American Academy of Dental Sleep Medicine's President says "That There Needs to be Greater Acknowledgement by Them (Academy of Sleep Medicine Members) of the Value of Dental Sleep Medicine and Oral Appliances. DR Jeffery Pancer Feels it is Important to Increase Awareness of Dental Sleep Medicine.
There are major problems for many patients diagnosed with sleep apnea. Most patients are immediately prescribed CPAP, or continuous positive air pressure consisting of a mask, hose, compressor and possibly a humidifier and sent home with their new devices. There are many great success stories with CPAP use this leads patients who do not tolerate the treatment to often feel like failures.
Nothing could be further from the truth, in fact, according to numerous medical studies in the most prestigious journals only 23-45% of patients tolerate CPAP. These studies also show that even among patients who use CPAP most only wear it for 4-5 hours a night not the recommended 7 1/2-8 hours nightly. The patients do not fail CPAP; rather the system fails the patient.
Patients who cannot tolerate CPAP or who wear it but feel no better or even worse are usually not informed of alternative treatments. Many who are told about alternative treatments often are referred directly to a surgeon because many sleep physicians are more comfortable with physician referrals than they are in referring to a dental practitioner. The problem is that upper airway surgery has not been nearly as effective as oral appliances in treating obstructive sleep apnea.
Dr Shapira founded I HATE CPAP! LLC to help patients challenged by CPAP and his website http://www.ihatecpap.com is designed to help patients find their way thru the confusing maze of medical jargon and referrals. He emphasizes that he does not "HATE CPAP". He initially was met by resistance by a few members of the medical community because of the name of his website but enlightened physicians now recognize that Dr Shapira's website http://www.ihatecpap.com is not in competition with the sleep community but is actually promoting sleep medicine in a very positive way. Many patients who had quit their treatment with CPAP at great personal health risk have returned for sleep apnea treatment as a direct result of this website, This is also making the roads and highways in Chicago safer because patients with untreated sleep apnea have a 600% increase in motor vehicle accidents.
An article in Sleep and Health Journal discussed the advantages of oral appliances from a sleep apnea dentist over surgery. The article SLEEP APNEA TREATMENT: ARE DENTAL APPLIANCES MORE SUCCESSFUL THAN SURGERY? can be found at the following link.
http://sleepandhealth.com/modules.php?name=News&file=article&sid=55&tid=22 another article in Sleep and Health Journal, Oral Appliances vs. CPAP, can be found at:
http://sleepandhealth.com/modules.php?name=News&file=article&sid=130&tid=22
A recently published article showed minimal improvement with CPAP tolerance after surgery. The article "Impact of upper airway surgery on CPAP compliance in difficult-to-manage obstructive sleep apnea" was published in Arch Otolaryngology Head Neck Surg. 2008 Sep;134(9):926-30 by Chandrashekariah R, Shaman Z, Auckley D.
Division of Pulmonary, Critical Care, and Sleep Medicine, MetroHealth Medical Center, Case Western Reserve University
Their conclusion was "CONCLUSION: Upper airway surgery in select patients with OSA may improve CPAP compliance and should be considered as a potential adjunctive therapeutic measure in poorly compliant patients with OSA." Reading the study actually showed that the patients who were CPAP non-compliant defined as using CPAP for less than 4 hours a night increased their CPAP use only minimally and still required CPAP use. "A mean increase of 48.6 minutes in CPAP compliance was noted after surgery (P = .03)" The increase of 46 minutes(mean) showed that not only did the patients still require use of CPAP but that they were still using CPAP far less than the recommended time even after surgery.
The CPAP pressure needed was reduced only slightly "mean CPAP pressure setting (11.8 cm H(2)O before surgery vs 10.4 cm H(2)O after surgery; P = .09)" The 11 patients in the study all still required CPAP.
The usage of oral appliances was not discussed in the article but previous studies have shown that oral appliances are more effective than surgery and have much greater compliance than CPAP. The majority of patients who given a choice between CPAP and oral appliances overwhelmingly prefer appliances. http://www.ihatecpap.com is an educational site devoted to informing patients and their loved ones about the dangers of sleep apnea and providing extensive information on CPAP alternatives. There is a find a dentist area on the site to help patients find a Sleep Apnea Dentist in their area.
Dr Ira L Shapira put this site together a Diplomate of the American Board of Dental Sleep Medicine who is a pioneer of this field.
He was involved in research in the 1980's as a Visiting Assistant Professor at Rush Medical School's Sleep disorder clinic working with Dr Rosalind Cartwright a psychologist who was involved in the creation of Sleep Medicine and is probably the single individual most responsible for Dental Sleep Medicine being accepted as a major component of sleep medicine. She published the first medical articles on oral appliances utilizing the Tongue Retaining Device invented by Dr Charles Samuelson a Psychiatrist. She has been a champion of Dental Sleep Medicine from its inception. The February 2006 issue of SLEEP published new parameters of care for oral appliances that recommend oral appliances as a first line of treatment equal to CPAP for mild to moderate apnea and as an alternative treatment for severe apnea when patients do not tolerate CPAP. The American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine endorse these findings. This is only possible due to enormous contribution of Rosalind Cartwright.
Dr Shapira returned to the Sleep Center at Rush in the 1990's and treated patients with oral appliances until 2001. He has continued his work in Dental Sleep medicine in the Chicago area. He teaches a course in Dental Sleep Medicine to dentists from around the United States at his Gurnee, Illinois practice. He has recently started a new practice Chicagoland Dental Sleep Medicine Associates dedicated to bringing the finest in dental sleep medicine treatment to Chicago and Suburban patients. He currently has four Chicagoland Dental Sleep Medicine locations in the Chicago area. Gurnee, Skokie, Bannockburn and Schaumburg but is planning several additional offices across Chicago proper and in other suburbs.
