If you’re living in a fox hole, CPAP is highly inconvenient. Army physicians took this simple truth and turned it into a study that has buoyed the case for adjustable oral appliances.

CPAP compliance can be challenging under ideal conditions. Add the dust, sand, and lack of electricity under combat conditions, and therapy adherence can be virtually impossible.

Major Aaron B. Holley, MD, FACP, ran an ICU unit in Afghanistan for 6 months where he treated combat-related injuries. He saw the harsh Arab landscape firsthand, a place where proper sleep is not a priority. Even in cases of clearly identified sleep apnea, most troops could not afford to give up pack space for CPAP devices and batteries.

Back home at Walter Reed National Military Medical Center (WRNMC), Bethesda, Md, Holley and Lt Col Christopher J. Lettieri, MD, FACP, FCCP, FAASM, continued their work to improve sleep for veterans. They believed that if oral appliances (OAs) were as effective as they were convenient, they could ultimately contribute to a stronger fighting force.

Lettieri, Holley, and additional colleagues attempted to find the answer to this question, ultimately publishing research in the December 2011 issue of CHEST. The study, titled Efficacy of an Adjustable Oral Appliance and Comparison With Continuous Positive Airway Pressure for the Treatment of Obstructive Sleep Apnea Syndrome, confirmed excellent results among mild to moderate sleep apnea sufferers.

Accidents and Explosions
Not surprisingly, the quality of sleep among soldiers can be a shambles during combat deployment. Explosions and less-than-ideal sleeping arrangements are unavoidable, but combined with sleep apnea can be even worse. “We know that most injuries are not battle related,” says Lettieri, a lead author of the study. “We have accidents, and if soldiers are sleep deprived, they are going to lack focus and be more prone to accidents.”

It’s a problem on U.S. roadways, but the stakes are even higher when lethal machinery is mixed in. “If you are driving a 40-ton tank around, you can’t afford to make bad decisions,” adds Lettieri, program director, Sleep Medicine Fellowship, WRNMC. “Research shows that chronic low-level sleep deprivation impairs reasoning, decision-making, and slows reaction time. You don’t want that in a combat-deployed troop.”

Beyond the obvious benefits of reduced accidents and convenient placement in a ruck sack, they found that even post traumatic stress disorder (PTSD) may be affected by poor sleep. “We have all these guys coming back with PTSD, and we broke it down into guys who were injured, and those who were not,” explains Lettieri. “Among guys who did not sustain a combat injury, almost universally they had some underlying sleep disorder.”

“When I was over there, we were sleeping next to an air field,” adds Holley. “It’s the nature of deployment that you don’t get a fixed and regular sleep schedule. Even if you take out PTSD and the anxiety of being subjected to mortars and rockets, you still have a situation where people are getting disturbed and fragmented sleep at best.”

Between 2004 and 2006, the Walter Reed sleep clinic gave out oral appliances and CPAP to service men and women on active duty. “When they went to a place without electricity, it would cause problems and sometimes even prevent some people from being able to go overseas,” explains Holley. “The dusty dirty environment made CPAP too difficult to keep clean. Filters in the machines were frequently going down and having problems.”

Large Pool Yields Better Findings
Armed with findings from one of the largest patient populations to date, Army researchers found that adjustable OAs are nearly as effective as CPAP treatment for patients with mild to moderate 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,” says Lettieri, 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.”

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 remote environments where electricity 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,” adds Lettieri.

The study in CHEST evaluated and compared results of overnight sleep studies in which patients used adjustable OAs or CPAP devices. 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, compared to past reports (62.3% versus 54%).

In most research trials of oral appliances, patients receive oral appliances after they have already failed with CPAP.  It amounts to a selection bias because patients have already failed, and researchers often never really know why they failed. “We thought our data set was unique because a fair proportion of our patients did not fail CPAP since they were given both at the same time,” explains Holley. “The problem with doing this in the real world is you run into cost limitations. It is not cheap to do either of these therapies individually, never mind giving both to everyone up front. This is true in the military or civilian world.”

Changing Perceptions
Holley contends that physician “CPAP followers” are fairly devoted, tending to favor the humidification features of the modality. “Some docs are comfortable with what they are comfortable with, regardless of the evidence, even when it is compelling,” laments Holley. “It takes time to change people’s minds. How much will change with this study is hard to say. I would hope we have at least shifted the thought process and debate so that pulmonologists like me are more likely to not automatically go to CPAP for mild to moderate. It really does work just about as well as CPAP for people who have mild to moderate disease.”

Lettieri and Holley believe the study will (and should) contribute to a shift toward considering OAs earlier in the patient experience. More comparisons with CPAP are necessary, but Holley admits it can be difficult to level the playing field. “CPAP is electronic with a smart card that records compliance,” he says. “We know exactly how well it’s working. The struggle with studying oral appliances is that you must rely on self reporting from patients as to how much they use it. We can prove that oral appliances work, but the next thing to prove is if patients actually wear them more than CPAP. We suspect they do, but we have yet to prove it.”

Building the case is something that Lettieri is content to do. As a 40-year-old physician in a relatively young field, he has seen awareness grow exponentially, and he has helped the military change its perceptions. At Walter Reed, the size of the sleep lab has doubled in recent years and the staff has tripled. Consults have gone from 70 per month to often 70 in a day.

In a culture where sleep deprivation is part of the culture, Lettieri admits that raising awareness has not always been easy. “When I enlisted, the recruiting slogan was ‘We do more by 9:00 a.m. than most people do all day,’” he muses. “We get up early and operate at night. There is a sleep-when-you-can mentality. Americans as a whole keep shortening their average sleep time at night. Since the 1970s, we have about 1.3 hours less per night. The military is even worse.”

SIDEBAR: Military Intelligence
As program director of the Sleep Medicine Fellowship at Walter Reed National Medical Center, Bethesda, Md, Lt Col Christopher J. Lettieri, MD, FACP, FCCP, FAASM, has seen the evolution of sleep medicine. In a culture where sleep deprivation is often considered a badge of honor, the 40-year-old Lettieri has succeeded by educating top brass and soldiers alike with a powerful message: Well-rested soldiers are more effective in the field of battle.

Nowadays, the sleep lab at Walter Reed is a full-fledged sleep disorders center that is recognized as a center of excellence. In addition to pulmonologists, neurologists, pediatricians, and even psychiatrists are applying for fellowship training. Sleep Diagnosis & Therapy sat down with Lettieri to talk about the explosion in sleep awareness and the implications for the military.

How tough is it to get proper rest in the military?
Lettieri: If you are talking about deployment, your sleep quality gets worse because you go from the relatively quiet environment to sleeping among a bunch of other people. There is more noise, radios, helicopters, explosions, and the constant stress.

Is sleep apnea more or less common in the military population?
Lettieri: Sleep apnea is common in general, and it’s common in the military. Even though we tend to be younger and more physically fit, we still have a lot of sleep apnea.

Why is that?
Lettieri: Some of it is anatomic, but a lot of it has to do with chronic low level sleep deprivation. You lose your ability to maintain tone of your upper airways. Back when I was a fellow, I did a research study called, “Obstructive Sleep Apnea Syndrome: Are We Missing an At Risk Population.” Across America, most people thought about sleep apnea in the 55 year-old overweight guy snoring in your waiting room. But really you see it in younger, thinner people. And if you don’t think about it, you’re going to miss the diagnosis.

