What should I know about sleep apnea?

This article gives information on the different types of sleep apnea and the available treatments.

Sleep apnea is a type of sleep disorder characterized by interruptions or pauses in breathing during sleep. These interruptions can be significant and can be potentially life threatening. Because of this, the disorder can have an important impact on quality of life as well as the health of a patient.

Kim LaJack, Director of the Sleep Disorders Center at Opelousas General Health System, says symptoms of sleep apnea might include loud snoring, excessive daytime sleepiness and feelings of exhaustion upon awakening, as if sleep had never taken place. Other symptoms include depression, irritability, morning headaches, loss of sex drive, lack of concentration and memory problems.

If untreated, sleep apnea can lead to accidents due to drowsy driving as well as health issues such as hypertension, heart attacks, diabetes and strokes, according to LaJack. 

The Three Types of Sleep Apnea 

1. Obstructive sleep apnea: OSA is essentially breathing that is interrupted by a physical block to airflow despite respiratory effort, causing complete or partial closure of the airway during sleep. The three causes for OSA are enlarged tonsils blocking the airway, an enlarged neck or a large tongue blocking the airway. 

2. Central sleep apnea: This type of sleep apnea occurs when the brain fails to send the appropriate signal to the muscles responsible for initiating breathing. “We see this with patients who have neuromuscular disorders or who are on a lot of pain medication,” LaJack explains. “Sometimes patients with heart failure also experience central sleep apnea.” 

3. Complex sleep apnea: This type of sleep apnea encompasses a combination of obstructive and central sleep apnea, with the airways closed off and breathing suspended. 

“While there are three different kinds of sleep apnea, the most frequently treated at Opelousas General is obstructive sleep apnea,” LaJack says. 

Diagnosis and Treatment

Giving the history of symptoms to a qualified physician is the only way to determine if a patient's experience requires a sleep study, says LaJack. Patients who have undergone initial evaluation spend an evening at the Sleep Disorders Center at Opelousas General Health System, where their sleep is closely monitored. 

“Monitoring involves obtaining information about sleep stages, including heart rate, respiratory effort and oxygen and carbon dioxide levels,” LaJack says. 

The treatment for sleep apnea varies depending on the cause. OSA in adults involves initiation of continuous positive airway pressure (CPAP) therapy. The CPAP machine delivers a pressure into the patient's airway by way of a mask and tubing, acting as a splint to hold the airway open. LaJack says OSA in children is generally treated with tonsillectomy. On occasion, children will need to be treated with CPAP, and with family support, it often is successful. In regards to central sleep apnea, PAP therapy involves an added element of delivering a breath during pauses in breathing. 

Dr. Joseph Y. Bordelon, Medical Director of the Sleep Disorders Center, emphasizes, “No matter the cause of the sleep apnea, the goal of therapy is to maintain an open airway so that the patient can have a more restful night of sleep, experience improved quality of life, and to prevent complications associated with untreated sleep disordered breathing. If we can delay someone's premature trip to the funeral home or nursing home, then we have been successful.”

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All about sleep apnea

This article provides much information on sleep apnea, including signs you may have it, and what you should do to get checked if you think you might have sleep apnea.

Think you might have sleep apnea? Not sure what the symptoms are? It's a growing sleep disorder that people are more and more being affected by.

Sleep apnea affects some 18 million Americans and around 850,000 Canadians. The etymology of the word apnea translates into the suspension of breathing or the absence of respiration. Pauses can last anywhere from a few seconds to a few minutes, this can occur up to 30 times per hour in some cases.

Obstructive sleep apnea can be mild, moderate or severe. The severe form of this ailment can progressively degenerate, leading in some cases to death in patients. Sleep apnea often goes undiagnosed as extreme snoring. Both sexes experience sleep apnea but it is more common in males than females. Certain racial groups are also more prone to this condition, Hispanics have higher rates of sleep apnea than Caucasians.

Common Sleep Apnea Statistics

The Sleep Disorders Guide has provided the following research information.

- 1 in every 15 Americans has sleep apnea

- University of California’s San Diego campus discovered 17 percent of the 54 African Americans had obstructive sleep apnea. The 346 Caucasians tested only had an 8 percent indicator

- 1 in 50 Americans are undiagnosed

- obstructive sleep apnea patients are at an increased rate for traffic incidents

- People driving drowsy is responsible for 100,000 car accidents, 40,000 injuries and up to 1,550 deaths per year if your bed partner has this condition you are unlikely to get any sleep

- stroke, hypertension and heart disease are all linked to sufferers of sleep apnea

A lack of proper sleep has been linked to cognitive problems in the workforce and decreases in educational achievement. Memory and complex decision making skills are also affected at an increased rate leading to occupational accidents and fatalities.

