Issuu

WINTER 2015 PREMIERE ISSUE SUPPLEMENT

INSIDE THIS ISSUE

Sports Stars Spread Sleep Awareness

Harry Sugg DDS Sleep Apnea Dentistry

A Long but Rewarding Journey

Koala Center for Sleep Disorders

I Scored a lot of Touchdowns in My Career

But No Score was as Big as being Treated for Sleep Apnea – Roy Green former NFL wide receiver

Signs and Symptoms of Sleep Apnea ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

Loud Snoring Morning Headaches Excessive Daytime Fatigue High Blood Pressure Inability to Lose Weight Choking/Gasping Sensation that wakes you up Acid Reflux Depression/Mood Swings Decreased Sex Drive

Koala Center for Sleep Disorders – Arrowhead Mark Castle, DDS 8110 W. Union Hills Blvd., Ste. 430, Glendale, AZ 85308 623-594-9787 | arrowhead@koalasleepcenters.com

Why I Joined For the everyday general dentist, we need practical integration for our patients, while still working with the medical field that supports us.

Erin E. Elliott, DDS

Diplomate American Board of Dental Sleep Medicine

Join Today The American Sleep and Breathing Academy is the first to offer a multi-disciplinay approach to Sleep Medicine. Our patient education and public sleep and wellness campaigns will further assist you with the patient tools you need to be a Sleep Care Provider who leads the way with current concepts in sleep medicine.

AmericanSleepandBreathingAcademy.com

From The Editor Lucid Thoughts TELL PEOPLE ONE THING TO PROTECT THEMSELVES AND

ne of the tenants of the American Sleep and Breathing Academy “ASBA” is to ensure that the sub-specialty of sleep medicine benefits from the practical integration of dentistry and medicine. The mission of the Academy is to

strengthen the profession by forming a true multidisciplinary approach to sleep medicine and overall sleep health.

AVOID PROBLEMS ASSOCIATED WITH

The Academy facilitates the improvement of professional networking within the field by

TOO LITTLE SLEEP,

expanding the scope of involvement to all healthcare professionals and administrators

IT IS THIS: ...THE

involved in sleep health and wellness.

MOMENT WHEN A CONSCIOUS

Sleep & Wellness magazine is a consumer-orientated publication distributed to over 110

EFFORT OF WILL

thousand dental and medical practices, as a complimentary copy for your waiting

IS REQUIRED TO

room patients.

KEEP YOUR EYES OPEN. DROWSI-

Our patient education, public sleep and wellness campaigns will further assist you with the

NESS IS A RED

patient tools you need to be a sleep care provider who leads the way treating sleep

ALERT THAT YOU

medicine. The ASBA hosts an annual convention every April for its membership and all

NEED SLEEP.”

interested sleep professionals. 2016 will see the conference hosted April 15-16 in Scottsdale, AZ. Sleep medicine is an incredible opportunity for any professional who has an interest in treating sleep disordered breathing patients either with oral appliance therapy or continuous positive airway pressure, and membership in the Academy is a must.

DR. WILLIAM C. DEMENT

Publishing Sleep & Wellness Magazine is produced, published, and distributed quarterly by the American Sleep and Breathing Academy, Phoenix, AZ. All rights reserved. Reproduction in whole or part may be granted by written permission. Produced in the United States of American Rates: Complete details regarding circulation, coverage, advertising rates, space sizes, and similar information are available to prospective advertisers. Editorial Contributions: Every precaution is taken to ensure accuracy, but the publishers cannot accept responsibility for the correctness or accuracy of information supplied herein or for any opinion expressed.

-Alan HickeyManaging Editor

CUSTOMER SERVICE American Sleep and Breathing Academy S&W Magazine Customer Care 1745 W. Deer Valley Road, Bldg 1, Suite 112, Phoenix, AZ 85027 PHONE: 714.720.8262 E-MAIL: info@myasba.com www.americansleepandbreathingacademy.com

SLEEP & WELLNESS

2016 A Conference For Healthcare Professionals

April 15-16

Scottsdale, AZ AmericanSleepAndBreathingAcademy.com

Table

of Con

tents

8 10

Sleep Health Welcome To Koala Center for Sleep Disorders of Arrowhead

13 16 20

INFOGRAPHIC Sleep Is Awesome

Sleep Apnea Dentistry A Long But Rewarding Journey

COVER STORY Sports Stars Spread Sleep Awareness

Living Heart Foundation

Q&A Insomnia

Promotes General Wellness

Sleep & Wellness-Winter 2016

No Matter the Arena Sleep Boosts Performance

Sleep & Wellness Winter-2016

Written By Andrew Lee

It is often overlooked in spite of the fame and fortune of a professional sports career, that retired stars are members of your community and want to contribute to your overall health awareness. And that’s why Pro Player Health Alliance team has teamed up with ZQuiet, the largest snoring company in the world.

