Sleep apnea has been getting a lot of press over the last few years – and for good reasons. Scientific studies have linked this condition to heart disease, weight gain, and even strokes. Researchers also report that obstructive sleep apnea (OSA) can affect nearly every system in the body.
If left untreated, sleep apnea can literally kill a person.
Thankfully, there are ways to treat OSA – weight loss and the use of CPAP machines are the most common.
Unfortunately, many patients hate their CPAP masks. Why is this? And what can they do about it?
“But I Hate CPAP Masks!”
15 Reasons Why People Hate Their CPAP Machines
What is it about CPAP masks and machines that make some people think they’re the modern equivalent of a medieval torture device?
Here are the top 12 most common complaints:
1. Wearing a mask to sleep is totally uncomfortable
Many people start off with the wrong size mask. One size does not fit all. Getting the correct size might be the right solution for some folks.
2. The pressure might be wrong
CPAP machines force air through the airway, specifically while someone is lying on their back. If a person changes position during the night, the air pressure can be too strong. This can be uncomfortable. Try testing different pressures to find the right one for you.
3. The mask might not work for people with nasal congestion
People who have a cold or chronic nasal congestion might not get the amount of air they really need. Inflammation, mucus, and even anatomy can limit the amount of air they receive. Additionally, the forced air can make their condition even worse.
4. It is really difficult for some people to get used to
It can take up to one month to get used to a CPAP mask. However, even with time, some people just never get used to it. It’s uncomfortable and they end up ripping it off in the middle of the night.
5. Some people don’t tolerate forced air in their nose
Another reason people hate CPAP masks is because of nasal passage sensitivity. Forced air can be uncomfortable, but this air can also lead to excessive dryness. This, in turn, can lead to irritation and even nosebleeds.
6. Masks aren’t the best option for people with claustrophobia
Being in a dark room with a mask over your face isn’t anyone’s idea of fun, especially those who suffer from claustrophobia.
7. There isn’t enough education or proper follow-up to address patient concerns
Sleep apnea patients aren’t always keen on investing time in follow-up appointments. But doing so will give their doctor input as to why they’re experiencing discomfort and whether the CPAP machine is working or not.
Talk to your doctor if you don’t like wearing your CPAP, they may suggest a physiologic alternative such as a dental sleep appliance by a neuromuscular dentist such as Dr. Ira Shapira. To get an assessment from Dr. Shapira, however, you do not need a referral.
This switch could make a huge difference in your comfort level – and ultimately, your health.
8. People with sensitive or acne-prone skin end up with breakouts
No one likes to get a breakout – especially adults. Unfortunately, some people experience irritation or rashes if anything, including a CPAP mask, touches their skin.
9. The CPAP machine is too loud
Some people can fall asleep anywhere. Others need a dark, silent room. For those in the latter group, a CPAP machine is often just too loud to get adequate rest.
10. It is common to wake up with a dry mouth and stuffy nose
Due to the forced air, the airway can dry out. This can lead to some inflammation, discomfort, and even swelling the next morning.
11. People forget to clean their machine regularly
Some people feel this is a hassle, while others simply forget. Either way, they run the risk of getting very sick due to the bacterial build-up in the machine.
12. Some patients can get aerophagia or air in lungs.
Symptoms of aerophagia include abdominal distension, bloating, belching, and flatulence.
13. Some patients are prone to sinus infection, pneuumonia, or bronchitis.
This ties in to how CPAPs can house bacteria. Recent studies have shown how CPAPs can be a route for infection in sleep apnea patients.
14. Can cause a change in bites or occlusion.
Long term use of CPAPs can change bites or occlusion. Acting like a headgear used in orthodontics, CPAPs can pull the maxilla back. Dr. Shapira has called this the “Smashed Face Syndrome.”
15. They have a mild form of sleep apnea
There’s a question as to whether people with milder forms of sleep apnea even need a CPAP machine. They wonder why they need to experience discomfort when there might be other options available.
Alternatives for People with Sleep Apnea Who Can’t Stand Wearing a CPAP Mask
Are there any alternatives for people who cannot tolerate their CPAP masks? Yes, there are options!
Dr. Ira Shapira can offer his CPAP intolerant patients at least two dental oral appliance, including:
A Tongue Retaining Device (TRD) – A soft suction device that keeps the tongue from relaxing into the back of the throat.
