Sleep Apnea Treatment Is Moving Toward Oral Appliances

[roster]

GURNEE, IL, December 01, 2008 /24-7PressRelease/ -- CPAP is the Gold Standard for treatment of obstructive sleep apnea however numerous controlled studies spanning several years show the majority of patients do not use their CPAP on a regular basis. Numerous studies have shown that only 23-45% of patients actually use their CPAP. Other studies have shown that even patients who use their CPAP average only 4-5 hours a night not the recommended 7 1/2 -8 hours a night. Studies with BiPAP, APAP, Ramping and the multitude of masks show that these improvements have minimal affect on patient compliance. The one factor that predicts success with CPAP is initial acceptance. Patients who like CPAP treatment immediately after diagnosis appear to be compliant in the long term.

Dental Sleep Medicine offers sleep apnea treatment with oral appliances that patients find a more comfortable alternative to CPAP. The American Academy of Sleep Medicine has accepted oral appliances as a first line treatment for mild to moderate sleep apnea and as an alternative treatment for severe apnea when patients do not tolerate CPAP. The American Academy of Dental Sleep Medicine has endorsed this position. The National Sleep Foundation has declared that oral appliances are a treatment "whose time has come".

Dr Ira L Shapira, a Chicago dentist has a mission to increase the public's awareness of sleep apnea and the absolute need for patients to follow up with treatment or risk possible dire health consequences. He created I HATE CPAP LLC and the companies website http://www.ihatecpap.com that is a major source of information on sleep apnea treatment. The site covers all forms of treatment but focuses primarily on Dental Sleep Medicine and oral appliances. The poor compliance of patients with CPAP is at crisis levels and results in billions of dollars of avoidable medical expenses. Patients with untreated sleep apnea have a six fold increase in heart attacks and strokes and heavy snoring has been shown to cause a 10 fold increase in Carotid Atherosclerosis leading to a 1000% increased risk of stroke. Patients with untreated sleep apnea have slower reaction times than patients who are legally drunk and a six-fold increase in Motor Vehicle Accidents. One study showed that patients with mild apnea and no symptoms of daytime sleepiness had a 300% increase in motor vehicle accidents involving severe injury to one or more people.

http://www.ihatecpap.com is specifically designed by Dr Shapira to appeal to patients who have tried CPAP and discontinued using it. This is a large majority of diagnosed patients and many if not most are then lost to follow-up care. Many of these patients were never presented alternatives to CPAP so they see no reason to be reevaluated. Increasing awareness of the dangers of untreated sleep apnea and offering hope for successful treatment is what http://www.ihatecpap.com does best. That may be o to the passion of the creator of the site.

Dr Ira L Shapira, a Gurnee dentist was an early pioneer of oral appliance treatment. He became involved over concern for his three-year-old son Billy. Billy had large tonsils, poor sleep, night sweats and heavy snoring. When Dr Shapira and his wife Elise expressed their concerns to the pediatrician they were told he would outgrow the problem. When Billy was 5 years old he was held back from kindergarten and it was suggested that he had ADHD and that Ritalin might be appropriate treatment. At this point they decided to override the pediatrician and saw an ENT would not remove the tonsils because he would lose the pediatricians referrals. Dr Shapira arranged for Billy to have a sleep study done at Rush Sleep Center, which showed that Billy ha severe sleep apnea.

Billy had his tonsils out and his mouth widened orthodontically and became a straight "A" student and graduated college double major, double minor Magna cum Laude. Immediately after removal of the tonsils Billy went to a 95% growth curve, did not wake repeatedly, and did not need Ritalin.

Over the Last 25 years since Billy's sleep test research has shown that 80% or more of ADD and ADHD cases are related to sleep apnea. We now know that growth disturbances from disturbed sleep are well documented, as are immune deficiencies. Delayed brain development and even permanent changes in brain development are traced to untreated sleep apnea. The American Academy of Pediatric Medicine says that snoring can never be ignored in young children and that any apnea should be treated even if they only occur once an hour.

Dr Shapira spent the night with his son at the sleep lab and developed a life long interest in sleep apnea and snoring treatment. He became a visiting Assistant Professor at Rush and did research on the relation of jaw position to sleep apnea using neuromuscular dentistry techniques. His research showed that the jaw relations of apneic men were very similar to women with TMJ problems. The National Heart Lung and Blood Institute (NHLBI) released a report on that very subject.
CARDIOVASCULAR AND SLEEP-RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS: NHLBI WORKSHOP. This excellent article can be found at: http://www.nhlbi.nih.gov/meetings/works ... j_wksp.pdf

