Severe Bruxism/ Neuromuscular Dentistry/ Dental Sleep Medicine/ TrigeminoCardiac Reflex and SPG Blocks are all connected and part of the same system

Dr. Shapira TMJ 0 Comments

What is the common underlying link of all of these.  The Trigeminal Nerve and the Autonomic nerves of thee Sphenopalatine Ganglion.
Self-Administered SPG Blocks can improve many autonomic issues in patients.
This is the connection of TMJ disorders to problems with the gut.
The connection of Aiirway collapse secondary to dental issues has been well established.
Bruxism is far more than a habit it is part of a medical group of disordrs.
. 2018 Aug; 4(8): 329–331.
Published online 2018 May 18. doi:  [10.1016/j.hrcr.2017.06.013]
PMCID: PMC6092563
PMID: 30112280

Grinding to a halt: Stimulation of the trigeminal cardiac reflex from severe bruxism

Key Teaching Points

  • • The autonomic nervous system has an intricate relationship with the heart; severe vagal stimulation can produce bradycardia and asystole.
  • • The trigeminal cardiac reflex is a powerful brain stem reflex that can be associated with a sudden onset of parasympathetic dysrhythmia, sympathetic hypotension, or gastric hypermotility.
  • • Bruxism, which is reported in 8% of the population, can stimulate the trigeminal cardiac reflex and lead to profound vagal effects on the heart.

Introduction

The trigeminal cardiac reflex (TCR) is a unique, powerful, and well-established neurocardiogenic reflex that is a result of stimulation along the path of the fifth cranial nerve (trigeminal nerve). It can produce adverse cardiorespiratory changes including hypotension, bradycardia, and asystole, as well as gastric consequences such as hypermotility. This reflex has been reported to occur in various surgical conditions, as well as in neurosurgical interventions.

Sleep bruxism, thought to be a more intense form of rhythmic masticatory muscle activity, has a prevalence of about 8% and has been explicitly linked to the TCR.We report a case of a young woman with severe bruxism who incited her TCR, which subsequently produced profound nocturnal pauses that ultimately required dual-chamber pacemaker implantation.

Case report

A 27-year-old woman presented with palpitations and syncope. Three years prior to presentation she developed nocturnal and early morning nausea and vomiting that would often wake her from sleep. She was noted to have a long-standing history of severe bruxism with physical signs on examination of significant attrition. This had persisted despite the use of a retainer and bite block. Evaluation with Holter monitoring revealed sinus bradycardia, intermittent second-degree type II atrioventricular (AV) block, and a pause of 8.6 seconds (Figure 1). Interestingly, the rhythm strips showed simultaneous effects on both the sinus and AV node, suggesting an autonomic etiology. Of note, these rhythm disturbances were principally nocturnal in nature. While she was wearing the Holter, the husband was awake and corroborated that she was having severe episodes of bruxism. Further cardiac evaluation was unrevealing, including a normal echocardiogram, cardiac magnetic resonance imaging, sleep study, and thorough autonomic testing. With her constellation of symptoms—severe bruxism, AV nodal block with cardiac pauses (that were predominantly nocturnal), and gastrointestinal symptoms—we diagnosed her with hypervagotonia from stimulation of the powerful TCR from severe bruxism (Figure 2). Out of concern for risk of cardiac death from these pauses without a stable ventricular escape, we elected to place a dual-chamber pacemaker for bradycardic prevention.

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Holter monitoring revealed sinus bradycardia, intermittent second-degree type II atrioventricular block, and a pause of 8.6 seconds

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Illustration of the trigeminal cardiac reflex. X = motor nucleus of the vagus nerve; ∗ = Gasserian ganglion; V = trigeminal nerve.

Discussion

This case highlights the intricate and noteworthy relationship between the autonomic nervous system and the heart. Our patient developed high-grade AV block and syncope owing to significant and profound hypervagotonia. Based upon her evaluation and corroboration of these events by her husband, we deemed that her intense vagal stimulation was a consequence of her severe bruxism, which was eliciting the TCR.

The TCR (Figure 2) is a powerful brain stem reflex that can be associated with a sudden onset of parasympathetic dysrhythmia, sympathetic hypotension, or gastric hypermotility. The proposed mechanism of this reflex is stimulation of the sensory nerve endings of the trigeminal nerve (Figure 2, cranial nerve V), which sends signals via the Gasserian ganglion (Figure 2, indicated by asterisk) to the sensory nucleus of the trigeminal nerve (Figure 2 inset). The afferent pathway then continues along the short internuncial nerve fibers in the reticular formation to connect with the efferent pathway, the motor nucleus of the vagus nerve (Figure 2, cranial nerve X). The last part of the reflex is formed by cardioinhibitory efferent fibers, which connect the motor nucleus of the vagus nerve to the myocardium.

Bruxism is a common occurrence in the population (8%) and has been associated with alterations in the autonomic nervous system and stimulation of the TCR. The mechanism behind the TCR stimulation is felt to be 2-fold. Firstly, masticatory movements (rhythmic masticatory muscle activity) and secondly, teeth contact can stimulate mechanoreceptors in the periodontal tissue. The link between bruxism, TCR, and alteration in the autonomic nervous system is important to highlight as it is well established that the autonomic nervous system plays a critical role in the pathogenesis of various cardiac arrhythmias, particularly atrial fibrillation. Although not specifically related to our patient, the fact that bruxism is so common raises the potential role it could be contributing to autonomic drivers of atrial fibrillation, and this is something that requires further research examination.