Mandibular Advancement Devices (MAD) – A mouthguard worn over the upper and lower teeth that pulls the lower jaw forward to keep the airway open.
At last, people who hate CPAP masks have a way to reduce their sleep apnea symptoms, as well as the risk of developing other serious health conditions. And with less noise and discomfort, they can finally get a good night’s sleep.
Have you been suffering through each night wearing an annoying CPAP machine? Contact our office today to schedule an appointment – we’ll discuss what CPAP alternatives might best fit your needs.
DNA and RNA Appliance are used to Treat a wide variety of issues including TMJ disorders, Headaches, Migraines, Snoring and Sleep Apnea. Postural disorders to impaired breathing can be related to chronic head and neck pain and spread postural issues throughout the body.
It is vitally important for dentistry and medicine to address the development of airway issues that last a lifetime. I primarily work with older children, adolescents and adults in my practice. Children, even very young children receive the biggest benefit from expansion of airways. The DNA/RNA Appliance gives an important second chance to patients who did not properly develop as children. Adults can now be treated without orthognathic surgery, tongue reduction and other invasive procedures.
The DNA Appliances are changing the field or dental orthodontics from cosmetic shifting of teeth in available bone into the field of Epigenetic Orthopedics correcting problems that conventional orthodontics never addressed.
Orthodontics utilizing braces and brackets or plastic aligners as used by Invisalign, Smile Direct and other systems is about moving the teeth in the available bone to create a prettier smile and straighter teeth. Phased orthodontics in children has to a small extent embraced expansion of bone to create more space to straighten the teeth. Airway has only been minimally addressed by most of orthodontics.
There are many orthodontists who still practice “Contraction Orthodontics” also known as “Four on the Floor” or Bicuspid Extraction cases. The thought process is the you “Amputate” the teeth to make room in the mouth for all of the remaining teeth. This Contraction Orthodontics” makes the teeeth fit but crowds the tongue and impairs breathing.
Unfortunately, until recently the question of airway and ideal development of the jaws has not been addressed. There have been major changes in the last few hundred years to patterns of orofacial and cranial bone growth. These are negative epigenetic changes due to environmental issues including pollution, changes in how babies are fed and nurtured as new borns ant throughout their early lives. This has led to a massive problem of underdeveloped maxillas, mandiibles and airways.
I became involved in the early 1980’s in managing airway in adults by treating sleep apnea and snoring. I saw my son Billy had issues but when he was ready to start Kindergarten he was evaluated and I was told he had ADD, ADHD, could not start Kindergarten and needed to be on
Ritalin for life. You worry about your child’s when they cannot start kindergarten and I refused the diagnosis and took Billy to Rush Medical School for a sleep study. He had severe sleep apnea and we proceeded to have tonsils and adenoids removed and at 5 orthopedic expansion of hist maxilla. He had a tongue and lip tie corrected as well. He became a straight “A” student, went from 50% growth curve to 90% growth curve, slept well and mood was vastly improved. He graduated college double major, double minor Magna Cum Laude, His drug of choice was Oxygen not Ritalin. I became a Visiting Assistant Professor at Rush Medical School Sleep Center in 1985 and did research into similarities in jaw position in sleep apnea patients and TMJ patients.
Breast feeding is a major factor in the development of proper facial form. “Form follows function” is a truth in medicine and the changes in how babies are fed and nurtured has changed, which changes their development. These changes in growth and development affect airway and sleep, intelligence and learning and most importantly brain development and function and can lead to learning and behavioral disorders including ADD, ADHD and ODD. Many of these disorders are related to sleep disordered breathing including snoring, increased upper airway resistance syndrome (UARS), Respiratory effort related arousals (RERA) Hypopnea, Sleep Apnea.
The underdevelopment of the nasal oropharyngeal airway is the single biggest culprit and creates problems not just in infants, children and adolescents but also problems that last a lifetime. Sleep Apnea can cause issues with insulin resistance, memory loss and dementia, they cause a 300-600% increase in heart attacks and strokes as well as motor vehicle accidents, are implicated in hypertension, metabolic syndrome and obesity. Ideally a narrow airway is corrected before 8 years of age and it was thought expansion was limited if not impossible in adolescents and adults. The DNA Appliance has changed all that and expansion is possible throughout your life.
