Dr Shapira Awarded Diplomate Status with American Board of Sleep and Breathing. Currently in Boston Learning Advance Pain Management at Harvard Medical School.

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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.

https://americansleepandbreathingacademy.com/

What is Sleep Apnea? Does Your Loved One Snore, Stop Breathing and Gasp for Breath?

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Trouble breathing while asleep? It could be sleep apnea

what-is-sleep-apneaSnoring is the most common warning sign of sleep apnea.

Do you find it difficult to breathe when you sleep or find yourself snoring far too often? You could be suffering from something called sleep apnea.  Many patients are

Many patients are unaware of their sleep apnea, even when it is very severe or life-threatening and concerned family or friends inform them of the problems.  If you have loud disruptive snoring there is an excellent chance it is a warning sign.  Listen to the warning before it’s too late!

Sleep apnea is a sleep disorder which occurs when breathing stops and starts repeatedly. You could have sleep apnea if you know you snore loudly and you still feel tired right through the day even if you thought you had enough sleep. Sleep apnea can happen when your throat muscles relax at the wrong time or when your brain fails to send the correct signals to the muscles that are responsible for controlling breathing.

These are some of the common sleep apnea symptoms:

  • Sleepy all day
  • Loud snoring
  • Short lapses in breathing while asleep
  • Sleep a lot but still tired
  • Suddenly waking up accompanied by a shortness of breath or heart palpitations
  • High Blood Pressure or Hypertension
  • Waking up with a dry mouth or a sore throat
  • Headache, especially morning headache
  • Insomnia, waking during the night and not being able to return to sleep.
  • Concentration problems
  • Motor Vehicle Accidents or near misses
  • Marital Discord

What  are some of the most common sleep apnea causes?

Apnea comes from the Greek meaning “want of breath”

The most common type of sleep apnea is called obstructive sleep apnea (OSA). This is when the muscles in the back of your throat relax and block your air flow.  This is actually an active process, when we breathe in we create a vacuum that sucks our airway shut, usually at the base of the tongue.When this happens, not enough oxygen gets into your blood. Your body reacts very quickly and you normally find yourself waking up suddenly with a choking or snorting noise. It tends to happen time and again through the night, so you just can’t get enough sleep.

Sleep Apnea is the most severe form of sleep disordered breathing and is a total blockage of the airway.  Hypopnea is an incomplete blockage of the airway that still causes oxygen to drop significantly but may just have snoring with total stoppage of breathing.  Upper airway resistance syndrome (UARS), also called Respiratory Related Arousals (RERA) is a partial blockage of the airway and is usually found in younger healthier and thinner individuals, especially women.  It can cause all the same symptoms as Sleep Apnea and is one of the major cause of  Fibromyalgia.

People with certain characteristics are more likely to experience sleep apnea. For instance, if you are overweight, a male or a smoker you are more likely to get sleep apnea. There are other physical reasons for sleep apnea, too. You might be more likely to get sleep apnea if you have a thick neck, a receding chin or enlarged adenoids or tonsils. Some allergies can cause sleep apnea too.  Many of the patients do not fit this clinical picture but still experience sleep apnea.  This is due to the configuration of their upper and lower jaws and tongue.

The problem could be dental related

The National Heart, Lung and Blood Institute of the NIH published a report on “The cardiovascular and sleep related consequences of Temporomandibular Disorders”. They have recognized that the same underlying mechanisms are involved in snoring, sleep apnea and TMJ disorders.

There are ways to relieve sleep apnea and it may be surprising to learn that dental solutions could help. You don’t have to suffer needlessly as these days there are devices available which have been shown to be very beneficial for sleep apnea sufferers.

Some of the most commonly used devices used by dentists look a bit like a sports mouth guard. They gently and comfortably move the lower jaw forwards and downwards and help to keep your airways open.  These are called Mandibular Advancement Devices (MAD) and there are over 100 types available.

