WHO KNEW - by Grethe Whitman

Who Knew?

Wow! I have been informed about Periodontal disease and the Oral-Systemic Link for sometime but wasn’t aware about the link between Sleep Disorders and the Oral-Systemic Link! Were you? 
Thank you to Drake Lab, Henry Schein, and imagn Solutions for the opportunity to learn
about Sleep!

This is another topic that merges dentistry with medicine.
With the trends in medicine “leaning” towards wellness and prevention this is a great opportunity to develop relationships with referring Physicians and Sleep Specialists. We can have questionnaires and we can send our patients home with a sleep machine but we can’t make the official diagnosis of sleep apnea.
Only a Sleep Specialist can do that.

Sleep has become a “hot topic”. It really is the foundation of health. I was surprised to hear that 50% of the population snores. A lot actually goes on with our brain and bodies while we sleep,

that is if you are getting quality sleep. There’s an independent study that shows an association between sleep disruptions and an increase in HbA1c. I also didn’t realize there is a new CDT code coming in 2018 that allows dental offices to check blood glucose levels chair side and then refer to a physician.

Research is also looking at sleep disorders in children. Possibly 8 out 10 children are having
sleep disruptions. There seems to be a link between sleep and ADHD. Even bed wetting can be associated with a sleep disorder. Evidently, CPAPs (Continuous Positive Airway Pressure) are not recommended for children routinely. The first recommendation is to look at the tonsils and adenoids. Orthodontics should be a consideration also. Important to note - there was some data showing ortho with bicuspid extractions could be a factor in sleep disruptions. Think about it.
Sometimes it leaves patients with more narrow arches which can have an effect.
Having an open airway is key to successful sleep. Here are a few of the causes and concerns today that are impacting airway- less breastfeeding, softer foods in our diet, malocclusion, and allergies.
Obesity is discussed as a “symptom” of a sleep disorder but not a cause. It is stated that losing weight can have a dramatic effect on sleep apnea.

Sleep apnea isn’t the only sleep disorder out there. 
Ever heard of UARS? Me either. It stands for Upper Airway Resistance Syndrome. It has a tendency to “just” disrupt sleep without all the other complications. It is seen more in the younger population, more females than males, and less weight issues.
How posture affects the airway really makes sense. Think about this, if your head leans just 3 inches forward, it will round the airway and can cause an issue. Also, with correct posture, our heads weighs about 12 pounds. If you are tilted just 3 inches forward, your head weighs 42 pounds. Now I understand why I need my chiropractor!!

Compliance with a CPAP can be an issue. There is only 65 - 83% compliance. It is the only
solution for certain types of sleep apnea. 
The 3 types of sleep apnea are - Obstructive, Central, and Complex. Obstructive is treated well with an oral appliance. Central requires a CPAP because it has to do with signals from the brain. Complex does well being treated with both, a CPAP and oral appliance.

There are several screenings available. Some more detailed than others. Some may say, yes you have a sleep disorder, but may not diagnose the severity of the problem. You have to decide what works in your practice. This is a pretty easy conversation to start in the hygiene exam with the right questionnaire.

There is some good news. Naps are OK but should only be 20-30 minutes. You will get stage 1-2 sleep but not REM.

Here’s what matters:
Go take a course on Sleep.
Go to different ones to see which philosophy suits yours. 
Draw your own conclusions. 
Decide which therapy best suits your practice. 
Talk to your colleagues that are incorporating Sleep in their practice.
Learn about medical billing! Use a 3rd party for your medical billing to get started or until you can manage it yourself. Lots of insurance companies will pay for sleep therapy but require certain documentation that has to be followed to a tee. There is definitely a learning curve for medical billing but it is doing the right thing for our patients. Guess what else was mentioned? Medical billing for Perio.
Our world is constantly changing and moving forward. What a great place to be.