Sleep & Wellness-Winter 2016

Recently the news has been filled with sleep related deaths that can be linked directly to sleep apnea. These we know about because of their high public visibility but we know that there are thousands upon thousands of deaths that don’t make the news each year. The majority of these thousands of deaths are everyday people who walk through your office doors, and walk back out of those doors unscreened and untested. Pro Player Health Alliance and ZQuiet’s mission is to educate the public and drive these patients to your office. Now we’re passing the ball off to you and it’s up to you to help us win the fight against sleep disorders.

Oral Appliances This story is about oral appliances, and how critical support from our industry partners makes it possible to provide therapy. We feel you could catch the passion evident in the dedicated professionals who support us beyond creating the Sleep Herbst, EMA and Dorsal Fin. Can you see a connection between what they do and the patient in front of you that you are trying to convince to get diagnosed? The ZQuietSA is cleared to treat OSA and is the perfect predictor device. Widely used in the medical community as a proof of concept for oral appliance therapy, The ZQuiet-SA comes in four diﬀerent advancement sizes and requires virtually no chairtime so it can be a wonderful tool in your practice to see if a sleep apnea patient is a candidate for oral appliance therapy.

ZQuiet ZQuiet works by keeping the mandible in an advanced position and maintains the patient’s airway at night. ZQuiet’s 2-Step Comfort System provides 2 unique mouthpieces designed to help your patients treat snoring comfortably and eﬀectively. Some patients need just a small advancement, while others need a little more. ZQuiet gives you both mouthpieces to insure that the noise stops so your patients and their family can get the quiet, restful sleep they deserve. Any dentist or physician can order the ZQuiet snoring solution for their patients through the website at proplayersleep. org. American Sleep and Breathing Academy members can login with their academy number on americansleepandbreathingacademy.com to receive a special discount on orders. David Gergen, Eric Dickerson, Roy Green, Marcus Allen

It’s fair to say there are few in the profession with more passion for connecting people with treatment than David Gergen and the Pro Player Health Alliance team. By 2008, Gergen had spent over 30 years improving jaw and tooth function by making orthodontic appliances. Servicing and training under a number of the ﬁeld’s leading providers, including Dr. Harold Gelb, Dr. Robert Ricketts, Dr. A. Paul Serrano and Dr. Edward Spiegel, Gergen raised the standard of orthodontic appliance. His innovations brought him Top Dental Lab Technician in the Country honors. Not enough for someone driven to excel; he looked around and realized that he had friends and family with obstructive sleep apnea who were completely untreated. They had been diagnosed and given CPAP, with many unable to comply with the therapy. They were risking all of the negative impact of not breathing well while asleep. Always a sports fan, Gergen knew the story of Reggie White of the Philadelphia Eagles who passed away in 2004 due to complications from untreated sleep apnea. Reggie White and Roy Green were teammates on the Philadelphia Eagles. Charles Barkley the biggest star in the city at that time had just been traded from the Philadelphia 76ers to the Phoenix Suns. All three of these superstars knew each other very well. Gergen, knowing he needed to be part of a solution so his friends would not suﬀer the same fate, put these two related issues together and changed the course of his life’s work.

Sleep & Wellness Winter-2016

Professional athletes are used to standards set at the highest levels – this prompted Gergen’s Orthodontic Lab, already a top tier appliance creator, to carry on at that level while embracing sleep apnea device fabrication. It was while working for the greatest dentists in the country Gergen learned the technique of supporting the airway by using an acrylic appliance to hold the jaw slightly forward while the patient is asleep. The device is small, easy to wear, and can be very eﬀective in opening the airway. It rapidly became obvious that this was a therapy that needed a little promotion – something that is successful, easy to make and for patients to use. He saw that patients loved it and tended to wear them all night, every night. Obstacles to overcome included medical practitioners who did not have a good understanding of the workings of the jaws and the eﬀect that minor repositioning can have on the upper airway. Dentists also had a great deal to learn about the upper airway and their role in treating the disease diagnosed by the sleep doctors.