The DNA Appliance is an FDA approved orthodontic device that can often correct all of these issues. The RNA version of the
DNA Appliance is an FDA approved Sleep Apnea Appliance. Both the DNA and RNA Appliance utilize Epigenetic Orthopedics to grow larger airways and offer the possibility of curing sleep disordered breathing in all forms. The process of growing a larger airway has been called Pneumopedics by Dr David Singh who invented the DNA Appliance.
I will present several video testimonials of patients who have utilized the DNA/RNA Appliances. The first one is a patient experiencing major improvement in nasal breathing after just a few months of treatment. When the maxilla is expanded the roof of the mouth widens and high palates correct themselves flattening out. The hard palate is the roof of the mouth but that same bone is also the floor of the nose. With epigenetic expansion the cross section of the nose dramatically increases in both height and width. The expansion of the mouth makes more room for the tongue.
Nasal breathing increase the amount of Nitric Oxide the body produces which is the single most powerful antioxidant known. A Nobel prize has been given for work on Nitric oxide.
Sleep Apnea is a serious medical issue for millions of Americans. There are many treatments available to treat Sleep Apnea, the best known treatment is CPAP or Continuous Positive Airway Pressure which uses a compressor to deliver pressurized air through the nose and/or mouth through a mask. CPAP is extremely effective when it is used by patients but only about one in four patients prescribed CPAP actually use it on a regular basis. The 25% of patients who utilize CPAP is dwarfed in number by the 60% of patients who reject or fail CPAP completely. Approximately 15% try to manage CPAP but do poorly. Success is not the norm with CPAP in spite of the fact that it is extremely effective when used and is considered the “Gold Standard” of treatment.
The primary reason patients don’t use CPAP is that they “Hate CPAP”. Oral Appliances are also extremely successful at treating Sleep Apnea and are considered a first line approach for mild to moderate sleep apnea and an alternative to CPAP for severe sleep apnea. They are under prescribed primarily due ignorance in the medical community about effectiveness. CPAP is a billion dollar industry that has tremendous monetary power and thee makers of CPAP machines also make much of the diagnostic instrumentation for sleep.
The website https://www.IHATECPAP.com is an excellent resource to learn more about Sleep Apnea diagnosis and treatment. The name of the website is from patients who when asked why the wanted an oral appliance would commonly reply “I HATE CPAP!”
The following is a video of a physician describing his experience with an oral appliance to treat sleep apnea. Many physicians choose not to utilize CPAP but rather a comfortable oral appliance. Oral Appliances are excellent for managing Sleep Apnea but the DNA/RNA Appliances offer a “CURE”! Patients with sleep apnea must have their sleep apnea treated but it can be managed for a lifetime without negative consequences.
The following video is a physician whose life was affected by her sleep apnea and who chose to seek a cure for her apnea rather than just a treatment. She has not completed treatment at the time this video was made. Prior to treatment she was living in a state of exhaustion. The RNA Appliance is acting as both a sleep appliance and is growing her airway orthopedically. When the DNA/RNA Appliance is used to cure sleep apnea it actually results in a 24/7 improvement in airway not just a correction during sleep. This patient discusses oral Myofunctional Therapy which can aid in expansion and ideally should be utilized in every single orthodontic treatment. More important pediatric dentists and physicians should learn to be aware of these developmental issues and address them as soon as possible to prevent future issues. In retrospect, my son would have been far better off having his airway issues treated far earlier. Brain development is changed by sleep apnea even in infants and very young children.
TMJ Disorders, Chronic Headaches and Migraines and other types of Orofacial pain are often associated with airway issues. The National Heart Lung and Blood Institute published a report “The cardiovascular and sleep related consequences of TMJ disorders” The NHLBI of the NIH considers Sleep Apnea to be a TMJ disorder. The DNA Appliance is often utilized as a second phase of treatment for patients with TMD. The following is a patient who has lived her entire life with an underdeveloped maxilla and is using the DNA/RNA appliance to pneumopedically grow a larger airway and orthopedically grow her maxilla in order to treat her TMJ disorder. While she is still early in treatment she feels that her TMJ disorder has been cured. Her lower jaw (mandible) was locked in a posterior position and maxillary expansion has given it freedom to move forward and relieve abnormal pressure in the TM Joints
The next video is a patient who has lived with chronic head and neck pain for many years and initially was treated with a neuromuscular dental orthotic and is now utilizing the DNA Appliance to complete her treatment (Phase 2 ). She describes a wide variety of improvements after wearing the DNA Appliance for a couple of months. When you breathe better and correct airway issues it has positive effects throughout the entire body.