This is extremely important information that links TMJ disorders including headache, migraine, earache, sinus pain, facial pain, TM Joint clicking and popping, neck pain, jaw pain and numerous other disorders to sleep and sleep disorders. Morning headaches are a frequent symptom of disturbed sleep and Fibromyalgia is also considered a sleep disorder. The full report can be found at: http://sleepandhealth.com/modules.php?n ... 237&tid=22

Suffer No More is an excellent article published in Sleep and Health Journal on TMD or Temporomandibular Dysfunction. It is available at: http://sleepandhealth.com/modules.php?n ... 237&tid=22

Dr Shapira was a charter and Credentialed member of the Sleep Disorder Dental Society which later became the American Academy of Dental Sleep Medicine, is a Diplomate of the American Board of Dental Sleep Medicine, a Founding member of DOSA, the Dental Organization for Sleep Apnea and was recently named to be on the Board of Directors of the Illinois Sleep Society.

When the American Academy of Sleep Medicine accepted oral appliance treatment of sleep apnea they recommended that dentists treating apnea should be well versed in treatment of TMJ/TMD disorders. Dr Shapira has has been involved in treating TMJ disorders and chronic pain for almost 30 years and is a Fellow and Regent of ICCMO, the International College of CranioMandibular Orthopedics. It is the premiere group focusing on Neuromuscular Dentistry and it's use in the treatment of chronic head and neck pain. Dr Shapira is a representative from ICCMO to the TMJ Dysfunction and Pain.

He has worked for several years on http://www.ihatecpap.com to pass on knowledge about sleep apnea and snoring to the general public and to creat a site where patients could find dentists trained in Dental Sleep Medicine. Dr Shapira teaches courses on Dental Sleep Medicine in his Gurnee office and has also lectured at ICCMO and the American Academy of Anti-Aging Medicine (A4M) on sleep disorders.

The second project Dr Shapira has been working on is minimally invasive early removal of wisdom teeth with collection of Stem Cells. He holds several patents on methods and devices to collect bone marrow and stem cells from developing third molars in young children. He hopes to change the practice of dentistry so patients no longer have to suffer through wisdom tooth extractions. His techniques will almost eliminate morbidity associated with third molar removal. The young healthy stem cells collected through his procedures will enable more people to benefit from future stem cell developments and possibly a future vaccine against aging.

About Sleep and Health Journal

Dr Ira L Shapira is an author and section editor for Sleep and Health Journal, President of I HATE CPAP LLC, President Dato-TECH, and has a Dental Practice in Gurnee with his partner Dr Mark Amidei. He has recently formed Chicagoland Dental Sleep Medicine Associates to provide sleep apnea treatment in Skokie, Bannockburn, Schaumburg with additional Chicago offices to be announced shortly.

http://www.24-7pressrelease.com/press-r ... -77187.php

[jnk]

I'm sure Dr. Ira helps many people, but I personally file such self-engineered press releases as his under 'cost-effective form of advertisement.' And as the press-release page says: "24-7 Press Release disclaims any content contained in this press release."

[Slinky]

You read this article too, eh, Rooster? If only the sleep "professionals" had any clue as to just how badly they manage their profession and how badly they let their patients down. *sigh* But then, heaven forbid, they should accept the responsibility for the dismal success rate for CPAP therapy.

... http://www.ihatecpap.com is specifically designed by Dr Shapira to appeal to patients who have tried CPAP and discontinued using it. This is a large majority of diagnosed patients and many if not most are then lost to follow-up care. ...

...Patients who like CPAP treatment immediately after diagnosis appear to be compliant in the long term.
...

That sure as h*ll wasn't me!!! I HATED it and slept WORSE my first 30 nights on CPAP!

... The American Academy of Sleep Medicine has accepted oral appliances as a first line treatment for mild to moderate sleep apnea and as an alternative treatment for severe apnea when patients do not tolerate CPAP. ...

I saw no mention of costs for those dental appliances, did you? And how many insurances will pay for them? Since using this chin strap I've had some jaw issues and may end up w/a dental appliance myself. Ain't that a bummer? CPAP and dental appliance? *sigh*

[LSAT]

There are OTC appliances available...I've seen them on TV. They are advertised to treat snoring.
http://www.puresleep.com/index.htm

[stacia123]

That's not so much a news article as it is a poorly written advertisement. I highly doubt treatment is "moving toward oral appliances", it's just some dude selling oral appliances wants you to think so.

[Slinky]

"I" AIN'T giving up my xPAP!!!!!

[Velbor]

Just for the record, and without endorsing Dr. Shapira or his advertising (though I must say that his web site is full of good information), for SOME of us, oral appliances DO work very well (documented by PSG) and are considerably more convenient than PAP. Some people use both at the same time. For me, the appliance is my primary therapy, but for dental reasons I use PAP several days a week to give my aging teeth a rest.

