Posts by: Momentum

Is Sleep Apnea a Disability?

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man laying down

Today, over 18 million people in the United States suffer from obstructive sleep apnea, and some government studies indicate that it may be even be 50 million. Understanding the dangerous medical risks  that come with a diagnosis are important for many people who are either directly impacted or may be impacted in the future (OSA has a possible strong genetic basis). Visiting a certified sleep apnea doctor like the professionals at the Michigan Head & Neck Institute is the best way to see if you may have this potentially debilitating condition.

 

Disability Status

So, is Sleep Apnea a disability? The short answer is no. But the facts of the matter are much more complicated than that. The Social Security Administration does not classify sleep apnea as a claimable source of disability, but many of the problems that are associated with sleep apnea could qualify under the categories of heart problems, breathing disorders, or even the resulting mental deficit that accompanies Sleep Apnea’s impact on oxygen levels in the brain. Over a billion dollars are lost annually from business whose employees have OSA.  If you feel tired after sleeping or are known to snore a lot, a sleep apnea test is the best way to see if you have sleep apnea or are at risk for these complications.

One of the most dangerous risks with Sleep Apnea is the development of chronic pulmonary hypertension, which can change IQ, personality, and even lead to chronic mental disorders and death. These symptoms and conditions can severely impact a person’s ability to work properly and can be qualifying factors for disability through the SSA. While it is not considered a common result of sleep apnea, cases do exist, and you should monitor your condition with the help of a professional.

Probably the most widespread link to  Obstructive Sleep Apnea that can lead to disability from Social Security is “residual functional capacity.” If you can still work but only in a limited capacity, your RFC will reflect this. The SSA will look at your capabilities and consider if you are still able to perform your work or not, within reason. For example, a pilot or a machinist could be severely impacted at work by daytime sleepiness and typically cannot continue in that field. An accountant’s secretary can continue to work since their mistake is not deadly to anyone.

 

Treatment Options

Consult a professional for proper sleep apnea treatment, but there are plenty of ways to mitigate the effects. One of the best ways is to lose weight if you have these extra pounds. Being overweight is a major risk factor for sleep apnea, and other conditions associated with being overweight are linked to sleep apnea as well as diabetes and large neck size. Treatment usually involves the addition of a continuous positive airway pressure device or “CPAP” machine to your sleep routine. A CPAP machine facilitates proper breathing and restores adequate oxygen levels by providing airflow while you sleep. Other times, positional therapy provides patients with a way to sleep on their sides in a position that allows unobstructed breathing. In some cases, surgery could also remove some of the obstruction in the form of parts like tonsils or adenoids, or by modifying the jaw, soft palate, or tongue. For those who do not want the CPAP, an Oral Appliance (mouthpiece) can bring your jaw down and forward causing the collapse in the back of the throat to remain open for breathing in and exhaling out. The majority of people in the world can be comfortable with an OA but not with a CPAP. And the National Institute of Health now recognizes the safety and validity of an OA to control OSA.

 

Look at Options With a Professional

If you think your sleep apnea or its side effects are inhibiting your work, consult a physician to see if you qualify for disability due to an aspect of your disorder. They can help assess your residual functional capacity by monitoring your daytime sleepiness and oxygen levels. They can also provide ideas of how to restore your functionality through the addition of a CPAP machine, an Oral Appliance, or if surgery would be beneficial in your case. Usually, they have enough experience to also aid you by providing a diagnosis and reviewing your options for what to claim on a disability form. The professionals at the Michigan Head and Neck Institute have extensive experience diagnosing and treating sleep disorders and a consultation is the natural first step towards recovery or disability assistance.

Fried Food and OSA

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Who doesn’t like fried food?  Fried food is probably the most widely consumed food in the US (and worldwide).  In fact, more than 25% of adults consume fried foods every day.

Sometimes we probably forget that frying food actually alters the composition of it. What are we really eating, and where?  Eating fried foods in restaurants is riskier, as we don’t always know how old the oil is or what all it has been used for.  With constant reuse, the oil becomes tainted and starts getting absorbed into the food more and more.  This can contribute to weight gain, high blood pressure and increased cholesterol levels.  Many restaurants have started using trans-fat-free cooking oils.

