences of sleep apnea:
Because of the constant cyclical nature of this repetitious arousal phenomenon, people who suffer from obstructive sleep apnea can't get a good night's sleep. Other than the impact that snoring has on partners; this is the most annoying part of sleep apnea. They often experience excessive daytime sleepiness and tiredness, along with Neurocognitive deficits. Bellevue dentists say that because people with sleep apnea are prone to fall asleep easily at inappropriate times, they risk experiencing more motor vehicle accidents and pose a greater danger to others on the road. Additionally, when impaired work performance from excessive tiredness is factored into the equation, it is easy to imagine the many other social and economic costs sleep apnea presents to society.
Along with the generally decreased quality of life, they also experience an increased risk of hypertension, heart disease, stroke, metabolic syndrome, insulin resistance, impotence, cognitive dysfunction, and depression. Bellevue dentists say that many people with sleep apnea are obese. However not all obese people are apneic, and there are many non-obese people who experience sleep breathing disorders.
Other common findings in people with sleep apnea are enlarged tonsils, elongated palate, uvular lengthening and edema, and thick necks. Sleep apnea is more common among men and among people in the African American and Hispanic populations, according to the National Institutes of health. Bellevue dentists say that others at risk include anyone with a family history of sleep apnea, people who are overweight, have high blood pressure, possess small airways in nose/throat/mouth, etc.
Bellevue Sleep Apnea
Sleep Disordered Breathing (SDR) occurs along a continuum, stretching from snoring all the way to breath cessation, or complete apnea. Bellevue dentists say that its most innocent manifestation is snoring which occurs when the tissues of the throat (soft palate, uvula, and back of the tongue) relax and vibrate against each other during breathing. Its worst manifestation is the complete cessation of breathing with its concomitant lowering of blood oxygen levels (hypoxia).
During sleep or relaxation, the muscles of the mouth and throat relax and the size of the airway decreases. This narrowing of diameter in the airway increases the rate of airflow traveling through the throat. This creates a low pressure environment and an opportunity for the flexible soft tissue airway walls to collapse into the opening. Bellevue dentists say that this is similar to sucking hard on a thin flexible milkshake straw and seeing it collapse on itself. As these issues at the base of the tongue and soft palate collapse and approach each other, rapidly moving air speeding past these structures creates a vibration in the tissues heard audibly as snoring.
When the airway collapses completely, all airflow stops, creating an apnea. This occurs despite repeated efforts to breathe where diaphragmatic and chest wall muscles continue to struggle almost violently to take a breath. Bellevue dentists say that without free flowing oxygen to enrich the lungs, blood levels of oxygen decrease and carbon dioxide levels increase. These changes in blood oxygen and blood chemistry stimulate an arousal or partial awakening in the brain, which in turn increases motor activity to drive the muscles around the airway to open the airway so breathing can resume. The sleeping person then gasps and chokes as the airway opens and they take in a breath or two. They then quickly settle back into a more relaxed state only to see the entire cycle repeat itself again, and again, and again.
Severity of sleep apnea is rated or diagnosed by the AHI or "Apnea-Hypopnea Index". This measures the number of times each hour there is an episode of altered breathing.
There is now an escalating amount of information from the medical research that frequent nighttime arousals (which occur when the oxygen level in the blood drops and the need to breathe overpowers sleep), set in play insidious biochemical processes which produces subtle yet serious injury to the body.
It is now believed that sleep apnea is an oxidative stress disorder. Bellevue dentists say that the plausible biological mechanism is through a "deox/reox mechanism". During moments of cyclical intermittent hypoxia, an enzyme is activated which creates a burst of free radicals which increases inflammatory biomarkers (cytokines such as C-reactive protein) and adhesion molecules which lead to endothelial dysfunction and atherosclerosis, heart disease and stroke. People with sleep apnea can have elevations in mediators which are implicated for SA have shown reductions in inflammatory mediators which are implicated in cardiovascular disease and endothelial dysfunction.
Bellevue Sleep Apnea Treatment
Strictly defined, apnea is the cessation of breathing - which by interpretation is the lack of oxygen entering the body. Hypoxia is an incremental decrease in oxygen saturation in the blood stream, meaning it carries less oxygen in the blood cells. Bellevue dentists say that therefore, treatment for sleep apnea is aimed at keeping the airway open so that normal breathing occurs through the night and hypoxia can be avoided. This is commonly accomplished via a pneumatic splint, or through repositioning the mandible forward either through the use oral appliances or through surgical methods to advance the lower jaw forward.
Other surgical methods characterized by surgically removing portions of the soft pallet, or stiffening the soft through the use of implants or creating scar tissue, have enjoyed very mixed results and poor patient acceptance. Many other less invasive strategies are also employed such as positional therapy, and weight reduction
A relatively new strategy for supporting the airway accomplished by pulling the lower jaw forward, much as paramedic would do to open the airway when dealing with an unconscious person. Bellevue dentists say that oral dental appliances made of plastic trays, anchor on the teeth and help hold the lower jaw in a forward position and thus keep the tongue from falling on the back of the throat when relaxed. Oral appliance therapy is currently enjoying a wide surge in popularity due in large part to the inability of many people to tolerate CPAP therapy.
Traditional pneumatic splint therapy (CPAP) has enjoyed mixed patient acceptance. While its success rate is clearly good among those who can put up with the therapy, there are a lot of people who are CPAP intolerant, whose condition is mild enough that an oral appliance is preferable.
Due to the effective use of oral appliance therapy for repositioning the mandible and pulling the base of the tongue forward, a landmark publication occurred in 2006 has now established that oral appliances are indicated for mild to moderate obstructive sleep apnea. Bellevue dentists say that this is a very significant occurrence.
Bellevue Dental Sleep Medicine
As mentioned above, oral appliances which hold the lower jaw forward, have recently gained considerable popularity. The staggering numbers of people who are non-compliant or intolerant of CPAP device, and who face a life-time of problems without nightly therapy, now have an acceptable alternative therapy. It is generally well tolerated and quite often preferred over a CPAP device. However its use is generally limited to treating mild to moderate sleep apnea. Bellevue dentists say that when CPAP can be tolerated and/or there is a severe sleep apnea diagnosis or other extenuating circumstances, CPAP is preferable.
Oral appliances this serve a very important in treating today's epidemic of obstructive sleep apnea. This has created a new sub-specialty in dentistry, called "Dental Sleep Medicine". The American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine have come together to develop standards and protocols for the joint effort to treat sleep apnea as it relates to the use of oral appliances.
The American Academy of Sleep Medicine has recently published its Practice Parameters regarding Oral Appliances for Obstructive Sleep Medicine. In part they read:
"Oral appliances (OAs) are indicated for use in patients with mild to moderate OSA who prefer them to continuous positive airway pressure (CPAP) therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP. -Oral appliances should be fitted by qualified dental personnel who are trained and experienced in the overall care of oral health, the temperomandibular joint, dental occlusion and associated oral structures." - American Academy of Sleep Medicine, Practice Parameters
The American Academy of Sleep Medicine has recently published its Practice Parameters regarding Oral Appliances for Obstructive Sleep Medicine. In part they read:
"Oral appliances (OAs) are indicated for use in patients with mild to moderate OSA who prefer them to continuous positive airway pressure (CPAP) therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP. -Oral appliances should be fitted by qualified dental personnel who are trained and experienced in the overall care of oral health, the temperomandibular joint, dental occlusion and associated oral structures." - American Academy of Sleep Medicine, Practice Parameters
The bottom line is that sleep apnea is a medical condition. Bellevue dentists say that the standard-of-care requires a proper diagnosis by a sleep physician through appropriate testing on a snoring patient who also has sleep apnea, they have made a presumptive diagnosis which could turn out to be fatal. Modern standards-of-care and accepted practice parameters discourage dentists and physicians from unilaterally treating snoring without proper sleep analysis by a sleep physician. Likewise, people should not elect to self-treat their snoring without a proper evaluation by someone trained in such analysis.