Dr Shapira has excellent working relationships with several sleep centers besides Rush and has trained many sleep technicians in the art of appliance titration. He regularly works and trains technicians with Dr Alexander Golbin and The Sleep and Behavioral Medicine Centers in Skokie, Bannockburn and Vernon Hills and can see patients in the Bannockburn office. He has an office in American Sleep Center in Skokie and in Schaumburg in the office of Dr Alan Acierno a prominent dentist known for his compassionate manner and excellent prosthetic and cosmetic dentistry. He has trained technicians at Evanston and Glenbrook Hospital Sleep Centers, Lake Forest Hospital Sleep Center, Alexian Brothers Sleep Center, Central Dupage Hospital Sleep Center, Merit Sleep centers, Saint Francis Hospital and numerous other sleep labs in Illinois and Wisconsin. His titration protocols have been sent to sleep labs around the U.S.
His dental practice in Gurnee, Illinois is Delany Dental Care Ltd and in addition to sleep apnea Dr Shapira and his partner Dr Mark Amidei practice General, Cosmetic and Reconstructive Neuromuscular Dentistry. They use their knowledge of Neuromuscular Dentistry to treat patients with Chronic Pain, Chronic Daily Headaches, Migraines and TMJ Disorders. They are also able to make Pure Power Mouthguards, which are used by professional and amateur athletes to increase physical performance and balance. See the PPM site for more information on these incredible mouthguards. http://www.ppmmouthguard.com/ An exciting study will be released shortly from Rutgers on the effectiveness of these Neuromuscular Mouthguards in enhancing athletic performance. Dr Amidei and Dr Shapira hope to fit members of the CUBS, BEARS, WHITE SOX, and BLACKHAWKS in the coming year and hope to make next year a championship year for Chicago.
Dr Shapira's research in the 1980's at Rush was to evaluate the jaw position of patients with sleep apnea and to compare it to the jaw relations of patients with TMJ disorders. Treating patients with chronic TMJ disorders and severe pain has been a professional passion of Dr Shapira. A story he wrote in Sleep and Health Journal, SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTOR prompted hundreds of patients to find neuromuscular dentists to treat their chronic pain. SUFFER NO MORE IS AVAILABLE AT: http://sleepandhealth.com/modules.php?name=News&file=article&sid=237&tid=22
The National Heart Lung and Blood Institute (NHLBI) of the National Institute of Health (NIH) published a paper CARDIOVASCULAR AND SLEEP-RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS that confirmed the research that Dr Shapira did at Rush in the 1980's. This excellent article can be found at: http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf
A RECENT ARTICLE IN "Chest. 2008 Aug;134(2):332-7. Epub 2008 May 19. Links a significant increase in breathing amplitude precedes sleep bruxism." This article showed that Sleep Bruxism "is closely preceded by physiologic changes occurring in sequence, namely, a rise in autonomic sympathetic-cardiac activity followed by a rise in the frequency of EEG and suprahyoid muscle activity" This study stated that "Sleep Bruxism (SB) is a stereotyped movement disorder that is characterized by rhythmic masticatory muscle activity (RMMA) and tooth grinding." Sleep bruxism has long been associated with chronic morning headaches, facial pain and TMJ disorders.
"RESULTS: Measurements of respiration showed significant changes over time. Four seconds before RMMA muscle activity, the amplitude of respiration is already increased (8 to 23%); the rise is higher at the onset of the suprahyoid activity (60 to 82% 1 s before RMMA); the rise is maximal during RMMA (108 to 206%) followed by a rapid return to levels preceding RMMA. A positive and significant correlation was found between the frequencies of RMMA episodes and the amplitude of breath (R(2) = 0.26; p = 0.02). The amplitude of respiratory changes was 11 times higher when arousal was associated with RMMA in comparison to arousal alone.
Patients looking for help with Sleep Disordered Breathing, Apnea, Hypopnea, Upper Airway Resistance Syndrome or Snoring can find help at http://www.ihatecpap.com. Patients looking for help with TMJ Disorders, Chronic pain or wanting to learn more about Neuromuscular Dentistry can go to http://www.IHATEHEADACHES.org
Dr Shapira is giving his Dental Sleep Medicine course on November 14-15, 2008 and is traveling to India as a featured Lecturer with Dr Alexander Golbin at the end of November into December.
Dr Shapira emphasizes that he does not HATE CPAP, but that CPAP numerous studies have shown that while CPAP is very effective compliance is very poor. These studies have shown that only 23-45% of patients prescribed CPAP actually use their machines. Even patients who use CPAP average only 4-5 hours a night not the recommended 71/2-8 hours a night. The problem is not that so many patients do not use CPAP, the problem is that many of these patients are not offered alternative treatments to CPAP.
http://www.IHATECPAP.com fill that gap. The goal of the website is to help patients find treatments that they can integrate into their lives for long term use. Just as CPAP is not for everyone the same holds true for oral appliances so Dr Shapira also discusses surgical alternatives to CPAP as well.
The majority of patients offered a choice of CPAP or an Oral Appliance chose the dental appliance primarily because of comfort. This is very important because of the adverse health effects of untreated sleep apnea. One study showed a 36% decrease in 8-year survival in patients with moderate sleep apnea that was not treated compared to treated patients.
About Dr Ira L Shapira
Dr Ira L Shapira is an author and section editor fo Sleep and Health, President of I HATE CPAP LLC, President of Chicagoland Dental Sleep Medicine Associates, President Dato-TECH, and has a Dental Practice with his partner Dr Mark Amidei. Dr Shapira holds several patents on collection of stem cells during early minimally invasive removal of wisdom teeth
