Author: Michael Kelley

Everywhere in the world, sleep problems are on the rise. According to The Lancet Respiratory Medicine, 936 million individuals have sleep apnea, and 85% are undiagnosed cases. Meanwhile, local experts estimate that 50 to 70 million Americans have sleep-related problems. Why is the world struggling so much with sleep? The answer could be in the contents of your next meal. Specialists have been closely observing the relationship between daily food intake and sleep patterns in recent years. “Eating healthy and allowing the body to absorb proper nutrients provides the brain with the chemical environment that it needs to produce the neurotransmitters that it needs to maintain adequate sleep,” explains Dr. Ana Krieger of the Center for Sleep Medicine at New York-Presbyterian. It should come as no surprise that our food choices during the day affect the way we sleep. Thus, you are what you eat is more than just an old adage, it is a simple scientific fact. While scientists admit that the research is relatively new, there have been enough consistent results across studies to determine what types of food can aid or derail sleep. For instance, carbohydrates, saturated fats, and sugars from candies, soda, and confectioneries are generally linked to lighter and less restorative sleep. Meanwhile, more fiber, fish, and vegetables are associated with deeper and better sleep quality. If all this sounds familiar, that’s because it’s rudimentary healthy eating advice that our own family doctors have been telling us for years. And now, as a nation, we’re paying the price for years of unhealthy eating. Here’s the good news: optimizing your diet for better sleep is actually not that hard to do, especially today when there’s a ton of information online about healthy eating trends that actually work. For instance, while the famed keto diet is associated with short-term insomnia, Insider reveals that long-term adherence to ketogenic eating habits actually leads to deeper sleep —and even less overall required sleep. Meanwhile, following the Mediterranean dietary profile, in women, is associated with less bouts of insomnia. Simply eating healthier leads to better sleep. So why is it so hard to do? The answer lies in sleep deprivation. Dr. Tiffany Lester of Parsley Health details why the brain craves unhealthy food when we’re sleep deprived. Glucose is the brain’s primary fuel source. Partial or total lack of sleep can lead to impairments in the way we metabolize glucose. The result is that even though we’re well aware of why gorging on chips and cookies is bad for us, our own brain tells us to go for it. Sleep deprivation significantly weakens our willpower to resist deliciously unhealthy food. The more unhealthy food we eat, the worse our sleep quality gets. And the more our sleep quality worsens, the more we crave unhealthy food. It’s a vicious cycle that’s affecting not just Americans but also millions around the world. If you’re suffering from insomnia, weight problems, or both, one of the most straightforward solutions is to take back control of your diet. After all, there is such a thing as eating your way to a good night’s sleep.

Anaheim, CA: Anaheim Regional Medical Center More than 40 former NFL players woke up early on Saturday, November 16, 2019 in an attempt to create a positive pathway for their health as opposed to responding to problems that may occur in the future. This was possible thanks to Living Heart Foundation (LHF) and the NFLPA’s Professional Athletes Foundation (PAF) health assessment at Anaheim Regional Medical Center where the retired athletes attended and went through several screening stations that used the latest techniques in identifying potential concerns. Sleep is becoming more of a focal point in health each year, but not just how much sleep you get or at what times; the airway and what happens (or doesn’t happen) during sleep is now under the microscope.Every LHF/PAF health assessment for the former players contains an obstructive sleep apnea station that is overseen by Pro Player Health Aliance (PPHA) who chooses local highly qualified and experienced dental professionals who are American Sleep and Breathing Academy (ASBA) diplomates to conduct the screening for sleep disordered breathing. Dr. Bradley Eli, Dr. Alex Kalmanovich and Dr. Dian Olah we’re selected for this event and received spectacular feedback from the players. Once former players complete a brief Epworth Sleepiness and STOP-BANG form to establish their risk for sleep disordered breathing, they have the option to accept a home sleep test (HST) which is administered by Ez Sleep Home Sleep Testing on site. Ez Sleep has 24/7 patient support, instructional videos/papers and a return shipping label for every patient who is tested. The results are interpreted by a board certified sleep physician who provides a diagnosis and treatment options. Depending on the outcome of the HST report, the players are able to receive treatment with a CPAP or oral appliance therapy. Oral appliances are exclusively fabricated by Gergen’s Sleep Appliance Lab and sent back to the treating doctor in under two weeks. The PAF OSA program has effectively changed the lives of hundreds of former players who are now able to receive a better night’s sleep. If you are interested in learning more about the OSA program, ASBA Diplomacy, PPHA, Ez Sleep In-Home Testing or Gergen’s Sleep Appliance Lab, please email skylar@myasba.com.   [foogallery id=”14362″]

