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January 20, 2019
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Hate  Your  ‘CPAP’ ??

Of the ten problems listed by Mayo Clinic that people who use CPAP for obstructive sleep apnea (OSA) commonly have with their CPAP, none address the power source problem!  Where do you plug the machine in?  Camping, backpacking, hunting, etc. — a small custom-made oral device may be your answer. Below are Mayo Clinic’s list.

First is the wrong style or size of mask. There are dozens of styles and it could take weeks for you to find the right one, especially if you have facial hair. There are masks that cover your nose and mouth and others that go on or into your nose - if you can tolerate them.

Second on the list is a real BIG problem — patients cannot get used to having that mask on their face. Studies have shown that if a patient cannot tolerate any mask within the first month, they usually never will be able to tolerate one.

The third problem they list is the patient’s inability to put up with air being forced into their airway. Some have a constant pressure; some have two different pressures; and some have automatic pressure based on how you breathe.

The fourth issue is the dry, stuffy nose caused by the pressurized air which can lead to other problems with the sinuses. Humidifying the air can help but increases contamination.

Fifth is claustrophobia and suffocation feelings resulting in panic attacks. And the higher the pressure required, the more these feelings can cause the patient to become intolerant to CPAP.

Leaking masks is the sixth issue and they can leave marks on the face for hours in the morning. Dry eyes, skin problems, and ulcerated lesions on the nose are common. Facial hair is a major reason for a leaking mask for men.

Number seven on the list is the difficulty in falling asleep with this pressurized air. It is just very hard to get used to.

Eighth is the dry mouth. The tongue sticks to the roof of the mouth.

Ninth is the removal of the mask during the night without knowing that you did it. The patient wakes up with the mask on the floor and may have been without it for hours.

And now number ten - the noise from the CPAP machine and the air leaks around the mask. This irritates both the patient and the bed partner. Some bed partners lose as much as 1-2 hours of sleep each night because of this issue resulting in a sleep disorder for them as well.

These are the top 10 listed by Mayo Clinic but there are still big problems. Cleaning the mask and hose is one of those big problems. Studies have shown that after cleaning the machine, hose, and mask as prescribed by the supplier, there is still a biofilm on the inside of the hose and mask. Fungus and staph have been cultured from the surfaces of “cleaned” hoses and masks! Of course, this is dangerous since pressurized air can force these into the airway. This biofilm cannot be removed by merely rinsing with a solution of any kind; it has to be removed physically which is difficult with a corrugated hose that is several feet long!

There is a comfortable alternative to the CPAP with NO strap marks. Oral devices placed by a qualified dentist trained in oral device therapy have been used effectively for decades to eliminate or reduce OSA. Some CPAP users still feel tired during the day or wake up unrefreshed. This is because CPAP may cause a lot of sleep disruption that the oral appliance doesn’t cause. Each disruption resets the sleep cycle and the patient may never get into REM sleep.  Breathing with a CPAP is unnatural while breathing with an oral appliance is natural.

If you are a camper, backpacker, hunter, etc. and are having trouble finding a way to keep your CPAP going during the night, you should look into an oral device as the possible solution to the problem. One bad night’s sleep can ruin a camping or hunting trip.

Dr. Donald Johnson founded Northwest Treatment Center for Snoring & Sleep Apnea in Coeur d’Alene to help people live free with no limits!  He is the only dentist in the Inland Empire that is both a Diplomate in the American Sleep and Breathing Academy and a Qualified Dentist in the American Academy of Dental Sleep Medicine.  His office is at 114 W. Neider Ave., near Costco.  The website for more information is www.NwSleepDoc.com and the office phone is (844) 847-6673.  Schedule an appointment for a free consultation today!

     Sleeping — the most important part of your 24-hour day. It helps restore and maintain our body’s immune, musculoskeletal, and nervous systems. It also helps to maintain mental health including performance at our daily tasks, our mood, our memory, and our sexual health. If you live to be 90 years old, you should have spent 30 years asleep. That’s the way God made you.  Over-stimulating daily activities, less-than-great lifestyle choices, work deadlines, as well as iphone and iPad technology make it much harder to get the eight hours we need. And there are many medical conditions that also make it much harder to get those eight hours.