[roster]

Just for the record, and without endorsing Dr. Shapira or his advertising (though I must say that his web site is full of good information), for SOME of us, oral appliances DO work very well (documented by PSG) and are considerably more convenient than PAP. Some people use both at the same time. For me, the appliance is my primary therapy, but for dental reasons I use PAP several days a week to give my aging teeth a rest.

Velbor, What was the total cost of your appliance? How often do you go in to get it checked/adjusted? How long have you been using it? Thanks,

[jnk]

Just for the record, and without endorsing Dr. Shapira or his advertising (though I must say that his web site is full of good information), for SOME of us, oral appliances DO work very well (documented by PSG) and are considerably more convenient than PAP. Some people use both at the same time. For me, the appliance is my primary therapy, but for dental reasons I use PAP several days a week to give my aging teeth a rest.

Thanks, Velbor. I always particularly appreciate your posts.

Any new developments for you since the details you gave in this thread?: viewtopic.php?p=239557#239557

[Velbor]

Velbor, What was the total cost of your appliance? How often do you go in to get it checked/adjusted? How long have you been using it? Thanks,

I've been using the Klearway since Feb 1999 - almost at my 10th anniversary.

I'm currently using my 4th appliance. With earlier models, the plastic gradually became brittle and discolored. Much better chemistry now. Also need occasional replacement due to changes in dentition and oral geometry due to aging, due to major dental repair work, and due to long-term stresses on the appliance itself. It's a rather hostile environment, holding the lower jaw forward while asleep. My current appliance has been in use since Aug 2006; has needed some minor repair work, but is still going strong. Typical life expectancy should be over 3 years; insurers reportedly will scream if less than that, but they've paid anyway (see cost comments below).

Early on in the process, more frequent visits (every few weeks to every few months). Now, with more experience, and no problems, I often go 6 months to a year without a checkup. No, that's not really fair. I go to my regular dentist office every 3 months, and they're very attentive to any changes that might be due to the appliance. My appliance itself is managed through the Department of Oral and Maxillofacial Surgery of a large teaching hospital; my physician is both a dentist and an oral surgeon. I also see, every 6 - 12 months, a "medical" sleep specialist who coordinates my medications and my CPAP. My appliance doctor/dentist, my medical sleep doctor, and my dentist, talk to each other. I insist upon it, and I make sure that it happens.

I should also say that (unlike what is typical for PAP), I have always been instructed to make my own appliance adjustments. When both the doctor and I think that it's at an optimal position, for each new appliance, we get a PSG done to confirm.

Cost: nothing. That is, nothing out of pocket for me. Everything is based on the ICD coding: Obstructive Sleep Apnea is a medical condition. So all claims go to my medical insurance, not dental. I'm in a BC-BS HMO plan; my primary physician refers me to my appliance physician; they take impressions, send them to a fabrication lab, and deliver the appliance to me to check fit. All covered by medical insurance. My understanding is that the appliance would otherwise run me somewhere about $1000 each time. The insurance process doesn't always go smoothly, and often the hospital asks patients to pay up-front pending insurance reimbursement, but so far between my complaint letters and my doctor's complaint letters, and our working together to be sure we have pre-authorization from the outset, I've not had to pay anything. Same is true for my CPAP machine and equipment, and all of my PSG's. When you learn how to work the system, the system does work. (Unfortunately, it penalizes everyone else.)

Regards, Velbor

[Goofproof]

As Al, tells Tim the Tool Man, "I don't think so!' It's only useful for those that can hold their breath in DeNile! Jim

[Guest]

Heh. I never liked CPAP in the beginning and don't particularly care for it now, although I'd say I'm at a point where I'm neutral about it and find it rather annoying and inconvenient if I want to go camping. I'll have to agree with him on the ADD thing, though. I had that diagnosis for years and I think really I had chronic sleep deprivation because note when I have good nights with the CPAP I don't have any attention problems.

[roster]

........ I'll have to agree with him on the ADD thing, though. I had that diagnosis for years and I think really I had chronic sleep deprivation because note when I have good nights with the CPAP I don't have any attention problems.

Somewhere on the forum there is a post I made of an article about two good pediatric doctors. They found out over time that 80% of the children they were seeing with ADD/ADHD actually had sleep apnea. With successful treatment for sleep apnea the symptoms of ADD/ADHD went away.

Good for these doctors. Shame on the thousands of doctors that are treating children with ADD/ADHD symptoms with powerful drugs with many side effects while failing to diagnose sleep apnea.

BTW, stick with your cpap.

[Mamma R]

My husband has one of Dr. Shapira's appliances it works great!!! it has saved out marriage . He was unable to wear the cpac machine but he wearing the appliances faithfully. I'll tell you if you can't or won't wear the machine then get an appliance. What's wrong with free advertising the fact of the matter is people are finding out that there are alternitives to the machines people have hope again.