The processes that take place during frying are:

-oxidation

-polymerization

-hydrogenation

Yes, frying makes food crunchy and more appetizing (which makes us eat more), but the food then loses water and absorbs fat.  A higher consumption of fried foods is associated with a laundry list of health risks including:

-cardiovascular disease (leading cause of death, globally)

-type 2 diabetes

-hypertension

-OSA (Obstructive Sleep Apnea)

Adults are not the only age group who is guilty of this consumption.  Studies have shown that students are eating more fried foods and exercising less, clearly related to more “screen time”, which then also leads into sleep disturbances.  You can see how this is a cycle.  Sleep disturbances = higher BMI = increased health risks.  This can also cause the start of depression at a young age.

 

body mass index chart

 

Keep in mind that obesity is the strongest predictor of OSA.  Usually the first thing that your doctor (sleep specialist) will tell you during your consult is that you may need to lose weight.  Weight loss has always been recognized as a treatment for OSA. Inadequate sleep has been known to also cause an increase in appetite for foods high in carbohydrates, starches and sugars, thus preventing weight loss.

Unfortunately, nowadays, everyone always seems to be in such a rush and not have any time to make their own food or go to the grocery store.  This definitely plays a part in food choices that we make.  If you just worked a 10-hour day at the office and are driving home in traffic, the last thing you want to do is go to the store and then cook a healthy meal.  You are hungry and you want to eat something quick and easy (and satisfying) right?

 

fast food and sleep apnea

 

One option to avoid this scenario completely is to meal-prep on the weekends when you have more time.  That way you can pre-cook dinners and freeze them, cut up fruits and vegetables and separate them into bags or tupperware, and you can even make lunches to take to work.

This eliminates the work during the week after a long day and gives you the option to eat a well-balanced healthy meal, rather than driving to a fast food restaurant or eating a fried item off of a restaurant menu.

well balanced healthy meal

The most popular fried foods (according to different studies) are:

-fried chicken

-fried fish

-french fries

-fried rice

-fried potatoes

-potato chips/tortilla chips

-fried plantains

Consuming fried foods 4+ times per week puts you at a much higher risk for developing chronic diseases as opposed to people who only eat them occasionally (once or less per week).

obstructive sleep apnea

The different chronic diseases that can stem from an unhealthy diet have many similarities to the diseases associated with OSA.  If you look on my website, www.michiganheadandneck.com, you will see the following facts about sleep disorders:

  • Left untreated, sleep apnea increases one’s risk of heart attack and stroke
  • Drowsiness is blamed for some 200,000-400,000 auto accidents annually, with the cost at $50-100 billion
  • 90% of those who snore exhibit sleep apnea tendencies
  • Hypertension is present in approximately 50% of patients with diagnosed OSA
  • Uncontrolled sleep apnea can lead to exaggerated fibromyalgia, concentration problems, type II diabetes, stroke and irritable bowel syndrome
  • Over long periods, uncontrolled sleep apnea results in intellectual and memory deterioration
  • Sleep apnea can cause high blood pressure to develop, as well as heart and lung problems
  • Anxiety also has a negative relation to sleeping soundly
  • Because of sleep disorders, thousands of jobs are lost annually, with the cost in U.S. production exceeding $60 billion
  • Sleep apnea has played a role in several disasters including the three-mile island meltdown, the Challenger explosion, and the Exxon Valdez oil spill
  • The lack of oxygen to the brain and body caused by sleep apnea episodes can also contribute to increased chances of stroke, depression, fatigue, weight gain, irritable bowel syndrome, and type II diabetes.

At Michigan Head & Neck Institute, we offer treatment for Obstructive Sleep Apnea that consists of creating a custom-fit oral appliance (mouthpiece) which is comfortable and can be adjusted to meet the requirements of each patient.  Dr. Klein works with each patient to provide the best options for their specific treatment.  For more information please call (586) 573-0438 or visit www.michiganheadandneck.com.

 

References

Gadiraju, T. V., Patel, Y., Gaziano, J. M., & Djoussé, L. (2015). Fried Food Consumption and Cardiovascular Health: A Review of Current Evidence.Nutrients, 7(10), 8424-30.doi:10.3390/nu7105404

Dobrosielski, D. A., Papandreou, C., Patil, S. P., & Salas-Salvadó, J. (2017). Diet and exercise in the management of obstructive sleep apnoea and cardiovascular disease risk. European respiratory review : an official journal of the European Respiratory Society26(144), 160110.doi:10.1183/16000617.0110-2016

Canadian Medical Association Journal. (2012, October 1). Poor sleep in adolescents may increase risk of heart disease.ScienceDaily. www.sciencedaily.com/releases/2012/10/121001124753.htm