These conditions of fact would strongly suggest that people should be advised to not self-treat their snoring with self-made appliances or other non-professionally supervised methods, or by using "fringe" methods often seen advertised - especially if there is daytime tiredness, cognitive decline, or concern from others about stopped breathing during sleep.
These conditions of fact also require that dentists be exceptionally wary of agreeing to fabricate and deliver snoring and sleep apnea appliances without the involvement of a physician or a sleep lab. This is because they must suspect an occult or hidden sleep apnea problem until it is ruled out. Bellevue dentists say that to make a snoring device without proper evaluation would be to make a presumptive diagnosis that there isn't an underlying sleep apnea problem, which would and could leave many parties open to problems.
Dentists and physicians are now working together to provide an expanded array of options to help many people who suffer from snoring and sleep apnea, including the annoyed and sleepless partners who must sleep with a snorer or one who stops breathing during the night - over and over and over again!
Snoring shouldn't be dismissed as being a "cosmetic" or innocently, albeit annoying, problem. It's no joke for those who do it and for those who must suffer sleeplessly next to them. Finally there is another way out of the nightmare. For dentists, physicians and their patients - there's another life to be saved, another relationship to mend, and more good night's sleep to be achieved!
Sleep Medicine Bellevue
The advent of continuous positive pressure and the use of oral appliances created new treatment strategies and practice growth opportunities for physicians and dentists, especially as they choose to work together. To be sure, the science and practice of Sleep Medicine has created new strategic opportunities between medicine and dentistry.
With the American Academy of Sleep Medicine stipulating that oral appliances should be considered for mild to moderate obstructive sleep apnea, and that qualified dentists should work with sleep physicians to treat obstructive sleep apnea, dentists and physicians have new treatments available to them which help patients and grow practices.
Physicians are now seeking qualified sleep dentists to help their patients who snore or who could benefit from oral appliances because of a mild to moderate sleep apnea diagnosis, or because they have failed at CPAP therapy. Physicians, both generalists and specialists, recognize the wonderful contribution that dentists can have in helping them with patients who snore and who could benefit from an adjunctive treatment which is gaining in popularity and acceptance. Sleep physicians are also now realizing that dentists represent a rich referral source because they are naturally positioned in health care to both screen for sleep apnea as well as being uniquely qualified to provide treatment which advances the mandible and opens the airway.
As for dentists - they are becoming increasingly aware of the problems of snoring and sleep apnea. They are learning that because they see hundreds of patients each month and already have a vested interest in the oral environment and the patients overall health, that they are in a natural position to inquire about snoring and other sleep problems and make appropriate referrals for care.
Dentists are thus ideally situated to find people with sleep disordered breathing within their practices and from within the general population, to make appropriate referrals to physicians for a diagnosis and treatment, and to provide care through fabrication of oral appliances which assist in successful management of the airway.
Wise physicians now recognize that with the advent of oral appliances and the appearance of trained sleep dentists that they have another way to help their patients. Bellevue dentists say that the important thing for physicians to know is that by working with qualified dentists, they now have a way to treat the significant number of their patients who have been diagnosed with OSA but who remain at risk due to CPAP failure, or who have mild-to-moderate sleep apnea but are not a candidate for CPAP, or who have a snoring-only problem.
Because of these facts, astute physicians and dentists are beginning to work together to educate not only their own patients, but the public in general about sleep apnea. Bellevue dentists say that public information meetings, display ads, cross-promotional referral information, direct mailings, press releases, news interviews and briefings, and support group seminars are some of the many ways that physicians and dentist can cooperatively work together within their own communities.
Bellevue Dental Sleep Appliances
OSAP - The OSAP appliance is made of a flexible soft plastic to ensure maximum comfort. It can be made with or without an air passage. As an added bonus, it can be used for home bleaching techniques. There is a trial version available which provides an inexpensive way to test tolerance for oral appliance therapy. It can work well with upper edentulous (no teeth) and some full edentulous patients.
Silent Nite - The Silent Nite appliance is a very popular treatment for snoring. It is a smaller appliance and is very comfortable to wear. It is used mainly for people who are snorers or who have a very mild sleep apnea. It is not as durable as other appliances and has much less adjustability.
SnoreGuard - This appliances is easily assembled in the dental office. It is shaped to fit the upper dental arch and has a ramp behind the lower front teeth. Bellevue dentists say that this ramp prevents the wearer's lower jaw from falling back. Also, the tongue works to fin the opening between the upper and lower portions, which helps to keep the airway open.
Thornton Adjustable Positioner (TAP) - The TAP 1 diagnosis appliance is the only appliance that can be titrated in the sleep lab while the patient is asleep. The Thornton Adjustable Positioner uses the principle of cardio-pulmonary resuscitation to keep the airway open in order to heal patients maintain proper breathing techniques. Bellevue dentists say that oxygen is allowed to flow adequately into the airway with the help of a device that holds the lower jaw forward to prevent collapse of the airway and eliminate instances of breathing cessation. With improved breathing, patients a chance to sleep with decreased snoring. The TAP device is comfortable and adjustable to fir patients' unique size and shape mouths.
SomnoMed MAS Appliances Bellevue
The SomnoMed MAS fits over the upper and lower teeth, much like a sports mouth guard. It is a precision-made, clinically-tested medical device, which is highly effective (in most cases) in preventing snoring and mild to moderate obstructive sleep apnea. Bellevue dentists say that the SomnoMed appliance does not impinge on the tongue space and it allows normal open and close jaw movement; you can even close your mouth and lips to avoid a dry throat. The SomnoMed has stainless steel adjustment screws on the side of the appliance to provide incremental levels of jaw advancement. This optimizes the effectiveness and comfort-level of treatment, as the jaw is moved only as far as required to alleviate snoring and OSA.
Herbst Telescopic Appliance Bellevue
The Herbst Appliance has been proven to be effective on chronic snoring and mild to moderate obstructive sleep apnea sufferers. This appliance allows patients to move laterally and vertically without disengaging the appliance. Also, if it is determined that the initial position does not provide the anticipated relief of the condition, the mandible can easily be moved forward by two options of adjustability. Bellevue dentists say that the first option is traditional hardware with sets of 1,2 and 3 mm shims for advancing those increments only. The second being the telescopic version allowing the clinician to advance in ¼ mm increments by making one full turn of the protrusion collar up to 6-8mm from the start position. The appliance can be fabricated from hard acrylic, thermoactive and soft materials and is tooth retained via friction or clasps.
Adjustable PM positioned Bellevue
The Adjustable PM Positioner utilizes materials and a design that provides the patient control of adjusting the jaw position under the dentist's supervision. Studies have shown that this appliance is successful in treating 77% of patients with moderate obstructive sleep apnea. The appliance fits over all maxillary and mandibular teeth and is made of a special acrylic material that softens in hot water to provide a combination of comfort, strength, and retention. This material has proven to be very durable. Bellevue dentists say that expansion screws are located on the right and left buccal areas to allow maximum space for the tongue and easy anterior-posterior positioning of the mandible to achieve optimal effectiveness. This design permits lateral and forward movement to maintain jaw comfort.
APM Ultra Bellevue
The APM Ultra is the next generation Adjustable PM Positioner. The APM Ultra has incorporated many design features that will increase patient comfort and acceptance in addition to effectiveness. The appliance is made of a comfortable heat-sensitive acrylic and achieves its retention by projections of acrylic (no clasps). Bellevue dentists say that it is open in the front for easy breathing through the mouth and allows for excellent freedom of jaw movement. Expansion screws are located on the right and left cheek side segments that allow for precision adjustment of the lower jaw in a forward position to open the throat. It has smaller overall size with shorter periphery and increased tongue space.
Klearway Bellevue
The Klearway sleep apnea appliance works by keeping the teeth together and holding the lower jaw and tongue forward during sleep to open the airway. Klearway has excellent retention to stabilize the appliance during jaw movements which occur during sleep. Bellevue dentists say that it covers the biting surfaces of all teeth and does not encroach on tongue space. It is an adjustable appliance allowing forward adjustments. Klearway allows the patient to feel less restricted and thus less claustrophobic. Lateral and vertical jaw movement is permitted which enables the patient to yawn, swallow, and drink water without dislodging the appliance. Patients with bruxism are also very comfortable in this appliance. The appliance comfortably conforms securely to the teeth for an excellent fit.