One of these devices is the TAP 1 appliance that is one  the most effective devices available.  It consists of an upper and lower appliance connected with a hook and a bar.  There is a handle that is turned to advance the lower jaw.  This handle acts as a volume control for your bed partner.  who can turn off your snoring and increase your airway. The Somnodent appliance by Somnomed is one of the most comfortable appliances available.

A second device that may be used is a tongue retainer. This is a splint which holds the tongue in the right position and works to ensure the airway is kept open. Overall, dental solutions not only improve oral and dental health for sleep apnea sufferers, but improve sleep patterns and reduce snoring, too.

Could your medical solution be a Dental Appliance right for you?  Start living a better life now.

If you think you suffer from sleep apnea and have tried ways of relieving it without much success, then it may be time to consider a dental solution to this dangerous medical problem.

We will need to examine your mouth and throat properly and may be able to give useful recommendations about what can be done to help you relieve your symptoms.  Oral appliances are a first line treatment for mild to moderate sleep apnea.  CPAP is still considered the first choice for severe sleep apnea but oral appliances are considered an alternative to CPAP for patients desiring a more comfortable treatment or for patients who cannot tolerate CPAP.

Sleep disorders are often associated with other TMJ and orofacial pain disorders. Differential diagnosis of sleep and orofacial pain disorders is essential to health.…

Sleep Apnea Effects and Symptoms

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Sleep Apnea Effects and Symptoms

sleep-apnea-effectsAre you always tired when you wake up, even when you have slept a full eight hours? Do you frequently wake with morning headaches or sore throats? Are other snoring symptoms causing sleepless nights for you and your bed partner? Do you frequently struggle to stay awake during the day? If any of this sounds familiar, you are not alone.

For the millions of Americans who deal with the challenges caused by Sleep Apnea or other sleep disordered breathing  symptoms, this is no laughing matter. There are many resulting emotional and physical side effects that are blatantly evident, but there are additional health concerns and social impacts that may affect you as well. Sleep apnea effects are to be taken seriously.

What Happens During Sleep Apnea

When we are awake our airways are taken for granted.  They remain open without any effort on our part.  When we fall asleep and especially as we enter deeper sleep our muscles begin to relax.  In healthy patients with excellent airways this does not present a problem.  In patients with small airways due to small mouths, large tongues or disproportionate anatomy this muscle relaxation can lead to airway compromise.  The vacumn of breathing can then cause the soft tissues to collapse partially or completely blocking the airway.

The mildest form of sleep disordered breathing is simple snoring. The soft tissues vibrate due to close proximity but sufficient air continues to flow.  According to Mayo clinic, research the spouses of snorers can lose up to 15 % of their sleep.  Heavy snorers have up to a 600% increase in Carotid Atherosclerosis just from the vibrations of snoring.  The carotic artery supplies blood to the brain.

Obstructive Sleep Apnea is where the airway closes completely.  The patients oxygen drops, the heart slows (radycardia) followed by awakening and a rapid heartbeat(tachycardia) .  In other words, the patient is SUFFOCATING.  The Apnea index is how many times an hour this suffocation takes place.  it can happen a few times an hour which is mild sleep apnea or it can happen dozens of times an hour.  Each event creates an awakening.  Patients may hundreds of times in a single night.  Because the awakening are very brief (measured by EEG) patients are often not aware that they are waking but they do experience the negative effects the next day.

Common Sleep Apnea Symptoms and their impact

Fatigue

Fatigue is a much stronger word than tired. It is an ongoing, severe physical and mental weariness that has a significant negative impact on your ability to stay alert and function normally throughout the day.  Excessive daytime sleepiness occurs when normal function is no longer possible throughout the day.

Cognitive functionality

If you have undiagnosed and untreated sleep apnea, you are not just dealing with a lack of sleep. The repeated occurrences of oxygen being cut off to the brain also impairs your cognitive behavior and functionality. This includes symptoms such as foggy thinking, short-term memory loss and the inability to concentrate.  Patients with untreated sleep apnea have slower reaction times and up to a six fold increase in motor vehicle accidents.

