Patient #103 was referred to our office by her physician.  She was suffering from obstructive sleep apnea.  In addition she had been diagnosed with fibromyalgia and was taking Lyrica 3 times a day to help manage the symptoms.  She complained of severe daytime sleepiness which forced her to take Provigil, an alerting medication, since her job required her to drive long distances each day.  She had attempted CPAP to manage her obstructive sleep apnea, but was not able to tolerate the therapy.

An oral examination revealed a dental condition that predisposes people to having obstructive sleep apnea.  As shown in the photo, this patient has a significant overbite.  This means that her mandible did not fully develop into its normal position in the skull.  Because of this, the tongue base is positioned too far back in the throat and sleep apnea easily results.

Patient #103 was fitted with an oral appliance and immediately noticed a relief of her symptoms of severe daytime sleepiness.  In addition, she also noticed that her symptoms of fibromyalgia were significantly reduced.  As a result, she was able to significantly reduce her Lyrica dosage.

Before and after home sleep monitoring with the Watch PAT showed that her sleeping pulse rate dropped by 10 beats a minute using her oral appliance!  This indicates a much more restful sleep.  In addition her nightly percentage of REM sleep increased from a below normal 10% to a normal 20%.

In her words, Featured Patient #103 said: “I feel 100% better!”

Patient #102 came to our office for relief from his snoring which was keeping his wife awake.  Further questioning revealed that he was suffering from a significant amount of daytime fatigue and sleepiness.   To rule out the existence of obstructive sleep apnea, we sent him home with a Watch PAT home sleep monitor.  

Patient #102 is a classic example of someone who would never get a diagnosis of obstructive sleep apnea if evaluated by a sleep lab. Patients like this do not meet the minimum criteria for obstructive sleep apnea but still have a significant amount of upper airway collapse (heard as snoring) through the night which results in significant sleep fragmentation.  In other words, while they do not stop breathing during sleep and their oxygen levels do no drop, they have to labor to breath through a partially collapsed airway.  This is much like trying to breathe through a very narrow straw.  This is a very unrestful sleep.  To see the results of his initial home sleep test click on the image below.

Initial home sleep test

Patient #102 is joining a long list of patients we have treated who had a sleep study and were told they had no problem.  However, after sleeping with their oral appliance to eliminate the snoring that was effecting the sleep of their bed partner, these patients report feeling better.  Since everyone reacts to sleep deprivation in different ways, the reports from these patients vary.   Most will say that they awaken more refreshed.  However, many of these patients report a significant reduction of daytime sleepiness and fatigue as did this patient as illustrated by the following chart.

The Epworth Sleepiness Scale is a subjective assessment of daytime sleepiness.  The Fatigue Severity Scale measures fatigue as perceived by the patient.  Notice the dramatic improvement in both daytime sleepiness and fatigue as experienced by this patient with oral appliance therapy.  Not only has this patient’s life been enhanced by this therapy, but his bed partner is now sleeping better with the elimination of his snoring.

Patient # 101 (face masked out for privacy) was referred to us by her physician.  She had been diagnosed with obstructive sleep apnea and was not able to tolerate CPAP therapy.  Her fatigue level was 45 out of 63 on the Fatigue Severity Scale. In addition, she was diabetic and was not able to keep her blood sugar under control.  She had high blood pressure which was well treated with medication.  She reported that she would normally awaken 4-5 times a night to go to the bathroom and also stated that she would vomit in the middle of the night most nights.  

To understand vomiting in the night better watch the following video. Notice how much effort the woman in this video is making to breath in air. This effort generates negative pressures within the abdominal cavity and the contents of the stomach can literally be sucked out of the stomach. This is why heart burn occurs commonly with sleep-related breathing disorders.  In our patient’s case, this phenomenon caused night time vomiting.

The first night using her oral appliance, she slept through the night without awakening to go to the bathroom and she did not vomit in her sleep.  Now, one month after using her oral appliance, her blood sugar is under control and her physician is reducing her diabetes medication.  To understand why there is a significant connection between her blood sugar and sleep go here.  In addition to having her diabetes medicine reduced, her physician is now reducing her medication for high blood pressure.  The change in her fatigue level is shown in the following chart:

Furthermore, with no change in her exercise schedule or food consumption, she is now, for the first time in years, loosing about a pound a week.