Recognize sleep and chronic pain as separate disorders

Sleep apnea and chronic pain often co-exist, but it is also important to understand each condition individually for the best treatment options. In the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it is mandated that coexisting medical and mental conditions should be independently specified when treating patients. This then raises the question, which came first, pain or sleep disturbance?

Studies suggest that 50 to 70 percent of chronic pain patients suffer from a sleep disturbance and that 89% of patients seeking treatment for chronic pain report at least one complaint related to a disturbed sleep and wake cycle, according to a recent study.

Sleep apnea, restless leg syndrome and periodic limb movements in sleep are the most commonly cited ailments associated with pain. In fact, sleep apnea is diagnosed in 17 percent of headache patients, which exceeds population rates.

It is evident that pain impairs sleep, but there is evidence of a biodirectional relationship between pain and sleep. Increased pain in the daytime is often linked with poor subsequent nighttime sleep and poor sleep is associated with augmented next-day pain.

What is the relationship between pain and sleep?

In patients that suffer from chronic pain, the study states that a self-perpetuating cycle can be set in motion in which joint, myofacial or musculoskeletal disease leads to fatigue. This then leads to decreased exercise and physical deconditioning. Patients then begin to spend more time in bed, which causes their basic circadian cycle to be disrupted.

And as a result, the basic physiologic rhythm of sleep is lost and this lack of movement and sleep begins to lead to more pain and even more sleep loss. Obtaining less than six hours or more than nine hours of sleep can be associated with greater next-day pain. To help improve sleep among these patients it is important to encourage exercise. More strenuous exercise during the day will help to promote better sleep. Just make sure the exercise patients are performing is completed at least three hours before bedtime.

It is important for us as dentists to be on the lookout for signs and symptoms of sleep apnea. This is also the case for chronic pain among our patients–especially when the two are connected. By gaining a better understanding of this link, you can not only identify these conditions, but treat them individually for the best results.

Insomnia and sleep apnea can lead to premature birth, study says

With new research becoming available, it is important that we remain aware of new connections with sleep apnea. In a new study published in the journal Obstetrics and Gynecology, it was found that insomnia and sleep apnea can lead to premature births. And, from this, it augments the prevalence of serious health-related issues in preterm babies, such as cerebral palsy.

Premature births that occur before the 37th week of pregnancy are a major problem worldwide. About 15 million premature babies are born in the world every year, which places them at an increased risk of death from birth-related complications. Aside from cerebral palsy, preterm children can experience developmental disabilities, hearing impairments and other health problems because they were unable to fully develop in the womb.

The connection with sleep disorders

In an analysis of three million pregnant women from 2007 to 2012 in California, it showed that better sleep could minimize the number of premature births. Researchers analyzed anonymous records that contained medical history for these women about their pregnancies and the delivery of their babies.

It found that about 2,300 women had been diagnosed with a sleep disorder during pregnancy–insomnia and sleep apnea were the most frequent problems. From this information, it was found that insomnia increased the risk of preterm birth by 30 percent while sleep apnea increased it by 40 percent.

The study also found that 5.3 percent of women with sleep disorders gave birth before 34 weeks compared to 2.9 percent among women without sleep disorders. Understanding this relationship is important because there is a need for interventions to minimize preterm birth rates.

Unfortunately, many times pregnant women often go undiagnosed, which is why it is important to seek a diagnosis for proper care. Results from this study can help alert physicians and dentists to this potential danger.

 

Effect of CPAP use on blood pressure in patients with sleep apnea

The use of continuous positive airway pressure (CPAP) therapy is the most commonly used treatment option for sleep apnea. While it can be a successful form of treatment, not all patients wear the mask throughout the night. However, a new study published in the Journal of Hypertension shows that use of the CPAP machine did have a long-term impact on a patient’s health by reducing blood pressure.

With this information, we can further look at the long-term impact of oral appliance therapy for the health of our patients and a reduction in blood pressure and hypertension. It is apparent that the use of treatment of sleep apnea is key in protecting patients and their health in the long-run.  

The impact of treatment

This study looked to evaluate the impact of long-term use of CPAP on clinic and ambulatory blood pressure (BP) in patients with resistant hypertension (RHT) and obstructive sleep apnea (OSA). It observed 66 patients with RHT and moderate/severe OSA, using CPAP for at least a year. Clinic BP and 24-hour BP were obtained before and after follow-up.

The results showed that the average use of CPAP treatment was five hours per night with 78 percent using it at least four hours per night. There was a significant reduction of 24-hour and daytime systolic ambulatory BP. And controlled BP increased from 39 percent to 57 percent.

It was concluded that the treatment of OSA with long-term use of CPAP significantly reduces BP among patients with resistant hypertension. This is especially true with uncontrolled ambulatory BP at the baseline. What this means is that treatment is essential in not only improving OSA, but hypertension and BP too.

And while this study does not cover oral appliance therapy, we can assume the same can be said for continued use of an oral appliance. This is definitely something we need to keep an eye on and look further into. But it is clear that treatment of sleep apnea is essential to overall health and well-being.

Finish the Year Off on the Right Foot with Upcoming Lectures

With summer coming to an end, do you have the rest of your year planned out? We only have four months left before we reach the end of 2017, which means now is the time to get some extra lectures and classes in before the New Year.

 

To help you get a better picture for what is coming up in the next couple months I have listed my remaining lectures below:

September 29-30, 2017

Topic: Sleep & Pain Mini Residency Session 2

Location: Atlanta, GA

October 5-6, 2017

Topic: Dentistry and dental marketing International conference

Location: Las vegas, NV

October 13-14, 2017

Topic: Advancing your Dental Sleep Medicine Practice

Location: Atlanta, GA

October 19, 2017

Topic: ADA 2017 Meeting -Sleep Medicine Panel: Ask the Experts

Location: Atlanta, GA

October 27-29, 2017

Topic: Orofacial Pain Mini Residency Session 2

Location: Charlotte, NC

November 3-4, 2017

Topic: Dental Sleep Medicine and TMD

Location: London, England

November 10-11, 2017

Topic: Sleep, TMD, & Craniofacial Pain Symposium

Location: Las Vegas, NV

December 1-2, 2017

Topic: Sleep & Pain Mini Residency Session 3

Location: Atlanta, GA

December 8-9, 2017

Topic: Screening & Increasing Case Acceptance in Dental Sleep Medicine

Location: Jupiter, FL

There are a lot of great destinations in this list, with even more important topics to cover. I encourage you to attend a couple (or all) lectures before the end of the year. We have a lot to talk about that can help you continue to improve the services you offer your patients. I look forward to seeing some of you at an upcoming lecture!