CPAP is unquestionably the most successful treatment available for sleep apnea. Unfortunately average use of CPAP is only 4-5 hours/night, not the recommended 7 1/2 hours a night. This can lead to deadly consequences for many reasons. The 25% of patients who wear their CPAP all night every night are not at risk. Regular use of CPAP, all night- every night can change your health and welfare in amazing ways. It is the patients who try to be compliant with CPAP but cannot tolerate who are at greatest risk.
The risks of heart attacks (myocardial infarction) and strokes(cerebral vascular accidents) are increased up to six-fold in patients with untreated sleep apnea. The risk for MI and CVA is greatest between the hours of 3:00 AM and 5:00 AM. Patients who wear their CPAP for only 4-5 hours abandon this life-saving treatment before the time of night where the risk is greatest. These patients will see improvements in quality of life though tiredness is still frequent.
Oral Appliances (http://www.ihatecpap.com) are also considered a first line treatment for mild to moderate sleep apnea and an alternative treatment to CPAP for severe sleep apnea when the patient does not tolerate CPAP. Studies have shown that properly titrated oral appliances can be as effective as CPAP in most patients.
Compliance with oral appliances is much higher than with CPAP however they may be less effective than CPAP in some patients.
The use of combination therapy may be ideal for all patients who do not tolerate CPAP for the entire night. If patients wear an oral appliance and use CPAP lower pressures are necessary increasing CPAP comfort (and hopefully compliance) and if the patient discontinues use of CPAP the oral appliance will continue to prevent some or all apneic events.
Many patients find that oral appliances are very effective when properly titrated and switch from CPAP to oral appliance treatment only. It is very important that oral appliances are fitted by experienced sleep apnea dentists with extensive training in sleeping both sleep apnea and TMJ disorders.
The American Academy of Dental Sleep Medicine awards Diplomate status (D,ABDSM) to dentists who have demonstrated advanced knowledge in the field of Dental Sleep Medicine.
I have taught courses in Dental Sleep Medicine to dentist from across the U.S. for several years. These are intensive courses for dentists and their teams who want to learn expertise in Dental Sleep Medicine. The courses are limited to a maximum of 6 dentists and their teams and are held 3-4 times a year. The courses are given in my Lake County Dental office in Gurnee, Il.
I gave a full day course on Dental Sleep Medicine to 86 members of the Illinois Academy of General Dentistry in May 2011 and also a 1 hour lecture at the Illinois Sleep Society the following week. A full day lecture is a good start in the steep learning curve of Dental Sleep Medicine. My regular course offer a more intensive education with an hour a month of consultations on difficult cases.
Sleep Apnea treatment with oral appliances can also cause some TM Joint problems. These are usually minor and easily managed. The treatment of TMD (temporomandibular disorders) and the associated headaches, facial pain, migraines, sinus pain, neck pain and numerous other issues are a different matter. Patients who have both severe pain and sleep apnea should seek out neuromuscular dentists who are trained in both sleep apnea treatment and TMJ disorders.
ICCMO, the international college of CranioMandibular Orthopedics is the organization that promotes scientific advance and education in neuromuscular dentistry. There is no educational resource for neuromuscular dentistry in the midwest.
My dental practice, Delany Dental Care Ltd is currently preparing to move to a new facility in Gurnee that will allow training in Neuromuscular Dentistry. The neuromuscular dental institue will offer introductory and advanced courses in treatment of TMJ disorders, TMD, Headaches and Migraines utilizing Neuromuscular Dental therapy.
The Las Vegas Institute is the premier organization teaching Neuromuscular Dentistry as part of a comprehensive educational program. This new program is designed for dentists who want to understand more about the incredible power of neuromuscular dentistry in treating head , neck and facial pain but are not ready to commit to the expense LVI. It is also meant for LVI alumni who want hands on experience in treating pain utilizing multipe modalities in conjunction with a diagnostic neuromuscular orthotic.
We are also initiating a new treatment program for out of town patients who want to jump start treatment. We are accepting only two out of town patients a month at this time. Patient will be prequalified prior to their first visit. Our goal is to accomplish rapid reduction in pain as quickly as possible by combining a diagnostic neuromuscular orthotic with trigger point reduction and treatment with trigger point injections and spray and stretch techniques, utilization of Sphenopalatine Ganglion Blocks to address the autonomic nervous system component of chronic pain, Evaluation of related sleep disorders at the Sleep and Behavioral Medicine Institute by Dr Alexander Golbin a leader in the field of sleep medicine and author of “The World of Childrns Sleep” and the only textbook on “Sleep Psychiatry”. Patients with Sleep Apnea can also receive an oral appliance in the same time frame.
The head and neck work in conjunction with whole body mechanics and each body part effects the whole. This field is called Posturology and a diagnostic neuromuscular orthotic is a key component in allowing full body corrrections.
The time intensive nature of therapy is why we are only accepting two long distance “quick start” patients a month. These patients will arrive on Sunday so that a full day is avaialable on Monday, Tuesday, Wednesday and Thursday morning will be used to consolidate care. The patient will have their diagnostic neuromuscular orthotic Moday afternoon. Tuesday morning and afternoon treatment will vary based on individual patients needs.
More information on Neuromuscular Dentistry can be found at: http://www.sleepandhealth.com/neuromuscular-dentistry
The website http://www.ihateheadaches.org has extensive information on headaches and migraine treatment with Neuromuscular Dentistry.