Published in Cardiology Journal Scan / Research · February 06, 2019;Fried Food Consumption Associated With All-Cause and Cardiovascular Mortality; BMJ : British Medical Journal

Association of fried food consumption with all cause, cardiovascular, and cancer mortality: prospective cohort study BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.k5420(Published 23 January 2019)

Cahill LE, Pan A, Chiuve SE, et al. Fried-food consumption and risk of type 2 diabetes and coronary artery disease: a prospective study in 2 cohorts of US women and men. Am J Clin Nutr2014;100:667-75. doi:10.3945/ajcn.114.084129 pmid:24944061

Teen Obesity & OSA

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We already know that OSA causes (and is related to) other serious health issues, no matter what your age is.  The following article focuses on teens diagnosed with OSA who are also battling obesity.  Studies have shown that 60% of obese children have OSA.  The author mentions the “chicken or egg” story, because many times it’s hard to know which came first. “We could think of sleep apnea as a symptom of obesity. But we could also see it the other way around”, says Dr. Nicholas Chadi.  Childhood obesity is a global epidemic and is associated with an increased risk of adult obesity in addition to increased risk of cardiovascular disease.  Obesity can magnify the OSA symptoms and exacerbate symptoms such as hypertension, arterial stiffness, and metabolic issues.

The obesity/sleep apnea cycle can be very destructive, especially for younger children and adolescents.  They are not getting enough quality sleep, thus making it more challenging to control their diet and exercise.  They start getting headaches during the day and may even experience high blood pressure.  The motivation is not there, and many times eating is used to stay awake for energy.  Another issue is children being attached to their phones or iPads at night, making it harder to get to sleep.  Recent research shows a strong connection between sleep deprivation and mental health problems like depression and trouble concentrating.  It is estimated that teen depression is on the rise, affecting anywhere from 3%-5% of teens.  For obese teens, however, we are looking for a much higher number, between 60%-70% who are depressed.

Weight loss benefits not only OSA severity but also cardiometabolic consequences related to both OSA and obesity. Unfortunately, weight loss through diet, exercise, and/or medications is difficult for adolescents to comply with.  CPAP therapy (still the gold standard of care) may assist with weight loss and may also improve some of the metabolic abnormalities of OSA and obesity.  Oral appliances are another option that has recently been medically accepted as a gold standard for even moderate OSA when the individual is CPAP intolerant, and then there is always surgery as a last resort.

Dr. Chadi says, “Really, the issue here is that we need to know more about sleep apnea in teens to research better ways to prevent it and treat it — and then once we’ve confirmed the diagnosis, really making sure that teens have access to treatment for that problem.”

Please click below for the full article:

https://www.cbc.ca/news/health/teens-obesity-sleep-apnea-1.3853491

Balance and Disorders of the Inner Ear

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Saying, “I’ve fallen and I can’t get up” is something that we all have joked about, but it is actually a very serious matter.  Balance is one the leading health concerns of people over the age of 65 and more than 1/3 of this population suffers a fall in the United States each year.  If you don’t have good muscle strength and joint mobility, then you most likely don’t have good balance.  Balance is defined as a state of equilibrium characterized by the cancellation of all forces by equal opposing factors.  In other words, maintaining an upright posture while standing or moving.

Loss of balance caused by temporomandibular disorder is often not considered by those in the health community.  The tensor veli palatini muscle when tense will torque the eustacian tube and may cause dizziness or balance loss.  This muscle may release with injections to its neighboring masseter sphenomandibularis or anterior temporalis muscles.  I explain to my patients that when neighboring muscles begin to tighten, it is similar to the domino game in which one domino is pushed down, the next and then the next domino will begin to fall also.

Stimulation of the temporomandibular joint tissues is known to evoke a reflexive response in the tongue and other craniofacial muscles.  It can also stimulate postural reflexes initiated through projections to the brainstem’s reticular formation.  There have been multiple studies concerning the maxillary-mandibular relationship and its positive or negative influence on a patient’s posture when the proper vertical dimension is altered.