San Francisco, CA: With September coming to an end, so was the tour of Living Heart Foundation (LHF) and Professional Athletes Foundation’s (PAF) nationwide health screening events for former NFL players. In the second to last screening being held of 2019, American Sleep and Breathing Academy Diplomate, Dr. Stanley Dintcho was invited by Pro Player Health Alliance (PPHA) to oversee the sleep apnea station which was one of the several health evaluation stops for players at the event. The event is part of LHF’s HOPE (Heart, Obesity, Prevention & Education) program that is a comprehensive obesity research initiative designed to promote healthy lifestyles and weight-management among former professional football players. Throughout the screening, former players are scheduled to undergo a brief oral exam and review their answers from a STOP-BANG or Epworth Sleepiness Questionnaire with the screening staff. After educating them on the effects of untreated sleep apnea, they are offered to take a Home Sleep Test (HST), provided by Ez Sleep In-Home Testing, which monitors the player’s sleep and is used to diagnose sleep apnea. Thanks to the benefits of the PAF, former players are able to receive diagnostics and treatment with no out-of-pocket cost. Treatments for OSA, when medically indicated, typically include oral appliances made by Gergen’s Sleep Appliance Lab or CPAP.  David Gergen, CEO of PPHA, has said, “The relationships created between our diplomates and the former players have lead to an enormous spike in community outreach/awareness of obstructive sleep apnea in those communities.” Dr. Dintcho says, “For the many athletes that attended, it shows the great commitment retired athletes have for taking the best preventive care and treatments available. They are all awesome individuals of talent off the field as they were on the field. Retired Athletes of the Bay Area know how treating Sleep Apnea as soon as possible; along with Great Oral Care Promotes Greater Health Benefits and Longevity.” Dr. Stanley Dintcho graduated from Temple University School of Dentistry in Philadelphia, PA, in 1970. Upon graduation, Dr. Dintcho answered the call to duty and served in the US military as Captain in the US Air Force. In 1972, he returned to civilian life and opened the doors to his dental practice, where he continues to utilize state-of-the-art technology and revolutionary treatment methods in dentistry. Dr. Dintcho’s unique, personable style of quality-packed consultative dentistry known as the Dintcho Method has created a very loyal clientele. Dr. Dintcho continues to pursue his greatest passion: dentistry.   To register for diplomacy at the next ASBA Sleep and Wellness Conference, click here or email skylar@myasba.com

The Sleep and Wellness Magazine | SUMMER 2019 issue is online! Click here or see below to view the entire version of the latest magazine.   ASBA members can enjoy the benefit of receiving a hard copy of every quarterly issue at no extra cost by subscribing. To order your copy now and subscribe to Sleep and Wellness Magazine, email skylar@myasba.com.  

