Posts by: Momentum

The Relationship Between Obstructive Sleep Apnea and Obesity

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The Relationship Between Obstructive Sleep Apnea and Obesity

An estimated 18 million people have Obstructive Sleep Apnea (OSA). Out of that number, approximately 80% are unaware they are a victim.  OSA is often associated with obesity, and about 65% of Americans are now considered overweight, or obese. Obesity and sleep apnea make for a not-so-good concoction and can be detrimental.

To be classified as obese, you must have a Body Mass Index (BMI) greater than 30. BMI correlates with the severity of OSA, and even though more women than men are obese, the prevalence of OSA in men is higher. It is possible that fat is distributed differently between women and men.  For example, while fat accumulates in the tongue with weight gain, women in general have lower Mallampati scores (see image below).

obstructive sleep apnea and obesity

Women also have a shorter oropharynx (see image below) and therefore a shorter section of upper airway at risk for nighttime collapse.

image 5

Alternatively, men have a higher neck circumference and increased deposition of fat around the neck region, meaning more fat around the airway.  A neck circumference greater than 17 inches in a man and 16 inches in a woman increases the likelihood that the airway will collapse during sleep.  Those affected repeatedly stop breathing and are usually startled awake by a choking reflex.

obesity and sleep apnea

The high percentage of obesity in today’s world can be attributed to numerous causes.  Levels of physical activity have decreased, caloric intake has increased, and no one is getting enough sleep. Those three elements alone are a model for obesity.  If a person is overweight and suffering from OSA, he/she may not be motivated to exercise or maintain a proper diet.  One of the main symptoms of OSA is chronic daytime sleepiness, ultimately impairing a person’s ability to function properly.   Additionally, lack of sleep can impair the body’s metabolism, making it even harder to burn calories.

Obesity is not only a problem for adults, it has become a huge concern among children. Over the last 20 years, obesity-related medical conditions and sleep apnea discharges from the hospital have increased by over 400%.  OSA in children can lead to excessive daytime sleepiness, cardiovascular complications, ADHD and learning deficiencies.

If you think you may have Sleep Apnea, click here to take Dr. Klein’s Sleep Disorder Test . You can also visit us on FaceBook.




8/10/16 Article from Christchurch Hospital in New Zealand

Centers for Disease Control and Prevention

Sleep Medicine Reviews Journal, December 2009

Pediatrics Journal, Michael Schechter, April 2002




8/10/16 Article from Christchurch Hospital in New Zealand
Centers for Disease Control and Prevention
Sleep Medicine Reviews Journal, December 2009
Pediatrics Journal, Michael Schechter, April 2002


How Sleep Deprivation Affects Work Performance

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We’ve all been tired at work before. It’s not a good feeling. For many of us, this doesn’t happen very often, but imagine waking up tired every day.  People suffering from Sleep Apnea are awakening unrefreshed and fatigued every morning, leading to a cycle of stress, anxiety and depression.  It is proven that Sleep Apnea diminishes concentration and the ability to think clearly, which has an adverse effect on a person’s work performance. The relationship between sleep apnea and work performance is an issue that needs to be resolved as soon as possible.


There are 3 types of Sleep Apnea:


  1. Obstructive – when your airway becomes obstructed by either the soft tissue in your throat or by your tongue falling backwards
  2. Central – when there is a disruption in communication between your brain and your respiratory system (Common among those who have sustained a traumatic brain injury)
  3. Mixed – a combination of the above two types of Sleep Apnea

If you are experiencing any of the above, there are a variety of symptoms that can occur as a result.  All of these symptoms could potentially put you (or someone else) at risk while at work.

Fatigue, for instance, is extremely common among those suffering from Sleep Apnea.  The body is reacting to prolonged physical and/or mental stress. If your body is struggling to keep you breathing throughout the night, it is going to be tired in the morning.  The whole system has overexerted itself and is bound to be exhausted by the time you are supposed to get up and go to work. Fatigue can cause a person to become withdrawn, irrational and sometimes even angry. Approximately 45% of the US working population reports having sleep problems, which in turn leads to a higher number of accidents in the workplace.