Are physicians outside of the sleep realm starting to think about sleep apnea outside of the stereotypical patient categories?
Lettieri: With some of my prior research, and in a lot of the lectures I do now, I am trying to get people to think about it in the less typical person, such as the younger girl with chronic headaches and depression. Or the young guy who has unexplained fatigue and ADHD. I’ve always thought we had a lot of it in the military because of this chronic low level sleep deprivation.

Are there examples among fit combat soldiers?
Lettieri: We have had young, active duty guys who get diagnosed with sleep apnea. If it is toward the earlier part of the war, what do you do with them? You cannot bring CPAP in the theater with you. If you’re living in a fox hole, where are you going to plug it in?

Are CPAPs possible at the larger bases?
Lettieri: Even with the more mature theaters we have now, where everybody has laptops plugged in and lamps, you still can’t plug in a CPAP. The Central Command that runs the war said you can’t bring it. So what do you do now? You’ve got a young guy, and if you tell him he has sleep apnea, he may be out of a job. The alternative is oral appliances.

When did oral appliances emerge as a viable alternative?
Lettieri: A couple of years ago, when we started this, oral appliances were largely considered an alternative to CPAP. You could consider oral appliances if they had a really mild disease, or really hated CPAP.

What do you with young guys who have severe disease?
Lettieri: You can’t say, ‘Well you’re out of the army.’ So we pushed the envelope way beyond what was accepted, because we don’t have to justify cost to an insurance company.

At one point, we had more experience with oral appliances than most of the country combined. We had to get this message out, so we published two papers almost back to back.

Why did you focus so much on the oral appliances?
Lettieri: We did it largely to conserve the military fighting strength. On one hand, we want to find alternatives to CPAP, because while it is great, lots of people don’t like it.

Across the country, it’s a constant battle with better adherence. You can say that with all medical care, but the difference with CPAP is it has an integrated compliance monitoring device. So we look at this thing and we can tell exactly when the person used it. Some people abandon therapy, and roughly half of people on CPAP have regular use of their therapy. That’s terrible.

CPAP may be great, but if people aren’t going to use it, we’ve got to have another treatment option. For us on a more personal note, we also have to maintain the fighting strength. We must be able to send people into combat.

You don’t diagnose sleep apnea, and then let soldiers go out with an untreated medical disorder. That is not good for anybody. In that case, you are taking very sleepy people and putting them in harm’s way, and you’re going to see more accidents.

How effective are oral appliances?
Lettieri: Nothing’s perfect by any means, but even half of the people with severe disease got what we considered to be adequate therapy. It depends on where you draw your line in the sand.

We use strict criteria for what we consider to be effective therapy, and there is nobody in the world that would argue that adjustable oral appliances work. If we realize that only half the people are actually using their CPAP anyway, then you’re no worse off. Even if CPAP were completely effective, half the people are not going to use it.

What do you think of non adjustable or fixed devices?
Lettieri: The problem is that you get one shot to fix them. We found that they are OK, but only for really mild disease. Anyone with moderate to severe, you need adjustable. And these are ones you can titrate, just like you do when adding a higher dose of a medication or a range of pressures with CPAP. Adjustable ones ought to be used, and are probably more cost effective in the long term because more people get adequate therapy.

What do you think of tongue control devices?
Lettieri: These are essentially suction bulbs affixed to your tongue that pulls your tongue forward. They really don’t work well—maybe for very mild disease they can be adequate. Most patients find them uncomfortable and they are not used much in clinical practice.

Physically exhausted but mentally wide awake, it’s what insomniacs experience nightly.

The problem hits 40 million Americans. Women are more likely to have it than men, and those sleepless nights can lead to a dangerous, potentially deadly problem.

Alesandra Rain, Former Sleeping Pill Addict, explains how easy it is to get hooked, “Initially they work extremely well and so you think you’re safe. Unfortunately they turn on you pretty rapidly. That little innocent sleeping pill became something that was quite dangerous and nearly took my life.”

Alesandra Rain started taking prescription sleeping pills, after a bad car wreck and a wrecked marriage. Soon, she was hooked, taking 60 Ambien and 240 other sleep meds every month, mixing them with hundreds more pills for pain and depression.

Rain describes how many pills she was taking by the time she got help, “By the end I was on 1000 pills a month. If it can happen to someone like me it can happen to anybody.”

A study by the National Sleep Foundation found 30 percent of American women use some sort of sleep aid, at least a few times a week. Other research shows 84 percent of new moms experience insomnia.

Sleep Psychologist Doctor Kimberly Justice says just being a woman makes you more prone to sleep problems.

Kimberly Kirkpatrick Justice, Ph.D., Licensed Psychologist, explains how menstruation, pregnancy, and menopause are all causes for sleep problems, “All of those things can add to sleep disruption.”

The American Academy of Sleep Medicine, recommends using hypnotics, like Ambien, Lunesta or Sonata, only once or twice a week, for a few weeks. Like cocaine and crystal meth, you can build up a tolerance to sleep meds. Mixing the drugs with alcohol is dangerous, too.

You should also avoid grapefruit and grapefruit juice while on sleep meds. The fruit can make the drugs absorb into your bloodstream faster, and cause over sedation. For Alesandra, rehab was the answer to her sleeping pill problem.

Rain explains how hard it was to get off the drugs, “I wished I had been hooked on heroin. I would have been through it a lot quicker. What started as my biggest mistake in life, was heading down this path, has turned out to be this most enormous gift.”

She now runs her own non-profit, helping others from around the world overcome their prescription addictions.

Doctor Justice says after a person quits taking sleeping pills, there is a period of withdrawal called insomnia rebound, where the insomnia gets worse.

She says it’s important women know that will pass, and after you beat a sleeping pill addiction you can get back to a normal, restful sleep cycle.

BACKGROUND: A third to half of Americans experience insomnia or complain about lack of sleep. The National Sleep foundation found that 30% of all women in America use some sort of sleep aid. Sleeping pills are “sedative hypnotics,” a class of drug used to initiate sleep, and include benzodiazepines, barbiturates, and various hypnotics. Benzodiazepines are commonly anti-anxiety medications that can also make a person drowsy enough to sleep, such as, Xanax, Valium, Ativan, and Librium. Barbiturates cause sedation by depressing the central nervous system. They can be prescribed as sedatives, but are more commonly used as anesthesia. Newer medicines, such as, Lunesta, Sonata, and Ambien, help reduce the time it takes to fall asleep and are “non-habit forming.” Sleeping pills may help treat the problem of insomnia short term, but can cause harm to people who have certain medical conditions, including liver or kidney disease (Source: webmd.com).

For More Information Visit The Womens Sleep Center

More information about Prescription Sleeping Pills is available at the Mayo Clinic Website

New research has found sleep disorders cost the Australian economy more than $5 billion a year in health care and indirect costs.

On top of that, Deloitte Access Economics estimates people with sleep disorders suffer a reduction in life quality equivalent to more than $31 billion a year.

The figures account for lost productivity, absenteeism and poor work performance attributed to a lack of sleep.

The Sleep Health Foundation says it is time preventative health campaigns focussed on the need for a good night’s sleep, as well as a good diet and exercise.

The Numbers
More than 1.5 million adult Australians, or 9 per cent of the population, suffer from sleep disorders, including sleep apnea, insomnia and restless leg syndrome.

“What these conditions have in common is that they disrupt sleep and cause daytime symptoms,” said Professor David Hillman, the director of the West Australian Sleep Disorders Research Institute.

“The daytime symptoms are those ones of sleep disruption, tiredness, lethargy, and really sub-optimal brain function.”

Professor Hillman is also chairman of the Sleep Health Foundation, which asked Deloitte Access Economics to quantify the economic impact of sleep disorders.

