Sleep Deprivation

Posted by on May 13, 2016 in Blog | 0 comments

This image, I found the other day,  is a great summary of the effects from sleep deprivation:


Effects of Sleep Deprivation

AAA Drowsy Driving Numbers Signal Large Problem

Posted by on Nov 7, 2014 in Blog | 0 comments

AAA has confirmed the effects of sleep deprivation. Here’s an article for your consideration:The AAA Foundation for Public Safety’s long-awaited report on the effects of drowsy driving concluded that as much as 21% of crashes (from 2009-2013) in which a person was killed, likely involved a drowsy driver.

“If these proportions are applied to all reported crashes nationwide, results suggest that an average of 328,000 crashes annually, including 109,000 crashes that result in injuries and 6,400 fatal crashes, involve a drowsy driver,” wrote AAA analysts in a report released this week.

According to the National Highway Traffic Safety Administration (NHTSA), approximately 1.4% of all motor vehicle crashes in the United States, 2.2% of those that resulted in injuries, and 2.5% of all fatal crashes in years 2005-2009, involved a drowsy driver, and those crashes resulted in a total of 5,021 deaths over those years.

“However, the official government statistics are widely regarded as a substantial underestimates of the true magnitude of the problem,” writes AAA. “This study estimates that as many as 6% of all crashes in which a passenger vehicle is towed from the scene, 7% of crashes that result in any injuries, 13% of crashes that result in sever injuries requiring hospitalization, and 21% of fatal crashes involve a drowsy driver.”

Standards for Dental Sleep Medicine Facility Accreditation

Posted by on Nov 7, 2014 in Blog | 0 comments

Dr.Pick’s dental facility has been recognized as one of only 30 dental sleep facilities in the United States certified by the American Academy of Dental Sleep Medicine. Once again this certification is another example of Dr. Pick’s desire to provide quality dental sleep oral appliance services to his sleep apnea patients.

Dental sleep medicine facilities that seek to earn accreditation through the AADSM must meet the quality measures outlined in the Standards for Accreditation of Dental Sleep Medicine Facilities. These standards were created in order to ensure that accredited facilities demonstrate proficiency, practice, and professionalism in the treatment of patients with sleep apnea and sleep-related breathing disorders.

Through adherence to these Standards, accredited facilities demonstrate a commitment to excellence in the knowledge, experience and ability of dental sleep medicine facilities to manage ongoing care for patients:

Accredited facilities must adhere to the Standards for the appointment, responsibilities and continuing education of staff including a dental director, clinical auxiliaries and coding and billing personnel.

Policies and procedures regarding the acceptance of patients, documentation, patient treatment and billing at an accredited facility must be developed and followed in order to meet the Standards for accreditation.

Adherence to Standards regarding safety, consumer service and follow-up must be met to ensure that patients receive optimal care at an accredited facility.

AACP 29th Annual International Clinical Symposium

Posted by on Nov 7, 2014 in Blog | 0 comments

Dr. Pick attended this meeting and received two academic and clinical certifications. Dr. Pick joined a group of very select sleep dentists by adding certification from the American Board of Craniofacial Pain. He was named a Diplomate of Craniofacial Dental Sleep Medicine, a relatively new certification that recognizes the connection between the jaw position and the openness of the airway. This position also is critical in determining any underlying jaw joint functional issues.

Also, Dr. Pick was recognized for his efforts in attaining Diplomate, American Board of Craniofacial Pain in May of 2013. This meeting’s graduation ceremonies for both Diplomates were academic and clinical goals that were years in progress and preparation.

Dr. Pick’s certifications involved hundreds of hours of continuing education hours pertaining to sleep medicine, craniofacial pain, and TMJ treatments. Written exams, oral exam presentations, and case studies were the requirements for these particular certifications.

These difficult Diplomate accomplishments are truly a recognition of Dr. Pick’s quest in providing the best diagnostic and treatment services for his patients.

Army Surgeon General Reiterates Importance of Proper Sleep

Posted by on Oct 18, 2014 in Blog | 0 comments

Here’s an interesting article that expresses the deep concern for sleep deprivation and its ramifications on anyone’s workplace activities.

Alcohol or poor sleep? For the military, it just may be a game of “pick your poison” after the Army Surgeon General essentially declared that sleepy soldiers were just as impaired as drunk soldiers.

“When we’re talking about cognitive dominance [by our soldiers] you absolutely have to focus on ensuring a healthy brain, ensuring that [they] have that mental agility,” Lt. Gen. Patricia D. Horoho said Wednesday during a presentation entitled The Human Dimension at the Association of the U.S. Army’s annual conference in Washington, DC.