Enter the NFLPA Enter the NFLPA - while looking for a way to make an impact, longstanding friendships with current and former sports stars resulted in conversations about their sleep breathing problems. Several players fit the same profile found across the country in countless dental offices – people at risk for sleep breathing problems, diagnosed but given only one solution. What was required was a highquality solution.

Connecting with Patients Professional athletes are used to standards set at the highest levels – this prompted Gergen’s Orthodontic Lab, already a top tier appliance creator, to carry on at that level while embracing sleep apnea device fabrication. The Sleep Department was added in 2009 and in 2012 was one of only two labs in the country authorized to make Medicare-approved devices. Over 100,000 custom appliances now serve sports stars, including legendary NBA and NFL athletes, and even more everyday people, helping them to better health.

Now Gergen’s Sleep Department is making the ZQuiet line of custom oral appliances, the ZQuiet Pro-Plus Dorsal and the ZQuiet Sleep Herbst, for ZQuiet Network Dentists. The ZQuiet Network was established to provide a group of practitioners to receive patients resulting from ZQuiet’s extensive marketing campaigns that each year reaches millions of consumers aﬀected by snoring and OSA. If you are interested in adding more patients to your practice, go to proplayersleep.org to learn more about the ZQuiet network program.

Eight Simple Questions How can you use this in your practice? Every dentist and other medical professional struggles to help their patients see their risk factors for disease – we can see it but they don’t. We know that men carry a greater risk of OSA, they tend not to see the doctor, and they deny signs and symptoms clearly observed by others. How can the dentist connect with these guys? Sports! If your patients won’t listen to their spouse, or you, maybe they will listen to NFL Superstar Roy Green or NBA Hall of Famer Charles Barkley! Charles and Roy are both extremely excited to continue educating and assist in the ﬁght against sleep apnea. Roy Green says, “It all begins with eight simple questions, now, that’s not too painful, is it?” 1. Do you snore loudly? 2. Do you often feel tired, fatigued, or sleepy during daytime? 3. Has anyone observed you stop breathing during your sleep? 4. Do you have or are you being treated for high blood pressure? 5. Are you over weight? 6. Age over 50? 7. Do you have a large neck? 8. Gender male? “If you say yes to 3 or more questions go get a sleep test”.

Ex NFL Superstar Roy Green & NBA Hall of Famer Charles Barkley

Sleep & Wellness-Winter 2016

Gergen and Green spent a signiﬁcant amount of their own time and money traveling the country working with veteran groups and football fans before they realized the impact on the retired professional football community as well as the community as a whole from sleep apnea and related co morbidities including diabetes, obesity, heart disease and stroke. Charles Barkley is one of the most inﬂuential and outspoken celebrities in the country, and is very enthusiastic to add his charisma to this campaign. Charles is, and has always been, very concerned about the health of all current and former athletes. This catapulted stars from all over the country such as Marcus Allen, Tony Dorsett, Eric Dickerson, and Chuck Foreman to make sleep disorder education a priority in their communities.

ASBA 2015 will prove to be a turning point in the identiﬁcation and treatment of sleep disorders based on the commitment of Pro Player Health Alliance and ZQuiet to raise awareness of this disease. If you want to team up in the eﬀorts of Pro Player Health Alliance and work with a sports icon in your community, join the fastest growing academy in the country, American Sleep and Breathing Academy “ASBA”, at AmericanSleepAndBreathingAcademy.com Look for publicity from Gergen’s Orthodontic Lab and the Pro Player Health Alliance, the partnership that Gergen and Green created, to help you connect with your patients. Getting celebrities involved with health care is better for us all. It might even get the attention of that high risk gentleman in your chair!

Charles Barkley, David Gergan, Roy Green

Some retired athletes are more than just celebrities: Dr. Archie Roberts was an NFL quarterback and went on to become a cardiologist and Founder of the Living Heart Foundation. Its HOPE (Heart, Obesity, Prevention, Education) Program is a comprehensive obesity, pulmonology, sleep, dentistry and overall health campaign sponsored by the NFL Player’s Association’s Professional Athletes Foundation, which strives to promote healthy lifestyles among former NFL players. According to a study by the New England Journal of Medicine, up to a third of NFL players suﬀer from sleep apnea and as many as 60% of NFL linemen may suﬀer from the disorder.

