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Unraveling the Mysteries of Sleep, Quality of Life, and OSA

By Gary Core, DDS, Dental Specialist, Core Sleep Solutions & TMJ of Arizona

Digital - July 2024
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The American Medical Association (AMA) states that there are 30 million adult Americans with Obstructive Sleep Apnea (OSA).  And only 6 million of them are diagnosed and treated.  Hence, there are 24 million adult Americans driving while drowsy, operating machinery with a few hours of sleep, and/or experiencing exhaustion. The American Academy of Sleep Medicine (AASM) is making a national effort in their studies and reports on education on the value and biological necessity of sleep, across the board, in every spectrum.

 

OSA occurs while a person is sleeping and they stop breathing, and an apnea is for ten seconds up to one minute, several times a night.  An individual can have as many as 100 apneas in one night. With OSA, the upper airway is blocked partially or completely while sleeping. The reduced airflow triggers the brain to wake up the person. This stops the person from sleeping soundly and getting necessary oxygen for vital organs.  Besides the obvious effects of minimal and interrupted sleep, there are several health ramifications.

 

For a full discussion on factors that may raise risks of OSA, please see: https://www.nhlbi.nih.gov/health/sleep-apnea/causes, National Heart, Lung, and Blood Institute article: Sleep Apnea Causes and Risk Factors. Updated March 24, 2022
 

The long-term ramifications of untreated OSA are potentially quite dangerous. These can include cardiovascular disease, adult-onset
asthma, diabetes, liver problems, hypertension, and higher blood glucose and cortisol levels. In addition to the serious health ramifications of OSA, the psychological and physical value of sleep can’t be overly emphasized. The Sleep Foundation discusses this in detail. One item of importance: “Regular sleep disruptions, as well as sleep disorders, that affect sleep architecture like sleep apnea, can have serious consequences for physical health and mental health.
”Why Do We Need Sleep? Updated, April 5, 2024. https://www.sleepfoundation.org/how-sleep-works/why-do-weneed-
sleep

 

Yet, OSA doesn’t have to have adverse effects on patients.

My team and I, at Core Sleep Solutions, in the Phoenix metro area, have been treating OSA patients for decades, with over a 90% success rate.  We know that the Mandibular Advancement Device (MAD), specifically, the Herbst Device (acrylic retainer) is a very effective treatment. We have treated over 5,500 patients with oral appliance therapy.  Having an OSA diagnosis myself motivated me to pursue numerous hours of continuing education in this field.

We have seen considerable amounts of patients who have low compliance with CPAP; haven’t gotten their desired results; or find CPAP units bulky, cumbersome or noisy….

The Function of MAD’s – Herbst Devices

Oral appliances essentially hold the mouth and jaw in a position to allow the individual to get enough airflow. In essence, Mandibular Advancement Devices (MAD’s) advance the lower jaw forward opening the airway for breathing and preventing the tongue as an obstruction.

 

Features of the Herbst Device

Not only is this oral appliance effective in treating OSA, but patients find it very comfortable.  The appliance is discreet, eliminating the noise and bulk that come with the conventional CPAP machine and it is exceptionally durable, so patients don’t have to worry about frequent repairs or replacements with normal use.

 

Symptoms, Treatment & Getting the Herbst Device

Patients are pleased to find that our treatment process is not overly complex.  PCP’s (including internists) are generally the first group of physicians that observe OSA symptoms, and this is where patients complain of drowsiness, exhaustion, or often lack of concentration.  Other OSA symptoms are:

  • Snoring

  • Weight Gain

  • GERD

  • Morning headaches

  • Not feeling rested after a night’s sleep

  • Periods of not breathing during sleep

  • Excessive daytime sleepiness

  • Problems with memory or concentration

  • Feeling irritable, moody or depressed

  • High blood pressure

  • Increased blood glucose and/or cortisol levels

 

Once we have the referral from the PCP, (or possibly a pulmonologist, neurologist, or otolaryngologist) we proceed further with treatment. Some patients have already undergone a recent sleep study, or we give them their Home Sleep Test to take.  After a confirmed diagnosis, we:

 

  • Make a digital impression of their teeth,

  • Conduct 2/3 fittings for precision/customization of the Herbst Device, and-

  • Follow-up with a few visits to monitor acclimation.  (Patients are pleased that the acclimation period is usually just 1 – 4 weeks but can be up to 6 weeks.)

 

But due to the elusive insidiousness of the disorder and lack of readily available information, I do have genuine concerns for those who are left untreated. Alarmingly, the American Academy of Sleep Medicine (AASM) says that: “Economic burden of undiagnosed sleep apnea in U.S. is nearly $150B per year.” August 8, 2016 - Press Release. https://aasm.org/economic-burden-of-undiagnosed-sleep-apnea-in-u-s-is-nearly-150b-per-year/. With respect to that, I have treated many individuals who have had undiagnosed OSA for years, and even decades.  Their spouses thought they were lazy or unmotivated, when they were unaware themselves of their problem. We want our patients to get quality sleep.  Sleep rebalances, restores, and recharges hormones and enzymes.  Sleep is instrumental in improving memory, regulating metabolism, and reducing mental fatigue.

 

To recap, patients with untreated OSA often experience lack of concentration, memory, and focus, - which causes an onset of other problems.  They are then challenged in their careers or academia.  But, after using oral appliance therapy, patients have decreased daytime sleepiness, less health issues, and overall better quality of life.                                  

 

As we move forward in this field of treatment, let’s unravel these mysteries formerly wrapped around sleep, quality of life, and OSA!

About the Author:

Gary Core, DDS, has been practicing dentistry for over 40 years, and caring for people in a gentle and compassionate manner has always been his approach.  Dr. Core graduated with his Doctorate of Dental Surgery in 1979.  He has extensive training in all phases of dentistry - including, but not limited to: orthodontics, TMJ Disorders, and OSA.  He did a one year residency in the study of TMD/TMJ with world renowned Dr. Tanaka and has participated in several programs that include studies on occlusion, TMD, and airway management.  He has been treating TMD/TMJ and OSA for over 40 years and has amassed over 2500 hours of continuing education in this inter-related field.  Dr. Core decided to further pursue the study of OSA when he himself was diagnosed with OSA, so he empathizes with others.  He leads his team at three clinic locations in Phoenix, Tempe and Chandler, AZ. He can be reached at Core Sleep Solutions, (602) 866-1429 or Bernstein & Core - TMJ of Arizona (480) 820-6800 or learn more by visiting his website, www.core-sleepsolutions.com.

Writing Contributor:

Shirley Premont, is the Founder/Life Coach/Corporate Trainer for Power for Life. ​ Shirley leads companies & individuals to discover purpose and healthy lifestyles. Her team of experts provide public relations and marketing for health professionals in Arizona. Interested in learning more about Power4Marketing or Power of Life, please check out her website, www.power4life.biz or call her at (623) 288-3122 or (480) 881-6438

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