The next video is a patient who has had a lifetime of sinus issues and TMJ issues. While here TMJ issues were dealt with her small airway would create a less stable result and relapse. The DNA Appliance is being utilized to increase her airway and led to dramatic improvements in he sinus issues. Listen as she discusses how improved breathing is improving all aspects of her life.
Shimshak et al published a paper in Cranio Journal in 1998 looking at medical expenses in patients with TMJ disorders and found that there was a 300% increase in medical expenses in every single field of medicine. We now know that sleep and airway are very closely related and that the increase in medical expenses has many causes but treatment with the DNA Appliance addresses a wide spectrum of these issues. I wrote an article for Cranio Journal in 2013. The full ediitorial can be found at https://www.tandfonline.com/doi/pdf/10.1179/crn.2013.001?needAccess=true. I was asked to write this editorial by Riley Lunn tthe editor of
Cranio Journal because I had been treating sleep and airway issues since 1982 long before most of medicine or dentistry ever looked at airway and sleep apnea.
TMJ Alias, The Great Imposter, Has a Co-Conspirator: Poor Sleep
The next patient is much younger and his parents who are both Chiropractors brought him in to address airway issues that were leading to forward head posture and was affecting his posture in his entire body. Chiropractors are very aware of how head and jaw position affect the entire body.
The DNA Appliance is giving three dimensional expansion and there is a cascade of positive outcomes that occur as airway improves.
The next video is of Lewis who is now utilizing his RNA Appliance instead of CPAP while he is growing a larger airway. He appreciates being able to go camping with his appliance, something he could not do with CPAP.His teeeth have straightened out and he has a bigger better lower jaw.
The DNA and RNA Appliance utilize Epigenetic Orthodontics which is the single most exciting advancement in dentistry today. While it is called epigenetic orthodontics a more accurate name would be epigenetic orthopedics because it actually grows and reshapes and idealizes the bone rather than just move the teeth. This is far different than typical orthodontics.
This technological advances of the Vivos System allows us to comfortably create (grow) big wide healthy looking smiles even in patients with narrow arches. Patients with weak chins and poor profiles can see improvements often even early in treatment. In an ideal world every patient would naturally have developed big wide healthy arches with resultant large airways and enough room for their lower jaw to grow ideally.
One very special aspect of utilizing the DNA Appliance and Epigenetic Orthodontics is that the appliances are only worn for 14-16 hours per day. This is very different that standard orthodontics with brackets and wire or Invisalign®. Most of the wear can be done in your sleep, watching TV or commuting. During the day at work or with friends you can be free of the appliance. This is one of the special features patients love about the DNA Appliance, the convenient fit into your lifestyle.
The time when the appliances are out the teeth move to ideal position as nature and/or genes intended.
Typical orthodontics is a four-step process designed to move teeth through the bone. The first step is FORCE that creates PRESSURE (1) that compresses the periodontal ligament and puts pressure on the bone. The second step is INFLAMATION (2) which is associated with pain and discomfort. The third step which is RESORBTION (3) which is breaking down the bone by osteoclasts to create space. The fourth step is CONSOLIDATION (4) where new bone is formed. The process is then repeated after every orthodontic visit when braces are tightened or with each new Invisalign® tray.
Epigenetic Orthodontics is very different because it is a two step process. The forces are very light and movement is limited to 250 microns approximately every four days. The light forces are applied and growth and movement occur without inflammation which makes the entire process practically pain free. If there is any discomfort the adjustments are spaced out further.
Relapse is frequently a problem with orthodontics after orthodontists have used fixed braces to straighten crooked teeth. Relapse is the teeth moving back to their original position and relapse is why orthodontists make retainers. The reason for relapse is complex and not well understood. The hours when the appliance is out let the teeth follow natural eruption processes with far lower risks of relapse.
According to Dr. Dave Singh the Founder of the field of pneumopedics and craniofacial epigenetics which includes epigenetic orthodontics “there is a natural way for the body to remodel the upper airway, reshape bone and move teeth into their correct positions painlessly without the use of surgery, drugs or injections.”