Tackling Sleep Apnea Former players are no diﬀerent from your patients in their ability to tolerate PAP therapy or wish for a simpler solution. Gergen has used his sports connections to position his Sleep Lab as the leading promoter of sleep apnea awareness in the athletic community. Through the “Tackling Sleep Apnea” campaign, which was launched in 2012, over 200 retired NFL players including Roy Green, Derek Kennard, Tony Dorsett, Mike Haynes and many more legends have received obstructive sleep apnea treatment with a sleep appliance made by Gergen’s Orthodontic Lab. Eric Dickerson, who is another strong advocate of player health, was treated through the “Tackling Sleep Apnea” campaign by David Gergen’s good friend, Dr. Harry Sugg in Dallas, TX. He was very outspoken about how getting his sleep apnea treated and it improved his overall health and eliminated his headaches.

Marcus Allen, Eric Dickerson, Chuck Foremen

Sleep & Wellness Winter-2016

Tony Dorsett, a former Heisman Trophy winner and NFL Hall of Famer, had claimed before being diagnosed with obstructive sleep apnea to be “snoring like a freight train.” Then he received his sleep Herbst custom ﬁtted by Gergen’s Orthodontic Lab. Now that he breathes well while he sleeps he proudly boasts “Superman ain’t got nothin on me.” He gives credit to Pro Player Health Alliance, David Gergen, the NFLPA HOPE Program and Gergen’s Orthodontic Lab for being able to sleep well at night.

Multidisciplinary Approach To help dentists meet this health challenge, David also has invested in state-of-the-art digital technology including an advanced 3D printer and support for digital impressions. Since 2011, he has also sponsored well-received educational courses with a wide variety of speakers. Since 2013, Gergen has aligned with the American Academy of Sleep and Breathing to connect dentists, physicians, respiratory therapists and sleep technologists in education and collaborative care. The Academy’s vision is to create convenient, aﬀordably priced and highly reviewed classes, uniting both the medical and dental sides of the sleep community. These classes can be taken online or in person.

Spread the Word Celebrities like famous athletes are spreading the word – getting your patient’s attention, creating ‘targets’ for you to aim your eﬀorts towards. Dedicated professionals like David Gergen are out there stirring things up to raise awareness, all the while making the highest quality oral appliances for you.

Celebrities like famous athletes are spreading the word – getting your patient’s attention, creating ‘targets’ for you to aim your efforts towards.

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SPRING 2014Sleep • SLEEP&&Wellness-Winter W ELLNES S MAGAZIN E

2015

“...most people wake up feeling much more refreshed from lucid dreams that from everyday non-lucid ones!

WHAT IS LUCID DREAMING? WRITTEN BY CHARLIE MORLEY

UCID DREAMING IS ONE OF THE HOTTEST TOPICS WITHIN SLEEP AND DREAM RESEARCH RIGHT N O W , B U T W H A T I S I T ? How does

it work? And crucially, can it help us to sleep better? Charlie Morley, author of the bestselling book on the subject, Dreams of Awakening, helps us find out.

SO WHAT IS A LUCID DREAM? A lucid dream is a dream in which the dreamer is consciously aware that he is dreaming while the dream is happening. A

lucid dream is not just a very vivid dream or a very intense dream. Most people have experienced this type of dream at some point in their lives. Through the process of learning the art of lucid dreaming, you can experience this amazing phenomenon at will. In a lucid dream, the dreamer has not awakened. In fact, he is sound asleep but part of the brain has reactivated, allowing the dreamer to experience the dream state with self-reflective awareness. Once you know that you are dreaming as you are dreaming, you gain access to the most powerful virtual reality generator in existence: your mind.

S LEEP & WELLN ES S Winter-2015 MAGAZIN E • S PRING Sleep & Wellness

2014

Hay House author Charlie Morley received the traditional “authorization to teach” lucid dreaming from the Tibetan Buddhist master Lama Yeshe Rinpoche in 2008 and was asked to teach by meditation teacher Rob Nairn, who described him as “the most authentic practitioner of lucid dreaming and dream yoga teaching in Europe.” Charlie has run retreats and workshops around the world, written the book Dreams of Awakening, and given the first talk on lucid dreaming at the well-known “TED” conferences. You can learn more about Charlie at www.charliemorley.com or by watching Charlie’s TED talk on YouTube (www.youtube.com/watch?v=p1i6A7t6L2g).

