Author: Michael Kelley

Sleep pioneer Dr. William C. Dement died on June 17, 2020, according to a report from the Sleep Research Society (SRS). As a researcher, clinician, educator, advocate, and mentor, Dement’s legacy extends across the sleep community and beyond.  At Stanford University, where he spent nearly his entire career, Dement opened one of the world’s first sleep disorders clinics in 1970. During an extraordinary time of discovery that started in the 1950s, Dement and colleagues described the human sleep cycle and its sleep stages in the landmark paper, “Cyclic variations in EEG during sleep and their relation to eye movements, body motility, and dreaming.” SRS concludes: The legacy of William “Bill” Dement, the “Father of Sleep Medicine,” is the sleep medicine subspecialty, the thousands of people who have dedicated their careers to improving health through better sleep, the countless lives saved through the diagnosis and treatment of sleep disorders, and the recognition that “drowsiness is red alert.” Watch these videos, lectures, and interviews to learn more about Dement’s extraordinary career in the fields of sleep medicine and sleep and circadian research.   Source: Sleep Research Society

Sometimes it takes a national emergency to illuminate what people instinctively already know, namely that sleep and breathing are important. A new book called Breath: The New Science of a Lost Art may have garnered limited attention in a different era, but the COVID crisis has cast a spotlight on respiratory functions.  A report on National Public Radio explored many facets of the book by journalist James Nestor, particularly Nestor’s experiment in which he could only breathe through his mouth for 10 days. Equipped with nose plugs that made nasal breathing impossible, the physical maladies began to pile up.  “I went from snoring a couple minutes a night to, within three days, I was snoring four hours a night,” Nestor told NPR in describing his forced mouth breathing. “I developed sleep apnea. My stress levels were off the charts. My nervous system was a mess…I felt awful.” If left unchecked, Nestor’s experiment could have spiraled further. This is essentially the case for millions of Americans with sleep apnea who fail to address their sleep apnea. Toss in a global pandemic, and tenuous sleep patterns become even more erratic.  “When confronting the COVID-19 pandemic, though, sleep becomes even more essential because of its wide-ranging benefits for physical and mental health,” write officials at the Sleep Foundation. “Solid nightly rest strengthens our body’s defenses, and studies have even found that lack of sleep can make some vaccines less effective...Experts agree that getting consistent, high-quality sleep improves virtually all aspects of health, which is why it is worthy of our attention during the coronavirus pandemic.”  Source: NPR    

Insomnia is a hot topic in good times, but factor in a global pandemic and it becomes fodder for ivy league musings in The Harvard Gazette. Dubbed “the latest casualty” in the COVID-19 crisis, lack of sleep is the latest bio-rhythm to go off kilter during lockdowns and quarantines Harvard correspondent Clea Simon wrote the article during the mid-April core of the quarantine at a time when countless people around the world began experiencing the diabolical side effects of poor sleep. Harvard’s T.H. Chan School of Public Health saw fit to run an online forum on the topic, the fourth in a series of weekly sessions addressing “the emotional and psychological effects of the pandemic.” Calling the current situation a “perfect storm of sleep problems,” Donn Posner, the forum’s featured speaker, pointed out how disrupted daily routines worsen the sleep-robbing stress of the pandemic. “Think of sleep problems as infection,” said Posner, president of Sleepwell Associates and an adjunct clinical associate professor at Stanford University School of Medicine in the Harvard Gazette article. “We want to jump on it quickly. Think of it as a risk factor that we want to get on top of lest it spread.” “To nip insomnia in the bud, Posner recommended simple behavioral changes,” wrote Simon. “For example, even though it may seem counterintuitive after a lost night’s sleep, avoid napping, or at least cut it short. Likening naps to snacks, he warned that napping for longer than 20 minutes, or late in the day, ruins our “appetite” for sleep. Likewise, he dispelled the idea that sleeping late on weekends or after a night tossing and turning can make up for lost sleep.” Source: Harvard Gazette