Reporter Bryant Jordan in writes that part of maintaining a healthy brain is ensuring soldiers get enough sleep. The Army has understood the importance of sleep, but Horoho said this has often been disregarded by unit leaders who believe “that we’re being effective when we’re sleep deprived

“If you have less than six hours of sleep for six days in a row you have a cognitive impairment of 20 percent – that you are cognitively impaired as if you had a.08 percent alcohol level,” she said. “We never will allow a soldier in our formation with a .08 percent alcohol level, but we allow it every day to make those complex decisions.”

Horoho said Army researchers and scientists are looking at ways to keep the brain healthy. This includes training in techniques to reduce stress levels and even in the development of rations intended to fuel body and brain. “I really believe this is the new frontier. I think its unknown how powerful our Army can be if we start out with a healthy brain, and take the best from industry, academia and from our Army and training. I think that’s the power we’re going to really see optimizing performance.”

U.S. Army Sleep Apnea Research Suggests Adjustable Oral Appliances are a Good First-Line Treatment Option

Posted by on Oct 2, 2014 in Blog | 0 comments

FORT KNOX, Ky., Nov. 21, 2011 /PRNewswire/ — Patients with mild to moderate obstructive sleep apnea (OSA), a condition in which the airway collapses and blocks breathing for 10 seconds or more, may consider adjustable oral appliances (OAs), devices that fit within the mouth to prevent upper airway collapse, as an effective first-line treatment, according to two studies conducted by sleep medicine specialists from Walter Reed National Military Medical Center (WRNMMC) in Bethesda, Md.
The retrospective, peer-reviewed studies, published in the December 2011 issue of CHEST, the official journal of the American College of Chest Physicians, and in the current issue of the Journal of Clinical Sleep Medicine (JCSM), the official journal of the American Academy of Sleep Medicine, provide findings on OAs from the largest patient populations studied to date. The studies found that adjustable OAs are nearly as effective as continuous positive airway pressure (CPAP) treatment for patients with a mild form of OSA and are more effective than fixed oral appliances, particularly in patients with moderate to severe OSA.
“Historically, CPAP has been the primary treatment for OSA, but only half of patients tolerate this therapy, which requires wearing a face mask hooked to a machine each night,” said Lt. Col. Christopher Lettieri, M.D., one of the studies’ authors, an Army medical director and the chief of sleep medicine in the pulmonary, critical care and sleep medicine department at WRNMMC. “This new data offers a fresh look at adjustable oral appliances as an initial treatment for OSA in both the military and civilian sectors.” Eighteen million Americans, or 4 percent of men and 2 percent of women, suffer from sleep apnea, which can cause daytime sleepiness and has been linked to high blood pressure, heart attack, and stroke.
The military is interested in the potential of adjustable OAs, also called mandibular advancement devices, as alternatives to CPAP systems since some active duty service members deploy to austere environments where electricity needed to run CPAP machines is not always available. In these cases, reliance on CPAP may result in duty restrictions or separation from service.
“Adjustable OAs would eliminate duty assignment limitations associated with CPAP, allowing Soldiers to travel to remote areas as needed,” said Lettieri.
The study in CHEST, titled “Efficacy of an Adjustable Oral Appliance and Comparison to Continuous Positive Airway Pressure for the Treatment of Obstructive Sleep Apnea Syndrome,” evaluated and compared results of overnight sleep studies in which patients used adjustable OAs or CPAP devices. Results were measured by the apnea-hypopnea index (AHI) score, used to assess the severity of sleep apnea based on the total number of complete cessations (apnea) and partial obstructions (hypoapnea) of breathing that last for at least 10 seconds per hour of sleep. Researchers found that a significantly higher percentage of patients using an adjustable OA experienced successful reduction of their AHI score to below five apneic events per hour in this study compared to past reports (62.3 percent versus 54 percent).
In the JCSM study, “Comparison of Adjustable and Fixed Oral Appliances for the Treatment of Obstructive Sleep Apnea,” patients were treated with either adjustable or fixed OAs and a sleep evaluation was conducted before and during treatment with the devices. Patients using adjustable OAs had a greater reduction in obstructive events (AHI), revealing that adjustable OAs had a greater efficacy than fixed devices (57.2 percent vs. 46.9 percent) among this patient cohort.
A total of 497 patients were prescribed adjustable OAs in the CHEST study and 602 patients in the JCSM study. The studies included patients who participated in an overnight sleep study at the sleep disorders center at Walter Reed National Military Medical Center.
Aaron B. Holley, M.D., Anita A. Shah, D.O., Nathalie Paolino, D.O., and Arn H. Eliasson, M.D., also participated in the studies.
The U.S. Army offers two sleep medicine fellowship programs accredited by the Accreditation Council for Graduate Medical Education at Walter Reed National Military Medical Center and San Antonio Military Medical Center.