  Pankaj Singh, DDS, MD, does not mince words when assessing the knowledge levels of his dental colleagues. Even dentists who know the scope of oral appliance therapy often practice “with guesswork,” he says. Even more troubling, most of those in the traditional restorative realm “don’t know anything” about sleep apnea. As a private practice dentist in New York City, Dr. Singh has felt the frustration brought on by a lack of objective data. The thirst for a better way led Dr. Singh to co-found APP-NEA, LLC, a company dedicated to improving the practice of Dental Sleep Medicine and Oral Appliance Therapy using “deep machine learning and augmented intelligence” to develop predictive computational algorithms, new digital software and hardware technologies, and workflow processes that allow dentists to treat patients with obstructive sleep apnea more effectively, efficiently and predictably. “There is no such thing as predictive analytics and algorithms in dentistry,” says the 53-year-old Dr. Singh, who also serves as an attending in the Department of Otolaryngology and Oral & Maxillofacial Surgery, Lenox Hill Hospital, New York. “There are a lot more analytics used in medicine as compared to dentistry. Analytics are used on a daily basis across the entire industry of finance. In finance, they don’t make major decisions based on guess work.” Machine learning and artificial intelligence are actually making the financial trades. Dr. Singh points to a simple reason: Machines can analyze meta data from all kinds of news sources, as soon as it is made public and comes across digital channels. Machines are scanning these sources in real time, scouring digital platforms for certain key words. The analysis happens on a larger scale— faster and better than humans can. “We can only base our clinical judgment on the knowledge we have,” Singh muses. “Imagine if you take 200+ years of collective, sum total of knowledge across multiple doctors, clinicians and scientists and compile all that data and analyze it, and then figure out that you can actually not only create this data base of answers to the questions, but also which of the clinical, phenotypical, pre-test diagnostic and radiologic data-points are relevant and of what value, in being able to prospectively predict optimal treatment plan and treatment efficacy. A doctor can ask a question, and get an answer. That’s what our system does. It literally guides dentists into an exact dynamic workflow for optimal treatment plan for most effective treatment using oral appliances.” Too often, the consequences of what is guesswork for developing the initial bite are less than ideal results right from the start. “And patients have to keep going back and forth to the dentist, or worse, left to themselves to adjust the appliance, or the appliance doesn’t fit because they didn’t take the bite correctly,” Singh says When the patient doesn’t feel the benefit of the therapy, who do you think they’ll voice their upset. Patients will call their referring physician and say, “Oral Appliances don’t work”, “How could you refer me to someone like that? I want something else.” They aren’t realizing that dentists are not practicing based on objective data, and instead completely doing it subjectively, by guesswork and trial and error.” Factor in that the subject of sleep apnea and the dentists role in it’s treatment is not taught well, or at all, in dental school or in residency, and it adds up to a familiar theme: Dentists need help. Education for the dentists and their teams, and on the software side, there are limited offerings that cater to dental sleep medicine, even fewer that also include medical billing. “EMR and practice management softwares (PMS) are nothing more than a data warehouse,” Singh says. “There is no automated and guided workflow, no analytics built in there. Other PMS software don’t guide the doctor, into the most appropriate patient specific course of therapy for most predictive treatment outcome.” According to Singh, APP-NEA, LLC is aligned with practice parameters set by the American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine. It’s done ethically without “pushing oral appliances” when not indicated. MAD-FIT’s analytics actually exclude certain oral appliances if the patient has certain conditions. APP-NEA is a biotechnology company dedicated to the practice of dental sleep medicine, powered by analytics & driven by machine learning and augmented intelligence. It provides enterprise level cloud-based, comprehensive, turn-key and end-to-end practice and patient management system, so “dentists can manage their dental sleep medicine practice from anywhere, with predictive treatment planning, automated and guided dynamic workflow, including medical billing”. “Ultimately, what we want is for the doctors to really do what’s right by the patient, in the most expeditious, most comprehensive and ethical manner,” Singh adds. “Cloud computing allows us to analyze enormous data sets in real time. Not just from one doctor, one patient, but from multiple doctors, and even more patients, in real time. We can scale it globally, because sleep apnea is not just a local problem. It’s a world-wide epidemic.    