Fatalities Caused By Sleep Disorders

The impact of getting a lack of sleep can not be underestimated. Medical resident students work longer hours than most hospital staff. During the first year residency med students usually work a 24 hour shift every third night they can work up to 96 hours in some cases. Columbia University’s College of Physicians and Surgeons states that medical student hours can not exceed 80 hours per week with at least 24 consecutive hours free from duty in a week. These guidelines are often not adhered to with priority shifts and hours going to senior staff. The Accreditation Council for Graduate Medical Education found that residents who worked more than 80 hours per week were at risk for making significant medical errors that led to negatively impacting patients. Sleep related fatigue is a leading cause of medical errors facing hospitals and patients.

The Three Mile Island incident of 1979 resulted in a cooling malfunction in reactor #2, radioactive gas was released, fortunately there were no fatalities. Cooling to the reactor was eventually restored, this incident was thought to have been caused by lack of sleep of the plant employees. The occupational damage from lack of sleep ended up costing $975 million back in March 28th of 1979.

The Exxon Valdez Oil Spill was one of the worst environmental disasters in U.S. history. The 987 foot long oil tanker ran aground a reef in Prince William Sound, Alaska releasing 10.8 million gallons of crude oil into the Pacific ocean. The oil spill ended costing $3.8 billion to clean up. This incident again was related to the ships crew suffering from lack of sleep.

Who Is At Risk For Sleep Apnea?

The Centers for Disease Control and Prevention (CDC) states that one-third of U.S. adults or 34.9 percent are obese. The medical costs for treating obese people amounted to $147 billion in 2008 U.S. dollars. The male gender and certain racial groups are more at risk for sleep apnea than other demographics. Blacks are at a 47.8% increased risk of obesity compared to 42.5% for Hispanics. Whites have a 32.6% obesity rate compared to 10.8% for Asians.

Obesity and socioeconomic status go hand in hand when it comes to obesity. Blacks and Mexican Americans are prime candidates for the battle of the bulge. Among women obesity levels rise with education levels. Women with a college degree had a 23.4% obesity rate compared to 42.1% of women without a high school diploma. Men and women with college degrees have significantly lower rates of obesity. The common denominator is the more education people have the more income they earn and the healthier food they can purchase.

Simply put people with higher incomes are able to afford organic or natural foods. GM staple crops like GM corn are modified to produce higher yields. A Norway research study fed rats GM corn for 90 days, the end result was the rats feeding on the GM corn grew obese, in contrast to the rats fed on the non-GM diet. The physiology of rats is similar to humans, if rats grow obese from a GM diet than humans eating the same type of food will also become obese. Nutrient levels in today’s crops have decreased significantly since WWII, modern day food simply does not have the nutritional density it once did. A lack of nutrient dense crops results in people eating large quantities of food, the more food a person consumes to make up for the lack of nutrients the more weight they put on. Mexican Americans and Blacks from lower economic levels live in areas with an abundance of fast food outlets and grocery stores that do not have access to the organic food market because of the higher prices, this makes this demographic prime candidates for sleep apnea.

Diagnosing Sleep Apnea

The most direct method to diagnose sleep apnea is at a sleep clinic managed by qualified sleep technicians. The clinical name for the study of sleep is called polysomnography, this test measures brain wave activity, heart rate, breathing and eye and leg movements. Patients undergoing this study check in during the evening into a private room that has a video camera, the sleep room is adjacent to the monitoring room where the sleep technician monitors the patient. Sensors are placed on the legs of the individual to monitor restlessness at night. A sensor belt is placed around the abdomen and waist to monitor breathing, additional sensors are placed near the mouth and nose to measure the respiratory rate.

The final step in polysomnography is the attachment of a Continuous positive airway pressure (CPAP) device that attaches to the mouth of the patient. The CPAP machine supplies light air pressure through the mouth or nose, this pressure is enough to keep the airway open so the patient can breathe properly while sleeping. If the presence of obstructive sleep apnea is documented during the night the sleep technician will re-enter the room and apply a CPAP mask that is attached to a CPAP machine. The sleep technician will wait for the patient to enter a deep sleep before gradually determining the minimum airflow to keep the airway open. The technician will also monitor the patients other vitals for symptoms of sleep apnea. A definitive diagnosis can be made later by a physician sleep specialist that is dedicated to the study of sleep medicine.