What is the most common medical condition? Obstructive sleep apnea (OSA)

     OSA is a condition in which there are repeated episodes of partial or total blockage of the airway each lasting for 10 seconds or longer — sometimes 100 seconds. This causes the oxygen level in the blood to drop. This, in turn, causes a person to awaken subconsciously so breathing can start up again. These interruptions in breathing, oxygen levels, and sleep have a huge negative effect on the quality and quantity of sleep. And they sometimes occur hundreds of times during the night, and the patient has no idea that this is happening while they think they are sleeping.
     What are the most common characteristics of a person with OSA? Snoring and teeth clenching and grinding, and daytime tiredness. The clenching and grinding make those with OSA more likely to have cracked teeth, headaches, and jaw pain (TMJ dysfunction). Similarly, those who suffer from OSA are more likely to be depressed and stressed, which can lead to irritability.
     And while snoring doesn’t usually seem to a big deal, it leads to serious health issues — stroke, heart attack, diabetes, high blood pressure, anxiety, car/truck accidents, obesity, panic attacks, PTSD, depression, and poor work performance.

So how does OSA affect one’s sex life?

     OSA has been shown to be the cause of a loss of libido in women, and it has been shown to be the cause of erectile dysfunction (ED) in men. Testosterone is usually produced in correct quantities and therefore, sexual health is maintained. Lack of oxygen in the blood reduces the amount of nitric acid in the blood. Nitric acid is a vasodilator and therefore lack of this in the blood can result in ED. With OSA, hormonal levels can drop causing sexual dysfunction. Studies have found that lack of sleep makes one focus on self’s needs rather than other’s needs. Then the relationship suffers.

What can one do?

     A sleep study, either a polysomnogram (PSG) in a sleep lab or a home sleep test (HST) in one’s own home, is the way to determine whether or not the problem is OSA or not. Treatment is dependent upon that diagnosis. The treatment may be very simple — a change of lifestyle such as diet swaps, weight loss, avoiding smoking and alcohol as well as adjusting your sleeping position off the back. Or treatment may be more complicated. A mask with an air blower (CPAP) or an oral appliance may also be prescribed. A last line of treatment, surgery, may be prescribed. This may involve removal of tonsils and adenoids.

So, what’s the bottom line?

In a lifetime of 90 years, we should sleep for about 30 years, so it’s important. If you don’t get good, restful sleep and you snore, I suggest that you see a sleep doctor or dentist qualified in treating OSA at your earliest convenience… Your life depends on it!

Link to original article in the CDA Press here.

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February 27, 2017
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     Snoring is more than just loud noise—it is a warning sign of a bigger problem that has serious consequences.  Pain is more than just something to get rid of; it is a warning sign of something more serious.  Pain may be from a cut that may become infected—it may be from a tooth that has an abscess—it may be from your bite that is out of balance from the left side to the right side.  But pain always indicates that there is something wrong that needs your attention.  And the attention you need it is not to cover up the pain but to find the cause of the pain and get rid of that cause.

     Snoring is the same.  It’s a warning sign of a serious, life-threatening problem.  Many people who snore just go on the internet to find a quick, cheap way to stop the snoring instead of finding someone who can help them find out what is actually wrong—what is causing the snoring—so they can fix the cause!

     Snoring in children is very serious!  It usually is a warning sign that the airway is collapsing during sleep in the child.  This may be from adenoids that are too large or it may be from tonsils that are too large.  But it is imperative that the parent find out why the child snores and correct it because, among other serious side effects, it can lead to a decrease in the amount of human growth hormone (HGH) that the developing child gets.  This is a very serious situation.  If someone just says that the child will grow out of it later in life, they just do not know that this loss of HGH in childhood is not recoverable—the effects are lifelong.

     Likewise, snoring in adults is serious!  It has been show to lead to cancer, strokes, and heart disease.  It has also been linked to diabetes, ED, and even death.  Some people think they just have a big tongue, especially if there are scallop marks on the sides of the tongue.  One can look in the mirror and see if their tongue has those marks.  The tongue just seems to be too big to fit between the teeth and rests on top of the lower teeth.  But many health professionals never suspect that the jaw may be too small for the tongue—which is usually the case.  And if the jaw if too small, the treatment will be different depending on the age of the person.  Children, adolescents, and adults have to be treated differently.

     So snoring is a serious medical condition that requires that you find a health professional trained specifically in this area it you are going to have it successfully treated.  Only then can you avoid the serious health consequences mentioned above.  Who wants to end up with a stroke that causes you to be unable to walk or talk for the rest of your life?  Especially when it can be easily and successfully prevented with proper treatment.