  Results of a multi-year study by the Sleep Research Society concluded that insomnia rates soared among combat soldiers from 1997 to 2011, spiking considerably after the 2003 invasion of Iraq. As reported in Military Times, the study covered 1.3 million military personnel, and indicated a direct association between insomnia and exposure to combat. “In the eight years following the invasion, the rate of insomnia, a sleep disorder known to increase the risk of cardiovascular issues, diabetes, stroke, depression, and anxiety, skyrocketed 652 percent among military personnel,” writes J.D. Simkins in Military Times. “And while post-traumatic stress disorder and traumatic brain injuries suffered as a result of combat deployments have been identified as known contributing factors, solutions to the alarming trend have proven to be elusive. Until now.” Seeking answers to the newly discovered problem, the Department of Defense awarded a $2 million contract to the Noctem company to conduct trials on 800 Sailors and Marines in the most extensive sleep trial the department has ever undertaken. Led by Dr. Ann Germain, the treatment will consist of using the Noctem app, described as a smart phone platform patients can use to actively engage with their clinicians. “Patients using the app essentially have a sleep coach in their pocket, and the providers using the app can monitor, almost in real time, sleep health and behaviors that effect sleep quality,” Germain told Military Times. One way providers monitor a patient’s progress is by viewing a short set of questions patients answer each morning and evening to document sleep patterns. Recordings can then be compared to sleep statistics of other anonymous app users. “Based on the information compiled, a clinician can then offer a personally-tailored plan that addresses how to quell any existing detriments to sound sleep — nightmares, for example,” writes Simkins. Source: Military Times

  As oral appliance therapy continues to gain respect across the health care continuum, predictors of treatment outcomes are emerging. Small and detailed physiological studies that look at OSA endotypic traits (pharyngeal collapsibility and loop gain) can help determine greater oral appliance efficacy. PubMed reports: In 93 patients (baseline apnea-hypopnea index [AHI] ≥20 events/hr), researchers examined whether polysomnography-estimated OSA traits (pharyngeal: collapsibility and muscle compensation; non-pharyngeal: loop gain, arousal threshold and ventilatory response to arousal) were associated with oral appliance efficacy (percent reduction in AHI from baseline) and could predict responses to treatment. Multivariable regression (with interactions) defined endotype-based subgroups of “predicted” responders and non-responders (based on 50% reduction in AHI). Treatment efficacy was compared between the predicted subgroups (with cross-validation). Greater oral appliance efficacy “was associated with favorable non-pharyngeal traits (lower loop gain, higher arousal threshold and lower response to arousal), moderate (non-mild, non-severe) pharyngeal collapsibility and weaker muscle compensation (overall R2=0.30, adjusted R2=0.19, p=0.003).”  See the study abstract for more information    

  A ResMed-led analysis published in The Lancet Respiratory Medicine (July 2019) estimates that more than 936 million people have obstructive sleep apnea. As summarized in news-medical.net and elsewhere, the estimate from the multinational analysis by ResMed and 12 sleep researchers is nearly 10 times greater than the World Health Organization’s 2007 estimate of more than 100 million.   “More than 85 percent of sleep apnea patients are undiagnosed, meaning hundreds of millions repeatedly suffocate instead of getting healthy, restful sleep each night,” said Carlos M. Nunez, M.D., study coauthor and ResMed’s chief medical officer. “This raises their risk of workplace and roadway accidents, and can contribute to other significant health problems, such as hypertension, cardiovascular disease, or even poor glucose control for diabetic patients. We know the risks, and now we know the size of the problem is nearly 10 times greater than previously thought. Addressing it starts with screening patients we know to be high-risk.” Education for clinicians and patients alike can help get more people diagnosed, but Nunez contends that educational component should include a conversation about what constitutes good sleep. “For instance, some believe snoring may simply be a normal feature of how some people sleep, when in fact it’s one of the most important signs for the risk of having sleep apnea,” Nunez said. “With a global prevalence that approaches 1 billion people, patients and physicians need to consider the risks and ask the questions that may ultimately help them sleep and live better. This is no longer a problem that can be treated lightly or ignored.” Source: Medical News