Professor G. Dave Singh DDSc, PhD, BDS states on his website: “However, the entire human genome has now been sequenced, and we now know that certain genes are involved in moving teeth. Teeth are naturally-designed to move, for example, tooth eruption in a normally-growing child. In addition, the teeth in some people erupt in a specific arrangement, producing a beautiful smile. Dr Singh believes that the specific arrangement of teeth is due to certain genes. In fact, a natural process called ‘temporo-spatial patterning’ is at work. This process is the blueprint or body plan that is encoded by genes. In other words, the right and left sides of the body, the top and bottom of the body as well as the front and back of the entire body is under the control of a genetic body plan, including the teeth. Sometimes, however, the plan gets disturbed, producing crooked teeth and improper orthopedics.”:
Getting Older or Getting Better™. THE CHOICE IS YOURS! Come in and find out what is possible.
The Vivos DNA Appliance allows us to grow and develop a more ideal facial structure and a healthier airway.
Dr. Shapira has long had a special interest in developmental processes because of his work with sleep apnea in children and adults. Dr Shapira also has over 38 years experience in treating difficult TMJ Disorders, Migraines, headaches and other Chronic Pain. When these processes go are disturbed it changes how people breathe and swallow. Young children are frequently put in expanders to expand their maxilla or upper jaw. This is needed because of negative epigenetic changes caused by environmental allergies, food allergies or disturbed growth from insufficient breast feeding and bottle feeding.
Dr. Shapira, has taught classes to hundreds of dentists and their teams on how to treat sleep apnea with oral appliance therapy. It is one of Dr. Shapira’s students Dr .Martha Cortes who first introduced him to Dr Singh and to this exciting new field.
Dr Shapira has studied this field extensively and in 2014 gave a lecture in Buenos Aires, Argentina on the “Common Developmental Pathways of TMJ Disorders and Sleep Apnea.” These pathways are an example of negative environmental effects on development that can be reversed in adults who were not expanded as children. Prior to the DNA Appliance only extensive orthognathic surgery was available to widen or move bone.
Faces are different and each and every one of us is unique. Our appearance and physiology is determined by our DNA or genes. Genes determine our physiology and everything else about us. This is a description of Genetics
What many people are not aware of is that the environment and other factors can change how our genes express themselves. These types of changes are called Epigenetic changes.
Each person has a unique Genotype, these are the genes we inherited from our parents that when combined created a unique and special person. Identical twins actually share a identical DNA .
The Phenotype is how are Genes are expressed, the effects of the environment on us. These are the epigenetic changes that can be positive or negative in nature. This can be the difference between a big wide smile that shows all the teeth
What makes the DNA Appliance special is that it uses the patient’s own genes to modify and change not just the position of the teeth but the size, shape and position of the bone that holds the teeth as well as Pneumopedically change the size and shape of the airway. This 3-D spatial reconfiguring of the teeth and bone can make amazing changes not just in the teeth but in the face as well. The changes the DNA Appliance stimulates mimic the natural developmental process that occur in an ideal world. Biomimetic is the term used to describe what the DNA Appliance accomplishes, it mimics through biologic means what an ideal environment would have developed.
Oral appliances are frequently worn as a comfortable alternative to CPAP to manage snoring and obstructive sleep apnea. These appliances often protrude the lower jaw and are needed for life. Pneumopedics® is a term coined by Dr Singh to describe non-surgical upper airway remodeling is a different approach because instead of merely repositioning the lower jaw during sleep it gently allows allows the body to gently and gradually orthopedically increase the size of the upper jaw and increase the nasal airway. This has been shown in some clinical cases to create a cure for sleep apnea and snoring. The FDA-registered Daytime-Nighttime Appliance® system (or DNA appliance®) is worn during the evening and night for a total of 14-16 hours/day
Patients who are CPAP intolerant can utilize the FDA-cleared, patented mandibular Repositioning-Nighttime Appliance® (or mRNA appliance®) which works to maintain an open airway in the fashion of sleep apnea oral while gently re-developing the upper airway and moving the mandible or lower jaw and the teeth into a more natural position.
