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Sleep Apnea Short

By

J Tim Rainey, DDS, MAGD

Mary Claire Gray, RDH

I am J Tim Rainey, DDS, MAGD, the research scientist. Here I am at our Advanced Light Source lab station at UC Berkeley.

The Advanced Light Source is a Department of Energy-funded synchrotron facility that provides users from around the world access to the brightest beams of soft x-rays, together with hard x-rays and infrared, for scientific research and technology development in a wide range of disciplines.

This is my partner, Dr. Charles Ruefenacht , an equally “Mad Scientist” of Lafayette, California at our ALS lab. Owned by the Department of Energy, we are required to have I.D. badges and security clearance for access.

And welcome to the cleanest office

environment on the North American Continent.

We do this for the benefit of our patients, administrative staff, and

clinical staff

Here’s our Biowell Ozonated water set up, 4/09/2018. Ozonated water is the cleanest, safest, water for medical, dental, and veterinarian applications.

Office environment: Keep it cleanwith ambient 0zone

• This is our Longevity 03 unit in the back room.

• We leave it idling at the lowest setting, 1/32 LPM ( .03 LPM).

• Just exhaust it into the room

• With the HEPA filter running in the room, we don’t get excessive ambient 03.

• One off day on the weekend for 24 hours we will shut off the HEPA filters, turn the fan on the air handler to automatic, and turn the rheostat setting to a setting that keeps the air handler from running frequently.

• We have a “make-air” system, an attic fan that will change the air in the office in less than five minutes

Back in the real world of Refugio, Texas, here’s my partner Mary Claire Gray, RDH, Sleep Care Coordinator, at her work station for Obstructive Sleep Apnea,

documenting the airway of our assistant, Dina Serrano, RDA.

What is Obstructive Sleep Apnea? (OSA)

• The most under diagnosed potentially fatal disease for mankind!

11Obstructive Sleep Apnea

Obstructive Sleep Apnea

One of the most common sleep disorders.

Breathing is impaired (hypopnea) or completely stopped (apnea) due to an obstruction in the upper airway.

A single event lasts at least 10 seconds.

A typical sufferer has hundreds of events per night.

FACT: Untreated OSA can take up to 12+ years off your life.

Smoking takes only 7-10 (men)

Type II Diabetes takes 5-10

OSA increases risk of death by 46%

This is the first step in OSA diagnosis, starting with the upper airway.

Here’s the scientific data we generate from the Rhinometer.This shows very open airway from successful rhinoplasty surgery.

Next, we measure the important lower airway using the pharyngometer

Here’s the scientific data we generate from the pharyngometer.This shows restriction of the airway at the tonsillar region.

16

Sleep apnea raises death risk 46 percent: study

WASHINGTON (Reuters, Aug. 18, 2009) – Severe sleep apnea raises the risk of dying

early by 46 percent, U.S. researchers reported Monday, but said people with milder

sleep-breathing problems do not share that risk. (Since the person with OSA is in the

deepest stage of sleep, the person will NOT be aware of sleep disruptions.)

They said people with severe breathing disorders during sleep were more likely to die

from a variety of causes than similar people without such sleep disorders. The risks are

most obvious in men aged 40 to 70, Naresh Punjabi of Johns Hopkins University in

Baltimore and colleagues found.

Punjabi's team studied 6,400 men and women for an average of eight years. Those who

started with major sleep apnea were 46 percent more likely to die from any cause,

regardless of age, sex, race, weight or smoking, they reported in the Public Library of

Science journal PLOS Medicine.• Men aged 40 to 70 with severe sleep-disordered breathing were twice as likely

to die from any cause as healthy men the same age, they reported in the study. available online at:

• http://medicine.plosjournals.org/perlserv/?request=get-document&doi=1000132

•Stroke survivors, especially Mexican-Americans, whose sleep is interrupted by pauses in breathing (sleep apnea) are more likely to die or experience another stroke, according to preliminary research presented at the American Stroke Association's International Stroke Conference 2018 in Corpus Christi.

•Until this analysis of the Brain Attack Surveillance in Corpus Christi, Texas, there were no prospective data on the relationship between sleep apnea and recurrent stroke or death from large, population-based or ethnically diverse populations.

•The project enrolled 842 people (median age 65, 47 percent female, 58 percent Mexican American, 34 percent non-Hispanic white) who had an ischemic stroke caused by decreased blood supply between 2010-2015.

•Using portable sleep apnea-monitoring devices, they found participants had a median of 14 pauses (full or partial) in breathing per hour during sleep, with 63 percent identified with sleep apnea (10 or more breathing pauses/hour).•During follow-up (median time to event 584 days)

researchers found:• 10.7 percent experienced another stroke and 14.8 percent died.

• Each additional pause in breathing per hour was associated with a 9 percent increase in recurrent stroke or death.

• After adjusting for known risk factors, Mexican-American ethnicity was associated with a 1.7-fold increased risk in recurrent stroke or death due to Obstructive Sleep Apnea!

•Sleep apnea may be an important modifiable risk factor for poor stroke outcomes in general, and addressing the condition may help reduce stroke related health disparities in Mexican-Americans, researchers said.The National Institutes of Health funded the study.

What do they have in common?

