Sleep Apnea and Heart Attack Risk

A new study from the Mayo Clinic and reported in the Journal of the American College of Cardiology suggests that heart attacks that occur between midnight and 6AM are associated with sleep apnea.

"If a patient has a heart attack that wakes him or her from sleep, then it may be important to look for sleep apnea in them," said Dr. Virend Somers, one of the investigators.



More information on this study can be found at medpage today.

If you have sleep apnea or have had a heart attack that has awakened you from sleep, it's critical that you review this information.

Dr. Barsh

Validity of Medical Content - Your Responsibility!

Lately there are a plethora of blogs purporting to be information about snoring and sleep apnea but which are, in reality, articles from content farms or sales pitches for products couched in the form of what may or may not be valid content. The key is usually in the last paragraph "About the Author."

For example, a site called Find Diseases Directory has an article by Suzy Hughes with "Information on Central Sleep Apnea". In it Ms. Hughes recommends use of Ambien to treat central sleep apnea.

Another site, has an identical article by Suzy Hughes on Central Sleep Apnea. As does artipot.com.

The fact that the drug "Ambien" is misspelled in each of these articles as "Ambient" should lead readers to suspect that the content is not exactly valid.

The problem is not the content but rather exactly who "Suzy Hughes" is. When you search Google for Suzy Hughes and "unique content" you are taken to a site named Uber Articles. It turns out that Uber Articles is a site that provides content for blogs and web sites designed not to produce valid content but rather to produce content designed to attract search engines and with that search engine optimization the dollars from Google Advertising.

"Who else wants Totally Unique Content for their websites and newsletters - Absolutely FREE?"

The search engines are bored with seeing the same old articles again, and again, and again - So why not give them something unique?

They will love you for it - and as a result your search engine rankings - and your visitors - will soar. In fact, this is the single most effective way to get the top spots in the search engines. It costs nothing, so why not get started right now?

Using our powerful, secret, Unique Article Wizardâ„¢, we are able to deliver literally thousands of unique versions of selected articles - all you need do is cut and paste the article into your web page or ezine, knowing that, at most, there will be only one or maybe two identical versions anywhere on the internet. You are even free to use these articles offline (naturally all on- or off-line use is subject to our terms and conditions).

If you prefer, you can even sign up to receive unique articles direct to your inbox - formatted, for your convenience, in both fixed length (60 characters), and free-flow text. Again, no one else will receive an article identical to the one you receive.

The site is not interested in validating content but rather producing content on a grand scale in areas from dating to World of Warcraft.

My recommendation is that if you ever come across a blog or web site that has a link back to Uber Articles, you take the information offered with a grain of salt knowing it was created for the sole purpose of attracting search engines to a site and not to provide health information.

As ever, the web is a great source of information but it is unregulated. Anyone can post anything on the web - valid or invalid. Content is a commodity, search engine placement is a commodity. Medical information on the web is a valuable way to educate yourself about disease and treatment but it is your responsibility to validate the source of that content yourself and, before deciding on treatment, discuss that treatment with your physician or dentist.

Dr. Barsh

About.com, Snoring, Dentists

I don't know how many of you read About.com but last month they published an article entitled "Is Snoring a Problem? See your Dentist." We at Snoring Isn't Sexy(tm) and Quietsleep(r) would like to applaud their efforts and thank them for mentioning dentistry as an option in the field of sleep medicine.

But at the same time we'd like to correct a few inaccuracies in the article.

First a pet peeve of mine personally. About.com refers to doctors and dentists. While this is in common usage, it's blatantly incorrect. Dentists ARE Doctors. We received our degrees after four years of intensive education and training, many of us went on to receive post-doctoral degrees and many had internships and residencies. We encourage the proper usage of physician and dentist. Please...

The article stated that

However, if the sleep study rules out obstructive sleep apnea, or if the apnea is still very mild, then you might consider a visit to your dentist. A dentist can supply you with a dental appliance that can help you control your snoring. A dental appliance is a small plastic device that fits in the mouth. You wear it at night and it prevents the collapse of throat tissues that cause the snoring. These devices are easy to use and inexpensive. They are fitted to the individual patient and require no surgery.

While this is partially true, oral appliances have been approved for snoring and sleep apnea and as an alternative to CPAP when patients cannot tolerate the CPAP device. The statement issued in a parameters report from the American Academy of Sleep Medicine states

Oral appliances (OAs) are indicated for use in patients with mild to moderate OSA who prefer them to continuous positive airway pressure (CPAP) therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP. Until there is higher quality evidence to suggest efficacy, CPAP is indicated whenever possible for patients with severe OSA before considering OAs. Oral appliances should be fitted by qualified dental personnel who are trained and experienced in the over- all care of oral health, the temporomandibular joint, dental occlusion and associated oral structures.