As the COVID-19 pandemic presents increasing public health challenges, scientists from around the world have responded with openness and unprecedented speed, studying the SARS-CoV-2 virus and working to develop new diagnostic technologies, treatments, and tools for researchers.   Below you will find links to the medical community’s efforts to support clinical solutions for COVID-19   [one_half] Article: Mysterious pneumonia in China [/one_half] [one_half_last] Video: Analysis and learning from over 26,000 cases of COVID-19 in Wuhan Findings on coronavirus from a Harvard University public health leading researcher on coronavirus [/one_half_last][one_half] Article: Coronavirus Infections—More Than Just the Common Cold [/one_half][one_half_last] Article: A Trial of Lopinavir– Ritonavir in Adults Hospitalized with Severe Covid-19 [/one_half_last][one_half] Article: Estimated Influenza Illnesses, Medical visits, Hospitalizations, and Deaths in the United States — 2017–2018 influenza season [/one_half][one_half_last] Article: Novel Coronavirus and Old Lessons — Preparing the Health System for the Pandemic [/one_half_last][one_half] Article: Management of Critically Ill AdultsWith COVID-19 [/one_half][one_half_last] Article: Keep Your People Learning When You Go Virtual [/one_half_last]

Dentists looking to enter the arena of sleep medicine have many business and educational options, but too often the blueprint for real success remains elusive. Sleep Diagnosis and Therapy recently spoke with two innovators in the world of sleep medicine who have developed a new program called Comprehensive Sleep Services™ (CSS). CSS is designed to help dentists effectively, and profitably, treat patients suffering from obstructive sleep apnea (OSA). Prior to co-founding CSS, Ronald L. Cook, DDS and John Truitt established deep roots within the dental sleep medicine community. The ASBA chatted with Cook and Truitt to find out how CSS differs from other programs, and why dentists of all experience levels might wish to give it a try. How well suited is dental sleep medicine to working within the telemedicine framework, particularly during the COVID-19 crisis? It’s ideally suited, and I say that based on experience using telemedicine. In the Dallas Fort Worth Metroplex, between 2012 and 2019, we treated a total of about 12,000 dental sleep patients. All of those people received oral appliances. Telemedicine came into the model in 2016, so I would say we have at least conducted telemedicine visits on more than 4,000 patients. There’s nothing speculative about telemedicine. It’s tried and it’s proven. There are some companies out there that are working with dentists who are not creating medical necessity. There happens to be a board certified sleep physician signing over a test, but there’s never a GP visit, there’s never a telemedicine visit, and that’s wrong. You’re going to get recouped. Not just during the Corona virus, but moving forward and doing dental sleep medicine, telemedicine is going to be an imperative if you want to be a profitable practice. How long has telemedicine been around? Telemedicine in general has been around for about 15 years. We were the first ones to adopt it in dental sleep medicine with our diagnostic partner, Comprehensive Sleep Medicine. How well known is CSS at this point? We were looking to launch at the recent ASBA meeting. We were bringing this whole program, and the pinnacle of this whole thing was telemedicine. We had already been launching this back-end program as far as the dentists being able to be reimbursed and having us handle all of their insurance through CSS. The lead of that was already going to be telemedicine, so this has nothing to do with the Corona virus, other than serendipity of timing. This question is for Dr. Cook…As a practicing dentist, what has been your experience with telemedicine? My experience is a little bit different. I have only been associated with telemedicine for several years. What I found is that it has decreased treatment time by two to three months. What are the drawbacks of the traditional care routine (without telemedicine)? I’ll provide an example to illustrate the problems. From various sources, the patient comes to me and says, “My wife complains that I’m snoring.” I have him fill out the screening sheet. I show him the oral appliance and he gets excited. I say, “I know you want one of these, but the first thing we must do is go back to your primary care physician and get him to order you a sleep test.” The guy is excited about getting the appliance, but the excitement dims. Why does the enthusiasm dim? Now I have to send all the information I gathered to his PCP. I have to hope the patient calls his PCP. I usually then get a phone call from the PCP asking, “What do you need?” I advise him or her to please evaluate the information I just sent over and order a sleep study for the patient. You lose half of your patients right then. Once the sleep study is ordered, the PCP has no idea what to do with it. He also has no idea how to write orders to actually get the oral appliance. So time is the major enemy here, correct? Yes. Patients just keep dropping off as the months go by. By the time all that happens there are very few