The DNA appliance® and mRNA appliance® protocols can effectively address TMD issues and headaches in both adults and children. Dr Shapira is a leader in the use of the DNA Appliance to finish phase two treatment in TMD patients.
Treatment of Sleep Apnea with oral appliances is an excellent alternative to CPAP for mild to moderate sleep apnea and an alternative for severe sleep apnea when patient do no tolerate or want CPAP.
Since 1982 Dr Shapira has been a leader in the field of Dental Sleep Medicine. He sees patients in Highland Park and Gurnee Il.
HIGHLAND PARK, ILLINOIS 3500 Western Ave, Suite 101 60035 847-533-8313 www.ThinkBetterLife.com
GURNEE, ILLINOIS 310 S Greenleaf 60031 847-623-5530 www.DelanyDentalCare.com
Dr Shapira has added Diplomate Status by the American Board of Sleep and Breathing to his long history of being in the forefront of Dental Sleep Medicine. He first became involved in Dental Sleep Medicine and the treatment of Sleep Disorders in 1982. In 1985 Dr Shapira began research evaluating jaw position as a visiting Assistant Professor at Rush Medical School in Chicago.
The Sleep Disorder Dental Society (SDDS) was the first organization dedicated to the science and practice of Dental Sleep Medicine and attended the first meeting in 1992 in Phoenix. Dr Shapira was one of only 20 dentists at that meeting and the only dentist serving as an Assistant Professor of a medical School. He was later credentialed by the SDDS. The Sleep Disorder Dental Society became the American Academy of Dental Sleep Medicine and the American Board of Dental Sleep Medicine was formed and Dr Shapira was awarded Diplomate status.
He was also a founding member of DOSA or the Dental Organization of Sleep Apnea dentists. He taught courses to hundreds of physicians and dentists and lectured on the subject as the American Academy of Anti-Aging Medicine. One lecture from 1998 became a chapter in a medical textbook on Anti-Aging Medicine.
Dr Shapira was honored but being chosen to write the Guest Editorial when CRANIO: or the Journal of Cranio Mandibular Practice changed its name to the Journal of Craniomandibular and SLEEP Practice due to his influence in the growth of this important medical field that brings together the practice of Slkeep Medicine, Cardiology, Pulmonary Medicine and Dentistry
Dr Shapira is now a leader in the field of Epigenetic Orthodontics/ orthopedics and the use of the mRNA version of the DNA Appliance to offer possible permanent cures of Sleep Apnea through growth of the airway in a process called pneumopedics.
Dr Shapira practices in Gurnee at Delany Dental Care 847-623-5530
I am pleased to announce that I am now a new Diplomate of the American Board of Sleep and Breathing. I am a long term Diplomate of the American Board of Dental Sleep Medicine, Credentialed by the Sleep Disorder Dental Society (SDDS) and a Founding member of both the SDDS (Now AADSM) and Dosa , the Dental Organization for Sleep Apnea.
I did research into jaw position and sleep apnea as a visiting Assistant Professor at Rush Medical School from 1985 until 1991 and returned as an Assistant Professor from 1998 until 2001. I had the pleasure of working with Dr Rosalind Cartwright who was responsible for the growth of Dental Sleep Medicine.
I am currently in day two of my Harvard Medical School course on Advanced Pain Management. I am spending all of this week in Boston to improve on my skills in pain management.
The program is on Advanced Pain Management continuing Education with Academy of Integrative Pain Management and Harvard Medical School’s Top Pain Doctors.
Updates and Practice Recommendations to
Optimize the Assessment and Treatment of Pain
Headache, Fibromyalgia, Neuropathic, Myofascial, Cancer, Abdominal, Pelvic, Musculoskeletal, Spinal Pain.
Dr. Ira Shapira: “I love science. Science provides the necessary facts, to better understand people’s issues as a healthcare provider. Applying these facts properly (recognizing that every individual deserves personalized focus, attention and treatment), is the key to Effective TMJ and Sleep Disorder Solutions.”
Everyone experiences the occasional headache, shoulder pain, or sore neck. Most of the time we can dismiss the cause as nothing more than stress or our busy lives, but, when pain becomes a daily occurrence or is accompanied by other symptoms, there could be something more going on.
If you find yourself constantly battling fatigue, feeling as if your sleep is disrupted on a nightly basis, or if your family complaints about your snoring, you could have an underlying sleep disorder. There are several, common sleep issues (e.g.: sleep apnea) that plague many individuals like you.
