Please check out our article in Innovative Health Magazine’s Summer 2017 edition titled “Dangers of Underdiagnosis” Page 52
Please check out our article in Innovative Health Magazine’s Summer 2017 edition titled “Dangers of Underdiagnosis” Page 52
Please check out our article in Innovative Health Magazine’s Winter 2018 edition titled “Sleep and Pain” Page 32
Essential oils have been used throughout history to cure diseases and relieve symptoms of certain illnesses. Aromatherapy is the therapeutic use of these oils from plants to improve a person’s physical, emotional, and spiritual well-being. These vital compounds, which exhibit great medicinal qualities, can be found in seeds, bark, stems, roots, and flowers. They stimulate the immune system, fight off bacterial infections, increase circulation, alleviate headaches, soothe sore muscles, and even help you get a good night’s sleep.
Some examples of essential oils used and their health advantages include:
Each oil has certain health benefits, so patients must find the right oil to address their specific health concerns. Patients with cancer use aromatherapy primarily as supportive care for their general health. Oils can alleviate some of the symptoms of cancer and the side effects of cancer treatments like chemotherapy.
Everyone’s body chemistry is different, so there may be a period of “trial and error” involved in this process. Patients may need to try several different oils and/or combinations to see an improvement in symptoms and find the ones that work for them. Once found, they can either be applied directly to the skin (massage or acupuncture) or inhaled (home humidifier, shower, bath).
Odors (both good and bad) are known to have an affect on cognitive abilities and mood – affecting men and women differently. There are sex-specific differences in triggers of pain. For example, women with chronic headaches are more likely to cite stress and odor exposure as the cause, where men implicate other events like exercise as a trigger.
One study done at the University of Quebec showed that women experienced less pain during exposure to pleasant aromas. Researchers at Stanford discovered that chronic pain actually rewires the circuits in the brain as a consequence of the pain itself.
The effects of aromatherapy odors are a result of chemical components to receptors in the olfactory bulb, impacting the brain’s limbic system (the emotional center). The frontal cortex – used for taste and smell – is known to be activated by pleasant sensations of touch and sensory processing. Sensory processing in this part of the brain, which involves touch, temperature and pain, may be affected by smell (usually only in women).
Unfortunately the American Medical Association (AMA) no longer considers oils as an essential part of the medical curriculum, even though research suggests that patients do respond positively to this type of therapy.
In an article from HealthDay News published March 10, 2017, female cancer patients reported positive experiences with aromatherapy massage. Both physical and psychological benefits included comfort, relaxation, reduced pain and muscle tension, improved sleep, energy, appetite and mood. The women in the study felt pampered and reconnected to daily life. It was a pleasurable experience so they could temporarily “forget” about their disease.
To find out more about aromatherapy treatments, please call our office at (586) 573-0438 or email us at firstname.lastname@example.org.
Ibekwe E, Haigh C, Duncan F, Fatoye F. Economic impact of routine opt-out antenatal human immune deficiency virus screening: A systematic review. J Clin Nurs. 2017;26:3832–3842.
Soden K, Vincent K, Craske S, Lucas C, Ashley S. A randomized controlled trial of aromatherapy massage in a hospice setting. Palliat Med. 2004 Mar;18(2):87-92.
Montross-Thomas LP, Meier EA, Reynolds-Norolahi K, Raskin EE, Slater D, Mills PJ, MacElhern L, Kallenberg G. Inpatients’ Preferences, Beliefs, and Stated Willingness to Pay for Complementary and Alternative Medicine Treatments. J Altern Complement Med. 2017 Apr;23(4):259-263. Epub 2017 Jan 23.
Shin ES, Seo KH, Lee SH, Jang JE, Jung YM, Kim MJ, Yeon JY. Massage with or without aromatherapy for symptom relief in people with cancer. Cochrane Database Syst Rev. 2016 Jun 3;(6):CD009873.
Fellowes D, Barnes K, Wilkinson S. Aromatherapy and massage for symptom relief in patients with cancer. Cochrane Database Syst Rev. 2004;(2):CD002287.
Sánchez-Vidaña DI, Ngai SP, He W, Chow JK, Lau BW, Tsang HW. The Effectiveness of Aromatherapy for Depressive Symptoms: A Systematic Review. Evid Based Complement Alternat Med. 2017;2017:5869315. Epub 2017 Jan 4.
If you are a business owner, an HR Director, a newly hired employee, a union representative, or the spouse or friend of a company’s employee, then it is important to know how Obstructive Sleep Apnea (OSA) can affect a person’s life, health, productivity and safety.