“About 5 per cent of heart disease and high blood pressure is attributable to sleep disorders and depression is another consequence, around about 10 per cent of depression is attributable to sleep disorders,” Professor Hillman said.

“And then of course workplace accidents and productivity losses and for that matter losses of life quality.

“So it looked at all those consequences, worked out the proportion which was attributable to sleep disorders and then looked at the dollar costs that flowed from that.”

8 Hours
The researchers found the direct health costs of the disorders amount to about $800 million a year, while the other costs, like productivity losses and workplace accidents, total about $4.3 billion – that is $5.1 billion in total.

“When you first hear a figure like that it sounds like a lot, but when one thinks about the effects of sleep loss on your own function and then applies all the multipliers to it – these people have daily problems with sleep loss and the high proportion that exists in the community – I don’t think it’s surprising at all really,” Professor Hillman said.

The Sleep Health Foundation is keen to press the message that a small increase in funding for the treatment of sleep disorders could bring about a big net benefit for the economy.

Professor Hillman says while current preventative health messages focus mostly on diet and exercise, he would like to see future campaigns include the need for a good night’s sleep as well.

“It’s quite a common perception in the community that sleep’s an inconvenience that gets in the way of social life, family life, work and I have dealt with people who actually believe they can train themselves to sleep less,” he said.

“That’s simply not possible; this is a physiological need that has to be met and if you don’t meet it you can very readily measure the effects on brain function.”

For those who are uncertain, a good night’s sleep for the average adult amounts to at least eight hours.

Source: ABC News Australia

Insomnia is a serious medical condition that should be treated with evidence-based medicine because it is linked to depression, diabetes, hypertension, drug abuse and even death, according to a review of recent research co-authored by a leading University of Wisconsin-Madison sleep researcher.

“This review which is being published in ‘The Lancet” underscores the fact that insomnia needs to be taken seriously, and that health care providers should routinely ask their patients how they are sleeping,” says Ruth Benca M.D., director of the Wisconsin Sleep Laboratory.

About 25 percent of adults have sleeping problems and an estimated six to 10 percent have an insomnia disorder. Insomniacs have trouble falling or staying asleep, a lack of restorative sleep and daytime symptoms such as fatigue, trouble concentrating and mood disorders.

Benca and co-author Charles Morin from the Université Laval, Québec City, Canada, are well-known sleep researchers who reviewed more than 130 recent studies on human sleep. Their analysis showed that people with insomnia:

• Are fives times more likely to experience anxiety and depression
• Have double the risk of developing congestive heart failure and diabetes, and have an elevated risk of death
• Are seven times more likely to abuse alcohol or drugs over the next three and a half years compared with those without the condition
• Are likely to have continuing problems; 70 percent have insomnia a year later, and half still have insomnia up to three years later
• May be treated with drugs such as anti-depressants and antihistamines that have little evidence to show they work well for insomnia

“Whether insomnia appears along with these other conditions, such as depression and hypertension, or whether it causes them, it still needs to be treated,” says Benca. “And our review suggests that we need more research on the best clinical guidelines for treating patients with insomnia.”

The studies show that the best results come from treatment with cognitive behavioral therapy (CBT) and from hypnotic drugs such as Zaleplon and Zolpidem. CBT has none of the risks of drugs and uses methods such as relaxation techniques, sleep restriction, stimulus control, and education to produce better sleep. However, the authors note that there is a shortage of practitioners trained in CBT for insomnia.

They conclude: “There is an urgent need for more public education about sleep and broader dissemination of evidence-based therapies for insomnia, and education and training to prepare health-practitioners to attend and treat insomnia complaints according to clinical guidelines.”

Source: The University of Wisconsin School of Medicine and Public Health, Madison, WI

ResMed (RMD) announced earnings results Thursday. The company reported $0.42 EPS for the quarter, beating the consensus estimate of $0.38 by $0.04. The company’s revenue for the quarter was up 8.8% on a year-over-year basis.

Results: Net income for ResMed Inc. rose to $62.9 million (42 cents per share) vs. $58.5 million (37 cents per share) in the same quarter a year earlier. This marks a rise of 7.6% from the year earlier quarter.

Revenue: Rose 8.7% to $332.7 million from the year earlier quarter.

Actual vs. Wall St. Expectations: RMD beat the mean analyst estimate of 38 cents per share. It fell short of the average revenue estimate of $339.6 million.

Quoting Management: Peter C. Farrell Ph.D, chairman and chief executive officer, commented, “On a regional basis, revenue in the Americas increased by 12% to $182.5 million over the prior year’s quarter. Revenue outside the Americas was $150.2 million, an increase of 5% over the prior year’s quarter, on both a GAAP and constant currency basis. Our global operating profit for the December quarter was $67.3 million and cash flow from operations was a record $110.6 million, demonstrating excellent operating performance. During the quarter, we also repurchased 4.1 million shares, at a cost of $110.5 million, as part of our ongoing capital management program.”

Key Stats:
Gross margin shrank 1.1 percentage points to 59.7%. The contraction appeared to be driven by increased costs, which rose 11.7% from the year earlier quarter while revenue rose 8.7%.

Revenue has risen the past four quarters. Revenue increased 11.6% to $314.8 million in the first quarter. The figure rose 17.3% in the fourth quarter of the last fiscal year from the year earlier and climbed 12.4% in the third quarter of the last fiscal year from the year-ago quarter.

The company topped expectations last quarter after falling short of forecasts in the first quarter with net income of 33 cents versus a mean estimate of net income of 35 cents per share.

The increase in profit last quarter comes after net income fell in the previous quarter. In the first quarter, net income declined 10.9% to $50.5 million.

Looking Forward: Expectations for the company’s next quarter results are lower than they have been. Over the past sixty days, the average estimate for third quarter has fallen from 40 cents per share to 39 cents. In the past month, the average estimate for the fiscal year has fallen from $1.55 per share to $1.54 abs.

Source: Investors ResMed

Twenty Percent of Veterans suffer from Sleep Apnea

BELMONT, Calif, United States military veterans now have the option to use Provent® Sleep Apnea Therapy, a small, non-invasive nasal device for the treatment of obstructive sleep apnea (OSA). Ventus Medical, maker of Provent Therapy, today announced the U.S. Department of Veterans Affairs has granted a multi-year, Federal Supply Schedule contract that would expand access to Provent

It’s estimated more than four million U.S. veterans suffer from OSA, with a 61 percent increase of diagnoses between 2008 and 2010. Experts attribute that to an enhanced awareness of OSA, and exposure to dust and sand in Afghanistan and Iraq which may compromise respiratory health. People with OSA stop breathing multiple times each hour during sleep, often for ten seconds or longer. They frequently don’t recognize the symptoms, but their bed partner complains of loud snoring and long pauses in breathing.

“OSA is a chronic condition creating a significant burden on the Veterans Healthcare System. While continuous positive airway pressure (CPAP) is a safe and effective treatment, a substantial percentage of veterans don’t accept or adhere to this treatment,” said Richard B. Berry, M.D., Professor of Medicine at University of Florida. “There is a great need for access to new, clinically-proven therapies – particularly easy-to-use treatments – for the increasing number of veterans with obstructive sleep apnea.”

One of them is retired Air Force fighter pilot Colonel Win Reither, who is married with five children. Despite being slim and fit, he was diagnosed with OSA in late spring 2011. After completing a sleep test that documented mild to moderate sleep apnea, he was prescribed a pressurized CPAP mask to wear during sleep.