CPAP is the most widely accepted and effective machine to treat sleep apnea today. If you think you may be a sufferer of sleep apnea consult your physician regarding making an appointment at a sleep clinic.

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Common issues that hurt your sleep

This article discusses common issues that hurt people's sleep, and tells you what to do about them.

You might remember a time when you could drift off to sleep in an instant and remain in a state of blissful slumber well past lunchtime the next day. Now your sleep is more likely to be lighter and more fitful, and when you wake up in the morning you don't always feel refreshed.

A lack of good-quality sleep could be a natural consequence of changing sleep-wake patterns after menopause. It's also likely that the issue is physical--and fixable. Many conditions can disrupt your rest, and they can be treated. It's important to address these issues. Lack of sleep does more than make you drowsy. Chronic insomnia has been linked to a variety of health problems, including obesity, high blood pressure, heart disease, diabetes and depression.

Go through this list to see whether you might have one of these sleep-stealing conditions. Also check your medicine cabinet. Some medications, including corticosteroids, beta blockers, cold and flu remedies, and certain antidepressants also can interfere with sleep.

1. Sleep apnea

The conventional image of sleep apnea is of the overweight man who snores, but women of any size can also develop these repeated pauses in breathing while they sleep.

"A woman who has a narrow jaw or a change in muscle tone can get apnea," says Dr. Julia Schlam Edelman, clinical instructor in obstetrics and reproductive biology at Harvard Medical School and author of "Successful Sleep Strategies for Women and Menopause Matters: Your Guide to a Long and Healthy Life." Either of these anatomical issues can block oxygen from reaching your lungs (and subsequently the rest of your body) while you sleep. Snoring might not be your main symptom if you do have sleep apnea, but you will notice that you're especially sleepy during the day.

Solution: See a specialist for a sleep study. You may be able to relieve apnea with a few lifestyle adjustments, such as sleeping on your side or losing weight. Your doctor might also suggest an oral appliance or a CPAP machine that blows air into your airways to keep them open at night.

2. Diet

What you eat can affect your sleep. Spicy foods can contribute to painful heartburn. Big meals leave you uncomfortably full, and over time can contribute to obesity--a well-known risk factor for sleep apnea. Too much caffeine could keep you wide awake, even if you finish your coffee in the morning.

"It takes six hours to clear half of the caffeine from your body. If you have enough caffeine, it's still in your body at 4 in the morning," says Dr. Edelman. And though a glass of wine or two with dinner will make you feel relaxed or even sleepy, it won't help you sleep. "You can fall asleep, but once you're asleep you can't sleep deeply," she says.

Solution: Eat dinner at least a couple of hours before bedtime, and keep the meal light. Avoid spicy, fatty foods, as well as alcohol and caffeine. Also, don't drink too many fluids before bed. Having to constantly get up to go to the bathroom can disrupt your sleep, too.

3. Lack of exercise

Sleep and exercise complement each other. Working out regularly can help you sleep better, and conversely, you're more likely to exercise if you get a good night's rest.

Solution: Exercise every day if you can, ideally in the morning. Doing a high-energy aerobic routine too close to bedtime can have the opposite of the intended effect, making you too energized to sleep. A gentle yoga stretch before bed probably won't hurt, though. It might even help you relax.

4. Pain

Arthritis aches or any other kinds of pain don't make for restful slumber. Conversely, a lack of sleep can increase your pain. Researchers believe that a lack of sleep may activate inflammatory pathways that exacerbate arthritis pain. Poor sleep can also make you more sensitive to the feeling of pain.

Solution: In addition to the pain remedies your doctor recommends, try using a heating pad or taking a warm bath before bed to soothe achy joints or muscles. Lying against a body pillow can put you in a more comfortable position while you sleep.

5. Restless legs syndrome

Women are twice as likely as men to have restless legs syndrome (RLS)--a condition that causes a creepy, crawly feeling and uncontrollable movements in the legs at night. It's often linked to hormonal changes early in life and during pregnancy, but RLS can continue as you get older. RLS isn't just miserably uncomfortable--researchers at Harvard have linked this condition to an increased risk for heart disease and depression in women.