Disasters such as…
-The Three Mile Island Meltdown – occured when a shift change with awake personnel saw the previously missed warnings
-The Exxon Valdez oil spill in Alaska – the pilot was drunk but the co-pilot was asleep due to OSA
-The devastating Challenger explosion – caused by a faulty O-ring, which passed inspection by a drowsy inspector, resulting in the death of seven people
In addition to the above-mentioned catastrophes, don’t forget the countless train crashes, semi-truck accidents and airplane crashes seen on TV, heard on the radio, and printed in magazines and newspapers. Despite these publications, the true financial loss is seldom seen in any media outlets. It is simply not world news if your company loses $10,000.00 or even $100,000.00 due to employee tiredness or brain miscalculation.
The US Department of Transportation estimates that 200,000 vehicular accidents with death or serious injury occur each year due to sleepy driving, and even this does not make headlines!
Undiagnosed OSA creates a financial burden – costing an untreated adult about $6,000 on average. Direct economic costs include motor vehicle accidents, healthcare and medication, and also compensating behaviors like abusing alcohol, sleeping pills and stimulants. Indirect economic costs include factors such as stress on home life and personal relationships, and decreased productivity at the workplace. As seen, the economic cost of sleep disorders is disturbing.
On the contrary, the average annual cost for the treatment of OSA is about $2,000 per person. This is why it is so important to promote awareness of OSA and make sure that we are looking out for signs and symptoms associated with it. Here lies the economics of sleep deprivation. If you think you or a loved one may be suffering from OSA, please click here to take a sleep test.
*Chart provided by the American Academy of Sleep Medicine
People are, by nature, dismissive of the symptoms of sleepiness and the sounds of snoring. They are recognized as normal. Both patients and healthcare providers need to promote awareness that OSA is a chronic disease that needs to be taken seriously. Just like heart disease, it needs to be managed appropriately.
During regular check-ups with your physician, you should discuss any changes in sleep patterns. Many people fail to discuss symptoms of sleep quality. Additionally, doctors should be asking, “How are you sleeping”. Medical school does not emphasize training in Sleep Medicine, and therefore many healthcare providers are not aware of the comorbidities to look for in recognizing OSA. What makes it even more difficult is that people will not accept treatment for something they do not think is a problem. Many adults don’t even remember what a “good night’s sleep” is, or when the last time they had one was.
It is time for everyone to commit themselves to more being more aware of signs and symptoms of OSA. This includes government agencies, healthcare providers and patients being more educated, and health insurance companies ready to reward prevention and see the cost of timely diagnosis and treatment decrease dramatically.
*Chart provided by the American Academy of Sleep Medicine
Leaving sleep apnea untreated is like rolling the dice with your life every night. Please visit our website at www.michiganheadandneck.com for more information on the signs and symptoms of sleep disorders.
Strine TW, Chapman DP. Associations of frequent sleep insufficiency with health-related quality of life and health behaviors. Sleep Med 2005;6:23-7.
CDC. Perceived insufficient rest or sleep among adults-United States, 2008. MMWR 2009;58:1175-9.
Institute of Medicine. Sleep disorders and sleep deprivation: an unmet public health problem. Washington, DC: National Academies Press; 2006.
National Sleep Foundation. How much sleep do we really need? Washington, DC: NSF; 2010. Available at http://www.sleepfoundation.org/article/how-sleep-works/how- much-sleep-do-we-really-need. Accessed November 25, 2017.
American Academy of Sleep Medicine Task Force. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep. Aug 1 1999; 22(5):667-689.
Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla K. Increased Prevalence of Sleep-disordered Breathing in Adults. American Journal of Epidemiology (2013): National Center for Biotechnology Information. U.S. National Library of Medicine.
Hirshkowitz, Max et al. National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health: Journal of the National Sleep Foundation, Volume 1, Issue 1, 40-43.
Problems with the temporomandibular joint, or TMJ, are extremely common. Whether via teeth grinding, muscle clenching, poor posture, or surgery, the jaw can become stiff and unaligned. Over time, symptoms may grow to include dizziness, tinnitus, face and neck pain, headaches, and trouble opening and closing the mouth among other complications. TMJ symptoms and treatment vary from patient to patient; however, physical therapy reduces TMJ pain and offers benefits for all. A physical therapist is able to help relax, stretch, and release tense jaw muscles to reduce pain and give the stressed-out joint an opportunity to heal.