Bellevue Sleep Apnea
Custom-made mandibular advancement devices are an effective treatment option for snoring, upper airway resistance syndrome, and obstructive sleep apnea. Bellevue dentists say that evidence-based data indicates their efficacy, and international sleep societies recommend oral appliance therapy for patients with sleep-related breathing disorders. The following position paper by the German Society of Dental Sleep Medicine is to guide the interdisciplinary team in detail when to prescribe oral appliances. Seattle Dentists support the responsible use of OA as an effective treatment option for patients with sleep-related breathing disorders. Dentists advise of proper indication regarding OSA severity, body mass index, and dentition. It emphasizes the interdisciplinary approach of oral appliance therapy and suggests treatment under the guidance of dentists trained in dental sleep medicine.
Bellevue Sleep Apnea Syndrome
Over 12 years ago, an editorial in the New England Journal of Medicine asserted that untreated sleep-disordered breathing and particularly its major manifestation, obstructive sleep apnea, was a major public health problem equivalent to smoking. Bellevue dentists say that sadly, while this was an apparent clarion cry to action, there has been a marked reluctance on the part of the medical establishment to address this issue with the sense of urgency required. Sleep specialists can have a tremendous impact on the progress and growth of the industry by educating fellow physicians and the public about the serious health consequences of untreated Sleep Apnea, increasing the treatment capacity of their practices, and advocating better patient care by the caregivers with whom they deal.
Sleep Apnea Syndrome Bellevue
Undiagnosed obstructive sleep apnea (OSA) can contribute to hypertension, cardiovascular disease, stroke, and detract from overall quality of life. Dentists can play an important role in detecting, making recommendations for, and treating OSA with oral appliances. A survey of 18 questions of knowledge and opinion of, educational background for, and clinical experience with OSA and oral appliances was mailed to 500 general practice dentists in Indiana. Bellevue dentists say that two hundred survey returns produced 192 valid responses. Responders reported very strong positive opinions toward oral appliances. However, 58% of dentists could not identify common signs and symptoms of OSA, and 55% of dentists did not know the mechanism for mandibular advance devices. Only 39% of dentists could identify snoring, mild OSA, and intolerance to continuous positive airway pressure as possible indications for OA treatment. Respondents reported a general lack of education about both OSA and OAs. Only 31 were taught about this issue in dental school; 77 knew little or nothing about OA treatment for OSA patients; 57 learned from postgraduate training. Cooperation and referrals between dentists and physicians were rated as 'poor'. Bellevue dentists say that results suggest a need for increased education and training regarding OSA and OAs in dental school, as well as increased cooperation between dentists and physicians. Seattle dentist Dr. Shawn Keller is working hard to bridge this gap between dentists and physicians in the Seattle area for better patient care.
Bellevue Sleep Problems
Oral appliances for the treatment of snoring and obstructive sleep apnea (OSA) have become an accepted therapeutic modality. Many medical providers involved in the diagnosis and treatment of this disorder have neglected the importance of involving a trained dentist and a dental facility in the process of providing treatment. Bellevue dentists say that the purpose is to point out the potential for unexpected dental conditions and avoidance of medical and legal complications encountered in a relatively straightforward clinical encounter for the fitting and construction of an oral appliance.
Trouble Sleeping Bellevue
Symptoms and signs in 12 patients with severe obstructive sleep apnea (OSA) syndrome have been presented. The most common symptoms were snoring, increased motor activity during sleep and excessive daytime tiredness. Bellevue dentists say that the factors predisposing to OSA syndrome were obesity and anatomic abnormalities of the upper airway structure. In some cases the signs of OSA included hypertension, right heart failure, chronic alveolar hypoventilation and polycythemia.
Polysomnography showed sleep fragmentation and the prevalence of light sleep stages. The prevalence of sleep apnea tends to increase with age but the severity decreases. By the time that patients are finally diagnosed for sleep apnea, they have already been heavy users of health services for several years. Bellevue dentists say that it is possible that our findings reflect the presence of some of the risk factors that predispose people to having OSA, such as, obesity, alcohol usage, and perhaps tobacco consumption. .
Sleeping trouble Bellevue
Nightly nicotine withdrawal as well as other respiratory and pulmonary effects of smoking may result in sleep-disordered breathing, especially obstructive sleep apnea (OSA). We hypothesize that smoking is an independent risk factor for OSA. Bellevue dentists say that according to a recent study, aimed to determine whether there is a higher prevalence of smoking in patients with OSA compared with patients who do not have OSA. Adjusted for BMI, gender, age, and number of alcoholic drinks per week, former smokers were not more likely than non-smokers to have OSA. Cigarette smoke may be an independent risk factor for OSA in this referral population.
Bellevue sleep doctor
The incident of cardiovascular disease (CVD) was explored in a consecutive sleep clinic cohort of 182 middle aged men with or without obstructive sleep apnea. All subjects were free of hypertension or other CVD, pulmonary disease, diabetes, psychiatric disorder, alcohol dependency, as well as malignancy at baseline. Data were collected via the Swedish Hospital Discharge Register covering a 7-year period before December 31, 1998 as well as all questionnaires. Effectiveness of OSA treatment initiated during the period as well as age, BMI, systolic blood pressure, diastolic blood pressure at baseline, and smoking habits were controlled. Bellevue dentists say that the incidence of at least one CVD was observed in 22 of 60 cases with OSA compared with 8 of 122 subjects without OSA. In a multiple logistic regression model, significant predictors of CVD incidence were OSA at baseline and age after adjustment for BMI, SBP, and DBP at baseline. In the OSA group, CVD incidence was observed in 21 of 37 incompletely treated cases compared with 1 in 15 efficiently treated subjects. In a multiple regression analysis, efficient treatment was associated with a significant risk reduction for CVD incidence in OSA subjects. Dentists conclude that the risk of developing CVD is increased in middle-aged OSA subjects independently of age, BMI, SBP, DBP, and smoking. Bellevue dentists say that furthermore, efficient treatment of OSA reduces the excess CVD risk and may be considered also in relatively mild OSA without regard to daytime sleepiness.
Bellevue sleep doctors
Obstructive Sleep Apnea Syndrome is caused by an increased propensity for upper airway collapse during sleep. Bellevue dentists say that much of the airway is supported by a bony or cartilaginous framework, but the dual fundtion of the pharynx as both a conduit for deglutition and ventilation necessitates that its walls be muscular and this compliant and collapsible. During inspiration, negative pressure is generated within the airway by the action of the respiratory muscles. Air flow is governed by the Bernoulli principle and the Venturi effect. The Bernoulli principle states that a column of air flowing through a conduit produces a partial vacuum or negative pressure at the margins of the column. The Venturi effect describes the acceleration of flow as a current of air or liquid enters a narrowed passage. Bellevue dentists say that these forces act upon the pharyngeal walls during inspiration to promote collapse of the airway. Obstructive sleep apnea syndrome is not only a disease that presents with symptoms that are troubling to the patient and their family, but has severe complications which may be life-threatening. Despite new insight into the causes of the syndrome, treatment modalities remain suboptimal. Non-surgical treatments are limited by poor patient compliance, while surgical procedures have variable outcomes. Proper patient selection and long-term follow up may increase the effectiveness of the therapies and decrease the morbidity and mortality associated with the syndrome.
