There’s a New Guideline for Sleep Apnea Testing…

At the beginning of March we were introduced to a new set of guidelines for sleep apnea testing. The American Academy of Sleep Medicine (AASM) developed new guidelines with an expert task force of board-certified sleep medicine physicians. These guidelines were then published in the Journal of Clinical Sleep Medicine.

The Guidelines

Recommendations were based on a systematic literature review, meta-analyses, and assessment of the evidence using the Grading Recommendations Assessment, Development, and Evaluation (GRADE) method. These new guidelines also include circumstances in which an attended polysomnography in an accredited sleep center or home sleep testing should be done for suspected obstructive sleep apnea (OSA). It’s a lot to take in, but these guidelines were created to further help us dentists, and other physicians, better treat our patients.

In addition to new guidelines, there were also updated recommendations from previous practice parameters published in 2005 and 2007. For the foundation of high quality care when diagnosing OSA, two “good practice statements” were adopted:

  1. Diagnostic testing for OSA should be conducted along with a comprehensive sleep evaluation and adequate follow-up.
  2. Polysomnography is the standard diagnostic test for adults in which OSA is suspected based on a comprehensive sleep evaluation.

To further help clinicians in diagnosing OSA in adults, the following recommendations were also made:

  • Clinical tools, questionnaires and prediction algorithms should not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing.
  • Polysomnography, or home sleep apnea testing with an adequate device, should be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA.
  • If a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography should be performed for the diagnosis of OSA.

And the list goes on, but it is important to understand these guidelines so we can better care for our patients.

Where do Dentists Come Into the Picture?

As you know, dentists don’t diagnose sleep apnea, but we can recommend our patients seek outside help. If your patient is displaying signs and symptoms of sleep apnea, it is important to be prepared. While you can’t diagnose them, you can recommend a doctor to visit for a proper diagnosis. You can also share your knowledge of the process so your patient doesn’t go into it blindly.

To review the guidelines and learn more about these new additions, you can read the article here.

Can Sleep Apnea Treatment Improve PTSD in Veterans?

I recently read an article on a study focusing on CPAP treatment and PTSD in veterans. In this study, researchers found that post traumatic stress disorder (PTSD) symptoms improved in veterans with obstructive sleep apnea (OSA) who were treated with CPAP therapy. After reading this article, my question is: will oral appliance therapy have the same results? I definitely think the chances are high!

The Study

There were 47 veterans recruited, with 40 completing the study. Of those participating, 20 had mild-to-moderate PTSD and 18 had severe-to-very severe PTSD. Researchers found that improvements in PTSD correlated with the duration of CPAP usage, and veterans with severe-to-very-severe PTSD had larger improvements in symptoms.

The only significant predictor of overall improvement in PTSD symptoms was the amount of time the veterans used the CPAP machine. The findings of this study indicate that treatment of OSA reduced PTSD severity and diminished frequency of nightmares. With prolonged CPAP use, veterans continued to experience an improvement in PTSD symptoms.

Oral Appliance Therapy

While there doesn’t seem to be an available study on the use of oral appliance therapy in veterans with PTSD and OSA, we can use CPAP therapy as an example. For veterans with PTSD symptoms, he/she might be CPAP non-compliant or just not like the treatment. The availability of oral appliance therapy for our patients allows us to successfully treat OSA, while also potentially improving PTSD symptoms in veterans–it’s worth the try!

Contact my office to learn more about oral appliance therapy and what we as dentists can do to help our patients.

Chronic Pain and Addiction: What are Your Thoughts?

A Huffington Post article discusses the opioid epidemic in the United States. This epidemic continues to increase dramatically with over 2 million Americans struggling with abuse of an opioid pain reliever. This Huffington Post article discusses the effects of chronic pain and how addiction can grow from this. Let’s take a closer look:

The Article

An estimated 100 million Americans experience chronic pain. This chronic pain can be caused by an injury, with the most common complaints of headaches, neck pain, facial pain, lower back pain, and others. Unfortunately, though, many times the pain can be enigmatic and complex or difficult to diagnose. When this happens, treatment might seem too out of reach for many patients, who then result to pain medications, such as opioids, to cope.

Women and Pain

Women are more likely to suffer from chronic pain and TMD than men. Temporomandibular joint disorders can have a wide effect on the jaw, head, and neck, and can be attributed to headaches. TMD can also be linked to pain in the ears and can be caused by:

  • Bruxism
  • Poor Body Structure
  • Growth abnormalities
  • Trauma
  • Hormones
  • Stress
  • Problems in the brain and nervous system

This pain can also lead to further complications, such as sleep disturbances. With 42 million people reporting pain or physical discomfort disrupting their sleep throughout the week, it is important to provide our patients with proper treatment. Through proper treatment we can hope that we can eliminate or decrease opioid use and addiction among women.

Let’s keep an eye on this topic and see what more we can do as dentists and craniofacial pain specialists. But before I end, I want to know what your thoughts are on this topic? Should we be doing something more?

Managing Headaches in Patients with Sleep Apnea

Have your patients ever complained about headaches? Do they suffer from sleep apnea AND experience headaches? Many times, patients with headaches will have a hard time sleeping, or attempt to go to a quiet space to sleep in order to relieve their throbbing pain. One common indicator of sleep apnea is waking up with headaches. In fact, at least 50% of people who wake up with headaches might have sleep apnea. Another common problem that can cause headaches upon waking is bruxism, or teeth grinding. So, when your patients experience headaches, what do you do?

Providing Treatment

Sleep-related headaches are a throbbing pain, which can include nausea and vomiting. As a dentist, you can help provide relief through the availability of an oral appliance. Many times, bite guards or oral appliances can help relieve aching jaw muscles caused by bruxism or misaligned jaws that might be leading to sleep apnea.

Through treatment of sleep apnea with oral appliance therapy, your patients can experience improved sleep while also resolving any pain they might be experiencing from headaches. In addition to oral appliance therapy, it is also important for patients to maintain a regular sleep schedule as well.

Let’s take charge of our patients’ health by providing proper treatment of sleep apnea and headaches. Visit my lecture page for ways to learn more.