Charlie Morley

SOUNDS GREAT, BUT DO WE HAVE SCIENTIFIC PROOF OF ALL THIS? Yes. Up until the late 70’s, lucid dreaming was scoffed at by much of the scientific community as a “paradoxical impossibility,” which had no data to support its validity other than the subjective accounts of the lucid dreamers themselves. However, in the early 80’s lucid dreaming was scientifically verified through the joint efforts of Stephen LaBerge and Keith Herne (both universitybased sleep researchers).

“

IN A LUCID DREAM YOU ARE NOT ONLY EXPERIENCING A MUCH DEEPER LEVEL OF THE UNCONSCIOUS (YOU CAN’T GET MORE UNCONSCIOUS THAN ASLEEP) BUT YOU ALSO GAIN ACCESS TO IT OF YOUR OWN VOLITION.

More recently, studies from Frankfurt University’s neurological clinic and the Max Planck Institute of Psychiatry found that specific alterations to brain physiology appeared in lucid dreamers. Using brain-imaging technology such as magnetic resonance tomography and EEG, scientists can now pinpoint the actual “‘Aha! I’m dreaming!”’ moment of lucid awareness and its neurophysiological correlates. The researchers concluded that “lucid dreaming constitutes a hybrid state of consciousness with definable and measurable differences from the waking state and from the REM (rapid-eye movement) dream state.” They discovered that when lucid consciousness was attained within the dream, activity in areas associated with self-assessment and self-perception increased markedly within seconds. The apparent paradox of being both aware and asleep, which had previously caused a lot of resistance and skepticism from the scientific establishment, was simply a failure to understand how two distinct brain regions could be activated simultaneously.

OK. SO IT’S BEEN SCIENTIFICALLY PROVEN, BUT WHAT’S THE POINT OF LUCID DREAMING? A person who is having a lucid dream is conscious within the unconscious. This is a similar state to that used by hypnotherapists to guide us into the unconscious

mind and offer suggestions for healing. However, in a lucid dream you are not only experiencing a much deeper level of the unconscious (you can’t get more unconscious than asleep) but you also gain access to it of your own volition. In lucid dreams, we gain conscious access to the vast storehouse of knowledge that resides in our unconscious mind and thus open up a possibility to heal ourselves from addictions, phobias, negative thought processes, and limiting belief systems—all while we are sound asleep. I explore the benefits of lucid dreaming and teach how to actually do it in my book, Dreams of Awakening.

BUT WON’T I WAKE UP TIRED? No, in fact most people wake up feeling much more refreshed from lucid dreams that from everyday non-lucid ones! Lucid dreaming occurs almost exclusively within REM sleep, which is not a restful sleep state; in fact, an alternate name for REM sleep is “paradoxical sleep,” the paradox being that the brain is actually more active during dreaming than it is while we are awake. If we are not resting during our dreams, we might as well use them for self-development and psychological healing, right? Sleep research has demonstrated that once we are fully aware within our dreams, the brain starts exhibiting certain high-frequency brain waves that have been linked to feelings of oneness and psychological contentment, which will lead to a much more refreshing sleep.

SOUNDS GREAT! HOW DO I SIGN UP? There are loads of books available on the subject and some great websites too, which will help you to learn how to lucid dream. Get Googling! If you want a more practical experience, you can check out my workshop schedule for next year at www.charliemorley.com. S&W

15 37

“

Written By Janaye Key

for Sleep Disorders of Arrowhead

Welcome To Koala Center

The primary goal of a Koala Center for Sleep

Disorders is to help you sleep better than you ever have before so you or your patient can enjoy life to the fullest. Our team of fully trained dentists and staff are here to provide a comfortable treatment option for patients suffering from Obstructive Sleep Apnea and Temporomandibular Joint Disorder (TMD).

Sleep & Wellness Winter-2015

The American Academy of Sleep Medicine and the American Sleep and Breathing Academy approve oral Appliances for patients who suffer from snoring, mild to moderate sleep apnea and sleep disordered breathing. Our outcomes meet or exceed national averages. Oral Appliance Therapy is a non-surgical, non-pharmacological option, which is a comfortable alternative to CPAP. This therapy is often covered by medical insurance. Contact 623-207-8744 the Arrowhead ofﬁce for a list of in network plans. For nearly three decades, Dr. Rod Willey, founder of Koala Center for Sleep Disorders, career was centered on helping patients through the practice of general dentistry. He received advanced training in neuromuscular dentistry, orthodontics, and oral appliance therapy for obstructive sleep apnea which