Bellevue dentist sleep
Increased awareness that changes in sleeping habits and daytime behavior may be attributable to obstructive sleep apnea syndrome has led many patients to seek both information and definitive treatment. Dentists are able to identify patients with OSA and assist them in making informed decisions regarding treatment options. Bellevue dentists say that in patients who have identifiable anatomic abnormalities of the maxilla and mandible resulting in a narrow pharyngeal airway, orthognathic surgery appears to be an excellent treatment option. OSA is a common condition associated with significant morbidity and mortality. It is therefore important that dentists be aware of the signs and symptoms of OSA, so that the diagnosis can be confirmed and treatment initiated as soon as possible. Bellevue dentists say that as knowledge about the pathophysiology of OSA improves, treatments may be designed to address specific causes of the condition. In patients with identifiable anatomic abnormalities of the maxilla and mandible resulting in a narrow pharyngeal airway, orthognathic surgery appears to be an excellent treatment option.
Bellevue dentists sleep
Snoring correlates best with neck size, smoking, and nasal stuffiness. Obstructive sleep apnea, defined by nocturnal hypoxaemia, correlates best with neck size and alcohol, and less so with age and general obesity. Approximately 1/3 of patients with sleep apnea have another identifiable sleep disorder, usually requiring treatment. Bellevue dentists say that this suggests that practitioners evaluating and treating sleep apnea ought to be prepared to deal with other sleep disorders as well. OSA is also more common among minorities, than had been previously believed, but less co-morbidity may be associated. Logistic regression analyses showed that sex, BMI, and hypertension were closely associated with the risk of OSA. OSA is a common problem in the Korean adult population. Understanding and treatment of OSA may be essential in terms of intervention to reduce the risk of related medical problems.
Bellevue sleep dentist
There is increasing evidence that sleep apnea syndrome is associated with a considerable number of adverse sequelae, both behavioral and physical. Behavioral consequences include daytime sleepiness, impaired concentration and neuropsychological dysfunction, whereas physical consequences include cardiovascular disorders, particularly hypertension. Bellevue dentists say that compared to the general population, OSA patients appear to have at least twice as much hypertension, ischemic heart disease and cerebrovascular disease. This population of patients has a high incidence of other co-existing cardiovascular risk factors such as obesity, hyperlipidaemia, increased age, male sex, smoking history and excessive alcohol intake, which makes the identification of a clear independent association of OSA with cardiovascular disease more difficult. Bellevue dentists say that a growing, but not yet conclusive, body of evidence points to an independent link between OSA and ischaemic heart disease and stroke.
Bellevue sleep dentists
Sleep serves as an indicator of health and quality of life and therefore is highly and directly relevant to the practice of dentistry. Indeed, numerous studies have recently shown that sleep disorders often come with a broad range of medical and psychiatric conditions and also have a negative impact on health, mood, and quality of life. Bellevue dentists say that increasing evidence also points to a bidirectional relationship between sleep and health; that is, sleep disturbances contribute to the development of or increase the severity of various medical and psychiatric disorders, and these same disorders result in poor sleep quality.
Bellevue dentist sleep appliance
In older patients, sleep may be a vulnerable period for death and cardiovascular causes. Because of its high prevalence in the elderly, sleep apnea has been suggested to be one mechanism contributing to such sleep-related mortality. Bellevue dentists say that natural death during sleep in the elderly may be associated with specific pathophysiological events during sleep.
Bellevue dentists sleep appliance
Sleep apnea syndrome is estimated to affect as many as 2-3% of the adult male population. Excessive snoring and daytime sleepiness are but a few of the many clues to diagnosis. Bellevue dentists say that the phypoxemia occurring as a result of apnea may lead to pulmonary hypertension. Depressed respiratory center neural output or upper airway occlusion during sleep may cause the apnea. Your Seattle dentist has many treatment options available. Abnormal breathing and oxygen desaturation during sleep in subjects with chronic obstructive lung disease of the syndrome hypersomnolence with periodic breathing may represent the superimposition of smoking or obesity on a normal tendency to snoring and oxygen desaturation in men.
Bellevue snoring
Sleep disordered breathing is a complication of obesity estimated to occur in about 4-6% of overweight individuals. These respiratory disturbances during sleep incorporate a number of conditions including snoring, upper airway resistance syndrome and obstructive sleep apnea syndrome. It is thought that as well as having deleterious effects on sleep quality, these conditions may also promote cardiovascular and hormonal changes leading to an elevated blood pressure and an increased incidence of cardiovascular morbidity. Bellevue dentists say that evidence reviewed here points to an alteration in sympathovagal balance, baroreceptor sensitivity, insulin resistance and leptin, growth hormone and lipid levels. Whether these changes are a consequence of the associated obesity or the SDB itself remains to be proven.
Snoring Bellevue
Disordered breathing during sleep is widely under diagnosed in the United Kingdom. The condition is linked to increased use of medical resources and a greater risk of daytime sleepiness, which augments the risk of accidents. Dentists should ask patients and bed partners regularly about snoring and breathing pauses during sleep.
Bellevue sleeping disorder
Obstructive sleep apnea is an under diagnosed, but common disorder with serious adverse consequences. Regression analysis showed that the reciprocal of the hypopnea among cases was significantly related to log-transformed annual medical costs after adjusting for age, gender, BMI. Dentists conclude that patients with undiagnosed sleep apnea had considerably higher medical costs than age and sex matched individuals and that the severity of sleep-disordered breathing was associated with the magnitude of medical costs. Bellevue dentists say that using available data on the prevalence of undiagnosed moderate to severe sleep apnea in middle-aged adults, we estimate that untreated sleep apnea may cause $3.4 billion in additional costs in the U.S. alone. Bellevue dentists say that the prevalence of undiagnosed sleep-disordered breathing is high among men and is much higher than previously suspected among women. Undiagnosed sleep-disordered breathing is associated with daytime hypersomnolence.
Bellevue sleep disorder
The International Classification of Sleep Disorders distinguishes more than 80 different disorders, which can be effectively treated. Problems with falling asleep or daytime sleepiness affect approximately 35 to 40% of the U.S. adult population annually and are a significant cause of morbidity and mortality. Bellevue dentists suggest that however, the prevalence, burden and management of sleep disorders are often ignored or overlooked by individuals and society in general. This leads to an under appreciation and under treatment of sleep disorders, making this group of illness a serious health concern. Sleep medicine is a young discipline, and as such the full implications of treating sleep disorders and the extent of sleep-related problems are not well delineated. As a result of high prevalence, severe complications, and concomitant illnesses in untreated cases, the cost implications are immense. The costs can be direct, indirect, related, and intangible. However, relatively little has been published on the economic implications of sleep disorders. Bellevue dentists suggest that economic analysis can help evaluate available resources to set priorities and maximize management strategies for cost control without sacrificing safety, efficacy, or effectiveness. There has been considerable evidence of the cost-effectiveness of treating patients with obstructive sleep apnea, especially considering its high prevalence, morbidity, mortality, and concomitant health care consumption. Dentists and physicians have reviewed the economic balance sheet of sleep disorders and concluded that sleep medicine education and the availability of diagnostic and therapeutic facilities to treat sleep disorders will reduce.
Bellevue sleep disorders
The role of oral appliances for treatment of nonapneic snoring and sleep apnea is currently being assessed. Most patients with sleep apnea are being offered nasal continuous positive airway pressure (CPAP) as the treatment of choice. Bellevue dentists suggest that however, with mild sleep apnea, this group of patients is notorious for poor acceptance of CPAP. That is why oral appliances constitute an attractive noninvasive alternative for patients with sleep apnea, provided the efficacy, compliance, long-term tolerance, and satisfaction with these appliances are established. Adjustable mandibular positioning appliance is an effective treatment alternative for some patients with snoring and sleep apnea.
Bellevue sleeping issues
The mechanisms of action of oral appliance therapy in obstructive sleep apnea are poorly understood. Videoendoscopy of the upper airway was used during wakefulness to examine whether the changes in pharyngeal dimensions produced by a mandibular advancement oral appliance are related to the improvement in the severity of obstructive sleep apnea. Following insertion of the oral appliance the reduction in AHI was related to the increase in cross sectional area of the velopharynx. Bellevue dentists suggest that a mandibular advancement oral appliance increases the cross sectional area of the upper airway caliber is not eliminated by sleep, mandibular advancement oral appliances may reduce the severity of obstructive sleep apnea by maintaining patency of the velopharynx, particularly in its lateral dimension.