“I tried the CPAP device and it reminded me of the oxygen mask I wore in F-102 fighters,” said Reither from his home in Virginia. “I didn’t mind a bulky mask in the jet, but sleeping with one was a nightmare. All those tubes and the pump chugging away at night weren’t for me. My doctor offered Provent as an alternative and I’ve been sleeping great ever since.”

OSA is associated with serious medical conditions including high blood pressure, irregular heartbeat, heart attack, stroke and diabetes, as well as an increased risk of motor vehicle accidents due to sleep deprivation. People with moderate to severe OSA are almost five times as likely to suffer from heart disease, and have up to 10 times as many motor vehicle accidents compared with people who don’t have OSA.

“Leading sleep centers estimate that one in five veterans experience sleep apnea, a rate of OSA that is four times higher than in the general U.S. population,” said Peter Wyles, President and Chief Executive Officer of Ventus Medical, and former U.S. Marine. “We’re pleased to offer a clinically-proven solution to the millions of veterans who have served our country, but currently go untreated with this serious condition.”

Source: Ventus Medical

In a world where tiny iPods hold thousands of memory-intensive songs, should it be any surprise that a CPAP machine finally weighs less than a pound? Clarence Johnson, president and CEO of Somnetics International, observed the trends over the last decade, and decided to start a mini revolution of his own.

The result is the Transcend Sleep Apnea Therapy Portable CPAP System, a unit that company officials say is the smallest, lightest, and most portable CPAP on the market. “It also has the smallest, lightest, and most portable battery,” says Johnson, who relied on more than 25 years in the biotechnology industry prior to starting Somnetics 3 years ago. “These two things, in combination with the waterless humidification technology, will transform the way CPAP is delivered.”

Somnetics received FDA market clearance for the Transcend obstructive sleep apnea therapy device in July 2010. A little more than a year later, judges at the 2011 Medtrade show in Atlanta gave Transcend the Innovation Award for the product that best exemplifies high tech and state-of-the-art design.

Johnson knows that well-funded marketing departments at manufacturing juggernauts will try to overshadow the positive news, but he’s confident the message will spread. “To compete with the large companies head on would be folly,” says Johnson from his Minneapolis office. “Instead, we believe we have identified a route to market that is unique. Our product is unique, and we think our product strategy can succeed.”

Expanding Awareness
With increased utilization of direct-to-patient marketing, the young company intends to partner with DME and sleep physicians to reach out to the installed base of existing CPAP users. “We also need to market to DMEs and sleep physicians,” adds Johnson. “We want them to know that we intend to partner with them to improve their retail sales with a small and innovative CPAP.”

In addition to the unit’s compact size, judges at Medtrade appreciated the fixed pressure CPAP’s automatic altitude adjustment, good for up to 8,000 feet, with AHI and leak detection reported to compliance software. Tight pressure control at the mask means consistent performance that Johnson maintains is more than suitable for everyday use.

Sleep Doctors who may be unaware of the Transcend, will notice change in 2012. “We should be in sleep labs, but just have not gotten there yet,” adds Johnson. “We exhibit at the sleep meetings, and many sleep docs who attend the meetings have seen the device, and many will soon have an opportunity to try it on patients. One of our great marketing challenges for 2012 is to expand the knowledge of our product within the sleep physician community.”

Cash is King
Officials at Somnetics believe their product is ideal for self dispensing sleep labs looking for a viable cash retail device. Accepting that the Transcend won’t likely be considered as a first-line therapy device any time soon, Johnson believes his product’s niche is currently the growing travel market. “There is a big market for people who buy second CPAPs for travel,” he says. “We believe we can help create a bigger market there with our battery powered unit. For those interested in selling CPAPs for cash, we are a perfect partner. We will help market to your base, and give our customers all the marketing materials they need for free.

“We don’t want DMEs and sleep labs to add our device as a third- or fourth-entry primary device, because it will just sit on the shelf,” continues Johnson. “We think our first and best route to market is through patients who already have and understand CPAPs, and know what features they are looking for. Ultimately, patients will know about the device, and ask for it.”

For DMEs and self-dispensing sleep labs looking for cash sales, Transcend can attract customers looking for secondary travel devices. “Certainly Transcend is reimbursed like other CPAPs, so physicians can send patients to DMEs, and those DMEs can provide this as a primary device,” says Johnson. “And of course, when patients want to travel, they can do it. No other device is that convenient. Every other device is heavier, bulkier, bigger, and creates problems.”

Transcend can be carried and used on a flight, and as a medical device it does not count as a carry-on item. Sleep lab directors and DME providers should advise users to never check a sleep apnea therapy device with baggage because the chances for damage are high. “A doctor can provide a letter stating the user’s diagnosis and the need to carry and use the device on the plane, if necessary,” says Johnson. “Users should call the airline in advance to clarify procedures and in-flight policies.”

For the Medicare and insurance market, the Transcend is reimbursed under the same codes as any other CPAP. The device is not an auto-pap, but instead a fixed pressure CPAP. “We stop recommending at 16 cm of water for pressure,” says Johnson. “For anything above that, we think expiratory relief or Bi-PAP is required. The only thing we don’t have is expiratory relief. Other than that, Transcend is fully featured, and even has more features than some units.”

Waterless Humidification
One crucial feature of the modern CPAP is humidification, and Johnson reiterates that Transcend uses heat moisture exchange technology, which hospital-based respiratory therapists have long relied on for critical care ventilation patients. “We have a great deal of intellectual property developed around the concept of applying this technology to CPAP,” says Johnson, who holds a Master of Science degree in microbiology (biochemistry) from the University of Minnesota.

Somnetics is the first company to offer heat and moisture exchange humidification, a staple for patients on long term ventilation, but not used in CPAP until now. “An insert fits into the breathing circuit and captures exhaled moisture and warmth and returns that to the patient when they inhale with the next breath,” explains Johnson. “It is effective and satisfies humidification needs. When it becomes more widely understood, it will be an attractive option because it is small, easy, and portable. There is no hassle, no mess, and no water. It is a viable alternative to heated humidifiers.”

Somnetics sells its products through an established network of distributors and direct sales representatives serving markets across the U.S., and in key markets around the world. The unit is reimbursable under the standard CPAP HCPC code, and is accepted by most insurance companies.

As the Transcend launch continues, buyers can purchase with a standard 6-ft hose that will work with any mask or seal on the market. Two battery options are available, one with an overnight capacity of 7 to 10 hours at a pressure of 14 cm. “Another option is a multi-night battery that will last 14 to 16 hours minimum at 14 cm,” adds Johnson. “Both batteries work as uninterrupted power supplies for people living in hurricane zones or zones with frequent power outages. Ultimately, we listened to patients in putting this device together, and we feel we have incorporated what they want.”

At a Glance

• Transcend’s universal AC power supply automatically converts the power current for international use.

• Transcend and its accessories and parts are available at medical equipment dealers.

• Transcend is competitively priced with other CPAP devices on the market.

• The system comes with a 2-year manufacturer’s warranty.

• The Transcend Sleep Apnea Therapy Starter System is compatible with any CPAP mask via the Universal Hose Adaptor and standard 6-foot hose.

• The Transcend H₆B and H₉M Waterless Humidification Systems come with a proprietary interface that can be fitted with adaptors that are compatible with the most commonly used nasal seals.

• Automatically compensates therapy pressure to altitudes of up to 8,000 feet.

• Mobile power adaptor plugs into the DC power outlet in a car, truck, RV, boat, camper or mode of transportation with power. Mobile power adaptor can recharge the Transcend battery pack.

