When I have diagnosed sleep apnea some of my patients will ask, “What can I do besides wear that mask?” While it is completely true that nasal CPAP is the treatment of first choice for adults with sleep apnea, clinical research indicates that for some carefully selected patients a mandibular advancement device (MAD) may be an appropriate option.

What? Me MAD?

A MAD is an orthodontic device that opens the mouth slightly while moving the lower jaw (mandible) forward (advancement). This generally increases the size of the upper airway especially behind the tongue. The best ones are made to fit a specific individual’s mouth by a dentist who is familiar with making and adjusting them, a process which takes a number of weeks to optimize. Sometimes final adjustments to the devices are made during a sleep study.

The adjustment phase consists of two parts, the initial one out of the lab and a follow up. Initial adjustment is considered complete when the patient’s snoring is abated, preferably completely. A follow up sleep study is always recommended to ensure that the device has effectively eliminated the sleep apnea.

Pros and Cons

The main potential advantage of the MAD is convenience. Some patients find it less intrusive and cumbersome than nasal CPAP.

The main disadvantage is that one will not know whether it will work until after the follow up sleep study has been completed. Its initial cost is generally higher than nasal CPAP. Some patients will experience a change in their occlusion, i.e. how the upper and lower teeth fit together, but most do not find this to be a limiting problem. Other patients may develop TMJ (Temporomandibular Joint Disorder) pain from MADs.

Who should go MAD?

As with the success or failure of the majority of medical treatments, patient selection is critical in the decision to go with a MAD. In general, the MAD is a second line therapy. It is most effective in patients who have mild to moderate sleep apnea (based on sleep study findings), are non-obese and have apnea that occurs exclusively or predominantly while lying on ones back.

Bottom line an accurate diagnosisis is the most important thing. Diagnosis obstructive sleep apnea requires testing by competent professionals, an attended sleep study being the gold standard. Once the diagnosis is clear, one can discuss management options with his/her physician. Regular follow up is essential to ensure proper functioning of the device and optimal results e.g. better sleep quality and improved daytime functioning.

Did you know that getting less than eight hours of sleep per night could actually cause you to gain weight? When the body receives less than eight hours of sleep each night, it experiences sleep deprivation, which affects important hormones that regulate hunger and satiation.

The production of leptin, the hormone that tells the body it is full, is decreased when you don’t get enough sleep, and the production of ghrelin, the hormone that tells the body it is hungry, is increased. So a lack of sleep causes the brain to believe you need more food than you really need, which is why you feel hungry all day after a sleepless night.

But that is not all. You have probably also noticed that you are not only constantly hungry, you are hungry for junk food. Junk food is specially designed to satisfy specific aspects of self-gratification to which we are especially susceptible when fatigued.

The amount of sleep we get each night affects the types of foods we crave. Sleep deprivation affects the body’s cravings for carbohydrates and sweets. Foods that are high in carbs and sugar contain more glucose, which fuels the brain. When we don’t get enough rest, our brains search for ways to get more glucose so it can continue to function, leading the sleep deprived person to reach for a soda and a cookie rather than an apple.

The good news is that there are things you can do to help you sleep better. For starters, you can follow these simple tips for getting better sleep:

• Take a hot shower before bed. Not only is a hot shower or bath relaxing, but the cooling that takes place after a shower actually induces sleep. Our body temperature naturally increases as bed time approaches, preparing us for slumber.
• The three S’s of the bed. Only use the bedroom for three things and three things only- sleep, sex, and sickness. Keep the television, laptop, iPad and iPod out of the room. Train your brain to relax when you are in bed. Also, the LED lights associated with electronic devices is very stimulating to the brain.
• Keep the bedroom dark. The darker the room at night, the more melatonin the body produces. Even the slightest bit of light from an alarm clock or cell phone can interfere with melatonin production. If you need to get up in the middle of the night, use “low blue” lights, which will not interfere with melatonin production.

