Embrace Alternative Therapies Besides CPAP

This is important to think about: We are lying to ourselves if we don’t embrace alternative therapies other than continuous positive airway pressure (CPAP) for patients with sleep apnea. While CPAP therapy has been proven to be a successful form of treatment for patients with sleep apnea, it isn’t the only or best way for all patients.

As an alternative to CPAP therapy, oral appliance therapy is important to bring to the attention of your patients. By emphasizing how this alternative therapy option works, you can provide better treatment options for your patients. But, in order to successfully treat patients with oral appliances, I have a few things to point out.

Re-emphasize Bite Change

With your patients, it is important to re-emphasize the bite change that might occur. To help with this, ask the following questions:

  • Are you willing to give two minutes every morning?
  • Are you ok with your back molars not touching?

By asking these questions, you are setting your patients up for success. Oral appliances work, but many patients are hesitant or impatient. Asking if they are willing to give two minutes every morning to perform exercises after wearing the appliance at night will allow you to help them to ensure no bite changes occur.

The exercises work to keep their teeth aligned and bite unchanged. This is also important for the back molars. Use of the oral appliance can keep the back molars from touching if exercises are not completed. Treatment requires dedication from the patient and dentist.

Disruption in Veneers and Crowns

It is also important to note that if a patient has veneers or crowns and they pop off, that has nothing to do with the oral appliance. In fact, it has everything to do with how the treatment was conducted. Veneers or crowns that fall off or crack are typically due to not being cemented in place properly. This has nothing to do with the oral appliance.

Document Everything

This might be the most important part about treatment for your patients–not only because it helps the patient, but because it can protect your office down the road. I cannot emphasize this enough, but you must:

Document everything you say and that it did take place.

I have made this sentence bold while standing on its own because it needs to be said and engrained in your mind for every patient that walks through your office doors. Document everything. And I do mean everything. By including every detail, you can ensure proper treatment is conducted and your patients are made aware of what you said.

 

Diabetics with Sleep Apnea are at Increased Risk of Blindness

It is important to remain up-to-date with the latest advancements in not only dentistry, but dental sleep medicine as well. One way to do this is by setting up “Google Alerts” on your phone or email. This allows you to choose phrases that you are interested in receiving daily or weekly updates about.

One area I specifically focus on is sleep apnea and the different health conditions associated with it. Recently, an article came up about type 2 diabetes and its connect with diabetic retinopathy, which can lead to blindness.

The Background

Before we go into the study, let’s look at the background. Type 2 diabetes, as you already know, is a metabolic condition that has a long list of negative side effects when left untreated. One of the leading causes is obesity, which is the leading cause of obstructive sleep apnea (OSA), another dangerous disorder that can pose a greater threat to our patients’ health when untreated.

In a new study, patients who suffer from OSA and type 2 diabetes were found to have an increased risk of developing diabetic retinopathy. Despite improvements in glucose, blood pressure, and lipid levels, diabetic retinopathy remains very common. And, a loss of vision due to diabetic retinopathy can develop within less than four years.

Diabetic Retinopathy

If your patient is diabetic they are at risk for developing diabetic retinopathy, regardless of whether they suffer from OSA or not. This condition is generally considered a complication of poorly controlled blood sugar levels, and when excess sugar remains in the blood, it can lead to the blockage of tiny blood vessels in the eye. As a result, this can cut off the blood supply to the retina. The body will then try to compensate for this decreased supply of blood by developing new blood vessels in the eye. Unfortunately, though, these new blood vessels can leak easily and cause further complications.

The Study

Okay, now onto the study. In this study, 230 type 2 diabetic patients were assessed for OSA using a home-based cardio-respiratory device. Specialists also used retinal imaging to assess diabetic retinopathy. For those who were found to have OSA, they had a higher prevalence of diabetic retinopathy at 42 percent than those without, which was 24 percent.

A follow up appointment took place 43 months after testing was completed. At this visit, those with OSA were more likely to develop moderate to severe diabetic retinopathy than those without. However, diabetic OSA patients that underwent treatment for their sleep apnea had a lower risk for developing advanced diabetic retinopathy than those who did not seek treatment.