Stress is another factor, and I don’t know anyone who doesn’t have some sort of stress in their life.  There are different types of stress – acute and chronic.  Acute stress is short-term stress, like the feeling you get from cramming for a test. If you suffer from episodic acute stress, you have this feeling constantly.  Chronic stress is the long-term, debilitating stress.  Any of these have the ability to impair a person’s intellectual reactions and decision making skills.  Studies show that decisions made in a stressed state show poor judgement and can result in accidents and errors. Stress resulting from fatigue can be somewhat sneaky. Usually people think that they acclimate to stress, when in reality the stress has just been accumulating the whole time and then damages rational thought processes.

FACT: Stress-related accidents including those associated with sleepiness and fatigue account for 60-80% of total reported accidents.


Sleeping 6 hours or less per night also increases your risk for depression, and about 30% of people sleep less than 6 hours per night. It’s a vicious cycle that wears a person down over time.

how sleep deprivation affects work performance

Becoming complacent in the workplace can stem from depression, low energy levels and fatigue. Workers can become almost unaware of their surroundings and have a false sense of reality. In this mindset, they are less likely to react accordingly to a situation requiring their immediate attention. It is recommended that employees take needed breaks and have a sufficient lunch time so that they do not become overworked and overwhelmed. Some people who are not getting the appropriate amount of sleep may even use these break times as nap times so that they feel more refreshed while on the job.

Yet another symptom of sleep deprivation is lack of awareness.  In order for the brain to create awareness, it must be restored on a daily basis.  Poor sleep can drastically weaken the brain’s ability to become aware, thus impairing a person’s ability to make proper decisions. Studies show that the effect of fatigue on the brain can be just as detrimental as alcohol.



The Impact of Sleep on Safety’s Dirty Dozen

Published on August 10, 2016


Sleep Loss and Fatigue in Shift Work and Shift Work Disorder

Sleep Med Clin. 2009 Jun 1; 4(2): 257–271


Sleep and Anxiety Disorders

Dialogues Clin Neurosci. 2003 Sep; 5(3): 249–258
Studies Find New Links between Sleep Duration and Depression
AASM Journal 2014 Jan

TMJ Throat Tightness

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Have you ever had trouble swallowing? You are not alone. Approximately 1 in every 17 people will experience this symptom in their lifetime. Dysphagia can result from numerous causes including degenerative neurologic disorders (Parkinson’s or Multiple Sclerosis), traumatic head and neck injuries, respiratory conditions (COPD), autoimmune disorders (meningitis) and cancer treatments (radiation/medications) to name a few.

Dysphagia arises when there are problems with the swallowing process, occurring anywhere from the stomach to the mouth. Impaired function in the larynx, esophagus, palate or even tongue may be present, causing trouble when stimulating the swallowing reflex.

tmj trouble swallowing

Dysphagia and TMD

Many people suffering from TMJ disorder report trouble swallowing as one of their various symptoms. On either side of the mandible (lower jaw), the attachment of the anterior digastric muscles loops around the hyoid bone. When these muscles are tight or foreshortened, they can move the hyoid bone, in turn causing TMJ trouble swallowing.

tmj throat tightness

To alleviate this, one common treatment is to inject a small amount of Marcaine into the ligamentous portion of the anterior digastric at the anterior inferior border of the chin (tip of the chin). This modality often improves TMJ difficulty swallowing of food, liquids and even saliva.

Dr. Richard Klein has been utilizing this treatment in his practice since 1985 when he opened the Michigan Head and Neck Institute. For more information on the treatment of Dysphagia, please contact our office at (586) 573 – 0438 or

OSA and Railroad Crashes

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On May 12, 2016, Dr. Klein was to speak in Washington DC to a panel representing the Federal Motor Carrier Safety Administration regarding the concern of Sleep Apnea in our workers of transportation including, highways, railroads, air, and waters.