“I like to think of my patients as though they were members of my family. I want them to have the quality of care they can appreciate and that I would expect for myself or my family. That’s why I try to stay current with the latest findings in the field of Physiologic (TMJ) and Sleep Disorder dentistry.
Bedwetting can be devastating to the social core of families. While it is an inconvenience in younger children it can drastically disrupt family life as children age. Bedwetting can also be a warning sign for Sleep Disordered Breathing in children.
Sleep disordered breathing has been implicated as a primary culprit in the development of ADD, ADHD and other behavioral disorders.
Sleep disordered breathing may be mild and only consist of snoring or it may be severe. The Americn Academy of pediatrics is so concerned with the permanent life changing damage sleep disordered breathing can cause that they now consider even a single apneic event nightly dangerous.
Snoring should never be ignored in even the youngest children.
The Perfect Start system is designed to correct the environmentally caused epigenetic problems leading to a poor airway in young children. Orthodontics is often used to correct these problems in older children but it is generally agreed that between ages 4-7 is when critical changes in the maturing brain can lead to disorders like ADD, ADHD and Behavioral Disorders and Bedwetting, tooth grinding or clenching and snoring or restless sleep is a critical warning sign. These same airway problems create a need for orthodontics in children who have underdeveloped jaws. In adults we can now use the DNA Appliance to Orthopedically and Pneumopedically grow larger airways and big beautiful smiles.
I have been treating patients with Sleep Apnea for over 35 years but until I became aware of the Perfect Start System we have been primarily treating adults and older children and did not have an easy method treating the youngest children prior to development of behavioral and learning problems.
The first step in the Perfect Start System is a habit corrector that addresses unconscious habits that develop from constricted airways, insufficient time being breast fed and inadequate muscle development from soft western diet. Crowded teeth and the need for orthodontics is a phenomenom of the last 400 years. Prior to that time malocclusions were almost non-existent. The Perfect Start System is designed to reverse the negative growth and airway developmental changes modern life style has produced in children.
Do Not Delay, these changes will not correct themselves.
The Perfect Start website has testimonials from doctors and patients on how correcting sleep disordered breathing in young children can improve lives. Read more here.…
New Research in Canada recommends Sleep Apnea Screening Prior to Surgery
DR SHAPIRA IS A FIRM BELIEVER IN UNIVERSAL SCREENING FOR SLEEP APNEA AND HAS ESTABLISHED SLEEP WELL ILLINOIS LLC . Sleep Well sets up sleep apnea screening programs in physicians offices utilizing paper questionaires and home sleep studies. Reserch has shown how dangerous sleep apnea is and Dr Shapira believes the time for universal screening has arrived.
According to the study “A Matched Cohort Study of Postoperative Outcomes in Obstructive Sleep Apnea: Could Preoperative Diagnosis and Treatment Prevent Complications?” published in Anesthesiology.
This important study compared the postoperative outcomes in 4,211 patients with OSA. The comparison was whether they were diagnosed with sleep apnea before or after surgery compared to a matched control group of patients who did not have the sleep apnea. Those who were diagnosed with OSA prior to surgery were prescribed treatment with CPAP therapy.
“OSA is a common disorder that affects millions and is associated with an increased risk of surgical complications, but the condition often goes unrecognized,” according to lead author Thomas Mutter, MD from the department of anesthesia and perioperative medicine in the University of Manitoba, Winnipeg, Canada. “As many as 25 percent of surgical patients may have OSA, but the vast majority of these patients aren’t treated or don’t know they have the disorder.”
The study showed that patients with untreated OSA were at an increased risk of developing cardiovascular complications and more importantly that patients who were diagnosed and had their sleep apnea treated before surgery were less than half as likely to experience cardiovascular complications such as cardiac arrest or shock. While this study was done with CPAP it is well established that oral appliances will have siilar effects. This would also hold true for respiratory complications that were also twice as common in patients with sleep apnea.