Whether sitting or standing, people with TMJ problems often thrust their heads forward past their shoulders. This puts the neck, cranium, and cervical column out of alignment. It also adds stress to these areas. Because of the abnormal positioning, the lower jaw is forced to pull back. In turn, the joint tenses under the unnecessary pressure and leads to TMJ neck pain. We can show you how to adjust your posture and relax your body by aligning your head and neck with your shoulders.
With physical therapy, many patients are able to relieve jaw tension via simple exercises. These may include:
• Opening and closing
• Side-to-side movements
• Chin tucks
• Relaxed jaw maneuvers
We can also help you find the optimal resting position for your teeth. If you tend to yawn too wide, your therapist can work with you to avoid overextension and protect your jaw. The goal of regular exercise is to boost joint mobility and relax tense muscles around it.
If your TMJ pain is due to an injury or surgery, your physical therapist will work with you to repair and strengthen jaw facial muscles. In some cases, this regimen may include “low-load” exercises. Although these movements may not feel like progress, they are specifically meant to prevent further injury and inflammation.
Finally, we will help you identify and avoid the stressors that trigger TMJ problems. One of the most common culprits is teeth clenching or grinding. This can occur for many different reasons and is often a subconscious reaction to stress. People also tend to clench their jaws when chewing gum, focusing on a task, or performing strenuous activities. We can teach you not only to recognize when you are tensing your jaw, but also which situations cause it.
He or she may also have you adhere to a soft diet in order to avoid chewy and tough foods that irritate the jaw. These often include gum, popcorn, chips, steak, pizza, apples, and corn on the cob. Together, habit and diet modifications work to eliminate TMJ pain and give the joint a chance to heal.
TMJ discomfort impacts millions of Americans; however, many are able to find relief. To learn about the many options for TMJ relief, get in touch with our team at Michigan Head and Neck. You can reach our office in Warren at 586-573-0438.
Have you ever woken up and felt tension in your face or pain in your jaw? Do you frequently wake up with headaches? Is there tension in your neck and shoulder area? If so, you may be suffering from nighttime bruxism (grinding and/or clenching of teeth). Many people who suffer from stress clench their teeth during the day, and often this is even a reaction to a particular medication. A lot of us are unaware of clenching/grinding while we sleep, unless someone tells us that we’re doing it. So, we’ve decided to cover Bruxism causes and effects to help bring the issue to light.
For the last 50+ years, bruxism has been documented as a predominant factor in the onset (or continuance) of TMD and myofascial pain. Patients believe that bruxism is an underlying cause of their TMJ pain and dysfunction, and dentists believe that bruxism is part of the pathogenesis of TMJ disorder.
Let’s start with factors that can cause bruxism:
Stress – Anxiety, anger and frustration can result in teeth grinding/clenching.
Personality – If you are more competitive or hyperactive by nature, your chances of clenching and grinding your teeth (either at night or during the day) are greater.
Age – Bruxism is common in children when they lose their baby teeth and their adult teeth start erupting. It can also occur during the teenage and college years due to academic stress. As an adult, bruxism results from work stress, issues at home, financial stress, and undiagnosed sleep disorders.
Medications/Substances – Bruxism is unfortunately a side effect of many medications, especially stimulants for ADHD and OCD, as well as antidepressants. Coffee, caffeinated tea, energy drinks, tobacco and alcohol use also have a tendency to increase the risk of bruxism.
Other factors that may be related to bruxism include disorders such as Obstructive Sleep Apnea (OSA), Parkinson’s disease, GERD (acid reflux), dementia, Alzheimer’s, epilepsy, ADHD and OCD. Additionally, if there is a family history of bruxism, you may be more susceptible.
Now that we’ve talked about some of the Bruxism causes, let’s review the effects.
-Limited ROM (mouth opening up & down and side-to-side)
-Jaw pain, jaw clicking/popping
-Ear pain (Otalgia)
-Tooth mobility and/or hypersensitivity
-Sleep disturbances (for both you and your bed partner)
-Wear-and-tear on tooth enamel
Untreated bruxism can lead to eventual jaw joint dislocation, which will need to be corrected either with an intraoral orthotic or TMJ surgery.
As dental professionals are becoming increasingly aware of sleep disorders and how to diagnose them, more attention is being paid to potentially harmful habits like bruxism. It is now common that your dentist will ask you about daytime clenching/grinding (and your bed partner about grinding at night) during your regular check-up/exam. Increased masticatory function during sleep is thought to cause occlusal overloads and can lead to many complications during certain dental procedures. This especially affects the work of many Prosthodontists when doing restorative work including crowns, bridges and implants. Periodontists as well are treating many patients for gum recession resulting from clenching and grinding.