Bellevue oral appliance
Pharyngeal size and shape differences between pre and post trials of a mandinble-protruding oral appliance were investigated using cine computerized tomography. Bellevue dentists suggest that the cross-section area of these levels appeared to increase significantly with the appliance in place during wakefulness. The oral appliance appears to enlarge the pharynx to a greater degree in the lateral than in the sagittal plane at the retropalatal and retroglossal levels of the pharynx, suggesting a mechanism for the effectiveness of oral appliances that protrude the mandible.
Bellevue oral appliances
A burgeoning new arena in healthcare has opened to dentists with the potential to relieve the suffering of millions of people worldwide. Qualified dentists are increasingly being called upon to interface with the medical profession in an effort to manage the unstable upper airway during sleep. What has come to be called "oral appliance therapy" (OAT) involves the coordinated efforts of sleep physicians and the newly recognized Bellevue dentist. Bellevue dentists suggest that oral appliances have been developed that are effective in snoring patients and in patients with mild to moderate sleep apnea. Review with your Seattle dentist the appliances that are available, their possible modes of action, and their efficacy. In addition, the dentist is provided with guidelines on how to choose the appropriate patient for this therapy.
Bellevue Obstructive sleep apnea
Factors associated with increased severity of sleep apnea are: obesity, the supine sleep posture, and age, were tested for their association with the effectiveness of the Tongue Retaining Device. Bellevue dentists suggest that patients with substantial worsening of apnea index while in the supine sleep position were more responsive to the TRD than those who were equally affected in both sleep positions. Patients with mild to moderate obstructive sleep apnea (OSA) may be managed with different treatment options. Dentists compared the effectiveness of three commonly used non-surgical treatment modalities. Bellevue dentists suggest that the CPAP produced the best improvement in terms of physiological and symptomatic measures while the oral appliance was slightly less effective. Weight loss, if achieved, resulted in an improvement in sleep parameters, but weight control alone was not uniformly effective.
Bellevue obstructive sleep apnea dentist
Oral appliances are increasingly gaining a place in the treatment of sleep disordered breathing caused by upper airway obstruction. Bellevue dentists suggest that this review of publications since 1995 documents substantial progress in the scientific basis for this therapy. Imaging by several techniques has shown dentists that mandibular advancing oral appliances open the airway in awake and anaesthetized subjects, creating the presumption that this effect is maintained in sleep. Three controlled cross-over treatment trials have shown that patients consistently prefer oral appliance over continuous positive airway pressure therapy, especially when the treatment effect is strong. Bellevue dentists suggest that appliance design and use indicates a preference for adjustable mandibular advancing appliances. Complications of therapy appear to be infrequent, but evidence for safety of long-term use is still limited. Oral appliance therapy can be an effective therapy for sleep disorders caused by upper airway obstruction. Considering the accumulated evidence, it is no longer tenable to label oral appliance therapy an experimental procedure.
Bellevue obstructive sleep apnea dentists
Many patients with upper airway sleep disorders can be successfully treated with oral appliance therapy. It is necessary for dentists to recognize these patients and refer them to a physician for further evaluation. Dentists must not become primary care providers for these patients or attempt to treat a medical problem without the cooperation of a physician who must first give a formal diagnosis, which usually requires a sleep study. Dentists must also be able to treat the patients referred by physicians and to follow accepted procedures when fabricating, inserting, titrating, and providing follow-up care for oral appliance therapy. In addition, the dental community needs to continue to heighten the awareness in their local medical community and in their patient population as to the possible contribution of oral appliance therapy to the management of snoring and some of the sleep-related breathing disorders.
Bellevue OSA dentist
The Klearway appliance is the most extensively researched appliance available today. It has been shown to effectively increase airway size, to be worn consistently and to have a significant effect on both snoring and OSA. Bellevue dentists suggest that the treatment of snoring and OSA can be a very exciting and rewarding part of any dental practice. Improving the quality of someone's life with an oral appliance can significantly alter the dentist's perspective on health care delivery. Bellevue dentists suggest that an international group of dentists with expertise in this area, the Sleep Disorders Dental Society, provides a newsletter, an annual meeting, a slide set manual, and a library for member dentists and their patients.
Bellevue OSA dentists
The effect of weight loss following dietary restriction on disordered breathing on the pharyngeal airway is controversial in patients with obstructive sleep apnea (OSA). Dentists therefore prospectively studied 8 patients before and after dietary-produced weight loss. Mean weight loss was about 21 Kg. After weight loss there were significant improvements in PO2 and PCO2 measured during wakefulness, and in the number of desaturation episodes per hour of sleep, average desaturation per episode, and number of movement arousals. Bellevue dentists suggest that the number of apneas and hypopneas significantly decreased in six of eight patients. There was a significant correlation between BMI and number of disordered breathing events. Moderate weight loss in obese patients with OSA improves oxygenation during both sleep and wakefulness, decreases the number of disordered breathing events in many patients.
Bellevue OSA doctor
We investigated the influence of obesity on upper airway obstruction, especially the relationship between obesity and the type of obstruction. The site of obstruction was identified by means of endoscopic examination and dynamic MRI during sleep. Many obese patients have the circumferential type of obstruction. Bellevue dentists suggest that obstructive sleep apnea (OSA) affects a large portion of the population and is associated with repeated airway collapse leading to chronic intermittent pypoxia, exaggerated swings in intrathoracic pressure and post apneic arousal. OSA is associated with heightened sympathoadrenal tone and is a risk factor for cardiovascular mortality and morbidity. In addition to well-known mechanical and autonomic effects, OSA appears to be associated with systemic inflammation. Bellevue dentists suggest that this could provide one mechanism leading to cardiovascular disease. A central factor in the inflammatory cascade is nuclear factor kappa B, which is involved in the transcription of numerous genes involved in the inflammatory cascade. The object of this article is to review recent literature on some of the aspects of OSA related to proinflammatory state and the possible role of proteins as one mechanisms providing a link between sleep apnea and cardiovascular disease.
Bellevue OSA doctors
The association between breathing disorders in sleep and cardiovascular morbidity has been attributed to increased activation of the sympathetic nervous system; swings in intrathoracic pressure; altered blood coagulability; and, in recent years, acceleration of atherogenic process that are uniquely triggered be the apnea-related intermittent hypoxia and resultant oxidative stress. This latter explanation provides a better understanding of the natural evolution of cardiovascular morbidities in patients with breathing disorders in sleep and has major implications regarding the diagnosis and treatment of the disorder. Bellevue dentists suggest that the new understanding of the pathophysiology of cardiovascular morbidity in sleep apnea opens a new research front. To prevent cardiovascular morbidity in OSA, diagnosis and treatment of breathing disorders in sleep should be made at the earliest age possible.
Bellevue OSAS dentist
Most patients with obstructive sleep apnea have increased pharyngeal collapsibility (defined by Seattle dentists as an increased lung volume dependence of pharyngeal area), which predisposes them to upper airway occlusion during sleep. Bellevue dentists suggest that however, there are patients with severe obstructive sleep apnea who have low-normal pharyngeal collapsibility. The factors leading to nocturnal upper airway obstruction in such patients have not been ascertained. Ten overweight male patients were studied who had severe obstructive sleep apnea and low-normal pharyngeal collapsibility to determine the site of upper airway pathology in these patients. Dentists found that all ten patients exhibited paradoxical inspiratory narrowing of the glottis during quiet tidal breathing. This phenomenon was not observed in a matched group of 10 snoring, nonapneic male controls. Bellevue dentists suggest that it was concluded that paradoxical glottis narrowing may be a contributing factor in the pathogenesis of upper airway obstruction in patients with severe obstructive sleep apnea who have low-normal pharyngeal collapsibility.