• P₄ Overnight™ battery system provides sufficient power to operate the device for 7 to 9 hours at a pressure setting of 14 cm H₂O. The P₈ Multi-night™ battery system provides power for 14 to 16 hours of use at the same setting. Both the P₄ and P₈ batteries are designed to accommodate more than 250 discharge/recharge cycles with standard use.

• Transcend uses patented heat moisture exchange (HME) technology to provide humidification during therapy.

• The hygienic heat moisture exchanger (HME) is disposable and has no electric heating elements. HME technology works naturally with the user’s breath to provide humidification.

• Because it features waterless humidification, Transcend can be placed on the bed, on a pillow, in the bed stand drawer, or on the floor – wherever it’s most convenient.

• Air bearing blower technology makes Transcend quiet and vibration-free.

For more information about the Transend, visit http://www.mytranscend.com/

The Food and Drug Administration is giving pharmaceutical companies some rules for how they interact with consumers on social media. But the companies say they need a lot more clarification from the FDA before they’re comfortable getting back online again. The draft guidance encourages all responses to unsolicited requests for information, which could include requests from physicians for information on off-label uses for certain drugs, to be made in a nonpublic format.

In August 2011, many pharmaceutical companies shut down Facebook pages — especially those devoted to particular drugs — after Facebook stopped giving them the option to shut off public comments on those pages. The companies cited a lack of FDA guidance on how to handle social media comments as their reason for shutting down the pages. Most vowed to keep their pages shut down until the FDA provided guidance on how comments be handled.

Specifically, pharmaceutical companies want to know if they are liable for information posted by third parties on social media sites owned and operated by the pharmaceutical companies. What to do with information that could be considered reporting an adverse drug event is especially troublesome to the companies.

The FDA’s rules do not affect social media sites maintained by physicians or health care organizations. Many physician organizations, including the American Medical Association, have issued guidance to their members to proceed with caution and abide by patient privacy laws when communicating with patients online.

Source: American Medical News

U.S Army researchers recently cast a spotlight on adjustable oral appliances, with results of their study published in the Journal CHEST, titled “Efficacy of an Adjustable Oral Appliance and Comparison to Continuous Positive Airway Pressure for the Treatment of Obstructive Sleep Apnea Syndrome,” where they 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. The 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).

Click Here to Read Abstract

What are the implications for soldiers and civilians? Not surprisingly, the quality of sleep among soldiers can be a shambles during combat deployment. Explosions and less-than-ideal sleeping arrangements are unavoidable, but combine it all with sleep apnea and things get even worse. “We know that most injuries are not battle related,” says Lieutenant Colonel Christopher J. Lettieri, MD, FACP, FCCP, FAASM, a lead author of the study. “We have accidents, and if soldiers are sleep deprived, they are going to lack focus and be more prone to accidents.”

It’s also a problem on U.S. roadways, but the stakes are even higher when lethal machinery is mixed in. “If you are driving a 40-ton tank around, you can’t afford to make bad decisions,” adds Lettieri, program director, Sleep Medicine Fellowship, Walter Reed National Military Medical Center, Washington, DC. “Research shows that chronic low-level sleep deprivation impairs reasoning, decision-making, and slows reaction time. You don’t want that in a combat-deployed troop.”

Oral appliances can fit easily in a ruck sack, but do they actually work? Lettieri and his co-researchers decided to try their own study in an effort to add to the growing literature. Beyond the obvious benefits of reduced accidents, they found that even post traumatic stress disorder (PTSD) may be affected by poor sleep. “We have all these guys coming back with PTSD, and we broke it down into guys who were injured, and those who were not,” explains Lettieri. “Among guys who did not sustain a combat injury, almost universally they had some underlying sleep disorder.”

In the full in-depth interview, published in the Feb/Mar issue of Sleep Diagnosis and Therapy, the two lead authors Lt Col. Lettieri  and Major Aaron B. Holley, MD, FACP, discuss the study’s impact now that it has been in the public domain since late last year, and review the major findings and implications.

Source: SleepScholar

Hospitals and social media are a great mix, offering a wealth of opportunities for connecting with the community, patients, and even collaborating across health systems and between different hospitals. Some medical groups are wary of the liability and privacy issues that social media may open up, but others have found ways to manage these concerns and enjoy the benefits of using social media.

Click Here to read about inspiring ways hospitals are using social media, from crisis communication to customer service.

Click Here to go direct to the Mayo Clinics Online Health Community

Circadiance of Pittsburgh, PA celebrates the completion of its fifth year with a variety of planned new product launches. These launches promise to build upon the high quality standards and innovation that the home health care industry has come to expect from Circadiance.

In 2012 the company is planning to launch a variety of products that provide the CPAP patient a comfortable experience as well as offer the DME resellers and sleep lab professionals an alternative to the traditional hard plastic CPAP masks.

The company’s initial product, the SleepWeaver Mask – the only 100% cloth CPAP mask on the market – has evolved over the past five years. True to the company’s growth strategy, in 2011, Circadiance introduced the SleepWeaver Feather Weight Tube as an alternative to the bulky and rigid tubing options. For more information on SleepWeaver, the SleepWeaver Feather Weight Tube visit http://www.circadiance.com/sleepweaver-order.php.

To Read Full announcement Click Here

WASHINGTON, D.C.

Late last month, the FAA released its new flight and duty time rules for airline pilots. Designed to combat on-the-job fatigue, the rules take effect in two years.

The Department of Transportation identified the issue of pilot fatigue as a top priority during a 2009 airline Safety Call to Action following the crash of Colgan Air flight 3407. The FAA launched an aggressive effort to take advantage of the latest research on fatigue to create a new pilot flight, duty and rest proposal, which the agency issued on September 10, 2010.

A couple of sleep related components of this final rule for commercial passenger flights include:

10-hour minimum rest period: The rule sets a 10-hour minimum rest period prior to the flight duty period, a two-hour increase over the old rules. The new rule also mandates that a pilot must have an opportunity for eight hours of uninterrupted sleep within the 10-hour rest period.

Fatigue Management: Required training updates every two years will include fatigue mitigation measures, sleep fundamentals and the impact to a pilot’s performance.  The training will also address how fatigue is influenced by lifestyle – including nutrition, exercise, and family life – as well as by sleep disorders and the impact of commuting.

The final rule has been sent to the Federal Register for display and publication. It is currently available at:http://www.faa.gov/regulations_policies/rulemaking/recently_published/media/2120-AJ58-FinalRule.pdf, and will take effect in two years to allow commercial passenger airline operators time to transition.

A fact sheet with additional information is at http://www.faa.gov/news/fact_sheets/

Click Here to Download AASM Course Brochure

preliminary Schedule and TopicS

Sunday, February 26, 2012

7:00am – 8:00am Registration and Continental Breakfast* Managing a Sleep center

8:00am – 9:00am

9:00am – 10:15am

10:15am – 10:30am 10:30am – 11:30am

11:30am – 12:30pm

12:30pm – 1:30pm 1:30pm – 2:30pm

Office Models: Physician Office, IDTF, Outpatient Department, Corporate Structure Steven Hull, MD Employee Issues: Contracts, Training and

Legal Issues

Thomas Mandler, JD; and Ted Thurn

Break Contracts: Managed Care, Personnel, Hospital, Practice Purchase/Merger/Buy-out Kevin Ryan, JD Financials: Making a Business Plan, Securing Financing and Understanding Cash Flow Russell Wilson, CPA Lunch* Professional Liability Insurance/Loss Prevention: Protect Your Practice Now Kevin Ryan, JD

coding and reimbursement in 2012: planning for Today

2:30pm – 3:30pm 3:30pm – 4:30pm

4:30pm – 4:45pm 4:45pm – 5:45pm

Medicare: Issues Related to a Sleep Practice

Arthur Lurvey, MD

Insurance/Managed Care: Current Trends and Impact on Practice Paul Valentine Break

Fraud and Abuse/Compliance Plan

Jason Caron, JD

Monday, February 27, 2012

7:00am – 8:00am Continental Breakfast* future of Sleep Medicine practice

8:00am – 10:00am

10:00am – 10:15am 10:15am – 11:15am

11:15am – 12:15pm

12:15pm – 1:15pm 1:15pm – 2:15pm

2:15pm – 3:15pm

3:15pm – 3:30pm 3:30pm – 4:30pm

4:30pm – 5:00pm

Pro/Con Debate: Should You Be a DME Provider?