     Many people will go to the internet to find that quick, inexpensive way to stop the snoring and they think the problem is solved if there is no more nighttime noise.  They use devices like ZQuiet, GMSS, SnoreRx, VitalSleep, Snore Ex, Snore Eliminator, ProSnore, Zyppah (happy z spelled backwards), Snore Guard, etc.  A new one comes out every month; there are even ads for pillows and beds that will solve the problem.  But do they solve the problem?  Have they stopped the cause of the problem?  Are you willing to risk it?  That’s the real question!  It’s kind of like removing a nail from a flat tire and thinking that the nail is the problem when the real problem is the hole in the tire!!

     The beginning step a wise person should take it to have a trained health professional find the cause of the problem and then let them help you to eliminate that cause.  Sleeping in separate rooms or wearing ear plugs or getting a divorce is like removing the nail—the problem is not solved since the cause has not been eliminated.  Serious health consequences still exist.

          Dr. Donald Johnson founded Northwest Treatment Center for Snoring & Sleep Apnea in Coeur d’Alene to help patients stop their snoring and LIVE FREE WITH NO LIMITS!  His office is at 114 W. Neider Ave. in Coeur d’Alene, near Costco.  The website for more information is www.NWSleepDoc.com and the office phone is 1-844-84SNORE.  SCHEDULE AN APPOINTMENT TODAY!

 

 

February 18, 2017
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     Drugs can cause obstructive sleep apnea (OSA) and can make patients who already have OSA get worse.  An obstructive sleep apnea event is caused when the tongue blocks the throat repeatedly during sleep completely for at least 10 seconds.  If the number of those events is 5 or more per hour during sleep, a medical diagnosis of OSA is made.  Some of the signs of OSA include daytime sleepiness, loud snoring, witnessed breathing interruptions, acid reflux, and awakening due to gasping or choking.

     Antidepressant and antipsychotic medications can cause patients to gain significant amounts of weight, snore loudly, and end up with heart attacks and strokes.  Any medication which can cause a patient to gain weight has the potential to either cause OSA or make a preexisting condition of OSA worse.  OSA is mainly a structural problem of a narrow jaw and of a narrow upper airway.  If fat is added in the throat due to an overweight condition, the risk becomes much worse.

     Many antidepressants such as Pamelor, Paxil, and Elavil, stimulate people’s appetites.  Another side effect of some of these medications is to suppress rapid eye movement (REM) sleep.  Some of the costs of not getting enough REM sleep (should have 2 hours each night) include a more excitable nervous system which results in a lowering of pain thresholds.  There are also more cognitive problems such as learning and memory.

     Depakote, which is valproic acid, is a mood stabilizer used in treatment of bipolar disorder, seizure, and migraine.  One study revealed over 20% of patients on mood stabilizers gained 10 or more pounds over a one year period.  This can cause a great increase in OSA.

     Risperdal, Seroquel, Zyprexa, Abilify, and other anti-psychotics have been known to cause more than 5% weight gain in a great number of patients.  They also may cause insulin resistance and that can lead to diabetes.  Taking Zyprexa for just two weeks caused an increase in food intake by almost 20%.

     And, as is well known, chronic use of corticosteroids to reduce inflammation leads to significant weight gain.  A common one is Prednisone.

     Antihistamines, including Allegra and Zyrtec, have been found to increase overweight status of patients.  Over half of patients on these medications are more apt to be overweight.

     Patients on insulin have better control of sugar in their diets and therefore  should have better control of weight also.  But a study shows insulin by itself will promote increase in weight.

     Atenolol, metoprolol, and propranolol (beta-blockers) are associated with a significant amount of increased weight. 

     There are many, many more medications that cause weight gain which is causing sleep disturbances.  All patients, especially those who already have OSA, should be aware of the medications they are taking and note any weight gain to their sleep physician and the prescribing doctor to see if there are alternative medications they can take which do not cause weight gain.

     There is a simple test for OSA that can be done right in your home known as a home sleep test.  Make a free consultation appointment in our office to discuss this—OSA is deadly.  If you snore, have daytime sleepiness, or don’t feel FABULOUS when you wake up, you may have OSA.  And treatment does NOT have to be that “mask”.  Our website www.NwSleepDoc.com has a lot on information you may be interested in regarding OSA and its treatment.

       Dr. Donald Johnson founded Northwest Treatment Center for Snoring & Sleep Apnea in Coeur d’Alene to help patients stop their snoring and LIVE FREE WITH NO LIMITS!  His office is at 114 W. Neider Ave. Suite 102, in Coeur d’Alene, near Costco.  The website for more information is www.NWSleepDoc.com and the office phone is 1-844-84SNORE.  SCHEDULE AN APPOINTMENT TODAY!