Practice Parameters for the Treatment of Snoring and Obstructive
Sleep Apnea with Oral Appliances: An Update for 2005
SLEEP, Vol. 29, No. 2, 2006

Secondly, as far as appliances are concerned, the article in About.com mentions only two:

One such device is the Snore Guard. Snore Guard looks like an athletic mouthpiece. You wear it while you're sleeping and it prevents the jaw and tongue from dropping back to obstruct the air passages. It allows you to breathe easier, and keep breathing so you get a more restful sleep.

Another such appliance is called Silent Nite. These devices are flexible, small, thin, and quite comfortable to wear. Your dentist will determine from a questionnaire and from impressions of your upper and lower arch just what shape your Silent Nite should take. Snore prevention devices have proved successful in more than 85% of cases, while other treatment, such as surgery or drugs have a success rate of less than 50%.

While both appliances are still available to dentists, neither, in my opinion, is an adequate choice to treat a disease as serious as obstructive sleep apnea.

Better choices for treatment of snoring and sleep apnea are the TAP, Somnomed MAS, Adjustable PM Positioner, Klearway, and many others. Full description of many oral appliances are available at Quietsleep.com. Your dentist who is trained in dental sleep medicine will be able to guide you in which appliance is best for your problem and your mouth. But remember, it's really not about which appliance, treatment of both snoring and sleep apnea is about the therapy.

Dr. Barsh

Benign Snoring?

In a post on his blog today, a dentist Dr. Paavanj, discussed snoring and sleep apnea and its relationship to dentistry. In it Dr. Paavanj stated:

Can snoring be a sign of medical problems? If so, is there a particular type of snoring that signals the need to seek help?

A. Primary snoring has been reported in a few studies to have some link to hypertension, stroke and coronary artery disease.

However, there is a significant amount of debate about the health consequences of just snoring. The general consensus is that snoring is a benign condition. The intensity or loudness of the snoring has nothing to do with any health consequences.

While current thought may lead to controversy over whether snoring itself is a benign condition, there really shouldn't be but it takes redefining what snoring really is.

Obstructive sleep apnea is complete blockage of the airway in the pharyngeal (throat) area, snoring is partial obstruction and can be defined as obstructive hypopnea. This means there is, in snoring, a decreased amount of oxygen inspired with each breath which, in turn, can precipitate many of the same problems as apnea.

Since snoring can be a warning sign of sleep apnea and especially snoring accompanied by observed cessation of brathing, it's best to not treat any snoring as benign but to consider it as a wake up call (sorry for the pun) to visit a sleep physician or trained sleep medicine dentist for evaluation.

Snoring benign? Well maybe as far as the insurance companies are concerned but not as far as your health is concerned

Dr. Barsh

PURE SLEEP and other do-it-yourself "cures"

There is a mail-order device that is advertised heavily on TV that purports to be an FDA-cleared device appropriate for snoring. The device is called PURESLEEP and was invented by a dentist, Dr. Douglas Fenton.

According to the PURESLEEP web site:

" PureSleep is an FDA-cleared prescription dental device and uses a technique called 'mandibular repositioning' which has been clinically validated through years of research and testing. For the first time ever, it is available without a visit to the dentist or physician. That translates into savings of more than 80% off the price a dentist would charge!"

(If the manufacturer is reading this post, I would appreciate it if he would comment and post the FDA Clearance number and registration date because I could find no reference to the PureSleep Device at the FDA web site.I will happily retract the comments about FDA approval if the FDA reference material is provided)

Even so, the statement "prescription dental device" implies that a dentist must prescribe the appliance which clearly is refuted by the statement "available without a visit to the dentist or physician."

The web site goes on to state:

"PureSleep is an FDA-cleared prescription dental device, now available for the first time without visiting a physician or dentist. To determine if it is appropriate to prescribe PureSleep to you, it is necessary to answer a few simple questions on this website or by calling an automated voice response system, using the toll-free number below -- any time, day or night. In either case, your answers to these questions will be recorded, and if appropriate, PureSleep will be prescribed to you and your order will be shipped."

(THE FDA states: Intraoral devices to treat snoring and/or obstructive sleep apnea are prescription devices unless adequate directions for use (21 CFR 801.5) are developed and FDA clears a 510(k) specifically for over-the-counter (OTC) distribution.)

The questions, as posted on the web site:

"PureSleep is an FDA-cleared, prescription device. Because of this, you must be at least 18 years old to purchase or use PureSleep. Furthermore, before we can provide you with a PureSleep device, we will need to ask you some questions about your health. The Pure Sleep Company is not liable for any damages or injuries resulting from false or erroneous information provided by you.
Are you at least 18 years old?
Do you agree to the terms and conditions?