It was recognized decades ago that TMD could be casually related to episodes of loss of balance and published in the Arch Otolaryngol Head Neck Surg 1992, Chole Ra, Parker WS.

vertigo relating to tmd

Vertigo can be caused by a disturbance in a particular part of the inner ear, particularly the labyrinth, which is an important part of the vestibular (balance) system. The labyrinth interacts with other systems of the body, such as the visual (eyes) and the skeletal (bones and joints) systems, which helps to maintain the body’s position in space. Besides the visual, vestibular, and skeletal systems that may contribute to balance disorders, the dental (stomatognathic) system may also contribute to balance disorders.  It is when all four of these systems are in coordination with one another that equilibrium and balance will maintain a proper gait and posture.

inner ear vertigo

Dizziness is reported to be the most common complaint in patients over 75 years of age, with the elderly seeking treatment for dizziness more frequently than for hearing loss. Dizziness is defined as sensations of moving, including feelings of unsteadiness, wooziness, and lightheadedness.  People may feel like they are spinning, floating, swaying, tilting, or whirling. These sensations occur even when standing still or lying down.

What are other common balance disorders?

Tinnitus – buzzing or ringing in the ears (common TMD symptom that has been discussed in previous blogs), which can come with dizziness.

tinnitus tmd

Labyrinthitis –inflammation usually caused by a virus within the labyrinth; this is the part of the inner ear that contains the organs of balance that may cause dizziness or imbalance.

Labyrinthitis inflammation

Benign Paroxysmal Positional Vertigo (BPPV) – a brief, intense sensation of vertigo that occurs because of a specific positional change of the head caused possibly by a problem in the vestibular system of the inner ear.

Post-traumatic vertigo – dizziness resulting from a head injury, concussion, or whiplash.

Post-traumatic vertigo tmd

Meniere’s disease – inner ear fluid balance condition causing repetitive attacks of vertigo and is accompanied by pressure in the ears, vomiting, buzzing and/or ringing, and a partial hearing loss which can fluctuate during an episode.

Meniere’s disease tmd

Determining the cause of a balance disorder and what treatment options are appropriate is always the tricky part.  Are there any underlying medical conditions?

Ear infections, blood pressure changes, vision problems and medications contribute to balance disorders.  Medical conditions such as multiple sclerosis, stroke and Parkinson’s disease as well as temporomandibular disorders can also contribute to balance disorders.

If you are experiencing any of the above mentioned symptoms, then your first step would be to let your PCP know.  They will most likely refer you to an Otolaryngologist (ENT) who specializes in ear, nose, and throat diseases.  An audiometric (hearing) test will be ordered to test the patient’s ability to follow visual objects with their eyes and how the eyes respond to different types of information inputted into the vestibular system.

An MRI of the brain and/or a CAT scan will probably also be ordered to see the inner ear structures and nerve connections of these organs to the brain.

How to Sleep with Sleep Apnea

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how to sleep with sleep spnea

Have you taken the sleep apnea quiz? At the Michigan Head & Neck Institute, we’ve created a simple questionnaire to help you find the possible source of your restless sleep or loud snoring. Taking the do I have sleep apnea quiz can help determine whether you have this sleep disorder, and this guide will help you find out ways to sleep with your sleep apnea.



Symptoms of Sleep Apnea

Only a qualified sleep apnea doctor can accurately determine whether you have sleep apnea or not. However, here are some common signs and symptoms that may indicate you have sleep apnea:

  • Gasping or choking while sleeping
  • Chronic snoring
  • Pauses while breathing during sleep
  • Fatigue and drowsiness during the day after a full night’s sleep

These aren’t the only symptoms of sleep apnea, and even individuals who suffer from these symptoms may not have this sleep disorder. However, if you’ve been diagnosed with sleep apnea by a sleep apnea specialist, find out how you can enjoy a good night’s sleep again.



Getting a Good Night’s Sleep

At the end of the day, all you want is a restful night of deep, uninterrupted sleep. If your sleep apnea is causing you to snore loudly, your partner or family members may also be struggling to get a good night’s sleep.

Talk to your doctor about lifestyle changes that may help your particular case of sleep apnea. Often, losing weight, regular exercise and avoiding unhealthy habits like smoking, excessive alcohol and sleeping pills can all reduce your sleep apnea symptoms.



Improving Your Bedtime Routine

Other simple ways to improve your sleep include establishing a bedtime routine. Try sleeping on your side, or prop your head up if you are only comfortable sleeping on your back. Using breathing strips or a nasal dilator, try to keep your nasal passages open. Finally, you can try to keep your mouth closed by tightening those muscles. Chewing gum before bed is an easy way to attempt to keep your mouth muscles tight.