Solution: Try simple interventions first. Exercise every day, take a hot bath before bed, massage your legs, and cut back on things that can make you jittery--like caffeine and tobacco. If these measures don't work, your doctor may recommend one of several medicines that reduce RLS symptoms--including ropinirole (Requip), pramipexole (Mirapex), rotigotine (Neupro), or gabapentin enacarbil (Horizant).

6. Depression

"Depression is a common compromiser of sleep, and it's much more common in women than in men," Dr. Edelman says. Women who are depressed may sleep more than usual, but their sleep isn't restful. Some of the antidepressants meant to counteract depression, particularly SSRIs, can also interfere with sleep.

Solution: See your primary care doctor, psychologist, psychiatrist, or therapist for help, which may include medications, talk therapy, or both. If your antidepressant seems to be keeping you awake, ask your doctor to switch you to another drug.

7. Stress

It's impossible to sleep when the weight of the day is pressing on you. Finding a sense of calm before bed isn't easy, especially when you can't unplug from the demands of your day.

Solution: Establish wind-down time. Do a quiet, relaxing activity before bed that doesn't involve a screen. Talk to a friend or family member, sew, or read a real book--not one on a backlit tablet device.

"Just allow yourself to have quiet time," Dr. Edelman adds. And don't sleep with your smartphone on your bedside table.

8. Poor sleep habits

Sometimes insomnia stems from long-ingrained behaviors, like staying up too late or engaging in stimulating activities before bed.

Solution: Follow a few basic sleep hygiene strategies. Go to bed and wake up at the same times each day. Keep your bedroom cool, dark, and comfortable. Use your bed for sleep and sex only. If you can't fall asleep within 15 minutes, get up and leave the bedroom. Read or do another quiet activity for 15 to 20 minutes until you get sleepy.

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Does weight gain cause sleep apnea, or does sleep apnea cause weight gain?

This article discusses the link between sleep apnea and weight gain, and other serious consequences of untreated sleep apnea.

When you know that "apnea" is the Greek word for "without breath," you begin to understand how scary sleep apnea can be. Sleeping without breath? That just can't be good for you … and it's not. Because its main symptoms (snoring and daytime fatigue) are easily overlooked, it is one of the most undiagnosed sleep disorders in the country, according to Health Magazine.

Sleep apnea has been shown to be related to a host of health concerns, including hypertension and heart disease, but when it comes to the relationship between sleep apnea and weight gain, which comes first? Does weight gain cause sleep apnea, or does sleep apnea cause weight gain?

In one of those great anatomical double-whammies, the answer to that question is "yes" and "yes." The National Heart, Lung, and Blood Institute explains that sleep apnea happens when you're asleep and your upper respiratory passages relax. For most of us, that's no big deal. For some people, though, that can cause problems. It may be because their airways are more narrow, their tongues are too big, or their tonsils are too large. And it may be because they are overweight. If you're carrying extra soft fat tissue, it can actually thicken the walls of your windpipe, making it narrower and increasing your risk for sleep apnea. So yes, gaining weight can contribute to getting sleep apnea.

But it doesn't stop there. Because sleep apnea means that you never (and I mean, never) get a good night's sleep, the idea of any exercise seems absurd. It would be like having a newborn baby that doesn't ever grow up. Actually, it would be worse than that because even newborns will let you sleep for a couple of hours at a time. Sleep apnea doesn't. You can wake up gasping for breath every few minutes all night long, or you can just snort and snore and roll over many times in the course of sleep cycle. Either way, you don't ever run a full sleep cycle; your body never really gets the rest it needs to rebuild or rejuvenate. You are exhausted all the time. You know you need to exercise to lose some weight so you can sleep better, but you're out of breath just walking to your car; how in the world are you going to walk around the block or take the stairs instead of the elevator?

And just to add insult to injury, a 2004 PLOS study revealed that sleep-deprived people had higher levels of ghrelin, the hormone our body produces to stimulate appetite, and reduced levels of leptin, the hormone our bodies make to suppress appetite. So, yes, sleep apnea can contribute to gaining weight.