If you answer “Yes” to any of the following questions, then you may be suffering from bruxism.
For more information, or to schedule a consultation, please contact Dr.Klein at
(586) 573-0438, or visit our website at www.michiganheadandneck.com.
Van der Meulen MJ, Ohrbach R, Aartman IH, Naeije M, Lobbezoo F. Temporomandibular disorder patients’ illness beliefs and self-efficacy related to bruxism. J Orofac Pain. 2010 Fall; 24(4):367-72.
Kato T, Yamaguchi T, Okura K, Abe S, Lavigne GJ. Sleep less and bite more: Sleep disorders associated with occlusal loads during sleep. J Prosth Res. 2013; 57(2); 69-81.
Nishigawa K, Bando E, Nakano M. Quantitative study of bite force during sleep associated bruxism. J Oral Rehabil, 2001; 28:485-491.
Fernandes G, Franco AL, Siqueira JT, Gonçalves DA, Camparis CM. Sleep bruxism increases the risk for painful temporomandibular disorder, depression and non-specific physical symptoms. J Oral Rehabil. 2012 Jul; 39(7):538-44.
Lobbezoo F, Ahlberg J, Glaros AG, Kato T, Koyano K, Lavigne GJ, de Leeuw R, Manfredini D, Svensson P, Winocur E. Bruxism defined and graded: an international consensus. J Oral Rehabil. 2013 Jan; 40(1):2-4.
Lavigne GJ, Khoury S, Abe S, Yamaguchi T, Raphael K. Bruxism physiology and pathology: an overview for clinicians. J Oral Rehabil. 2008 Jul; 35(7):476-94.
Koyano K, Tsukiyama Y, Ichiki R, Kuwata T. Assessment of bruxism in the clinic. J Oral Rehabil. 2008 Jul; 35(7):495-508.
Svensson P, Jadidi F, Arima T, Baad-Hansen L, Sessle BJ. Relationships between craniofacial pain and bruxism. J Oral Rehabil. 2008 Jul; 35(7):524-47.
Kato T, Masuda Y, Yoshida A, Morimoto T. Masseter EMG activity during sleep and sleep bruxism. Arch Ital Biol, 2011; 149:478-491.
In my practice over the years I have treated countless pregnant women and have documented the symptoms and dysfunctions associated with TMD before, during and after pregnancy. One patient in particular that I remember had multiple pain symptoms, but went through 3 pregnancies, during which time the pain subsided. It was not until after her 3rd pregnancy that she started treatment because all of her initial pain returned. This relationship between TMD and pregnancy has been exemplified multiple times and is an interesting part of TMD issues in women.
Studies have shown that the prevalence of TMD in pregnant women is three times less than non-pregnant women. The pain threshold is much higher during pregnancy. Symptoms seem to disappear with the onset of pregnancy and reappear post-partum. This cycle is reflective of the sudden withdrawal of additional estrogen.
TMJ tissues contain cells with estrogen receptors – particularly the condyle, disc and joint capsule – as well as muscles of mastication. Estrogen has a great influence on the cartilage and also causes antiresorption on the bones. Additionally, estrogen reduces pain, or at least the perception of pain, during pregnancy due to an increase of collagen (type 3). Collagen type 3 is associated with Ehlers-Danlos syndrome (prevalent in some TMD patients), which can make joints overly flexible. As a result, orofacial pain and musculoskeletal symptoms “go away” during pregnancy.
Chart borrowed from:
Landi N, Lombardi I, Manfredini D, Casarosa E, Biondi K, Gabbanini M, Bosco M. Sexual hormone serum levels and temporomandibular disorders. A preliminary study. Gynecol Endocrinol 2005;20:99-103.
The biggest changes/increases in estrogen levels occur during the 2nd quarter of pregnancy (week 12). Pain has diminished by the start of the 2nd quarter.
Another factor that changes during pregnancy is range of motion (ROM). Studies have shown that mandibular intraoral opening increases during pregnancy and sometimes remains higher postpartum. Orofacial pain improves due to increased joint laxity allowing the ROM increase to occur.
Aside from pain, there are other side effects of TMD that can subside during a pregnancy, but sneak up on you postpartum. Maybe your insomnia goes away for a few months, or maybe your undiagnosed OSA (obstructive sleep apnea) is less noticeable to your husband. Remember to talk to your healthcare specialist about any symptoms you encounter, as insomnia and OSA during pregnancy can be linked to pre-term birth.