Amy Aronsky, DO; and Tilak K. Verma, MD, MBA

Break Quality Control: Inter-scorer Reliability, PQRS and Other Mechanisms Sairam Parthasarathy, MD Out of Center Sleep Testing: Equipment, Reimbursement and Strategy Douglas Kirsch, MD Lunch* Accreditation: Sleep Center, OCST and DME Sam Fleishman, MD Integrated Sleep Management Model: Testing, Treatment and Follow-up in One Place Patrick Strollo Jr., MD Break A Look Into the Future: A Legal Perspective Jason Caron, JD Final Discussion

Click here for detailed information from the ACCPs Website

AGENDA

Thursday, January 26

6:30 am - 7:10 am
Registration/Continental Breakfast/Visit Exhibits

7:10 am - 7:15 am
Welcome and Introductions

7:15 am - 8:00 am
Pretest
Peter C. Gay, MD, FCCP

8:00 am - 8:45 am
Structure and Function of Sleep
Phyllis C. Zee, MD, PhD

8:45 am - 9:30 am
Polysomnography 1
Bernie W. Miller, RRT, RPSGT

9:30 am - 9:45 am
Break/Visit Exhibits

9:45 am - 10:30 am
Polysomnography 2
Bernie W. Miller, RRT, RPSGT

10:30 am - 11:15 am
Testing for Sleepiness
Brian A. Boehlecke, MD, MSPH, FCCP

11:15 am - 12:35 pm
Group 1 Lunch (on your own)
Group 2 – Case Studies

12:40 pm - 2:00 pm
Group 2 Lunch (on your own)
Group 1 – Case Studies

2:00 pm - 2:45 pm
Hypersomnias of Central Origin 1
Alon Y. Avidan, MD, MPH

2:45 pm - 3:30 pm
Hypersomnias of Central Origin 2
Alon Y. Avidan, MD, MPH

3:30 pm - 3:45 pm
Break/Visit Exhibits

3:45 pm - 4:30 pm
Parasomnias 1
Carlos H. Schenck, MD

4:30 pm - 5:15 pm
Parasomnias 2
Carlos H. Schenck, MD

5:30 pm - 6:30 pm
Reception

Friday, January 27

6:45 am - 7:15 am
Registration/Continental Breakfast/Visit Exhibits

7:15 am - 8:00 am
Medicolegal Aspects of Sleep and Driving
Brian A. Boehlecke, MD, MSPH, FCCP

8:00 am - 8:45 am
Insomnia: Epidemiology and Evaluation
Allison G. Harvey, PhD

8:45 am - 9:30 am
Insomnia: Pharmacologic Treatment
James M. Parish, MD, FCCP

9:30 am - 9:45 am
Break/Visit Exhibits

9:45 am - 10:30 am
Insomnia: Cognitive Behavioral Treatment
Allison G. Harvey, PhD

10:30 am - 11:15 am
Circadian Rhythm Disorders
Phyllis C. Zee, MD. PhD

11:15 am - 12:35 pm
Group 2 Lunch (on your own)
Group 1 – Case Studies

12:40 pm - 2:00 pm
Group 1 Lunch (on your own)
Group 2 – Case Studies

2:00 pm - 2:45 pm
Sleep and Women
Susan M. Harding, MD, FCCP

2:45 pm - 3:30 pm
Sleep, Neurological Disease, and Seizures
Alon Y. Avidan, MD, MPH

3:30 pm - 3:45 pm
Break/Visit Exhibits

3:45 pm - 4:30 pm
Restless Legs Syndrome
Barbara A. Phillips, MD, MSPH, FCCP

4:30 pm - 5:15 pm
Perioperative Management for Patients With Sleep-Disordered Breathing
Peter C. Gay, MD, FCCP

6:30 pm - 7:30 pm
Case Studies Session (optional)
Phyllis C. Zee, PhD

Saturday, January 28

6:45 am - 7:15 am
Registration/Continental Breakfast/Visit Exhibits

7:15 am - 8:00 am
Cardiovascular Disease and Sleep
Sean M. Caples, DO

8:00 am - 8:45 am
Central Apnea Syndromes
Sean M. Caples, DO

8:45 am - 9:30 am
Obstructive Sleep Apnea: Epidemiology, Risks, and Outcomes
Charles W. Atwood Jr, MD, FCCP

9:30 am - 9:45 am
Break/Visit Exhibits

9:45 am - 10:30 am
Portable Monitoring
Charles W. Atwood Jr, MD, FCCP

10:30 am - 11:15 am
Positive Airway Pressure Therapy for Obstructive Sleep Apnea
Neil S. Freedman, MD, FCCP

11:15 am - 12:35 pm
Group 1 Lunch (on your own)
Group 2 – Case Studies

12:40 pm - 2:00 pm
Group 2 Lunch (on your own)
Group 1 – Case Studies

2:00 pm - 2:45 pm
Oral Appliances for Obstructive Sleep Apnea
Eric J. Olson, MD, FCCP

2:45 pm - 3:30 pm
Surgical Treatment of Obstructive Sleep Apnea
Eric J. Olson, MD, FCCP

3:30 pm - 3:45 pm
Break / Visit Exhibits

3:45 pm - 4:30 pm
Pediatric Sleep: Normal and Abnormal
Suresh Kotagal, MD

4:30 pm - 5:15 pm
Pediatric Sleep-Disordered Breathing
Suresh Kotagal, MD

Sunday, January 29

6:45 am - 7:15 am
Registration/Continental Breakfast/Visit Exhibits

7:15 am - 8:00 am
Case Studies and Posttest
Neil S. Freedman, MD, FCCP

8:00 am - 8:45 am
Sleep and the Psychiatric Patient
Lois E. Krahn, MD

8:45 am - 9:00 am
Break/Visit Exhibits

9:00 am - 9:45 am
Sleep and Pulmonary Disease
James M. Parish, MD, FCCP

9:45 am - 10:30 am
The Future of Sleep Medicine
Barbara A. Phillips, MD, MSPH, FCCP

10:30 am
Adjourn

Midday Case Studies

Thursday/Friday
Hypersomnia
Brian A. Boehlecke, MD, MSPH, FCCP
Insomnia
Allison G. Harvey, PhD

Thursday/Friday
Parasomnia/Neurology
Alon Y. Avidan, MD, MPH
Advanced Positive Airway Pressure
Peter C. Gay, MD, FCCP

Saturday
General
Susan M. Harding, MD, FCCP
Portable Monitoring
Charles W. Atwood Jr., MD, FCCP

By Christian Shepherd The Oxford Student Last updated: 16:07, 01/01/2012

A study by Oxford researchers of schizophrenia patients has found a link between sleep disruption and schizophrenia independent of medication and social isolation.
The study was the first of its kind in that it looked at the sleep-wake patterns of schizophrenia patients in the community rather than in hospital and over a period of weeks rather than a period of days.