Medical Treatment Options

Tricks and routines may help reduce the symptoms of your sleep apnea. However, for severe cases, medical treatment is sometimes necessary. Ask your doctor about the following options and see which solution is best for your situation:

  • Breathing devices, such as a CPAP machine
  • Dental devices
  • Surgery or implants

CPAP, or Continuous Positive Airflow Pressure, is one of the most common treatment options for sleep apnea. This device works by covering your nose and mouth with a breathing mask that provides constant airflow. The adjustable pressure can be fine-tuned by a sleep specialist until you are comfortable and can breathe easily while sleeping.

Dental devices can be used for moderate sleep apnea and are used to reposition your jaw or tongue. However, these devices can come with harmful side-effects and permanent jaw changes, so talk to your doctor or dentist before choosing this option.

Extreme cases can be treated with surgery. If you have excessive tissue inside your nose or in the back of your through, it may be removed in order to reduce or remove your sleep apnea symptoms. In some cases, removing tonsils, a soft palate implant or enlarged upper airways can also be beneficial. Of course, surgery should be a last resort and comes with potential risks and complications.



Sleep Well

If you believe you have sleep apnea or wish to discuss possible signs of a loved one having sleep apnea, contact us today. At the Michigan Head & Neck Institute, we have highly trained and experienced doctors who can identify sleep disorders, such as sleep apnea, and guide you through the best possible treatment plan. Enjoy a restful night sleep again, without snoring, restricted breathing and daily fatigue.

Warning Signs of Sleep Apnea

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Sleep apnea is a dangerous disorder that causes you to momentarily stop breathing multiple times per night. Because the symptoms occur while you are unconscious, you may not even be aware that you have a problem until someone else brings it to your attention. However, there are warning signs of sleep apnea that occur while you are awake as well. If you believe you may have sleep apnea, the best way to find out for sure is with a sleep apnea test. Once you have a clear diagnosis, the specialists at Michigan Head and Neck Institute may be able to help you treat the disorder.

 

Different Types of Sleep Apnea

There are two main types of sleep apnea. When most people use the term, they are talking about obstructive sleep apnea, the most common type. Another, less prevalent, type is called central sleep apnea. Though the effects are similar to OSA, the cause is very different as it originates in the central nervous system. Rarely, some people may have mixed sleep apnea, with both central and obstructive components.

A person with sleep apnea experiences short, repeated episodes during which he or she stops breathing while in an unconscious state. If you have OSA, this happens because the soft tissues in the throat collapse, blocking the airway. With the airway blocked, your brain doesn’t get enough oxygen and wakes you up slightly to clear the obstruction, but once you go back to sleep, the tissues in your throat start relaxing and the cycle begins again.

 

Warning Signs of Sleep Apnea

warning signs of sleep apnea

The brief awakenings during the night to clear your airway are usually not long enough to allow you to regain full consciousness, so you may not have any memory of them upon waking up completely. Many people with OSA do not notice any symptoms themselves but are informed by loved ones of symptoms like snoring and breathing cessation.

However, because sleep apnea prevents you from getting a restful night’s sleep, it can also cause symptoms that occur during the day. Some warning signs to watch for, day and night, include the following:

 

  • Loud snoring when sleeping or napping
  • Gasping or choking that wakes you up
  • Excessive sleepiness during the day
  • Night sweats
  • Sore throat or dry mouth upon awakening
  • Headaches in the morning
  • Decreased libido
  • Mood swings

If left untreated, OSA can cause or worsen the following conditions:

 

  • Depression
  • Diabetes
  • High blood pressure/cardiovascular disease
  • Stroke

 

Testing for Sleep Apnea

The most conclusive way to diagnose sleep apnea and rule out similar disorders is with a sleep study, also known as polysomnography. This can take place in a sleep clinic or sometimes in your own home. Regardless of where the test takes place, it involves applying various types of monitoring equipment to your body to keep track of your blood oxygen levels, breathing patterns, and airflow. A sleep apnea doctor then uses this information to make a diagnosis.

 

Treatments for Sleep Apnea

Your sleep apnea treatment depends on several factors, including its cause and severity. Most people respond to nonsurgical treatment methods, the most common of which are oral appliances and continuous positive airway pressure.

Oral appliances work in one of two ways: either they hold your tongue in a position where it cannot fall back and block your airway, or they open up the back of your throat by bringing your jaw forward. CPAP is a common form of OSA treatment in which you wear a mask over your nose and/or mouth connected to a machine that blows a continuous stream of air down your throat, preventing the soft tissues from collapsing. More severe cases of sleep apnea may require CPAP and you might need to scurry around to find a special face mask for sale.