The odds of early preterm birth before 34 weeks was more than double for women with sleep apnea, and almost double for those with insomnia – according to a study published in the September issue of Obstetrics & Gynecology.
Dr. Klein takes a conservative approach to treating TMD and OSA. Some of the treatments offered at Michigan Head & Neck Institute include wearing a corrective orthotic (mouthpiece) which can be adjusted as needed for each patient, physical therapy which can include tens unit usage, physical massaging of the area around the TMJ’s, heat applications, and pain-relieving injections. For more information please call us at 586-573-0438 or visit our website at www.michiganheadandneck.com.
Mayoral VA, Espinosa IA, Montiel AJ. Association between signs and symptoms of temporomandibular disorders and pregnancy (case control study). Acta Odontol Latinoam. 2013;26(1):3-7.
LeResche L, Sherman JJ, Huggins K, Saunders K, Mancl LA, Lentz G, Dworkin SF. Musculoskeletal orofacial pain and other signs and symptoms of temporomandibular disorders during pregnancy: a prospective study. J Orofac Pain 2005;19:193-201.
Warren PM, Fried LJ. Temporomandibular disorders and hormones in women. Cells Tissues Organs 2001;169:187- 192.
Macfarlane TV, Blinkhorn AS, Davies RM, et al. Association between female hormonal factors and orofacial pain: study in the community. Pain. 2002;97(1-2):5-10.
Silveira EB, Rocabado M, Russo AK, et al. Incidence of systemic joint hypermobility and temporomandibular joint hypermobility in pregnancy. Cranio. 2005;23(2):138-43.
Galal & El-Beialy, Waleed & Deyama, Yoshiaki & Yoshimura, Yoshitaka & Yoshikawa, Tetsuya & Suzuki, Kuniaki & Totsuka, Yasunori. (2008). Effect of estrogen on bone resorption and inflammation in the temporomandibular joint cellular elements. International Journal of Molecular Medicine. 21;785-90.
Do you get stressed out during the holidays? Are you getting enough sleep? Even though you may feel like there are not enough hours in the day, don’t forget to take care of yourself. Easier said than done, I know, but without proper sleep, your body will not be able to function properly.
By getting the daily recommended amount of sleep, your risk for developing illnesses is decreased. Proper management of your sleep cycle also means a decrease in healthcare costs. This can be especially helpful around the holidays when budgets tend to be overspent on gifts and travel. Don’t forget to sleep over the holidays.
Many companies are now actively promoting healthy sleep habits and encourage their employees to have sleep studies done and see their doctors regularly. Healthy employees equal happy employees, which means a more productive workforce overall. A common motto in today’s workforce is “work smarter, not longer”.
Stress is the one hindering factor that most often interferes with the quality and quantity of sleep that we get each night. When this happens night after night, we become fatigued. Many times people complain of “chronic fatigue syndrome”, which occurs from repeated insufficient sleep.
Sleep loss affects your cognitive abilities, work performance, and overall productivity levels in daily life. This can eventually spiral into depression and/or anxiety.
Something else that we need to be aware of is the increase in drivers traveling during the holidays. According to the National Highway Traffic Safety Administration (NHTSA), a higher volume of holiday travelers, including a significantly higher number of alcohol-impaired drivers, results in more crashes and fatalities at this time of year. Aside from alcohol-related incidents, we also need to be aware of icy road conditions, and people driving who are sleep-deprived.
The NHTSA states that during the Christmas period, for example, an average of 45 fatalities involving an alcohol-impaired driver occurred each day. That number increases to 54 per day over the New Year’s holiday. Medical professionals and hospitals across the United States prepare for this holiday traffic trauma. Additionally, the NHTSA estimates that approximately 100,000 crashes each year are related to driver fatigue/drowsiness. Sleep deprivation leads to lapses of attention while driving, which can attribute to behavior that would cause a car crash. Most crashes occur between 4:00 – 6:00 a.m, midnight – 2:00 a.m. and 2:00 – 4:00 p.m. Nearly one-quarter of adults (23%) say they know someone personally who has crashed due to falling asleep at the wheel.
(Statistics courtesy of The National Highway Traffic Safety Administration)
Most people have elevated stress levels during the holidays, whether it’s due to travel, food or financial issues. Try and remember to stop and take a deep breath, make sure you are getting enough sleep, and take care of yourself!
For tips and tricks on beating holiday stress, click here. To start your New Year off right, make sure to prioritize your health. If you think you may have a sleep disorder but haven’t done anything about it yet, start by calling Dr. Klein and getting more information on Sleep Disorders 586-573-0438.