Researchers suggest that the stabilization of sleep-wake patterns may be important in the treatment of schizophrenia and that a stabilized pattern could help patients become less social isolated.

Head of the research group Professor Russell Foster said: “For a long time people have noted that sleep is disrupted in mental health but it has always been assumed to be associated with medication or the fact that they are socially isolated and, as a result, it has been largely dismissed.”
Foster continued: “We have now shown in humans that there is a profound disruption of sleep wake timing. It is the first time that this has been quantified in a cohort of patients. It also seems to be independent of the drugs that they are on and independent of any form of social isolation, such as the lack of a job.”
According to Foster the most important thing to note about sleep-wake timings is that they are “more than just the inconvenience of not sleeping at the appropriate time of day. They have been associated with a whole raft of additional problems.”

These problems are not only social issues of isolation and difficulty in interaction but include immune dysfunction, cognitive disruption and metabolic abnormalities.
“If you can stabilize sleep-wake in these patient groups then you will hopefully mitigate, and maybe even eliminate, some of the comorbid (secondary) pathologies that you find in mental health.”

Second year experimental psychology student Roseanna Sharville said: “Like food and water, sleep is crucial for all living, breathing things. Intuitively, therefore, it certainly seems possible that long-term sleep disturbances could cause severe physical and mental health problems.”
The importance of the findings is supplemented by Foster’s statement that “one in every hundred members of the public is likely to have schizophrenia”.
“The mental health burden to the economy is greater than the cancer burden. Since its effects are long term and impact on family and carers also,” he continued. “We haven’t had any major innovation in mental health in years.”

Foster described possible methods of stabilizing sleep-wake patterns, which involve “trying to impose a temporal order on these individuals” by “stabilizing the light dark cycle and stabilizing the time that they eat”, as well as the use of drugs such as melatonin, which has been “shown under certain circumstances to stabilize sleep-wake in certain individuals with conditions where sleep can be disrupted, such as bilateral eye loss, but might also apply to patients with schizophrenia”.
The study has also has raised a much bigger picture about the nature of the link between mental health problems and sleep-wake abnormalities.
Foster notes how “most people ask ‘Is it cause and effect?’, but I don’t think you can really think about it in that way any longer. I think you have to think about it as common neurotransmitter pathways that are being affected.”

Foster describes a follow up study on mice where gene abnormalities previously linked to schizophrenia are created in mice to see whether “you would also have a big affect upon the sleep wake profile of the mouse and in the paper that has just been accepted, that is exactly what we see.”
The results of the work are not only applicable to schizophrenic patients but are “part of big and really exciting picture”.

According to Foster, the study is also the basis for a big initiative to look at “sleep-wake timings in mental health generally”, with preliminary data suggesting that “we might be able to use sleep as a predictor of impending psychiatric illness. If you have an early indicator then there is chance of going in early”.
Sharville said how the study would either “have led to a breakthrough in the study of this, and other, mental disorders”, or will have “encouraged the treatment of sleep difficulties in schizophrenic patients, no doubt improving the lives of the many suffering from this debilitating, and often terrifying, disorder.”

Related posts:

1. All About Options – Building Stronger Links Between Sleep Centers and Dentists
2. Sleep bruxism related to obstructive sleep apnea: the effect of continuous positive airway pressure.
3. Study: Sleep disorders normal for post-combat troops

SomnoMed provides diagnostic and treatment solutions for Sleep Breathing Disorders such as Obstructive Sleep Apnea and manufactures the SomnoDent product range. The Armed Services Association has confirmed SomnoMed is registered and eligible to provide SomnoDent to the United States Military personnel.

SomnoMed, Inc., manufacturer of the world’s leading oral appliance, SomnoDent for the treatment of Obstructive Sleep Apnea announces that the Armed Services Association (ASA) has confirmed the company’s SomnoDent registration to provide United States Military personnel OSA Treatment.

This registration confirmation coincides with a recent announcement from the US Army Medical Department stating custom made oral “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.”

“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.”

The military is interested in the SomnoDent, as alternatives to CPAP systems since some active duty service members deploy to 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.

Source: Somnomed.com

In the current issue of JAMA “Journal of the American Medical Association” A large study of Police Officers in the U.S and Canada found 40% of police officers had symptoms of a sleep disorder, including sleep apnea and insomnia.

Click here to view Abstract and Full article

Officers who screened positive for those disorders were also more likely to be burned out, depressed or have an anxiety disorder. Over the next two years, they committed more administrative errors and safety violations and were more prone to falling asleep at the wheel than sound sleepers.

“In general we have this cultural attitude of, sleep is for the weak,” said Dr. Michael Grandner, from the Center for Sleep and Circadian Neurobiology at the University of Pennsylvania in Philadelphia.

“When you’re in an environment where signs of weakness are particularly discouraged, there may be a social pressure to not address sleep problems or to shrug them off,” added Grandner, author of a commentary published with the new study in the Journal of the American Medical Association.

When police officers in particular suffer from sleep problems, he said, it becomes a public health and safety problem. “It’s not just the people with sleep disorders that are affected,” Grandner told Reuters Health. “If they’re impaired, you’re at risk.”

Researchers say police departments could do more to make sure that officers with sleep disorders receive appropriate treatment, which may include sleep machines, therapy or changes in work schedules.

For the new study, close to 5,000 police officers were surveyed on sleep problems and other health topics. That included Philadelphia officers and Massachusetts state police as well as a broader range of other U.S. and Canadian cops.

The officers were on average 38 to 39 years old and most had been in the police force for more than decade.

Dr. Charles Czeisler from Brigham and Women’s Hospital in Boston and his colleagues found that 40% of the officers screened positive for at least one sleep disorder.

The most common was sleep apnea, which affected a third of cops, followed by moderate or severe insomnia and shift work disorder, which consists of sleepiness and insomnia associated with working at night.

DEPRESSION, BURNOUT, ANXIETY

Officers with a sleep disorder were more than twice as likely as healthy sleepers to report depression, emotional exhaustion or burnout and anxiety disorders on their original surveys.

On follow-up questionnaires sent out over the next two years, they were also 40 to 60% more likely to report making serious administrative errors, falling asleep while driving or committing a fatigue-related error or safety violation during work.

Poor sleepers reported more citizen complaints and more often showed uncontrolled anger toward a suspect or citizen.

“You have people who are sleep deprived, which means that their ability to make good decisions, to respond effectively, to drive emergency vehicles well … all of those things are impaired,” said Bryan Vila, a criminal justice professor who studies sleep and performance in cops at Washington State University in Spokane but wasn’t involved in the study.

The researchers noted that being heavy increases the risk of sleep apnea, and that almost 80% of the officers they surveyed were overweight or obese.

Czeisler said the lowest rates of both sleep apnea and overweight and obese conditions were in Massachusetts state cops, and that that’s no coincidence.

Those officers get one hour paid exercise time for every work shift, he told Reuters Health, and undergo regular fitness tests that simulate chasing a suspect or dragging a victim, with a bonus in pay if they pass.

“It’s an impressive program and perhaps a model for the nation,” Czeisler said.

HEALTH AND SAFETY ISSUES

Putting in measures to catch sleep disorders early could help prevent future health and safety consequences, researchers say. Those could include on-the-job screening in police departments, according to Czeisler, and making sure cops with sleep problems get help.