I was told I have maxillary hypoplasia. I cannot show any teeth when i smile. I don’t want to re-arrange my face and have it go numb. Pls tell me of all other options
Dr Shapira Reply:
There are numerous methods to address your cosmetic problem. The first is to do nothing as you can function for a lifetime with maxillary hypoplasia. There are some common medical concerns related to maxillary hypoplasia . There is usually a nasopharyngeal airway restriction associated with Max Hypo. During the day this can lead to forward head posture and over time lead to other problems including back pain, neck pain and numbness of the hands and arms. This same airway restriction can lead to sleep apnea and snoring at night. RERAs or UARS are a milder form of apnea and all can lead to heart problems, endocrine problems increased weight, cognition problems etc.
Cosmetic approaches can vary based on examination and is based on several factors. As you know maxilary advancement carries a risk and is a major surgical procedure. It is possible to do a Rapid maxillary expansion and anteriorization with a surgical assist which is a much less invasive procedure and movement is done orthopdically.
The DNA Appliance utilizes Epigenetic Orthopedics to grow bone and AIRWAY orthopedically and pneumopedically. There are limits to intraoral movement but use of headgear (reverse pull) can be incorporated. I am in Illinois and do many DNA and RNA cases but if the condition is extreme Dr Martha Cortes in NYC is probably the premiere DNA practitioner in the world and I have sent he patients who commute to NY for treatment.
There is no reason that you can’t use an overlat denture on your maxilla to give and excellent look without actually correcting the problem. Snap in Smile treatment can give you an instant makeover for minimal cost. Depending on the degree of hypoplasia and the costs you want to incur it is possible to do a reconstruction with veneers, onlays and crowns to build the teeth out to a full smile. There will be increased thickness and a tendency to have some food retention after eating, usually a minor problem but some patients find it annoying.
In my practice I offer cosmetic only solutions but my preference is to achieve ideal airway and physiology as an integral component of cosmetic reconstruction. A large portion of my patients have been treated for sleep disorders, TMJ disorders, chronic neck,back or head pain and the cosmetics are used as a finishing technique. Most patients get the best cosmetic results when they are built on a platform of health.
The use of Physiologic Dentistry and the diagnostic aids they provide are essential in finding the best position regardless of the type of treatment decided on.
Treatment of Sleep Apnea with Oral Appliaaces is a well accepted first line approach for mild to moderate sleep apnea. Long term outcome studies in patients with cardiovascular disease are equal to treatment with CPAP and preferred by 90% of patients.
A new study has confirmed these findings in an Asian Population. This was the first studyin an Asian population. As expected the Mandibular Advancement Appliance worked well for the majority of patients. Please see Pub Med abstract below:
Laryngoscope. 2014 Jan 24. doi: 10.1002/lary.24607. [Epub ahead of print]
Adjustable thermoplastic mandibular advancement device for obstructive sleep apnea: Outcomes and practicability.
To assess outcomes including efficacy, adverse effects, and quality of life (QOL) of an adjustable thermoplastic mandibular advancement device (AT-MAD) fitted by an otolaryngologist for obstructive sleep apnea (OSA) treatment.
Prospective, nonrandomized, before-after study.
Sixty-four adult patients (40 men and 24 women) were recruited. Inclusion criteria were OSA patients who had failed or refused treatment with continuous positive airway pressure and surgery. Exclusion criteria were insufficient teeth, active intraoral disease, and temporomandibular joint(TMJ) disorders. Outcomes were measured using polysomnography, symptom questionnaires, Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep Questionnaire (FOSQ) before treatment and 4 to 6 months thereafter.
Mean apnea-hypopnea index (AHI) and ESS scores decreased from 17.7 ± 14.6 to 7.5 ± 10.9 and from 8.7 ± 4.9 to 6.5 ± 4.4, respectively, after treatment (P < .001). Thirty-nine patients (60.9%) achieved post-treatment AHI of <5, with the highest success rate in those with mild OSA (75%). FOSQ global scores increased from 16.4 ± 2.8 to 17.7 ± 3.0 (P < .05), along with most FOSQ subscale scores. Thirty-four patients (53.1%) regularly used the device for ≥5 nights per week. Adverse effects include TMJ discomfort, dry mouth, and excessive salivation, which were largely tolerable. Only four patients withdrew from the study because of adverse effects.
This is the first study in Asians demonstrating that an AT-MAD, if done properly, is a practical short-term treatment of OSA, with good outcomes including improved QOL. Its advantages are its low cost and ready-to-use nature. However, further randomized controlled trials are required.