 

Explore Treatment Options for Sleep Apnea

Once you know what is causing your symptoms, you and a sleep apnea doctor can determine the best way to treat the condition. You can schedule a consultation with Michigan Head and Neck Institute by calling 586-473-1533.

How an Injury May Result in TMJ Pain

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If you notice jaw pain following a fall, blow to the face, or whiplash injury, take it seriously. You may be experiencing the beginning symptoms of temporomandibular joint disorder. The longer the damage goes untreated, the worse the condition can get and the more difficult it can be to correct. As soon as you notice symptoms indicating a TMJ complex trauma, you should visit a dental clinic like Michigan Head and Neck Institute right away for TMJ injury diagnosis and treatment.

 

Understanding the TMJ Complex

The temporomandibular joint is the place where your lower jawbone connects to your skull. The TMJ complex includes the bones of the jaw and skull, the cartilage and other soft tissues that cushion the joint, and the muscles and tendons that move the jaw and hold it in place.

Any one of the structures within the TMJ complex can become inflamed or strained, resulting in pain, difficulty chewing, strange sounds like clicking or popping when you move your jaw, as well as other symptoms. These problems are collectively referred to as temporomandibular disorder or temporomandibular syndrome.

 

Traumatic Causes of Temporomandibular Disorder

TMD is a mysterious condition that is not yet entirely understood. Sometimes symptoms just show up, and doctors are unable to determine a cause. Other times, symptoms may be caused by arthritis or by habitual actions, such as clenching or grinding your teeth, that put pressure on the TMJ complex over time. In other cases, the disorder can be the result of a TMJ injury or trauma. A trauma is a severe physical injury, often caused by a sudden impact or violent motion.

A TMJ injury may fall into one of the following three broad categories:

 

  • Stretching of the TMJ Joint
  • A blow to the head or jaw
  • Whiplash

Specific Ways in Which TMJ Injuries Can Occur

tmj injury treatment

Stretching your TMJ for an extended period of time can put strain on the muscles and tendons of the joint, which can cause them to become inflamed. For example, if you had to keep your mouth open for half an hour or more during an extensive dental procedure, that could cause stretching and straining of TMJ tendons and muscles.

Symptoms of TMD may manifest after a blow to the side of the head, such as can occur from a punch or slap, or a blow to the jaw, such as might result if you fell down and struck your chin on the ground. Sudden impacts such as this can cause several types of injuries that can lead to TMJ symptoms:

 

  • Forcing your upper and lower teeth together, putting pressure on the TMJ
  • Dislocating your jaw, which can force the joint out of alignment and stretch the soft tissues of the TMJ complex
  • Fracturing or otherwise injuring the top portion of the mandible bone, known as the condyle

Whiplash is caused by forceful forward-and-back movement of the head and neck. It is commonly caused by rear-end auto collisions. Whiplash can cause the bone between the skull and neck to shift out of alignment, which in turn affects the jaw. Symptoms of whiplash may not show up for hours or even days after the accident.

 

When to See a TMJ Specialist

It’s never a bad idea to seek medical attention after an accident, even in the absence of symptoms, just to ensure there’s no damage. If you do have symptoms such as pain or difficulty moving your jaw, you should see a TMJ specialist as soon as possible. In the meantime, you can help prevent further damage by minimizing the movement of your jaw. Eat soft foods that are easy to chew and speak only when it is necessary.

 

Experience with TMJ Injury Problems

Michigan Head and Neck Institute has been treating TMJ problems for over 30 years. Contact us to schedule a consultation.

Oral Appliance Therapy for Sleep Apnea

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Oral appliance therapy is commonly used today in the treatment of mild to moderate Obstructive Sleep Apnea (OSA).  For patients who suffer from severe OSA and are utilizing a CPAP machine (gold standard for severe cases), an oral appliance can be used in conjunction with the CPAP for maximum benefit to the patient.  Some patients also use oral appliances when traveling or if they cannot tolerate the CPAP.  Although oral appliances are not always as effective as the CPAP, they are certainly better than nothing, and have still proven to reduce the effects of OSA and snoring while improving daytime performance.

Just like the CPAP opens up the airway by creating positive air pressure, an oral appliance opens up the airway by moving the lower jaw (mandible) forward.