Sleep Apnea Tied to Increased Cancer Risk

Posted by on Oct 2, 2014 in Blog | 0 comments

Two new studies have found that people with sleep apnea, a common disorder that causes snoring, fatigue and dangerous pauses in breathing at night, have a higher risk of cancer. The new research marks the first time that sleep apnea has been linked to cancer in humans.
About 28 million Americans have some form of sleep apnea, though many cases go undiagnosed. For sleep doctors, the condition is a top concern because it deprives the body of oxygen at night and often coincides with cardiovascular disease, obesity and diabetes.
“This is really big news,” said Dr. Joseph Golish, a professor of sleep medicine with the MetroHealth System in Cleveland who was not involved in the research. “It’s the first time this has been shown, and it looks like a very solid association,” he said.
Dr. Golish, the former chief of sleep medicine at the Cleveland Clinic, said that the cancer link may not prove to be as strong as the well-documented relationship between sleep apnea and cardiovascular disease, “but until disproven, it would be one more reason to get your apnea treated or to get it diagnosed if you think you might have it.”
In one of the new studies, researchers in Spain followed thousands of patients at sleep clinics and found that those with the most severe forms of sleep apnea had a 65 percent greater risk of developing cancer of any kind. The second study, of about 1,500 government workers in Wisconsin, showed that those with the most breathing abnormalities at night had five times the rate of dying from cancer as people without the sleep disorder. Both research teams only looked at cancer diagnoses and outcomes in general, without focusing on any specific type of cancer.
In both studies, being presented in San Francisco this week at an international conference organized by the American Thoracic Society, the researchers ruled out the possibility that the usual risk factors for cancer, like age, smoking, alcohol use, physical activity and weight, could have played a role. The association between cancer and disordered breathing at night remained even after they adjusted these and other variables.
Dr. Mitesh Borad, a cancer researcher and assistant professor of medicine at the Mayo Clinic who was not involved with the studies, called the findings “provocative” but said more research was needed to confirm the association. The studies were observational, and other, unknown factors may account for the correlation between sleep apnea and cancer.
Recent animal studies have suggested that sleep apnea might play a role in cancer. When mice with tumors were placed in low-oxygen environments that simulate the effects of sleep apnea, their cancers progressed more rapidly. Scientist speculate that depriving mice of oxygen may cause their bodies to develop more blood vessels to compensate, an effect that could act as a kind of fertilizer for cancer tissue and cause tumors to grow and spread more quickly.
The researchers wondered whether a similar relationship might exist in people with sleep apnea, in whom throat muscles collapse during sleep, choking off the airway and causing gasping and snoring as the body fights for air. Severe sleep apnea can produce hundreds of such episodes each night, depleting the body of oxygen.
In one study, a team at the University of Wisconsin School of Medicine and Public Health examined data on state workers taking part in the long-running Wisconsin Sleep Cohort, who since 1989 have undergone extensive overnight sleep studies and other measures of health about every four years. The landmark project was one of the first to reveal the widespread occurrence of sleep apnea in the general population.
The researchers found that the more severe a person’s breathing problems at night, the greater the likelihood of dying from cancer. People with moderate apnea were found to die of cancer at a rate double that of people without disordered breathing at night, while those in the severe category died at a rate 4.8 times that of those without the sleep disorder.
“That is really striking,” said Dr. F. Javier Nieto, one of the study’s authors and chairman of the department of population health sciences at the University of Wisconsin. “It could be something else, but it’s hard to imagine that something we didn’t control for is causing this.”
In the second study, researchers with the Spanish Sleep Network took a slightly different approach, looking not at cancer mortality among apnea patients, but at the incidence of cancer. They used a measure called the hypoxemia index, which looks at the amount of time the level of oxygen in a person’s blood drops below 90 percent at night.
About 5,200 people were followed for seven years, none of whom had a cancer diagnosis when the study began. The researchers found that the greater the extent of hypoxemia, or oxygen depletion, during sleep, the more likely a person would receive a cancer diagnosis during the study period.
People whose oxygen levels dropped below 90 percent for up to 12 percent of the total time they were asleep, for example, had a 68 percent greater likelihood of developing cancer than people whose oxygen levels did not plummet at night, said study author Dr. Miguel Angel Martinez-Garcia of La Fe University and Polytechnic Hospital in Spain. As time spent without oxygen increased, so, too, did cancer risk.
Although the study did not look for it, Dr. Martinez-Garcia speculated that treatments for sleep apnea like continuous positive airway pressure, or CPAP, which keeps the airways open at night, might reduce the association.
The Wisconsin study also did not specifically look at the impact of treatment for apnea on survival, either, but when people who were being treated with CPAP were removed from the analysis, the cancer association became stronger, “which is consistent with the hypoxemia theory,” Dr. Nieto said.
“I would say that this is one more instance that shows that sleep apnea can have profound impacts for people’s health,” he added. “Not breathing while you’re sleeping is a serious problem.”