Depression and irritability

The vicious cycle of chronic fatigue, sleep deprivation and cognitive impairment often leads to irritability and depression. In addition to the constant struggle of trying to cope with mental and physical exhaustion, there is also the embarrassment and stigma of falling asleep at inappropriate times during the day, most especially when it happens on the job.

Heart problems

The frequent cessation of breathing during a sleep apnea event decreases the oxygen in the blood and causes the nervous system to panic. Emergency signals are sent out to the brain and muscles.

This naturally occurring “fight or flight” response places unusual pressure on the heart and makes it work harder. Continuous occurrences of this increased stress may eventually put sleep apnea patients at greater risk for other heart complications and high blood pressure.

Sexual dysfunction and relationship problems

It may be embarrassing to talk about, but erectile dysfunction is not uncommon among men who also have a sleep disorder. Intimacy is another typical issue, because many couples choose to sleep in separate rooms so at least one of them can get a good night’s sleep.  Marital problems also occur due to conflict arising due to excessive tiredness or fatigue.

Problems with staying awake while at work or driving

Because of problems with fatigue and sleep deprivation, sleep apnea sufferers are also at a greater risk of being involved in an accident while driving or operating dangerous machinery.  

Performance problems at work

Problems with daytime sleepiness and cognitive impairment make it harder to focus and stay awake, and this often affects both quality and productivity on the job.  Many patients with sleeep apnea struggle to stay awake during meetings, miss important information or actually doze off.

Want some good news now?

There are a lot of health and safety risks associated with sleep deprivation caused by sleep apnea and snoring. The good news is these sleep disorders are treatable. The first step is usually a sleep test to determine the root cause of your disorder. The second step is treatment.

In the case of sleep apnea and snoring, there are numerous oral appliances that can be both comfortable and effective treatment.  We encourage you to look into solutions for your sleep problems. If you are suffering from the above-noted effects, you have nothing to lose.

Sleep Disorders and Memory Loss

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Are sleep disorders and memory loss plaguing your life?

sleep-disorders-and-memory-lossDo you feel tired all the time and like you can’t get enough sleep? Do you think this is having an effect on your ability to think and remember things? Both the quality and quantity of sleep can affect your memory. Fatigue interferes with your ability to retrieve and store information for later use.

If you are experiencing a sleep disorder and are experiencing memory loss, then much of what you are doing on a daily basis could be affected as a result. Whatever you are forgetting to do it will be influencing your ability to function well and enjoy life.

Maybe your brain is tired

Throughout the night, the sleep cycle plays a role in “consolidating” your memory. If you are failing to get sufficient sleep and you no longer remember what you are experiencing during the day you should explore the reasons why you are unable to sleep. There is a good reason to find out why your sleep disorder can affect your memory so that you can get back to normal.

One of the most common reasons for sleep loss, and the memory loss that goes with it, is a disorder known as sleep apnea. This is when normal breathing during the night stops and starts as the airways become temporarily blocked. When the flow of air stops you will find yourself waking up in an attempt to restart it. Normally, you can successfully restart the air flow, but only at the expense of your sleep. Sleep apnea can impact your memory, and the way your brain operates in general.

Better sleep could revive your retention

You shouldn’t just put up with poor sleep and memory loss. There are solutions available that are comfortable and effective. The lack of sleep and memory loss do not need to last forever. It is only a question of restoring your sleep and you will be back to normal. Fortunately, there are a variety of dental treatment options to improve the way you breathe and as a result, you will be able to sleep better.

There are various devices that we can provide that will ensure your airways are kept clear at night so that you breathe properly and sleep well while retaining your ability to recall.  The Thornton Adjustable Positioner (TAP) is just one appliance that can help you by opening the airway which allows oxygen to pass through to the lungs without obstruction. It looks at first sight like a sports mouth guard, but it does have a nice comfortable fit when you wear it at night and it has a 96% success rate.