You’re probably wondering how the oral appliance is controlled and/or measured to each patient.  This process, referred to as titration, is a method used which slowly advances the mandible forward until the patient reaches maximum medical improvement.  The standard titration protocol is to advance the mandible forward in 1mm increments over a period of several weeks while documenting the improvement/symptoms until the respiratory episodes are satisfactorily limited.  A licensed dental sleep medicine practitioner must of course do this titration. oral appliance therapy for sleep apnea

The upper airway has little support. Since there is inconsistency in the soft tissue and bony structures of the head and neck, there has to be mechanisms in place that adjust to these anatomical differences.

Upper airway obstruction increases during sleep, meaning increased collapsibility of the airway. Studies have shown that patients with sleep-disordered breathing (SDB) have anatomically smaller airways, which can trigger increased muscle activity and negative airway pressure.  SDB includes OSA, hypopnea, and UARS (upper airway resistance syndrome), and other non-airway problematic sleep pathologies such as restless leg syndrome, insomnia, narcolepsy, etc. that include diagnosis not in the scope of my practice.

People suffering from SDB experience frequent arousals from sleep and chronic sleep deprivation.  The most common symptom of this is loud snoring and/or apneas witnessed by bed partners.

What many people don’t realize is that sleep disturbances are often consistently reported in patients suffering from TMD (temporomandibular joint disorder) as well.

TMD is associated with primary sleep disorders, such as insomnia and OSA, and patients that commonly present with overlapping symptoms like morbidity and neuroendocrine disorders.  With long-term use of an oral appliance, a reduction in the signs and symptoms of TMD has been reported.

Sleep disorder symptoms

                                        Photo Courtesy of Hobart Orofacial Pain

 There are hundreds of oral appliances used to treat OSA.  Some names that may sound familiar include the following:

Herbst

TAP

Equilizer

NAPA

Klearway

Tessi

EMA

Moses

SUAD

Silencer

Esmark

HAP

Elastomeric

Z-training

Full Breath

TheraSnore

Silent Night

TPE

SnoreEx

TOPS

Snore-no-more

Narval

 

The pictures below show how the Airhead (a 3 dimensional piece movable demonstration model) visually documents mandibular advancement.

mandibular advancement

With oral appliance air flows normally   Without oral appliance air cannot                                                                                                                                 flow into lungs

One thing that the dentist/sleep medicine practitioner must look out for when treating a patient with OSA is any pre-existing jaw problems that are present upon delivery of the oral appliance. Oral appliance therapy can cause bite changes, which could lead to jaw problems down the road.

Quoting Dr. Clifton Simmons, My Friend, My Mentor:

Intraoral appliances (tongue-retaining devices or mandibular advancing/positioning devices) may be considered medically necessary in adult patients with clinically significant OSA under the following conditions:  at least 5 events per hour in a patient with excessive daytime sleepiness or unexplained hypertension, AND .A trial with CPAP has filed or is contraindicated, AND …The device is prescribed by a treating physician, AND …The device is custom-fitted by qualified dental personnel, AND …There is absence of temporomandibular dysfunction or periodontal disease.

The American Association of Dental Research defines temporomandibular disorders (TMDS) as a group of musculoskeletal and neuromuscular conditions that involve the temporomandibular joint (TMJ), the masticatory muscles, and all associated tissue.

Resolved, that dentistry is defined as the evaluation, diagnosis, prevention and/or treatment (nonsurgical, surgical or related procedures) of diseases, disorders and/or conditions of the oral cavity, maxillofacial area and/or the adjacent and associated structures and their impact on the human body; provided by a dentist, within the scope of his/her education, training and experience, in accordance with the ethics of the profession and applicable law.

The ADA House of Delegates approved Dental Practice Parameters for Temporomandibular (Craniomandibular) Disorders in 1997.  In these parameters of care, the ADA approved specific guidelines for assessing, diagnosing and managing temporomandibular disorders.

The orthopedic surgery community stopped treating TMDs in the 1980s.  Dentists are now the primary care providers for temporomandibular disorders.  Dentistry is the only professional that has the training and skills to differentiate dental pain from TMD musculoskeletal pain.

Dentists cannot divorce themselves from this duty.  A dentist does not have to treat the patient.  Any and all treatment can be referred to other dentists or health care practitioners.  This means that all dentists who examine living patients should evaluate them for TMDs.  Evaluation has been clearly described as a history, examination, and consultation.

So, there is a paradox. There is an area of care that the ADA has defined as within the scope of dentistry, has defined care through Dental Practice Parameters…and evidence-based care is available, and most state dental boards require competence in screening and diagnosis of this area of care.  Yet CODA does not require dental schools to prepare the dentist for this skill.

