Speaker at the Bloomington Convention Center – Community Presentation for the Diabetes Center “Obstructive Sleep Apnea and Diabetes”.

A patient called our office today with some interesting/unfortunate comments about his oral appliance that we made for him several months ago. He had previously had a sleep study with a diagnosis of “borderline” obstructive sleep apnea. This is the kind of diagnosis that will cause most sleep physicians to not recommend treatment due to a lack of severity. However, based on his symptoms of waking up not feeling refreshed and his loud snoring, we fabricated an oral appliance for him to wear at night.

He called today to tell us how wonderful the oral appliance was and how much better it had made him feel—until he lost the part that fit his upper teeth! After looking everywhere with no luck, he concluded that it must have ended up in the wastebasket by his bed and was thrown away unintentionally. Now, without the appliance, he is, in his own words, “miserable without it”.

It is fascinating to contemplate the diseases and disorders that are encompassed within the wide net of sleep-related breathing disorders. I read today in the latest issue of the journal, Sleep of a study correlating heavy snoring and the development of atherosclerosis.

In this study, 110 volunteers, each with mild, non-hypoxic sleep apnea were studied. In other words, these volunteers were so mild that many of them would likely not qualify for treatment by prevailing insurance standards. These volunteers were grouped according to whether they were considered “mild” snorers (snoring 0-25% of the night), “moderate” snorers (snoring 25-50% of the night), or “heavy” snorers” (snoring more than 50% of the night).

All of these volunteers had their carotid arteries evaluated with ultrasound for the presence of atherosclerosis. 20% of the mild snorers had atherosclerosis developing in the carotid artery, as did 32% of the moderate snorers and 64% of the heavy snorers.

This study has enormous public health implications regarding the management of atherosclerosis and stroke prevention!

As a part of my ongoing networking with other health care professionals, I had an opportunity to meet today with Jennifer Stone, an acupuncturist who practices at East West Acupuncture, with offices in both Indianapolis and Bloomington.  I met Jennifer about a month ago when we were both lecturing at the Hearteam Conference held at Bloomington Hospital. 

Jennifer is a fascinating and well respected acupuncturist who is affiliated with Bloomington Hospital’s pain management center.  I was intrigued to hear that acupuncture could help with sleep issues.  I will put more information on this site as I learn more about this interesting therapy.

This has been a gratifying week for us at the office.  I learned Tuesday that I had received my board certification for the American Academy of Dental Sleep Medicine.  This news is coupled with continual reports from patients experiencing a renewed quality of life as a result having their sleep apnea relieved with oral appliance therapy.  

Sleep related breathing disorders have some resemblance to the old story about the frog that is placed in a pot of water on the stove.  At first, the frog is quite happy in this tepid water.  As the water starts heating up, the frog feels a sense of unease, but is not quite sure what is wrong.  By the time he understands that the cause of his discomfort is the rapidly rising water temperature, he is too weak to jump out of the pot.

Many patients with sleep-related breathing disorders (like sleep apnea) are like our friend the frog and get to a point in their disorder that they find themselves in a vicious cycle that they can’t get out of by themselves.  The sleep apnea causes fatigue and/or sleepiness during the daytime.  Because of the daytime fatigue and sleepiness, it is quite difficult to exercise.  Weight gain quickly follows.  As weight is added, some of it goes to the neck.  This added fatty deposit in the area of the neck causes the upper airway to narrow more.  As the upper airway gets more narrow from fatty tissue encroachment, the sleep apnea gets worse……. and on, and on it goes. 

It is this cycle that causes the new patient we saw today, who was referred to us by his physician, to describe his life as “a living death”.  I fully expect this patient to experience a renewed sense of living once we help him get his disorder managed.

I’m really excited to have an opportunity to have this site as a place to post some of the newest information on sleep-related breathing disorders. These disorders are extremely common in the adult population (and present in far too many children!) and, yet, widely overlooked by many in the medical profession. Sleep medicine is a young field of medicine and it takes time for new understanding to filter down to direct application. It is part of the mission of The Center for Sound Sleep to increase the awareness of sleep-related breathing disorders to both the public and the medical profession.

Until recently, the most common method of treating sleep-related breathing disorders was with continuous positive air pressure (CPAP). This is a highly effective method of treating these disorders but patient compliance with this treatment is abysmal. However, highly trained dentists are now able to assist with more patient tolerant therapy. Please check this site often for current information on our understanding of these disorders as well as the newest techniques in managing them.

Dr. David E. Lawler