Bellevue OSAS dentists
While the upper airway normally remains patent during quiet breathing in wakefulness and sleep, patients with obstructive sleep apnea have repetitive periods of upper airway closure during sleep. The upper airway closures usually occur at various sites in the pharynx. Bellevue dentists suggest that the patency of the potentially collapsible pharynx during inspirations depends on the balance between subatmospheric pressure in the pharyngeal airway and airway dilating forces generated by pharyngeal muscles. The pressure required to collapse the upper airway in the absence of upper airway muscle activity, closing pressure, is normally subatmospheric. Bellevue dentists suggest that in obstructive sleep apnea, positive pressures are required to maintain patency of the passive upper airway. The pathophysiologic mechanism underlying upper airway closures during sleep form the basis for the treatment of obstructive sleep apnea. Bellevue dentists suggest that in general, these treatment modalities attempt to raise the pharyngeal pressure above the closing pressure, decrease the closing pressure, or increase upper airway muscle activity.
Bellevue sleep apnea risks
The obstructive sleep apnea syndrome (OSA) occurs in patients of all ages, from the premature infant to the elderly. Bellevue dentists suggest that much remains unknown about the pathophysiology of the syndrome. However, research suggests that OSA in all age groups is due to a combination of both anatomic airway narrowing and abnormal upper airway neuromotor tone. The anatomic predisposing factors for OSA differ over the lifespan. Bellevue dentists suggest that however, a smaller upper airway is noted in all age groups and probably predisposes to airway collapse during sleep. Despite the known anatomic factors, such as craniofacial anomalies, obesity, and adenotonsillar hypertrophy, that contribute to OSA throughout life, a clear anatomic factor cannot always be identified. This suggests that alterations in upper airway neuromotor tone also play an important role in the etiology of OSA. Infants and children are less likely than adults to arouse in response to upper airway obstruction and do not compensate for prolonged increases in inspiratory resistive load. Bellevue dentists suggest that the overall ventilator drive is probably normal in patients of all ages with OSA. However, upper airway neuromotor tone and reflexes during sleep vary with age and are increased in normal infants and children compared to adults, perhaps as a compensatory response for their relatively narrow airway. This compensatory perhaps as a compensatory response to their relatively narrow airway. This compensatory response appears to be blunted in children with OSA. Bellevue dentists suggest that further research is needed to fully understand the complexities of upper airway structure and function during both normal development and disease.
Bellevue sleep apnea treatment
Periodic sleep apnea may be due to repeated episodes of upper airway obstruction in patients who have a short thick neck and /or large jowls. Apnea due to compete cessation of breathing may occur to a lesser extent. Analysis of the sleep electroencephalogram shows that these patients rarely achieve deep sleep and have less REM sleep than normal subjects of comparable age. Bellevue dentists suggest that they are chronically sleep-deprived, a manifestation expressed by daytime somnolence, chronic fatigue and often by personality disturbances marked by paranoia, agitated depression and hostility. The definitive diagnosis of this syndrome may be established by monitoring during sleep, the electroencephalogram, measuring abdominal excursions through a mercury-in-silastic-strain gauge and recording air flow at the nose by means of thermocouple. Bellevue dentists suggest that as demonstrated by other investigators, chronic hypoventilation during sleep leads to both pulmonary and systemic arterial hypertension, which may produce generalized cardiac enlargement and congestive heart failure. The abnormalities in the periodic sleep apnea syndrome are abolished by establishing a patent airway either through tracheostomy or weight reduction.
Bellevue insomnia
Inflammation is associated with increased risk of cardiovascular disorders, arthritis, diabetes, and mortality. Bellevue dentists suggest that the effects of sleep loss on the cellular and genomic mechanisms that contribute to inflammatory cytokine activity are not known. Sleep loss induces a functional alteration of the monocyte proinflammatory cytokine response. A modest amount of sleep loss also alters molecular processes that drive cellular immune activation and induce inflammatory cytokines; mapping the dynamics of sleep loss on molecular signaling pathways has implications for understanding the role of sleep in altering immune cell physiologic characteristics. Bellevue dentists suggest that interventions that target sleep might constitute new strategies to constrain inflammation with effects on inflammatory disease risk.
Bellevue insomnia treatment
Sleep disordered breathing is not only a problem of the upper airway but is a systemic condition with endocrine and metabolic interactions. Bellevue dentists suggest that the accumulating body of evidence shows that SDB induces changes in the serum levels of secretory patterns of several hormones. Conversely, various endocrine disorders and hormone therapies may induce, exacerbate or alleviate SDB. Much of the understanding of the interactions between hormones and sleep-disordered breathing derive from intervention studies with nasal continuous positive airway pressure therapy. Bellevue dentists suggest that better understanding of hormones and breathing may open new perspectives in developing strategies to prevent, alleviate or cure sleep-disordered breathing and its systemic consequences.
Bellevue insomnia treatments
The structural properties of the upper airway determine its collapsibility during periods of muscle hypotina. Both rapid-eye-movement sleep and increases in nasal pressure produce hypotonia, which persists even after nasal pressure is abruptly reduced ...Hypotonic upper airway becomes most collapsible by the third breath after an abrupt decrease in nasal pressure, regardless of sleep stage and despite an increase in genioglossus-muscle activity. Bellevue dentists suggest that our findings suggest that predominantly mechanical rather than neuromuscular factors modulate the properties of the pharynx after abrupt reductions in nasal pressure.
Bellevue no sleep
The upper airway is the primary conduit for passage of air into the lungs. Its physiology has been the subject of intensive study: both passive mechanical and active neural influences contribute to its patency and collapsibility. Bellevue dentists suggest that different models can be used to explain behavior of the upper airway, including the "balance of forces" (airway suction pressure during inspiration versus upper airway dilator tone) and the Starling resistor mechanical model. As sleep is the primary state change responsible for sleep disordered breathing (SBD) and the obstructive apnea/hypopnea syndrome, understanding its effects on the upper airway is critical. These include changes in upper airway muscle dilator activity and associated changes in mechanics and reflex activity of the muscles. Bellevue dentists suggest that currently SDB is thought to result activation mechanisms intrinsic to sleep. Detection of SDB is based on identifying abnormal breaths and events, but the clinical tools used to detect these events and an understanding of their impact on symptoms is still evolving. Outcomes research to define which events are most important, and a better understanding of how events lead to physiologic consequences of the syndrome, including excessive daytime somnolence, will allow physiologic testing to objectively differentiate between "normal" subjects and those with disease. Obstructive sleep apnea is associated with raised blood pressure. Bellevue dentists suggest that patients with most severe sleep apnea, CPAP treatment reduces blood pressure, providing significant vascular risk benefits, and substantially improving excessive daytime sleepiness and quality of life.
Sleepless in Seattle
Normal sleep provides a period of physiologically reduced workload for the cardiovascular system for almost one third of the human life span. Bellevue dentists suggest that snoring, the most common disorder of sleep, heralds the presence of an unstable upper airway and alerts perceptive clinicians to the possibility of OSA. Epidemiologic evidence has implicated snoring as an independent risk factor for the development of hypertension, ischemic heart disease, and cerebral infarction. However, many investigators would attribute these adverse cardiovascular effects to the substantial prevalence of OSA in habitual snorers. Bellevue dentists suggest that the detrimental effects of OSA on hemodynamics and cardiac rhythm have been well documented, and recent data have linked OSA with increased cardiovascular mortality. Worsening hypoxemia during sleep likely contributes to the nocturnal mortality observed in patients with severe COPD. Effective treatment to prevent nocturnal hypoxemia is available for OSA and COPD, with current evidence supporting beneficial effects on survival.
No sleep Bellevue
Obstructive sleep apnea is common, readily diagnosed, and usually treatable. Bellevue dentists suggest that it frequently coexists undiagnosed in patients with cardiovascular disease, activates disease mechanisms known to elicit cardiac and vascular damage, and may be implicated in progression of cardiovascular disease and resistance to conventional therapeutic strategies. In the absence of definitive evidence from large-scale trials and a better understanding of potential cost-effectiveness, the likely benefits of diagnosis and treatment of OSA are presently best appraised by your Bellevue dentist on an individualized patient basis.