This has created an area of care in which many dentists do not have adequate training and skills to provide the necessary screening and diagnosis and therefore, there is an under diagnosis of TMDs…..

Dr Clifton Simons

 

 

 

 

 

 

 

 

 

 

 

 

 

Alternatively, treatment with an oral appliance can also act as a healing mechanism, as the physiologic balance of the muscles and their neurological connections are restored.  The patients wearing the appliances are returned to a healthy, balanced configuration as their muscles find the proper positions (jaw relationships).  The most important function of the jaw and surrounding muscles is to maintain an open airway.

Below are 2 examples of oral appliances that Dr. Klein uses in his office:

oral appliance 2

oral appliance

 

 

 

 

 

 

The designs have come a long way over the years.

 

old oral appliance

 

 

 

 

 

 

At Michigan Head & Neck Institute, we offer treatment for both TMD and Obstructive Sleep Apnea that consists of creating a custom-fit oral appliance (mouthpiece) which is comfortable and can be adjusted to meet the requirements of each patient.  Dr. Klein works with each patient to provide the best options for their specific treatment.  For more information please call (586) 573-0438 or visit www.michiganheadandneck.com.

 

 

Postpartum Sleep Deprivation

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According to research published in January 2018 in the Journal of Affective Disorders, another factor warranting further examination is sleep loss, which has been shown to precede manic episodes in a range of studies.  Sleep changes the body’s physiological state.  Serotonin, norepinephrine and dopamine are all involved in sleep.  Stage 1 is more of a transitional sleep period, while Stage 2 consists of high-voltage positive and negative discharges.  Stage 3 is a slow wave period of restorative sleep in which serotonin and norepinephrine are reduced, and Stage 4 is REM sleep.  REM sleep is the least restorative of all the stages, causes irregular breathing patterns and also causes a reduction of serotonin and norepinephrine levels in the brain.  In terms of brain function during REM sleep, there is increased limbic (emotional) activity and reduced prefrontal (rational) activity.  Circadian factors must also be taken into account, for example a daytime nap while the baby is sleeping will not produce the same results as sleep obtained overnight.  There are many sleep loss effects on the brain; for instance, sleep loss increases the risk for postpartum psychosis, more so if a person has a previous diagnosis of bipolar disorder.

According to the article, women who report manic episodes triggered by sleep loss could be more vulnerable to developing postpartum psychosis, although additional studies on the topic are needed.

 

Click here to read the full article.

Mild to Moderate Sleep Apnea Treatment

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Sleep Apnea Treatment: What Are Your Options?

Sleep apnea is a condition in which an individual stops breathing every few minutes during sleep, most commonly because the muscles at the back of the throat fail to keep the airway open. Left untreated, sleep apnea can lead to daytime fatigue, heart disease, hypertension, memory problems and mood disturbances. Fortunately, mild to moderate sleep apnea treatment devices are available for those who struggle with its effects.

mild to moderate sleep apnea treatment

Lifestyle Changes

For mild sleep apnea, changing your habits may resolve the condition. This could include losing weight if you are overweight or obese, discontinuing use of alcohol and/or sleeping medications, sleeping on your side or stomach instead of your back and quitting smoking if you smoke.

 

CPAP Treatment

The most common sleep apnea treatment is CPAP (continuous positive airway pressure). This involves a mask that you wear while you sleep that delivers a flow of air to prevent the breathing passages from closing. Those who use a CPAP mask can restore their regular breathing pattern and achieve a restful night’s sleep.

 

Alternate Treatments

Some people seek sleep apnea treatment options without CPAP because they find the mask uncomfortable or ineffective. Some of the alternatives to consider include:

  • Dental devices that keep the airway open while you sleep
  • Surgery to correct an underlying problem that contributes to sleep apnea, such as an overbite, enlarged tonsils or a deviated septum
  • Uvulopalatopharyngoplasty (UPPP), a procedure to remove soft tissue from the airway to keep it from closing

 

Seeking Help for Sleep Apnea

Many individuals who have sleep apnea don’t realize they are awakening in the night when breathing stops. If you have chronic snoring, depression, irritability and mood changes, trouble with learning and memory, sexual dysfunction and/or daytime sleepiness, these problems could be caused or exacerbated by sleep apnea.

Visit the Michigan Head and Neck Institute for diagnosis and mild to moderate sleep apnea treatment and other sleep-related issues. Call 586-473-6735 or fill out our online form to schedule a consultation with one of our physicians.