When you think about the irregular schedules of commercial drivers, it’s no wonder that the majority of them suffer from some kind of sleep disorder. The question is – How severe is it? The Federal Motor Carrier Safety Administration (FMCSA) reported, in 2010, that 35% of drivers sleep less than 6 hours per night on average. Ideally, they should be getting 7-8 hours, meaning that the drivers on our roads could be getting 50% of the rest that they need to function properly. Over an extended period of time, or the length of time they are employed as a commercial driver, this sleep deprivation significantly increases sleep-disordered breathing.
Commercial vehicle crashes related to drowsiness are 7 times more likely to be fatal than other drivers on the road. The size of the vehicles, the speed, and the inability to perform quick maneuvers can result in catastrophic accidents. Not to mention the cost factor when it comes to injuries, hospital care, time off work, property damage, insurance claims, etc. Driving and sleeping are clearly not a good mix.
An estimated 14 million people in the US are holders of a CDL (commercial drivers license), of which 7 million are employed as active interstate drivers. These drivers experience 341,000 crashes per year, which result in approximately 4,000 deaths. Fatigue is the largest cause (31%) of fatal-to-driver accidents. Afflicting between 28% and 80% of commercial truck drivers, OSA causes daytime sleepiness and increases fall-asleep-crash risk. -FMCSA Website
Drowsiness/Fatigue has been recognized all over the US as a main contributor to fatal crashes. This sleepiness while driving could be the result of:
This high prevalence of OSA in commercial drivers may be unsurprising, as they fall under 3 major categories for risk factors – male, obese, and middle-aged. In addition, many of them are smokers, drink a lot of caffeine, or use other stimulant products to stay awake behind the wheel, ultimately affecting their ability to get quality sleep when it is time for them to have a day off. It is also very possible that sleep-related problems, including sleep-disordered breathing, play a significant role in the high turnover rate among commercial drivers.
The National Transportation Safety Board (NTSB) has been urging the FMCSA to formulate specific rules regarding the screening of commercial drivers for OSA. Currently, there is only rule 49 CFR 391.41, which states that the commercial driver:
“(5) Has no established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with his/her ability to control and drive a commercial motor vehicle safely”
This rule unfortunately does not provide specific criteria for evaluation and treatment, nor does it specify OSA or other sleep breathing disorder. Therefore, companies become more hesitant to enforce screening because of the lack of specifications. If only everyone could agree that treating sleep disorders such as OSA among commercial drivers improves their work safety as well as the safety of other drivers on the road.
Employers have concerns about liability, staffing and scheduling, and screening may result in many drivers being removed from service. Our economy also relies heavily on trucking, so screening can impact the economy as a whole. An effective screening program would require careful consideration of work schedules and routes. While this may seem costly up front, data shows that health care costs and disability claim rates actually decline with proper screening and treatment.
Administration of sleepiness questionnaires (like the Epworth Sleepiness Scale) coupled with an objective assessment of sleep test (either take-home or in a lab) can undoubtedly improve safety on the roads. Sleep/wake cycles (along with prolonged sleep deprivation) are rarely taken into consideration when drivers are evaluated for the risks of developing disorders like OSA. It would be beneficial to evaluate drivers and their habits during time off, in addition to their driving periods.
Evidenced by multiple studies, CPAP treatment for OSA is associated with a significantly reduced crash risk for motor vehicle drivers following treatment, compared with untreated OSA (65% to 78% reduction in risk).
In 1981, the invention of the CPAP machine was an effective step in treating OSA. In 1995, the American Academy of Sleep Medicine (AASM) accepted the CPAP as the gold standard of treatment for OSA. In 2007, oral appliances (OAs) were considered acceptable treatment for those patients with mild to moderate OSA unable or unwilling to utilize or comply with CPAP. Patients diagnosed with severe OSA are still advised to initially use the CPAP.
There are over 100 different types of oral appliances that are made for the treatment of OSA. Dr. Klein works with each patient to provide the best options for their specific treatment.
At Michigan Head & Neck Institute, Dr. Klein offers exclusive treatment for OSA with a custom-fit oral appliance (OA), which is comfortable and can be adjusted to meet the requirements of each patient. Follow-up sleep studies will ensure that the OA is positioned properly. Please call our office at (586) 573-0438 for further information.
Higgins, JS et al. Asleep at the Wheel – The Road to Addressing Drowsy Driving. Sleep, Volume 40, Issue 2, February 1, 2017.