Insomnia doctor Bellevue
Sleep disordered breathing is prevalent in the general population and has been linked to chronically elevated blood pressure in cross-sectional epidemiologic studies. Bellevue dentists found a dose-response association between sleep disordered breathing at base line and the presence of hypertension four years later that was independent of known confounding factors. The findings suggest that sleep disordered breathing is likely to be a risk factor for hypertension and consequent cardiovascular morbidity in the general population.
Bellevue insomnia doctor
There is strong evidence for an association between sleep apnea and cardiovascular diseases, particularly OSA and hypertension. For other cardiovascular diseases, the evidence, although suggestive, remains circumstantial. Bellevue dentists suggest that although the comprehensive diagnosis and treatment of OSA is determined by overnight polysomnography, a history of witnessed apneas during sleep, daytime somnolence, and evidence of oxygen desaturation on overnight oximetry should heighten the index of suspicion for significant sleep apnea. OSA should be considered in patients with refractory hypertension, particularly in obese subjects without the expected nocturnal decline in blood pressure, and in patients with nocturnal cardiac ischemia, nocturnal arrhythmias, and stroke.
Bellevue insomnia dentist
Sleep-related breathing disorders are strongly associated with increased risk of stroke independent of known risk factors. Bellevue dentists found that the direction of causation favors sleep-disordered breathing leading to stroke rather than the other way around, although definitive proof of this awaits the results of prospective cohort studies. If causal, even a moderately elevated risk of stroke coupled with the high prevalence of sleep disordered breathing could have significant public health implications. Bellevue dentists found the relationship between sleep disordered breathing and stroke risk factors is complex, and likely part of the risk for cerebrovascular events is because of higher cardiovascular risk factors in patients with increased RDI. The mechanisms underlying this increased risk of stroke are multifactorial and include reduction in cerebral blood flow, altered cerebral auto regulation, impaired endothelial function, accelerated atherogenesis, thrombosis, and paradoxic embolism. Because of the effects of sleep disordered breathing on vascular tone, hypertension is believed to be a major mechanism by which sleep disordered breathing might influence risk of stroke. Because sleep related breathing disorders are treatable, patients with stroke should undergo investigation, with a thorough sleep history interview, physical examination, and polysomnography. Bellevue dentists found treatment of sleep apnea has been shown to improve quality of life, lower blood pressure, improve sleep quality, improve Neurocognitive functioning, and decrease symptoms of excessive daytime sleepiness. Further treatment trials are needed to determine whether treatment improves outcome after stroke and whether treatment may serve as secondary prophylaxis and modify the risk of recurrent stroke or death.
Bellevue dentists insomnia
Adverse effects of obstructive sleep apnea (OSA) including sleep deprivation, can contribute to the progression of heart failure. Bellevue dentists found the usual indication to diagnose and treat sleep apnea is subjective sleepiness. Previous studies suggest that patients with both heart failure and obstructive sleep apnea often do not complain of sleepiness, albeit their sleep time may be reduced. Therefore, we tested the hypothesis that patients with heart failure have less sleepiness and sleep less compared with subjects without heart failure for a given severity of OSA. Bellevue dentists found patients with heart failure have less subjective daytime sleepiness compared with individuals from a community sample, despite significantly reduced sleep time, whether or not they have OSA. In patients with heart failure, the absence of subjective sleepiness is not a reliable means of ruling out OSA.
Insomnia risks Bellevue
It is concluded that patients with CHD and obstructive sleep apnea are endangered by apnea-related ischemia and that these ischemic episodes lead to activation of the CNS and additional fragmentation of sleep. Patients with nocturnal ischemia should be screened for underlying sleep apnea even if nitrate therapy fails.
Bellevue cardiovascular
Obstructive sleep apnea (OSA) exert immediate marked cardiovascular effects, and may favor the development of systemic and pulmonary hypertension in the long-term. Bellevue dentists found that as for the pathogenesis of the acute cardiovascular changes, and first studies highlighted the role of OSA-induced hypoxia and mechanical changes. However, more recent work pointed to the role played by the arousal reaction terminating OSA, and to the activity of the autonomic nervous system during apnea and inter-apneic phase. As for the pathogenesis of chronic cardiovascular changes, recent findings suggest that the link between OSA and systemic hypertension may be through an abnormal function of the carotid body and underline the importance of chronic intermittent hypoxia versus continuous hypoxia in the development of stable systemic hypertension. Bellevue dentists found that on the other hand, OSA does not appear to enhance strongly the development of stable pulmonary hypertension. In this review, we analyze OSA-induced cardiovascular changes with particular emphasis on to the interplay of possible pathogenic mechanisms involved. Acute OSA-induced cardiovascular alterations during the apneic phase appear to result mainly from the mechanical effects of OSA, while during the interapneic phase they seem mostly determined by chemical factors and by the arousal reaction. In addition, the role of reflex changes elicited by resumption of ventilation should be reconsidered, since lung inflation seems to exert a positive effect on the cardiovascular changes occurring at the end of OSA. Bellevue dentists found that this would be in contrast with the inhibitory effects described as lung inflation reflex, and deserves further study.
Obstructive sleep apnea in Bellevue
In the past decade, obstructive sleep apnea has been increasingly recognized as an important and independent risk factor for cardiovascular disease. In addition, large cross sectional and prospective studies have demonstrated that sleep disordered breathing predicts hypertension, a major risk factors for cardiovascular disease, in a dose-dependent fashion. Bellevue dentists found that sleep apnea is associated with endothelial dysfunction and that it may be dysfunction and that it may be reversible with nocturnal continuous positive airway pressure. These studies ass further weight to the concept that sleep disordered breathing has profound adverse consequences on cardiovascular health.
Insomnia doctor in Bellevue
Sleep apnea is not the only condition causing sleepiness that increases the risk of traffic accidents. Consumption of alcohol, sleep deprivation, working at night, driving between the hours of midnight and 6 a.m. of for long periods without a break, narcolepsy, and the use of sedating drugs all cause sleepiness and have been implicated in traffic accidents. Bellevue dentists found that the presence of any combination of these factors also substantially increases the risk of a traffic accident. Sleep apnea is most likely a factor in a substantial number of accidents.
ADD Bellevue
Inattention and hyperactivity symptoms, the highly likely ADHD and probable ADHD groups were more likely than the non-ADHD group to have a variety of current and lifetime sleep problems. No significant difference in sleep problems was found between the highly likely ADHD and probable ADHD groups. Inattention, but not hyperactivity, was associated with greater sleep need and greater difference between sleep need and self-estimated nocturnal sleep duration. Consistent with prior findings from children and teens, ADHD symptoms in young adults are related to sleep problems. Bellevue dentists found that further studies on adults with ADHD should help refine our understanding of the causal basis for any implications of this association.
Bellevue ADD
It has been well documented that depression can lead to insomnia. However, evidence from previous research and from clinical experience indicates that the reverse can also be the case: long-standing insomnia can often lead to depression. Bellevue dentists find that for many people suffering from insomnia and depression, treating insomnia successfully without medication can lead the depression to lift as well. Studies showed that 70% of insomnia sufferers who were depressed before treatment and learned to sleep better were no longer depressed, or were significantly less depressed, once their sleep had improved. Bellevue dentists find that by contrast, among people who did not learn to sleep better, none experienced a significant reduction of depression. The conclusion is that, for many people who suffer from both depression and insomnia, treating insomnia successfully without medication can eliminate or significantly reduce the depression.
ADHD Bellevue
Obstructive sleep apnea (OSA) is a syndrome in which the airflow created from breathing ceases through the upper airway although diaphragm movement continues. Bellevue dentists find that resulting complications include severe daytime sleepiness, morning headaches, loud snoring, and disturbed nighttime sleep. Patients affected with OSA are frequently hypertensive and can have dangerous cardiac arrhythmias. The diagnosis of OSA requires an all-night polysomnographic recording; neither snoring nor other subjective complaints constitute adequate criteria for treatment. The treatment objective for OSA is to maintain airway patency. Bellevue dentists find that a potential treatment discussed here is temporary advancement of the mandible or tongue during sleep with the use of dental appliances.