If lifestyle changes are not enough to ease your body into a full night’s rest, contact a sleep center. You may have a medical condition such as sleep apnea that is interfering with your body’s ability to sleep soundly.

Did you know that sleep can make you thinner? While many people know that poor sleep is linked to health conditions like hypertension, diabetes and coronary artery disease; weight gain and obesity were off the list…until now.

A recent study of twins from the University of Washington demonstrated that sleeping less than seven hours a night on a regular basis is associated with an increased body mass index (BMI) – the measurement used by doctors to determine obesity.

What the researchers observed was that genetic predispositions for weight gain were enhanced among those getting “short sleep” of less than seven hours a night. Conversely, those who slept eight hours a night or longer had a lower BMI.

“Sometimes a tough problem can keep you up at night. In the case of being overweight, I suggest sleeping on it,” said Dr. Terrence Moore MD, Director of the 4BetterSleep Centers in the Park Cities area. “Getting eight hours a night makes weight loss and keeping trim easier.”

The reason for this is primarily hormonal. Insufficient sleep alters your metabolism, according to Dr. Moore. It increases hormones that stimulate appetite and decreases the hormone Leptin, which tells your brain you are full. Even worse, you crave sugar and carbohydrates, not broccoli – a consequence that will continue during your next sleepy day encouraging even more junk food cravings.

“The late-night munchies are biological consequences of sleep loss, not lack of willpower,” notes Dr. Moore.

And it is a huge problem affecting millions of Americans. Average hours of sleep per night have decreased by 1.5 hours over the past century – a trend that is accelerating. Since 2001, for example, the percentage of people getting approximately eight hours sleep decreased from 38 to 28 percent.

This chronic and widespread lack of sleep may be an important factor in the ballooning epidemic of obesity. Sufficient sleep can be a powerful weight loss tool by increasing the body’s natural appetite control and curbing junk cravings.

“While one or two late nights won’t necessarily affect your weight,” said Dr. Moore. “Habitual sleeplessness is a health risk. If you have trouble getting eight hours a night, you may need to see a specialist to find out why and to get back on track – for your weight and your health.”

Not sure if you have a sleep problem? Take an online sleep quiz. Learn more about sleep disorders and/or arrange for a sleep study by calling 214-466-7222 or at www.4bettersleep.com.

P. Terrence Moore, M.D.

4Better Sleep Centers
Wake Up to Life Again

8722 Greenville Ave #102
Dallas, Texas 75243
214-466-7222
www.4bettersleep.com

It’s Thursday night, after a long work day and you are ready to sit back, relax and enjoy a nice glass or two of red wine. For some of you a glass of wine calms you down after a busy day and gets you ready for a good night rest, but could it be affecting your sleep?

Indeed, medical research strongly supports beneficial effects of red wine in moderation, especially in the reduction of heart disease. But as the saying goes, too much of a good thing…

Many people may not understand wine’s darker side when it comes to a good night’s sleep. For example, have you noticed that your spouse’s snoring, after a glass of a pinot noir, can drive the fleas off the dog? As little as one glass of wine near bed time can make a snoring bear of a fairy princess. Further, it can exacerbate or even induce obstructive sleep apnea in some individuals which, long term, can lead to high blood pressure and premature death from stroke, heart attack and accidents.

Disrupted sleep, whether from alcohol, apnea, insomnia or poor sleep habits is responsible for negative mood, diminished motivation, impaired mental clarity and a reduction in one’s general sense of well-being. This often translates into being short with the kids, disinterested in the spouse, disconnected from friends and snappy with co-workers. Forget that promotion.

So, raise your glass to a life of good health, but remember that alcohol on board at bedtime can be a dream killer.

Things That Go Bump in the Night

Many parents have been startled from pleasant dreams to a child who appears emotionally distressed and inconsolable. Others parents can tell stories of a little one getting up from sleep to take a stroll about the house. So, just what is going on?

The above described scenarios represent two relatively common parasomnias, sleep terrors and sleep-walking. Parasomnias are sleep disorders that involve an undesirable behavior or event which occurs during sleep that involves abnormal movements, behaviors, emotions and/or dreams.