The rule for presenters is scheduled limit of 3 to 5 minutes.  Dr. Klein was granted a significantly longer period of time. He is a member of the American Sleep and Breathing Academy (ASBA) which instructs physicians, sleep technicians, respiratory therapists, nurses, and dentists that oral appliances are a viable alternative to the CPAP machine. Dr. Klein also spoke of the convenience of home testing (which was an issue that truck drivers addressed since they have a driving schedule that clashes with most sleep testing. Mr. Larry Minor (Administrator for Policy FMCSA) directed a question to Dr. Klein asking if compliancy can be measured. The answer is yes and many were unaware of the technology of the “DentiTrac” (a micro-recorder which can be used to indicate compliancy of truckers wearing their sleep device).

Shannon Watson (Senior Policy Advisor FMCSA) asked Dr. Klein to remain at the podium in case the panel had questions. Eleven varied questions were asked by the doctors and attorney on the panel. One of the topics discussed included cost comparison of Oral Appliances and CPAP.

The Journal of Primary Care March 22, 2016 documents “results show that serious preventable accidents were 5 times higher among truck drivers with OSA who fail to comply” Compliancy of Oral Appliance utilization is shown to be significantly higher in all OSA individuals when the mere fact of wearing the appliance for the full night of sleep and on all nights of sleep is considered.  Success of using a CPAP only 4 hours a night and only 5 nights of the week is a statistic that does not make sense. It allows insurance coverage if met, but what about the other 72% of the sleep time that OSA is not controlled.

Due to the ease of utilization, reduced fees, and enhanced compliancy, the ASBA believes the OA to be a much easier alternative and more superior to major surgery, or the CPAP machine (especially a CPAP in a truck driver or railroad engineer’s closet).


Listen LIVE tonight!

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Listen in tonight May 7th @ 7:00PM on Patroit Radio channel 1400AM or 92.7FM. Dr. Klein will be answering questions regarding TMJ and Sleep Apnea. Call in yourself and get some answers to some questions that you may have!

What do Bob Seger and TMD have in common?

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I had a GREAT time at the Bob Seger concert last night, March 26, 2015, at the Palace of Auburn Hills.

What do Bob Seger and Temporomandibular Joint Disorders have in common? In my initial evaluation report sent to my patient’s doctors, I explain how TMD can cause muffled hearing, Phonophobia (sensitive to sound), or even hearing loss. The templated explanations include my seeing Bob Seger five nights in a row at Pine Knob as a teenager. I had muffled hearing by the sounds of five consecutive nights of great ROCK n ROLL! The tensor tympani muscle attaches to the ear drum with a purpose of torquing on it to protect it from loud noises. That muscle protected my eardrum and has allowed me to continue hearing Seger many times over the past 50 years.
bob seger

Things to Avoid in Autumn if you Have TMJ

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It’s autumn in Michigan! Whether you’re eating apples at a Cider Mill or clenching with fear at a Haunted House, keep in mind the effects that both can have on your jaw. For someone with TMJ, eating an apple or continuous clenching can worsen symptoms such as headaches, eye pain, ear pain, dizziness, an (of course) jaw pain. If you open wide to eat an apple and hear popping or clicking while you chew, you probably want to talk to your physician or dentist about a possible TMJ problem. Click the link below to be taken to our TMJ checklist and see how many symptoms you might be experiencing on a daily basis.

TMJ Checklist

TMJ Checklist for Autumn

2nd Annual School Supplies Drive Begins August 25th!

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annual school supplies drive

Donate Here!

Beginning August 25th through September 19th we will be hosting our 2nd Annual School Supplies Drive for local Elementary School, Siersma. Some of the items needed include:

  • Backpacks
  • #2 Pencils
  • Boxes of Tissue
  • 12” Rulers
  • 24ct Boxes of Crayons
  • Highlighters
  • Small Pencil Boxes
  • Pens (Red or Blue especially)
  • Glue Sticks
  • Clorox Wipes
  • Two-Pocket Folders
  • One-Subject Spiral (Wide-Ruled) Notebooks
  • Composition Notebooks
  • EXPO Dry-Erase Markers

Donations can be dropped off at our office in Warren, MI located on the North side of 11 Mile Road (also the I-696 service drive) just one block West of Ryan Road. Items can be dropped off from 9am-5pm, Monday-Friday from 8/25/14 through 9/19/14. Thank you for helping us make sure the students at Siersma Elementary have a great year!

If you have any questions, please contact Lauren at (586) 573-0438 ext. 204 or by email at