Sharwood, Lisa et. al. Assessing Sleepiness and Sleep Disorders in Australian Long-Distance Commercial Vehicle Drivers: Self-Report Versus an “At Home” Monitoring Device. Sleep, Volume 35, Issue 4, April 1, 2012; 469–475.
Pack A, Dinges D, Maislin G. A Study of Prevalence of Sleep Apnea Among Commercial Truck Drivers. Washington, DC Federal Motor Carrier Safety Administration, 2002.
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Howard M, Desai A, Grunstein R, et al. Sleepiness, Sleep-Disordered Breathing, and Accident Risk Factors in Commercial Vehicle Drivers. Am J Respir Crit Care Med, Volume 170, 2004; 1014-21.
Mitler MM, Miller JC, Lipsitz JJ, Walsh JK, Wylie CD. The Sleep of Long-haul Truck Drivers. New Engl J Med, Volume 337, 1997; 755-61.
Pack AI, Maislin G, Staley B, et al. Impaired Performance in Commercial Drivers: role of sleep apnea and short sleep duration. Am J Respir Crit Care Med, Volume 174, 2006; 446-54.
US Government Publishing Office – Electronic Code of Federal Regulations
Available from: https://www.ecfr.gov/cgi-bin/retrieve – se49.5.391_141
National Sleep Foundation. Missing a Night of Sleep Renders Drivers Unfit to Operate a Motor Vehicle. Sleep Review – The Journal for Sleep Specialists; May 17, 2016. Available from: http://www.sleepreviewmag.com/2016/05/nsf-missing-night-sleep-renders-drivers-unfit-operate-motor-vehicle/
Undiagnosed and untreated OSA (obstructive sleep apnea) can cause many dangerous medical issues, even death. 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. Many of the issues that you will read about here are things that you may have never thought had anything to do with OSA, but hopefully by the end of this you will see how everything is related.
Increased Blood Pressure
OSA episodes produce surges in systolic and diastolic pressure that keep blood pressure levels elevated while you sleep. People that do not have sleep apnea experience a decrease in blood pressure during sleep. For many, blood pressure remains elevated during the daytime when breathing is supposedly normal. This is why screening for OSA is absolutely necessary when evaluating patients with hypertension. The use of a CPAP machine has been proven to decrease nocturnal blood pressure surges.
In 1981, Dr. Rees conducted a study, which reported the high incidence of sleep breathing disorders in diabetics. Since then, researchers have been able to document the different independent associations between OSA, insulin resistance, alertness, and glucose levels. Many times treating the OSA will, in turn, control the diabetes. Determining which one is the chicken and the egg is difficult. Having OSA can lead to diabetes, but many diabetics are also obese, which can lead to OSA. Diabetics have more complicated sleep patterns, as they need to get up to use the bathroom more often than non-diabetics. Imbalances in hormone melatonin experienced by diabetics also cause irregularities in the sleep-wake cycle.
Increased Blood Sugar
People with diabetes have higher levels of HbA1c (average blood sugar level over time) than people without diabetes. When this increase occurs, the risk of heart disease increases. There is a direct link between the severity of the OSA diagnosis and the level of the blood sugar, in that the more severe apnea cases have the highest HbA1c levels and vice-versa. In addition, multiple studies have proven that when OSA is treated, blood sugar levels improve. These findings hold true regardless of factors such as obesity, age and sex.
A study presented at the American Thoracic Society 2012 International Conference showed that moderate and severe obstructive sleep apnea predicted Type 2 diabetes, and that sleep apnea was associated with HbA1c levels.
Elevated Heart Rate
OSA causes irregularities in the Sympathetic Nervous System (SNS), which causes instability in the heart rate. OSA severity can also be linked to the Parasympathetic Nervous System (PNS), as it is directly affected by the circadian system. PNS activity is higher in non-REM sleep, which is noticed in non-OSA patients, but is much more predominant in OSA patients. This suggests that the higher the PNS activity, the greater the oxygen saturation fluctuations are. To measure the time interval between heartbeats, non-invasive methods can be utilized. Changes in HRV (heart rate variability) can be monitored to help predict future problems.
Reduced Blood Oxygen
Having an extremely low level of oxygen in the blood is known as hypoxemia, which over time, leads to hypertension and diabetes. Oxygen desaturation is an immediate consequence of OSA. Patients suffering from OSA experience oxygen desaturation in addition to periods of apnea and hypopnea. During these apneic periods, patients suffering from OSA are not receiving air delivery to the body system. If a patient cannot comply with a CPAP (recommended for Oxygen saturation levels below 90%) then oxygen therapy/ administration may be an option.