Bellevue ADHD
Upper airway sleep disorders are becoming recognized as common medical concerns. Multiple treatment options have been advocated, including the use of dental devices. Dentists are being asked by the medical profession to become a part of the treatment team. Bellevue dentists find that this may be a challenging task because of the large number of dental devices available, rapid advancement in the understanding of this disease, and numerous publications. Dental devices are indicated in snoring and mild-to-moderate obstructive sleep apnea patients after medical evaluation and referral.
Dentists Bellevue
Obstructive sleep apnea syndrome (OSA) is a common but under diagnosed, disorder that is potentially fatal. It is characterized by repetitive episodes of complete or partial upper airway obstruction leading to absent or diminished airflow into the lungs. Bellevue dentists find that these episodes usually last 10 to 30 seconds and result in loud snoring, a decrease in oxygen saturation, and chronic daytime sleepiness and fatigue. The obstruction caused by the soft palate, base of the tongue or both collapsing against the pharyngeal walls because of decreased muscle tone during sleep. Potentially fatal systemic illnesses frequently associated with this disorder include hypertension, pulmonary hypertension, heart failure, nocturnal cardiac dysrhythmias, myocardial infarction and ischemic stroke. Bellevue dentists find that the classic signs and symptoms of OSA may be recognizable by dental practitioners. Common findings in the medical history include daytime sleepiness, snoring, hypertension and type II diabetes. Common clinical findings include obesity, a thick neck, excessive fat deposition in the palate, enlarged tongue and pharynx, a long soft palate, and calcified carotid artery atheromas on panoramic and lateral cephalometric radiographs. Dentists aware of these signs and symptoms have an opportunity to diagnose patients with occult OSA. Bellevue dentists find that after confirmation of the diagnosis by a physician, dentists can participate in management of the disorder by fabricating mandibular advancement appliances and performing surgical procedures that prevent recurrent airway obstruction.
Dentist Bellevue
Oral appliances are increasingly gaining place in the treatment of sleep disordered breathing caused by upper airway obstruction. Since 1995, substantial progress in the scientific basis for his therapy have been made. Bellevue dentists find that imaging by several techniques has shown that mandibular advancing oral appliances opens the airway in awake anaesthetized subjects, creating the presumption that this effect is maintained in sleep. Three controlled cross-over treatment trials have shown that patients consistently prefer oral appliance over continuous positive airway pressure therapy, especially when the treatment effect is strong. Appliance design and use indicates a preference for adjustable mandibular advancing appliances. Bellevue dentists find that complications of therapy appear to be infrequent, but evidence for safety of long-term use is still limited. Oral appliance therapy can be an effective therapy for sleep disorders caused by upper airway obstruction. Considering the accumulated evidence, it is no longer tenable to label oral appliance therapy an experimental procedure.
Bellevue Dentists
The tongue-retaining device (TRD) was designed to increase the unobstructed dimension of the nasal breathing passage during sleep. Twenty male patients with diagnoses of sleep apnea syndrome, primarily of the obstructive type, confirmed by clinical polysomnography, were fitted with the device. Bellevue dentists find that the TRD holds the tongue in a forward position by negative pressure. Fourteen patients have been tested before and after this treatment, and ten of these have also completed two follow-up recordings four to six months after being trained in the use of this device. There was a significant improved sleep and significantly fewer and shorter apneic events on all nights when the device was worn. Bellevue dentists find that on the first night of wearing the TRD for a half night only, there was a significant reduction in the number of obstructive and central apneic episodes. The mean apnea plus hypopnea index while wearing the TRD is comparable with the rate reported for patients who have been treated surgically by either tracheostomy, although this group contained more severe cases.
Bellevue sleep related breathing disorder
Sleep related breathing disorders are common and often are associated with vascular complications such as arterial hypertension, coronary heart disease and stroke. Bellevue dentists find that the most widely studied form of these disorders is obstructive sleep apnea. Patients usually diagnosed with obstructive sleep apnea years after the onset of symptoms, which generally are nonspecific and include excessive daytime sleepiness, chronic fatigue and habitual snoring. The risk factors for sleep apnea are obesity, advancing age, male sex, and maxillofacial abnormalities. This review focuses on the diagnosis and treatment of obstructive sleep apnea and, specifically, on the utility of oral appliances in the management of this disorder. Bellevue dentists find that several treatment options are quite effective. Nasal continuous positive airway pressure, with an overall acceptance rate of 70%, is the most widely used treatment modality. Maxillofacial surgery, although effective, is reserved for patients who have not responded to the more conventional therapies. Newer methods include application of oral appliances. Oral appliances have been shown to alleviate the severity of respiratory disturbances during sleep by about 60%, with an overall acceptance rate of 75%. The long-term complications generally are minor and are related to occlusal changes and temporomandibular joint discomfort. With the advent of oral appliances, dentists are increasingly involved in managing the care of patients with sleep related breathing disorders. Bellevue dentists find that further studies are needed to determine the long-term complications of this type of intervention for the treatment of sleep related breathing disorders.
Bellevue sleep related breathing disorders
Sleep related breathing disorders are strongly associated with increased risk of stroke independent of known risk factors. The direction of causation favors sleep disordered breathing leading to stroke rather than the other way around, although definitive proof of this awaits the results of prospective cohort studies. Bellevue dentists find that if causal, even a moderately elevated risk of stroke coupled with the high prevalence of sleep disordered breathing and stroke risk factors is complex, and likely part of the risk for cerebrovascular events is because of higher cardiovascular risk factors in patients with increased RDI. The mechanisms underlying this increased risk of stroke are multifactorial and include reduction in cerebral blood flow, altered cerebral autoregulation, impaired endothelial function, accelerated atherogenesis, thrombrosis, and paradoxic embolism. Bellevue dentists find that due to the effects of sleep disordered breathing on vascular tone, hypertension is believed to be a major mechanism by which sleep disordered breathing disorders are treatable patients with stroke/TIA should undergo investigation, with a thorough sleep history interview, physical examination, and polysomnography. Treatment of sleep apnea has been shown to improve quality of life, lower blood pressure, improve sleep quality, improve Neurocognitive functioning, and decrease symptoms of excessive daytime sleepiness. Bellevue dentists find that further treatment trials are needed to determine whether treatment improves outcome after stroke and whether treatment may serve as secondary prophylaxis and modify the risk of recurrent stroke or death.
Bellevue respiratory disease
In the past decade, obstructive sleep apnea has been increasingly recognized as an important and independent risk factor for cardiovascular disease. In addition, large cross-sectional and prospective studies have demonstrated that sleep-disordered breathing predicts hypertension, a mechanism underlying this association, however, is not fully understood. Moreover, the independent contribution of obesity, which frequently coexists in these patients, to cardiovascular complications of sleep apnea is not clear. Bellevue dentists find that two studies ass important insights regarding these questions. The investigators propose that sleep apnea is associated with endothelial dysfunction and that it may be reversible with nocturnal continuous positive airway pressure therapy. These studies add further weight to the concept that sleep disordered breathing has profound adverse consequences on cardiovascular health.
Bellevue dentists sleep apnea treatment
Obstructive sleep disordered breathing is common in children. From 3 to 12% of children snore, while obstructive sleep apnea syndrome affects 1 to 10% of children. Bellevue dentists find that the majority of these children have mild symptoms, and may outgrow the condition. Consequences of untreated sleep apnea include failure to thrive, enuresis, ADD, behavior problems, poor academic performance, and cardiopulmonary disease. The most common etiology of OSA is adenotonsillar hypertrophy. Clinical diagnosis of obstructive sleep apnea is reliable; however, the gold standard evaluation is overnight polysomnography. Bellevue dentists find that treatment includes the use of continuous positive airway pressure and weight loss in obese children. These alternatives are tolerated poorly in children and rarely are considered primary therapy. Adenostonsillectomy is curative in most patients. Children with craniofacial syndromes, neuromuscular disease, medical comorbidities, or severe obstructive sleep apnea, and those younger than three years are at increased risk of developing postoperative complications and should be monitored overnight in the hospital.
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