“We have great treatments for sleep disorders, we have great screening tools, the technology is there,” Grandner told Reuters Health. Sleep apnea can be treated with a breathing machine and mask used at night, and behavioral therapy is often the first line of treatment for people with insomnia, he said.

Czeisler said next up is a study funded by the Federal Emergency Management Agency to look at sleep disorders in firefighters.

Source: JAMA

I have been involved in the diagnosis and treatment of sleep apnea for over 20 years. My first foray into the industry was with the Silencer in 1993. At that time I had no dental background and the practice of dental sleep medicine was just beginning.  Since that time, I have been involved with all aspects of the diagnostics and treatment of sleep disorders.  I am spending more and more of my time these days in the dental arena.  I am very impressed with the diligence and commitment of the dentist when it comes to working hard to understand all aspects of sleep medicine.

I believe the most misunderstood relationship in the practice of dental sleep medicine is the relationship between the dental lab and the dentist in building oral appliances for the patient.  What is often lost in the discussion of sleep medicine is that each oral appliance is made by hand, by a technician trained in the fabrication of dental devices, to the specification requested by the dentist.

I first witnessed this relationship while Dr. Wayne Halstrom developed the Silencer and his “lab man” Loris Campagnolo (then with Space Maintainers) developed the techniques that became the Silencer system. Here we are 20 years later and Loris is still working with Dr. Halstrom now in his own lab called Echelon in Burnaby British Columbia. When you ask Dr. Halstrom about the Silencer he often refers to the trials of finding materials and developing easily teachable and transferable techniques, all with the help of a highly skilled technician from which to bounce ideas. The Silencer has grown over the years to be a widely used oral appliance in the treatment of OSA. The durability of the device is well known and it is available from some of the best dental technicians in the country, Johns Dental Lab, Burbank Dental and Gergen’s Orthodontic lab to name a few.

The educational requirement of both the dentist and the technician have really evolved in the last several years. Dental sleep treatment is now recognized as first line OSA therapy and is easily accepted by the medical community. The challenges the dental community face in providing these devices have shifted from appliance and dental procedure issues to issues of practice management, medical insurance and patient qualification. 

Once again, the “Lab Man” is not far away. David Gergen C.D.T. of Gergen’s Orthodontic Lab has taken it upon him self to assemble advance courses in sleep dentistry that will give the dentist the tools to understand the requirements of dental sleep medicine outside of the standard dental issues of occlusion, impression technique and appliance selection.  Gergen focuses his courses on all the next steps after the Dr. has begun the practice of dental sleep medicine. Gergen has often told me that, “ the biggest mistake a dentist can make is to assume that sleep medicine is just like tooth whitening or Invisilign”.  The relationship between the dentist and the lab is taken very seriously at Gergen’s Orthodontic lab  “If the dentist is not successful we will never be successful”.

Reports from the Gergen’s courses have been excellent. Dr. Gerbholtz from Denver CO attended the meeting in Sonoma CA and had this to say “I left Sonoma with a new passion and a good working business model that actually made sense and worked. Where before I was seeing only 2 to 6 patients each month, I am now seeing 20 to 24 patients each month after Sonoma”. I found that the focus on internal marketing for the dental practice really paid off for some practices. Dr. Michael Van Leeuwen of Salt Lake City UT reports “I am now seeing three times the number of patients and they are all getting are sleeping better with the modified sleep Herbst appliance”.  My inspiration for this article came from the following quote from Dr. Harry Sugg of Dallas TX. “The in-depth presentations led to a much greater understanding of how we can help our patients with finding solutions to their sleep issues. So many of our questions were answered regarding insurance billing and coding, some we hadn’t even thought of.

“We were floundering before we went to Sonoma, and we had twelve cases in ten months’ time and where we were having problems due to the learning curve in insurance procedures. In just two short months, we now have over forty cases through. We took five staff members that received technical instruction, but more importantly, much more administrative understanding. Due to the detailed explanations given by Dr. Rod & Donna Willey we have been able to help many more patients. They have been tireless in assisting us to reach others with this information. “

In summary, if you are considering the practice of sleep dentistry or are looking for a dental team to treat your patient, take some time and develop the relationship. Understand that each therapy is customized to the patient and there is a whole team of highly trained individuals working behind the scenes making sure that everyone in the process has an excellent outcome.

Gergen’s Ortho provides the following sleep appliances- Sleep Herbst, the Silencer, EMA, TAP website is www.gergensortho.com The next course is in Las Vegas http://gergensortho.com/las-vegas-sleep-symposium

 Randy Clare is a mentor for the following  dental sleep study clubs www.scottsdalestudyclub.com www.sandiegostudyclub.com

Related posts:

1. Gergen’s Orthodontics Lab Releases “Respire” by Gergens
2. Three Big Questions
3. Efficacy of two mandibular advancement appliances in the management of snoring and mild-moderate sleep apnea: a cross-over randomized study.

Compumedics Limited (ASX:CMP) today announced another significant milestone of being awarded the contract to supply EEG equipment for the Neurology Department at Yale School of Medicine, Yale University, USA.  Under the contract Compumedics will supply its latest EEG products comprising the new Compumedics NEUVO® Long-Term EEG Monitoring (LTEM) system, Grael®HD, Profusion EEG 4 and Curry® NS7 software.  The systems are to be used for routine clinical EEG and surgical monitoring.  This purchase represents another major milestone in Compumedics’ strategic entry into the global $250 million p.a. LTEM/neurology market.

The sale, with an order value of more than AUD1 million, will see the installation of Compumedics’ latest EEG products into Yale University and follows several other significant EEG orders in the USA in the first half of FY2012. The NEUVO® LTEM systems can record a minimum 64 individual channels of high-density EEG data on a single patient for days or weeks at a time.  The Grael®HD system provides high definition EEG signals while the Siesta®802 remains the industry’s most compact wireless EEG recording device.  Compumedics’ digital amplifier technology and breadth of EEG diagnostic offerings is state-of-the-art and provides Compumedics with a unique point of differentiation from competing offerings. Compumedics’ products provide higher quality brain recordings and more precise brain analysis than alternatives, helping to improve patient outcomes.

The Department of Neurology at Yale School of Medicine describes itself as a research, teaching, and clinical centre devoted to improving the understanding and treatment of diseases of the nervous system.  The department is a major part of the Yale University School of Medicine and has several active clinical programs at local medical establishments.

Compumedics® equipment will help the Department of Neurology to achieve its goal of providing the highest level of patient care through state-of-the-art clinical programs, educating future leaders in the field of neurology and being at the forefront of neuroscience research within one of the world’s most prestigious universities.  The department has a long history of being a pioneer in the field of Neurology, such as establishing one of the first epilepsy monitoring units and creating one of the first stroke centres.

Dr. David Burton, Chairman and Chief Executive Officer of Compumedics Group commented,

“This contract is another important milestone for our Company. It reinforces our commitment to our customers and the patients under their care.  Compumedics has made significant investments in product development, targeting the neuro-diagnostics market to leverage its expertise in high-end amplifier design and physiological signal processing.  The world-class Yale University installation will establish a new and innovative standard for long-term EEG monitoring.   This project further underpins our strategy to grow our business across this important, but relatively new, market sector for Compumedics.  In particular, this prestigious sale to one of the world’s pre-eminent epilepsy monitoring centres validates our key growth strategy to penetrate the global LTEM market.  The LTEM market alone is more than twice the size of our existing core sleep diagnostic business.”

Source: Compumedics.com