Knowing this information can help us better treat our patients who suffer from sleep apnea, as well as diabetes.

 

There’s a Deeper Connection between Migraines and Sleep Apnea

I recently received a notification about a new study published in Medscape. This new study targeted a connection between migraines and sleep apnea, which I found to be very interesting. It suggests that patients with migraines, especially chronic, are at an increased risk for sleep disturbances.

There were about 37 percent of patients with migraines that responded to the survey and were deemed “high risk” for sleep apnea. And with over 75 percent of migraine respondents with sleep apnea diagnosed by a physician, it was worthwhile to being talking to patients about this connection.

Migraines and Sleep Apnea, a Link

Dawn Buse, PhD, a director of behavioral medicine for the Montefiore Headache Center in New York City, presented new results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study at the Congress of the European Academy of Neurology (EAN) this year. Both depression and anxiety have a bidirectional relationship with migraines.  This relationship exists in sleep disorders because they can aggravate migraines, just as migraines can worsen sleep disorders.

This study had 16,763 respondents, with 12,810 providing valid data. The participants were divided into those with episodic migraines (EM) and those with chronic migraines (CM). Respondents with CM had a headache on 15 or more days in a month. There were 11,699 participants with EM and 1,111 with CM.

Chronic and Episodic Migraines

The differences between EM and CM groups were clear, though. In the CM group, it contained more women, while the EM group was significantly more likely to be employed. What was also not surprising to Dr. Buse was that the CM group was more likely to have a higher body mass index (BMI).

In followups, the risk for sleep apnea was assessed as high or low by using the Berlin Scale for Sleep Apnea. From this, 37 percent of respondents were at a high risk for sleep apnea. The risk then changes across BMI categories. For men with EM, the rates skyrocket from 11 percent those those who are underweight to 18 percent for those who are normal weight and then to 35 percent for overweight individuals and 79 percent for those that are obese.

To contrast that information, rates for women followed the same pattern, but their risks were consistently lower than those among men. In addition, sleep apnea risk for patients with CM also rose with increasing BMI. Their risk was even higher in the obese category which had 92 percent of men and 84 percent of women at higher risk for sleep apnea.

Knowing this extra information is important for the care of our patients. By understanding the connection between migraines and sleep apnea, we can continue to treat both conditions successfully.

Sleep Apnea Played a Role in Carrie Fisher’s Death

We’ve talked about different famous people and how their deaths were associated with sleep apnea–or at least played a partial role. More recently we saw the death of beloved “Star Wars” actress, Carrie Fisher. While “Star Wars” fans mourned the death of their precious Princess Leia, we were learning a lot more about her health at the time of death. What is the most interesting is her sleep apnea. We are not sure if it was the cause of her death, but it played a major role in the downward spiral of her health in addition to many other factors, such as smoking and drug use.

The Causes of Death

While she didn’t die from just one cause, sleep apnea did play a major role. Last month the coroner’s office stated sleep apnea contributed to Carrie Fisher’s death. Some of the other factors included:

  • Atherosclerosis (a buildup of plaque in the arteries)
  • Drug use
  • Smoking

The coroner did not specify if it was illegal drugs or her current prescriptions for medical issues, but her past drug use did not help her health–that’s for sure. In addition to drug use, Fisher also smoked, which can greatly increase a person’s risk of developing coronary artery disease from atherosclerosis.

Her family did not seem surprised in the results and her brother stated, “If you want to know what killed her, it’s all of it.”

Sleep Apnea’s Role

Carrie Fisher has not hidden her struggles. In fact, she has been very vocal about her struggles with addiction and bipolar disorder, but what most people are not aware of is the sleep apnea diagnosis–it more than triples a person’s risk of death. This is especially true if they don’t know they have it. And while we don’t know if Fisher was aware of her diagnosis, we do know that it contributed to her death.

It is important to get our patients tested for sleep apnea as soon as possible. Whether it is through an at-home sleep study or an in-office study, it is important for your patients to seek diagnosis for proper treatment planning. Once a diagnosis has been made, oral appliance therapy is a great option to use.