patients who could enter into treatment because they never got all of the medical necessities done—the sleep test, the diagnosis, and the actual order for the oral appliance. What’s the scenario with telemedicine? With the telemed visit, there is a turnaround of two weeks maximum. As long as the patient shows up on the phone or the computer screen at the right time, these orders are generated immediately. The sleep test is sent out, the patient uses it, orders are generated, and it’s all over to me, the dentist, within two weeks—and we are good to go. The patient is still excited about the treatment and the momentum has not been lost. It’s a complete game changer. Telemedicine can be done anywhere. We’ve had patients confer in the parking lot on a lunch break on their phone, or from a cubicle on a hand held. It happens at home on a desktop. It is truly mobile medicine. The average sleep visit, whether it’s face-to-face or telemed, is around 10 minutes. Usually it’s a max of 10 minutes. It’s amazing the access that this brings, how much time it cuts down, patient convenience, and then of course just best practices—such as making sure every patient has a face-to-face with a medical GP. That’s honestly not happening in a lot of instances in the broader market. They will eventually get a recoup. They think they’re ok doing it right now because they don’t have a significant volume. How have your experiences primed you to offer the CSS program? When you’re delivering hundreds of oral appliances per month, you see a lot. We’ve been audited by every insurer, and by Medicare a number of times. We came out with flying colors. We’re following the rules. It’s not just greater access and being able to make it quicker, it’s also the correct way to do it. If you’re not having a face-to-face visit with a GP, or you’re not having a telemed visit, you’re wrong. Is there a misconception about getting involved in dental sleep medicine? At the very beginning there’s a complete misconception of what the dentist needs to know to be effective doing dental sleep medicine. The dentist needs to be a good dentist. They need to be a good general practitioner who understands best practices. You have a lot of individuals out there who want to learn about dental sleep medicine. They pack up the team, close the practice down for two days, and go into a course where they’ll talk a lot about things that are not applicable. The dentist becomes the professional conference attender. They keep thinking there is this other grain of magic that this next continuing education course will give them, and then back at their practice everything will be different—and it’s never different. I have an issue with the whole way information is disseminated, the information itself. When I look at the marketplace, I see a lot of vendors and clinicians making money off of “new blood” coming in, and the new blood is not activating and utilizing, and most importantly helping all of these people with OSA. The end result is a dentist getting the team all excited and then they come in Monday morning and after 15 minutes of looking at what it takes: screening patients; insurance billing; and selecting appliances—they quickly go back to doing some crown preps. I’d go to a seminar, and there was some good stuff, but it was always something to buy. Then I would not use it. And a few months later I had to buy something again and would not use it. There is nothing with dental sleep medicine to do that a dentist doesn’t already have in his office. There’s nothing to buy. In our program the patient has already been educated before they get to the dentist. Our call center has already educated that patient. We’re taking the administrative burden away from the dentist, and we actually give them the net profit. Somebody in our program can make $1,300 net profit for only 20 minutes of the doctor’s time, and an hour of assistance time. Those numbers are completely upside down if the general dentist is trying to do this on his or her own.   About CSS Co-Founders Ronald L. Cook, DDS graduated from Baylor University in 1984 with a B.S. in Biology and Baylor College of Dentistry in 1988 with a Doctor of Dental Surgery. He is dual licensed in the states of Texas and Oklahoma. He is a member of the American Dental Association, the American Academy of Dental Sleep Medicine, and an American Sleep and Breathing Academy Diplomate. He has been in private dental practice since 1989, and full-time dental sleep medicine since 2012.   John Truitt has held multiple senior management roles in both publicly and privately held companies in the sleep and dental category. He was instrumental in the listing, implementation, and growth of SomnoMed and relocated from Sydney, Australia in 2006 to expand operations to the Americas. From 2011-2019, Truitt was the co-founder and CEO of Texas-based Simple Sleep Services. After studying liberal arts at the University of North Texas, and emergency medicine at the U.S. Army Academy of Medical Sciences, Truitt continued his education in dental sleep medicine, orthodontics, chronic pain management, TMJ, and maxillofacial orthopedics under the tutelage of many world-renowned clinicians. Visit Comprehensive Sleep Services Website