The onset age of these disorders is generally from 2-6 years of age, but may be later. Frequently there is a family history of similar episodes in a parent or sibling. Recent studies suggest that, at least in one family, a specific genetic abnormality may be the root of sleep walking.

These sleep related behaviors usually occur in the first third of the night during what has been referred to as slow wave sleep. The initial sign may be a loud scream or moaning. The child may get out of bed and appear to observers to be terrified. Physical signs include rapid heart rate and breathing, dilated pupils and even sweating.

Factors which may trigger an episode of sleep walking or sleep terrors include insufficient or disrupted sleep, stress, some medications or an inter-current illness, especially with fever. Disorders which may be disguised as sleep terrors or sleep walking include nightmare disorder, sleep-related epilepsy, panic disorder or obstructive sleep apnea.

Most cases of sleep terrors and sleep walking require no specific treatment. Children with sleep walking and sleep terrors are generally physically and developmentally normal.

We advise you to take your child to a pediatrician or sleep specialist if these events occur more than a few times a month, become disruptive to the household, involve dangerous or potentially dangerous behavior and/or become associated with daytime sleepiness and abnormal daytime behaviors.

Because of the high prevalence of chronic insomnia, approximately 15% of the adult population, hypnotics, i.e. sleeping pills, are among the most commonly prescribed medications. If properly used, sleeping pills are a safe and effective way to promote sleep and enhance daytime functioning and sense of well-being for patients with insomnia. Here are a few important things to keep in mind if your doctor prescribes a hypnotic.

Since medications are not absorbed through the stomach lining, hypnotics should be taken immediately prior to bed on an empty stomach. If you have food in the stomach when you take the sleeping pill, it will remain in the stomach until the food is processed and emptied into the small intestine. Depending upon the size and composition of the meal, approximately three hours are needed for the stomach to empty itself. Bedtime should immediately follow taking the medication. Not adhering to this instruction is likely the single most frequent reason that patients report that sleeping pills do not work consistently.

Another mistake regarding taking hypnotics is waiting until you feel sleepy before going to bed after having taken the medicine. Doing this can result in extremely undesirable events from waking behaviors that are invariably associated with amnesia (memory loss) while under the influence of these medications. Furthermore, one could do something rather “out of character” or even dangerous. As such it’s probably a good idea to inform your spouse/partner if you are taking a hypnotic.

It’s best that hypnotic medications be taken at the same time every night. Do not take a sleeping pill if there is a reasonable likelihood that you are going to be awakened while the medication is “on board” e.g. doctor on-call, fireman, mothers with newborns, etc. Do not take these medications during plane flights. Of course, none of these medications should be mixed with alcohol.

How long these medications may be taken safely is a subject of some discussion. There are clinical studies which indicate safety of use for as long as two years. Most hypnotics have been approved for a short period of time, generally on the order of the few weeks, but there are many patients who have taken these drugs safely for a number of years. The length of the use should be based on the patient’s clinical response, clinical circumstances and the presence of adverse events.

Many patients are concerned that they may become addicted to sleeping pills, an unlikely occurrence which may be understood by clarifying the important differences between addiction and dependence. Dependence, in the context of medication usage, predicates that the person taking the medication feels better, functions better and/or has better health and longevity as a result of such use compared to non-usage.

By contrast addiction is characterized by a repeated behavior that leads to impaired functioning and/or health. The use of hypnotic medications has not resulted in this type of impairment. On the other hand, some patients may be dependent on hypnotic medications to improve their sleep and, thereby, their daytime functioning. Depending on one’s point of view, this dependence may or may not be a bad thing.

Sleeping pills, when taken as directed by a physician, can allow people to obtain quality sleep that they may not have had otherwise. If you have any questions about hypnotics or have problems with your sleep, please call 4BetterSleep Center – one of the most comprehensive sleep disorder treatment centers in Texas. Let 4BetterSleep put your sleep problems to bed.