Conclusion

When evaluating patients who present with symptoms of significant hypervagotonia, it is important to consider sleep-related causes, in particular sleep bruxism and its role in the TCR.

Footnotes

Dr DeSimone is supported by an NIH T32 training grant (HL 007111).

References

1. Reding G.R., Rubright W.C., Zimmerman S.O. Incidence of bruxism. J Dent Res. 1966;45:1198–1204. [PubMed]
2. Schames S.E., Schames J., Schames M., Chagall-Gungur S.S. Sleep bruxism, an autonomic self-regulating response by triggering the trigeminal cardiac reflex. J Calif Dent Assoc. 2012;40:670–671. 674–676. [PubMed]
3. Arasho B., Sandu N., Spiriev T., Prabhakar H., Schaller B. Management of the trigeminocardiac reflex: facts and own experience. Neurol India. 2009;57:375–380. [PubMed]
4. Gastaldo E., Quatrale R., Graziani A., Eleopra R., Tugnoli V., Tola M.R., Granieri E. The excitability of the trigeminal motor system in sleep bruxism: a transcranial magnetic stimulation and brainstem reflex study. J Orofac Pain. 2006;20:145–155. [PubMed]
5. Chowdhury T., Bindu B., Singh G.P., Schaller B. Sleep disorders: is the trigemino-cardiac reflex a missing link? Front Neurol. 2017;8:63. [PubMed]
6. Sjoholm T.T., Piha S.J., Lehtinen I. Cardiovascular autonomic control is disturbed in nocturnal teethgrinders. Clin Physiol. 1995;15:349–354. [PubMed]
7. Okada Y., Kamijo Y., Okazaki K., Masuki S., Goto M., Nose H. Pressor responses to isometric biting are evoked by somatosensory receptors in periodontal tissue in humans. J Appl Physiol. 2009;107:531–539. [PubMed]

DNA® & RNA® APPLIANCES by VIVOS: EPIGENETIC ORTHODONTICS, ORTHOPEDICS AND PNEUMOPEDICS: PATIENT TESTIMONIALS: VIVOS : The Breathe New Life Advantage.

Dr. Shapira Uncategorized 0 Comments

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.

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

Dr. Shapira Blog, Lake Forest, Sleep, TMJ 1 Comment

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?

Dr. Shapira Trouble breathing while asleep 0 Comments

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

Dr. Shapira Sleep Apnea Effects & Symptoms 0 Comments

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.

Sleep disorders and Work Performance

Dr. Shapira Sleep Disorder, Sleep Disorder Diagnosis 0 Comments

Sleep disorders and work performance: “How was your work day?”

sleep-disorders-and-work-performanceHave you had some bad days at work recently? Do you find that you just can’t get enough sleep and are tired at work? Do you find that you can’t focus at work because you are always feeling tired?  If your answer is yes, it is likely that you have a sleep disorder which can affect your work performance.

If you don’t address this problem soon you might find that the lack of sleep can affect your job performance. It may not be as good as it should be. It’s easy to miss deadlines if you’re not getting enough sleep at night and can’t concentrate. Not being able to focus at work may spoil your reputation and you could even lose your job.

Patients with untreated sleep disorders may find them delve falling asleep in meetings, especially after lunch.  Falling asleep in a meeting is not the impression you want to make on your boss.  Patients who drive for a living have up to a 1500% increase in motor vehicle accidents do to excessive sleepiness and slower reaction times when driving.

What is making you so tired?

Even if you think you are getting enough sleep, you may not be getting the right quality of sleep. You need to reach a deep sleep state in order to restore your body and revitalize it for the day ahead. This won’t happen if you are continually waking up throughout the night.

It could be that you are suffering from the sleep disorder condition known as sleep apnea. This condition happens when your airways become blocked from time to time while sleeping, causing you to wake up.  It is something that can keep on happening all night and can rob you of your sleep. Another symptom of sleep apnea is constant, loud snoring and if you are unaware you snore, then your partner will soon tell you!

A good sleep at night brings productive days

If the fact that you can’t sleep properly means you are always tired, then it is time to do something about it before you find you have lost your job due to poor work performance. There are some dental sleep apnea treatments available that don’t involve drugs and one popular and successful one is the Thornton Adjustable Positioner (TAP).

This device helps sleep apnea sufferers as it is placed in the mouth at night to open the airways. This allows oxygen to pass through the airways to the lungs without any obstacles in the way. The TAP works by forcing the lower jaw further forward, which prevents the collapse of your airway.  This means that breathing can continue without disturbance.  We ensure that the TAP is a good fit so that it does its job properly.

You should notice the improvement in your breathing quite quickly and you should get a lot more sleep as well.

Rock your work world once again

If you are feeling tired all the time and know it is affecting the way you work, you need to find out the root cause. You should have your medical condition confirmed through a thorough examination.

If you discover that you have sleep apnea or another type of sleep disorder then dental treatment can bring you relief from constant tiredness and better performance at work, too.