The questions continue:

1. Have you ever been diagnosed with central sleep apnea?



2. Do you have chronic asthma, emphysema, or any other severe respiratory disorder?



3. Do you have loose teeth, abscesses, or severe gum disease?



4. Do you have full dentures, or are you presently undergoing orthodontic treatment?



5. Have you had a dental implant within the last year? Note that crowns, caps, and bridges are not dental implants.



6. Have you been diagnosed with temporomandibular disorder -- sometimes called TMD or TMJ?



7. Does it hurt when you open your mouth wide or yawn?



8. Does it hurt when you chew, or use the jaws?



9. Does it hurt when you are not chewing or using the jaws?



10. Is your jaw pain worse on waking?



11. Do you have pain in front of the ears or ear aches?



12. Do you have jaw muscle (cheek) pain?



13. Do you have pain in the temples?



14. Do you have pain or soreness in the teeth?



15. Do your jaw joints make noise so that it bothers you or others?



16. Do you find it difficult to open your mouth wide?



17. Does your jaw ever lock closed so you cannot open it?



18. Does your jaw ever lock open so you cannot close it?



19. Do you have a problem with your bite being uncomfortable?

Having answered all questions in the negative, I was taken to the following screen:

Great! Your responses to the questionnaire indicate that it would be appropriate for you to use the PureSleep stop snoring solution.

You have the option of making two payments of $29.95 ($59.90 total) plus $7.95 for shipping and handling. However most of our customers prefer the ease and convenience of a single payment - and you can still take advantage of our risk-free 30-day Money Back Guarantee.

To purchase PureSleep, simply select a payment option below and then click the "Continue" button below. Your order will then be transfered to our secure shopping cart where you can complete your purchase.

I prefer the ease and convenience of a single payment.
I prefer to make two payments.

PLEASE NOTE: There is not one question that attempts to determine whether or not the purchaser may have obstructive sleep apnea. And yet the device is supposedly cleared just for snoring. Even if relevant questions were asked, every reputable scientific article states that history alone cannot make the diagnosis of sleep apnea and that it must be confirmed with a sleep study.

Let us realize that even if this device was approved for over-the-counter sale as an anti-snoring mouthpiece, people most likely to purchase it are loud snorers and are often likely to have overlying mild to severe sleep apnea.


Big problem!

Sleep apnea is a serious medical problem that can lead to heart disease, stroke, high blood pressure, diabetes, motor vehicle accidents due to drowsing off while driving and even erectile dysfunction. Even though the device may control the snoring, it may not adequately treat sleep apnea leaving you open, in extreme cases, for death while you sleep.

There are no easy answers in medicine or dentistry. If you have sleep apnea or even if you snore heavily with pauses in breathing at night (observed by your bed partner), have high blood pressure and if you are tired during the day you should be evaluated by a sleep physician or dentist trained in sleep medicine.

PLEASE DON't DO IT YOURSELF. It's not a joke. If you find that you need an oral appliance have it constructed by a dentist who has been trained in this therapy. Often your medical insurance will cover the charges.


As in all things caveat emptor - it's your health and your life.

Dr. Barsh

Drowsy Driving and Snoring

The National Sleep Foundation estimates that “drowsy driving� claims 1,500 lives and accounts for at least 100,000 auto accidents each year. Drowsy driving is almost as much a road hazard as alcohol related accidents. Truck drivers are especially subject to this problem because they live a sedentary lifestyle and have a high incidence of sleep apnea.

Sleep breathing disorders, including snoring and obstructive sleep apnea, are associated with heart disease, high blood pressure, stroke, mood disorders, motor vehicle and job-related accidents. There are accounts of employees being accused of on-the-job drunkeness when, in actuality, the problem was treatable sleep apnea.

You owe it to yourself, especially in these trying times when jobs are scarce, to talk to your physician or dentist about excessive daytime sleepiness and/or drowsy driving. A CPAP machine or, alternatively, a mouth device may solve your problem, save your job and even save your life.

Dr. Barsh

All Dentists Should Screen Their Patients for Snoring and Sleep Apnea

18 million people in the United States alone suffer from sleep apnea, untold millions more snore. As a country we are experiencing an epidemic of obesity which can be a precursor of sleep apnea. Both snoring and sleep apnea are related to heart disease, stroke, high blood pressure, depression, diabetes, erectile dysfunction and accidental injury or death due to drowsy driving.

Dentists are in an ideal position to ask a few simple questions (Do you snore loudly? Have you ever been told you stop breathing during sleep? Do you have high blood pressure? Do you tend to drowse off during the day?) and, if the patient answers in the affirmative, to either refer or initiate management for sleep apnea.

Easy, quick - maybe two minutes of time - to improve the health of their patients.

Ask your dentist to become involved.

Dr. Barsh