Increased Fatty Acids
OSA causes increases in nocturnal FFA (free fatty acids) that may be a catalyst to an underlying heart condition. Increases in FFA can cause insulin resistance and vascular dysfunction, and repeated exposure to these increases can promote cardiovascular disease and diabetes. Many studies have shown that supplemental oxygen will prevent the FFA elevations, thus the CPAP can be utilized here as well.
OSA is associated with arterial stiffness, depending on severity in diagnosis, that adds to cardiovascular risk.
Arterial stiffness determines how quickly the pulse wave of the heart travels to the edge and then comes back. How stiff the walls are (or not) directly correlate to the blood pressure oscillation. Patients with OSA have this arterial stiffness during the daytime as well as overnight. Vascular stiffness can be increased with OSA for many reasons – changes in elastin, endothelial dysfunction, oxidative stress and/or inflammation. Endothelial dysfunction occurs when the inner lining of the blood vessels are imbalanced and can lead to hypertension, diabetes, and many associated inflammatory diseases.
*The National Commission on Sleep Disorders Research estimated that sleep apnea is probably responsible for 38,000 cardiovascular deaths yearly, with an associated 42 million dollars spent on related hospitalizations.
As stated above, OSA can cause hypoxemia and very low oxygen saturation levels, causing disrupted sleep cycles. After repeated apneic episodes, blood pressure levels are increased, causing stress to the heart. The nocturnal apneas cause cardiac disease. Even though OSA and cardiovascular disease have common risk factors, studies prove that sleep apnea increases the risk for cardiovascular disease independently of other characteristics and/or risk factors. This link is further validated by the fact the CPAP treatment is proven to reduce blood pressure and improve ventricular function. Failure to control the sleep-related breathing problems can lessen the effectiveness of treatments for heart failure and result in accelerated deterioration of heart function.
*One of the largest epidemiologic studies conducted to date, the Sleep Heart Health Study sampling 6,424 community-dwelling individuals who underwent home polysomnography, documented increased risk of coronary artery disease, congestive heart failure, and stroke among patients with severe sleep apnea.
A few Additional Facts about Sleep Apnea:
At Michigan Head & Neck Institute, we exclusively offer treatment for OSA that consists of creating a custom-fit oral appliance (mouthpiece) which is comfortable and can be adjusted to meet the requirements of each patient. Each patient that chooses an oral appliance (OA) as their treatment plan will receive follow up sleep studies (either at-home or a in a sleep lab) which will ensure that the OA is positioned accordingly. There are over 100 different types of oral appliances, and Dr. Klein works with each patient to provide the best options for their specific treatment. Please visit our website here for more information.
*The National Commission on Sleep Disorders Research. Wake up America: a national sleep alert. Washington DC: US Government Printing Office; 2002.
Pamidi S, Tasali E. (2012). Obstructive Sleep Apnea and Type 2 Diabetes: Is There a Link? Frontiers in Neurology, 3, 126.
*Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Nieto FJ, O’Connor GT, Boland LL, Schwartz JE, Samet JM. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001 Jan; 163(1):19-25.
Johns Hopkins Medicine. “Untreated sleep apnea shown to raise metabolic and cardiovascular stress.” ScienceDaily, 31 August 2017. www.sciencedaily.com/releases/2017/08/170831101454.htm
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Zhang W, Si L. (2012). Obstructive Sleep Apnea Syndrome (OSAS) and Hypertension: Pathogenic mechanisms and possible therapeutic approaches. Upsala Journal of Medical Sciences, 117(4), 370–382.
Johns Hopkins Medicine. “What a few nights of sleep apnea can do to the body”.
Seetho IW, Parker RJ, Craig S, Duffy N, Hardy KJ, Wilding JPH. OSA is Associated with Increased Arterial Stiffness in Severe Obesity. J Sleep Res. 2014 December; 23(6):700-708.
Kufoy E, Palma JA, Lopez J, Alegre M, Urrestarazu E, Artieda J, Iriarte J. (2012). Changes in the Heart Rate Variability in Patients with Obstructive Sleep Apnea and Its Response to Acute CPAP Treatment. PLoS ONE, 7(3), e33769.
Jean-Louis G, Zizi F, Clark LT, Brown CD, McFarlane SI. (2008). Obstructive Sleep Apnea and Cardiovascular Disease: Role of the Metabolic Syndrome and Its Components. Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine, 4(3), 261–272.