Developed for the American Sleep and Breathing Academy “ASBA”, the App is designed to reinforce your knowledge about the elements of sleep medicine. Enhance your knowledge with questions to test your recall, interpretation and problem solving skills.           IOS, APPLE VERSION Click link to download   ANDROID VERSION. Click link to download Use anytime that’s convenient and help maximize your comprehension of sleep medicine and how it relates to the dentists role. Self-Study Modules – Eligible for Continuing Education (CE) Credit. Allows for networking opportunities with Academy members and diplomates. Source: ASBA/SleepDT

There are many exciting things going on in the world of sleep! At the American Sleep and Breathing Academy (ASBA) we are constantly seeking ways to improve the clinician’s patient turnout, as well as the patient’s avenues of treatment. The ASBA publishes articles regularly, relevant to upcoming courses, past events and interesting news pages related to sleep that are useful to share on your own webpages as well. We believe in arming the country with knowledge and awareness of sleep disorders which affect millions of people around the nation. When you follow us on Facebook, Twitter, LinkedIn, etc; you’ll remain up to date on the latest news in sleep medicine, as well as different courses and Academy functions. Our most important mission is to educate you. Follow us: Linkedin Group Twitter Facebook

In the wake of unprecedented restrictions associated with the COVID-19 global pandemic, clinicians and patients alike are asking; When it comes to minimizing the risk of spreading corona virus, how safe is a continuous positive airway pressure (CPAP) machine? While acknowledging that CPAP is an excellent treatment for sleep apnea, members of the American Sleep and Breathing Academy (ASBA), Phoenix, Ariz., believe that added caution is appropriate for unusual times. ASBA members agree with the American Academy of Sleep Medicine (AASM) which recently wroteon its website: “It is possible that using CPAP could increase the risk of spreading the virus to others around you…Using positional therapy or an oral appliance (if the patient already has one)…may also be effective for some patients.” The ASBA recommends strong consideration of oral appliances and positional sleep therapy as viable alternatives to CPAP. Part of the problem with CPAP is the shortage of filters and disposables now on the market. Additional difficulty with proper cleaning of masks causes more challenges when it comes to disinfection—with the situation made worse due to a shortage of distilled water. Patients can clean oral appliances similar to the way dentures are washed, primarily by soaking appliances in denture cleaning solution which kills bacteria and germs. Users can also soak oral appliances in hydrogen peroxide which is effective in killing corona virus. Another key difference between CPAP and oral appliances is that patients are not sharing oral appliances with anyone. At skillednursing facilities, assisted living homes, and even at apartment complexes that share centralized air—risks are increased through theuse of CPAP. For those who are concerned about CPAP spreading the virus, and for those who need treatment for sleep apnea, CPAP alternatives can potentially save lives. For someone using CPAP therapy, we simply do not have a firm grasp as to how dangerous it can be at this time. However, we know the virus can spread much more effectively through CPAP than it can through the regular breathing fostered by oral appliances. Even when masks are not leaking, patients are still getting air from surrounding areas because filters can’t work with 100% effectiveness. Potentially everybody who has sleep apnea could be more susceptible to contracting the virus, and ASBA members agree that it’s important to get screened, get treatments, and weigh the pros and cons. With this in mind, we endorse oral appliance therapy and positional sleep therapy as safer treatments for the public, at least for now. The above statement on behalf of the ASBA was authored by Chris M. Chui, D.D.S., co-founder of US Sleep Apnea, owner of San Francisco Dental Wellness, and a member of the ASBA Board of Directors. Dr. ChrisChui is double boarded in dental sleep medicine with the American Board of Dental Sleep Medicine and the ASBA.