So what's an overweight, sleep-deprived person to do? Don't despair; there are options. Traditional sleep apnea treatments such as CPACs (continuous positive airway compressors) can be helpful. Some people learn to sleep with them all night, every night. Others can never really get quite comfortable with it, but it might be just enough to get them moving in the right direction. Even just walking to the end of the street helps, and many sleep apnea patients enjoy bike riding because it lessens the pressure on their joints. The key is to tackle both issues – weight gain and sleep apnea – together, as improvements in one condition often yield improvements in the other. Just as the two worsen together, so they also improve together. Small changes can make a big impact over time, so the important thing is to talk to you doctor, don't give up, and take it one small step at a time.

If you feel like you never get a good night's sleep, sleep apnea could be to blame. Ask your doctor for more information, and remember that St. Francis offers a Sleep Disorder Center that can help identify the source of your sleeplessness.

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Medicine instead of tonsillectomy for children with mild obstructive sleep apnea - Ask a Pediatric Sleep Specialist

This article claims that a specific drug combination can replace the need for a tonsillectomy for children who have mild obstructive sleep apnea.

The anti-inflammatory asthma drug montelukast (Singulair) plus intranasal corticosteroids was an effective initial alternative to surgery for mild obstructive sleep apnea (OSA) in children, a retrospective study showed.

That strategy was associated with normalization of sleep findings in 62%,David Gozal, MD, of Chicago's Comer Children's Hospital, and colleagues found.

Overall, taking into account nonadherence and parents refusing the strategy, 81% were able to avoid surgery, the researchers reported online in Chest.

With "the absence of significant side effects and overall favorable safety profile associated with the use of either intranasal corticosteroids, or of oral montelukast," the combination "may ultimately replace adenotonsillectomy as the first line of treatment in mild OSA," they suggested.

Pediatric sleep apnea can resolve on its own, and that might have accounted for some of the results, Gozal's group acknowledged.

However, "the combined evidence from in vitro experiments showing marked reductions in tonsillar and adenoid tissue proliferation with application of corticosteroids or montelukast, and the experience garnered from clinical trials using either intranasal corticosteroids alone or oral montelukast alone," support a real effect.

Prospective randomized controlled trial evidence is "sorely" needed, the group concluded.

Until such a trial is done, it would be premature to offer the drug combo routinely,Christopher Carroll, MD, medical director of surgical critical care at Connecticut Childrens Medical Center in Hartford, commented in an interview with MedPage Today.

Nevertheless, "I don't think there's any problem with trying this before going to surgery," he suggested, noting that its OSA resolution rate was fairly competitive with the 75% rate found for surgery in a recent review.

"We tend to think that surgery is definitive and is curative 100% of the time, but that's just not true," he said. "And it carries a significant risk."

The retrospective review included 836 otherwise healthy children ages 2 to 14 who were clinically and polysomnographically diagnosed with mild OSA at three centers.

Among them, 752 accepted open-label treatment with a combination of oral montelukast and an intranasal corticosteroid for 12 weeks, with continued montelukast for 6 to 12 months if symptoms persisted at subsequent polysomnographs or a recommendation for surgery if they worsened.

Predictors of nonresponse were older age (odds ratio 2.3 for age older than 7, 95% CI 1.43-4.13) and obesity (OR 6.3 with BMI z score over 1.65, 95% CI 4.23-11.18).

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Mouth Guard to help with Sleep Apnea

A new mouth guard could replace CPAP for people who have mild to moderate sleep apnea.

Debbie Blenis doesn’t know yet if she has obstructive sleep apnea, but the Palm Bay woman knows all about the subject.

“My father has sleep apnea, and I understand what that can be like,” she said. “When he finally saw the doctor about it ... he was told he was a stroke waiting to happen.”

So, knowing sleep apnea runs in her family, aware of the dangers and already possessed of two of its classic symptoms, bruxism (grinding of the teeth) and snoring, she has agreed to be tested for the condition by her dentist, Dr. Lori Nelson of Ultimate Smile Design in Palm Bay.

Nelson and other dentists screen, and now, collaborating with sleep medicine specialists, treat patients for the potentially life-threatening disorder that causes breathing to stop during sleep.

So important is the subject to dentistry that the American Academy of Dental Sleep Medicine, a nonprofit professional society founded in 1991, has more than 2,800 members nationwide and is growing. It and other professional organizations, including the American Dental Association, now offer courses to better acquaint dentists with sleep medicine.

Last year, Dr. Gail Demko, president of AADSM and expert adviser to the Food & Drug Administration in oral appliance therapy, told the publication Dentistry IQ(dentistryiq.com) that dentists are particularly well-equipped to handle “sleep-disordered breathing.”