     Parents, you are usually the first-line persons to recognize that there a potential problem with your child in almost every area of your child’s life!  Sleep disordered breathing (SDB) includes snoring, upper airway resistance syndrome (UARS), obstructive sleep apnea (OSA), and obesity hypoventilation syndrome.  OSA is a condition in which the tongue, tonsils, or adenoids completely obstruct the airway for 10 seconds or longer more than once per hour during sleep for children.  And OSA may be overlooked by medical professionals—dentists and medical doctors—because the symptoms may not be recognized and the seriousness of the health consequences of undiagnosed OSA may not be well known to the examining doctor.

     Children experience UARS more often than OSA and this condition is usually caused by airway interferences.  It is experienced by children with an airway that is more prone to collapse due to abnormal airflow when they inhale or when they exhale.  With UARS, there is not a complete airway obstruction as in OSA but the condition causes fragmentation in the child’s sleep as well as activation of the “fight or flight” response.

     Some of the symptoms to look for in children are:

  • Forward head position which helps open the airway
  • Long, narrow face
  • Dark circles under the eyes
  • Wiggly, hyperactive, poorly behaved child
  • Difficulty following directions
  • Constant nighttime snoring and tooth grinding
  • Mouth breathing at night and/or during the day

These children are very high risks for:

  • Misdiagnosis of ADHD
  • Social problems
  • Poor performance academically
  • Low attention to any task
  • Behavioral problems at home and at school
  • Anxiety and/or depression
  • Altered brain function—delayed processing
  • Trouble completing schoolwork
  • Poor grades in school 

The big tip-off is mouth breathing.  Another is waking up gasping.  If your child is a mouth breather or snores, he or she should have a formal sleep study since the consequences of an untreated sleep disorder are so drastic.

     When the child breaths with the mouth closed, the tongue is on the roof of the mouth 10-15 times a minute all night long helping to cause the upper dental arch to be expanded properly from birth onward.  If the child breathes with the mouth open, the tongue is on the floor of the mouth and the pressure from the cheek muscles will cause the arch to be too small resulting in crowded teeth, need for orthodontics, and a lifetime of OSA and the health consequences.  The child may use “binkie”, thumb, or finger sucking to reposition the tongue out of the airway to get more air.

     Wear on the primary teeth is the easiet to detect.  The child may grind the teeth at night to help open the airway; this grinding helps to pull the tongue forward off the airway.  Grinding when the child breaths through the mouth is destructive to the teeth since the mouth is dry and there is more friction on the teeth.  These teeth need to be built up until the permanent molars are fully erupted or the child will have “short” teeth and a reduced vertical dimension resulting in reduced room for the tongue.  Also, chronic dry, chapped lips are another tip-off that the child is a mouth breather.  These conditions can lead to OSA.

     Tonsils and/or adenoids may be the cause of mouth breathing with adenoids causing more trouble.  This is because they cannot be seen as easily as the tonsils and may be overlooked by health prefessionals.  Therefore an endoscopic exam should be done on any child with these problems.  Frequent enlarged tonsils, frequent sore throats, and frequent ear infections are also indications that tonsils and adenoids should be ruled out as the cause of mouth breathing.

     If the tonsils and adenoids are the main problem, removal may be the best choice you should make with the medical doctor.  This will facilitate the proper use of the tongue muscle during breathing.  The goal here is to get the child to breath with the mouth closed which will position the tongue on the roof of the mouth to help with ideal growth of the child’s midface.  If the problem is the tonsils or adenoids and one waits until about the age of 7 to remove them, the effect of the removal may not be ideal.  At that time, after removal, a palatal expander placed by a dentist or orthodontist can help give the tongue it’s proper room and help in development of the dental arches.  This can help the child avoid UARS and OSA in the future.

     And after removal of the tonsils and adenoids, you may find yourself saying, “We have a brand new child!”

     Dr. Donald Johnson founded Northwest Treatment Center for Snoring & Sleep Apnea in Coeur d’Alene to help patients stop their snoring and LIVE FREE WITH NO LIMITS!  His office is at 114 W. Neider Ave. in Coeur d’Alene, near Costco.  The website for more information is www.NWSleepDoc.com and the office phone is 844-847-6673SCHEDULE AN APPOINTMENT TODAY!





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