Deep sleep and REM Sleep are vital for short term and long term memory

Short term memory loss is one of the first symptoms of disturbed sleep.  Cognitive function is especially connected to Stage three and four sleep.  Stage IV sleep is also known as Delta Sleep is no longer reported by sleep labs that now combine stage 3 and 4 sleep in the stage sleep classification.  This change occured partially because CPAP rarely restored stage 4 sleep so labs quit measuring Stage IIV sleeps, in fact they are no longer allowed to report stage IV sleep.

Alzheimers and Dementia are also closely tied to sleep disorders but their is a genetic link.  Poor sleep can cause more severe and more rapid onset of dementia and Alzheimers disease in patients genetically susceptible while other patients merely lose their short term memory and have decreases in cognitive thinning.  Poor sleep has an epigenetic effect on patients genetically susceptive.

Memorize this

If you are experiencing memory problems you should make sure you have a thorough examination to find out the root cause. If sleep apnea is the culprit we can install a device that will allow you to sleep better at night. More sleep could soon have a beneficial effect on the way your brain works and you should find that your memory is better, too.

Sleep Disorders and Loss of Sex Drive

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Trouble getting in the mood?

sleep-disorders-and-loss-of-sex-driveIf you have a sleep problem you may be experiencing a loss of sex drive too. Interest in any type of physical activity can be an issue if you have a sleep disorder. It takes quite a lot of energy to motivate your sex drive!

If you do experience a loss of libido because you just don’t get enough sleep, you certainly aren’t alone. For men with sleep apnea, studies suggest that 50% of sufferers also secrete lower-than-normal levels of testosterone throughout the night.

Sleep disorders and loss of sex life

If you are suffering from a sleep disorder like sleep apnea, when your breathing gets obstructed, you may also be secreting less sex hormone.  If this happens you will naturally have a low libido and in the long term your relationship with your partner may suffer. Not getting enough sleep due to sleep apnea not only affects your relationship but can also accelerate the onset of heart disease and other serious ailments.

Snoring often accompanies sleep apnea, so the sleep patterns of your partner may be affected too. Neither lack of sleep nor snoring loudly is good for your relationship.

Boost your love life with better sleep

There are dental treatments available that can restore your love life by helping you get better sleep. The Continuous Positive Airway Pressure appliance (CPAP) is one treatment options for patients suffering from sleep apnea, and is often recommended by doctors. It functions by sending small amounts of air into the nasal passages, which prevents the collapse of the throat while the patient sleeps so that normal undisturbed breathing can take place. However, this treatment is often found to be uncomfortable and noisy by patients.

The Thornton Adjustable Positioner (TAP) is a custom made appliance which has similarities to a mouth guard and it influences the lower jaw by holding it forward so preventing the airway from collapsing while ensuring continuous breathing. It has been found to a be a good alternative option to CPAP.

The Somnomed Appliance is another excellent choice for comfortably treating snoring and Sleep Apnea.  By using one or another of these devices you have a good chance of reclaiming your sleep and improving your love life.

Nothing kills the mood than falling asleep when your partner is feeling amorous

Treating your sleep apnea and snoring gives you more stamina and alertness.  Don’t fall asleep on your partner when they want to make love.  The anger that creates affects not just your nights but your future together.  When you’re sleeping well your body produces higher levels of sex hormones and you feel better in a multitude of ways.  Experience the life changing effects of restorative sleep.  Get you apnea treated and get your life back the way it should be.

Get your mojo back

Whatever the reason for your sleep disorder it is essential to get a proper diagnosis. If you are suffering from sleep apnea, you can receive dental treatment for it, which may involve wearing a device that helps you to breathe better.

When you are able to sleep more easily you will regain some of your lost energy and will be in the mood to reinvigorate your relationship.