Once, sleep medicine was strictly the province of specialist physicians who tested and treated apnea and related conditions, often prescribing use of sometimes-cumbersome continuous positive airway pressure devices, which use mild air pressure to keep airways open while patients are sleeping. It involves wearing a mask or other device that fits over the nose and mouth, which is connected by tube to a machine that blows air into the airways.

Patients determined by their physicians to have severe cases of apnea still are prescribed CPAP treatment, but a patient with mild to moderate sleep apnea now may be fitted by his or her dentist with a small, custom-fitted, mouth guardlike appliance that maintains an open, unobstructed airway during sleep.

“The device, which is worn while sleeping, repositions the mandible (lower jaw), so that the airway remains open,” said Nelson, who has practiced dental sleep medicine since 2006.

But it is not simply a matter of fitting a mouthpiece. Potential wearers must first undergo testing and studies, and the dentist’s work is done in conjunction with the doctor’s.

“The important thing to convey is that a dentist cannot treat these conditions alone,” said Dr. Duongvannak Keo, who practices dentistry on Merritt Island. “We’re not allowed to diagnose sleep apnea, we only screen our patients for it. Then, we can treat them based on a physician’s referral and recommendation.”

But dentists, because of their training and the very nature of their profession, do notice the signs.

“The clinical aspect of treating sleep-disordered breathing, be it snoring or sleep apnea, requires basic skills that have been taught to dentists in their restorative dental training. The most important aspect is the academic knowledge required to become part of a team that is treating a medical disease,” Demko said.

It is less a procedure than a process, dentists add.

“We are looking for signs of dental disease, no doubt, but we’re also looking at a patient’s bite and its possible effect on his or her overall health,” Nelson said.

That means questions about sleeping habits as well as teeth.

Nelson said that when a patient reports he or she is not sleeping well, the Epworth Sleepiness Scale, which measures daytime sleepiness by asking a patient to rate his or her likelihood of falling asleep, is used at Ultimate Smile Design, followed by checks of oral and nasal airways.

“If we see something that possibly indicates sleep apnea, we will order a sleep study, coordinated with the patient and his or her physician,” she said.

Keo agreed: “We guide them through the process and refer them to a sleep physician.”

Only after mild to moderate sleep apnea is diagnosed will the dentist recommend the new device.

“A pharyngometer is used to measure the pharyngeal airway size to assess the patient for obstruction, so when the patient is fitted, (the jaw) is in a scientifically specified position,” Nelson said. “And we do confirm things with another sleep study, which we have read by a certified sleep medicine physician.”

Thus, physicians and others who work with sleep apnea patients in the traditional, medical setting say they welcome the involvement of dentists, who may be the first practitioners to notice potential problems

“We work primarily with Dr. Keo, who is certified (in dental sleep medicine and oral appliance therapy),” said Kristina Weaver, sleep center supervisor for Parrish Medical Center in Port St. John. “We will do a sleep consultation and a sleep study, and if the patient has mild sleep apnea, he does the consultation. He makes the mold, and he fits the patient with the device.”

Patients should not expect, however, that the dental device will work on all sleep apnea patients.

“These devices are intended primarily for people with mild sleep apnea,” Weaver said. “The CPAP still is always the first alternative, because we know without a doubt that it will correct the problem. (The mouthpiece) is not as good as the CPAP, but if the apnea is mild, it may help.”

Keo, who estimates he has made about 100 oral appliances for sleep apnea patients, called them “devices for people who cannot tolerate CPAPs; people who are looking for alternatives,” and referred to the CPAP as “the gold standard.”

Furthermore, dentists who screen patients for possible sleep apnea are by no means attempting to usurp anything from physicians.

“We tell every physician, ‘Look, I’m not taking your patient, I’m just screening for problems that you can help with. I’m not taking your patients, I’m giving you patients.’ ”

Most physicians don’t realize that such appliances even exist, he added, and so the dentist becomes a source of information as well.

“I think this is the way of the future,” Nelson said. “This is where medicine and dentistry are headed: working together for the good of our patients.

Blenis couldn’t agree more.

“I absolutely think sleep apnea is life-threatening,” she said. “It’s easy to ignore, especially if you don’t sleep with a partner who would notice that you are snoring loudly, or that your breathing has stopped. ... I feel a lot of comfort in that my dentist is watching out for my overall health and not just my teeth.”

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