Chad JustinMike

Age: Mid 30’s (33, 33, 39)Overweight

Neck Circumference > 17”All diagnosed with obstructive sleep apnea

All died from complications from their obstructive sleep apnea

Justice Judge ScaliaWhat do they have in common?

Why do we sleep?

There are two basic theories:

1. RESTORATIVE 2. ADAPTIVE The more exercise performed, the more sleep is needed.

Rest & recovery

Lack of “deep” (non-REM) sleep results in a person feeling physically tired

Lack of REM sleep can cause you to feel anxious & irritable.

Various hormones (HGH) are secreted into the body during sleep.

Sleep serves important immune system functions and memory.

Sleep Stages

Sleep

REM25%

“Dreaming Sleep”

Non-REM75%

Sleep Stages

Sleep

Non-REM75%

Stage 15%

Shift from awake to sleep state

Stage 245%

No conscious awareness of environment

Stage 325%

Deep Sleep (AKA: “Delta Sleep” / “Slow Wave Sleep”)

Most Common Symptoms SNORING Excessive Daytime Sleepiness Hypertension (High Blood Pressure). If BP is uncontrolled or requires two medications to control the contributing factor is

probably OSA Multiple trips to the restroom at night

Other Symptoms Acid Reflux (GERD – Gastro Esophageal Reflux Disease) Morning Headaches Diabetes Sexual Dysfunction Social Problems

Contributing Factors Obesity & Large Neck Circumference Menopause Mouth Breathing

Signs & Symptoms of OSA

Heart Attack Risk Factor Increase

Independent Predictors of Myocardial Infarction

Risk Factor Odds Ratio

Standard 1.0

Overweight 7.1

Hypertension 7.8

Smoking 11.1

OSA 23.3Hung, et.al http://www.ncbi.nim.nih.gov/pubmed/1973968

OSA 23.3 !!!!!

And an additional risk factor/result of OSA:Obstructive Sleep Apnea May Increase Risk Of Gout, Study Suggests.

• The New York Times (9/11, Bakalar) reports researchers found that patients with obstructive sleep apnea are “more likely to develop gout.” The findings were published in Arthritis & Rheumatology.

• Dental professionals can point their patients to the ADA’s consumer website, MouthHealthy.org, for information about OSA

32OSA’s Deadly Path

FINALLY – Some good news….

IF you survive the snoring, sleepiness, car accident

risk, acid reflux, headaches, high blood pressure,

heart attacks and strokes…..

New research from Stanford University is

showing a strong relationship between OSA and

dementia & Alzheimer's Disease. So maybe

you’ll forget about all the things OSA has caused.

A USC study showed that 70% of dementia

patients had sleep apnea and there was a

strong correlation between the severity of

cognitive impairment and the severity of

the apnea.

not really

What is Obstructive Sleep Apnea? (OSA)

• The most under diagnosed potentially fatal disease for mankind!

• Sleep apnea can affect any individual of any age.

34

Complications of Obstructive Sleep Apnea in children

A 5 year study published in the journal SLEEP in April 2013 concluded:

The odds of having behavioral problems were six times

higher in children who had persistent sleep apnea.

Compared to youth who never had OSA, children with

sleep apnea were more likely to have parent-reported

problems in the areas of hyperactivity, attention, disruptive

behaviors, communication, social competency, and self-

care.

Children with persistent sleep apnea also were seven times

more likely to have parent-reported learning problems and

three times more likely to have school grades of C or lower.

Sample size of 263 children

“If I didn’t wake up, I’d still be sleeping”Yogi Berra

What this study says is:Hyperactivity, ADHD etc . is

B.S.!!!!!

Wake the child with ADHD up with Ritalin, (Methamphetamine) so he/she

can deal with the real world!!!The problem is that the child is NOT getting enough

sleep!

Fix the problem!!!!

Don’t treat the symptoms!

Case Study: Max

Warning Signs for the Clinician

Mouth Breathing Tongue Posture Bad Breath Poor school performance – ADHD Vacant Look to Eyes – Tears and Very Shiny Forward Head Posture Dental Crowding High Palatal Vault Allergic Shiners Nasally Voice Wet Pillow in the Morning Snoring Witnessed Apneas Large Non-Infected Tonsils Bed Wetting!!!!!!!!

Dentistry is still stuck in the 1900’s!

• What orthodontists think they are is dentists who move teeth around.

• There is a new field of orthodontics that is based on “Epigenetics”;

• Building enough bone to house the teeth!

• Crowding of teeth is really a relatively new phenomena.

• We have the same genes as our ancestors.

• Our children do not get enough stimulation from chewing to make their faces and jaws reach genetic potential.

• Also, if there are severe allergy problems, chronic tonsillitis, etc, mouth breathing can and does contribute to orthodontic crowding and “long face syndrome”.

• Failure of the face to grow can and does contribute to future problems of OSA!

After Ortho

I Think Not !

A Future Apneic?

Sometimes the obvious escapes everyone except the

first one to see the obvious...

Is it Obvious, Yet?

Obstructive Sleep Apnea

Questions?Call Mary Claire Gray, RDH/ Sleep Care Coordinator at (361) 526-4695 or email to

sleepwell@jtimrainey.com

drrainey@jtimrainey.com