I am extremely passionate about treating patients with sleep apnea and other sleep complications. Although I realize I cannot change the world Good God I wish I could, I know I can make a world of difference in the people I treat - Dr. Castle

led him to start the Koala Center for Sleep Disorders. Today his focus, and the focus of the Koala Center for Sleep Disorders dentists, is on an even greater goal — Saving Lives. For nearly three decades, Dr. Rod Willey, founder of Koala Center for Sleep Disorders, career was centered on helping patients through the practice of general dentistry. He received advanced training in neuromuscular dentistry, orthodontics, and oral appliance therapy for Obstructive Sleep Apnea “OSA” which led him to start the Koala Center for Sleep Disorders. Today his focus, and the focus of the Koala Center for Sleep Disorders dentists, is on an even greater goal — Saving Lives. The Dental director for Koala Center for Sleep Disorders of Arrowhead is Dr. Mark Castle. He has been practicing locally for over 4 decades. His commitment to his patients and the outcomes he has been able to achieve are well known.

“I am extremely passionate about treating patients with sleep apnea and other sleep complications. Although I realize I cannot change the world Good God I wish I could, I know I can make a world of difference in the people I treat, “- Dr. Castle According to numerous articles and studies, 20% of Americans experience some form of sleep disorder, including insomnia, snoring, and sleep apnea — many of who go undiagnosed and suffer unnecessarily. What’s even more dramatic is that these numbers are expected to increase, due in large part to the obesity epidemic in this country, which affects every population group from the aging baby boomers to young children. Sleep disorders are more than just a nuisance that affects both job performance and personal relationships.

Sleep & Wellness-Winter 2015

When you consider that studies have shown that men in particular who are affected by severe sleep apnea have an almost 60% increased risk of developing heart failure, it is clear that sleep disorders have become a lifethreatening health crisis. Snoring occurs when the soft tissue structures of the upper airway collapse onto themselves and vibrate against each other as we attempt to move air through them. This produces the sound we know as snoring. Large tonsils, a long soft palate, a large tongue, the uvula, and excess fat deposits in the throat all contribute to airway narrowing and snoring. Usually, the more narrow the airway space, the louder or more habitual the snoring. Snoring is the sound of partially obstructed breathing during sleep. While snoring can be harmless, it can also be the sign of a more serious medical condition known as OSA. When OSA occurs, the tongue and soft palate

A typical sequence of OSA occurs when a person stops snoring and is silent for seconds, or minutes. The body’s oxygen level drops and the blood pressure rises. The heart is forced to beat faster, causing the pulse rate to increase. The brain may cause the arms, legs or whole body to jerk in an attempt to wake the sleeper so breathing will resume. The silence may end with a loud snort, cough or gasp. This causes the sleeper to wake brieﬂy and begin breathing. Once asleep again, the muscles relax and the airway becomes blocked, cutting off the airway again. This cycle can occur hundreds of times per night. OSA is the most common form of sleep apnea. It ranges in severity from mild to moderate, to severe. Other forms of sleep apnea include Central and Mixed Sleep Apnea The Koala Sleep center of Arrowhead has

collapse onto the back of the throat and

treated more former NFL greats than any sleep

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center in the United States of America. This is a

ﬂow of oxygen. The condition known as Upper

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Airway Resistance Syndrome (UARS) is midway

efﬁciency of the sleep center itself. If you have

between primary snoring and true OSA. People

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older, overweight men and affects signiﬁcant

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percentages of women and children as well.

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more likely to have it also. The serious and life-

koalasleepcenters.com/phoenix-arrowhead/

threatening problems start when sleepers begin experiencing apneas, where breathing stops, and hypopneas, where breathing is shallow due to an obstruction. Breathing is usually blocked in the back of the throat because:

Sleep & Wellness Winter-2015 S LEEP & W ELLN ESS MAGAZIN E • S PRIN G 2014

AND SLEEP

HOW INABILITY TO SEE CAN AFFECT SLEEP/WAKE CYCLES

WRITTEN BY SETH WALLACE, MD

PATIENT SCENARIO

Here is what normally happens. Light enters the eye and causes a photochemical reaction in pigments in the retina. This reaction is kind of like flipping a switch, and electrical signals are passed down the optic nerve and on to the back of the brain, where they are processed.

DISCUSSION

There is a tiny part of the brain behind the eyes that sits next to the optic nerves called the suprachiasmotic nucleus (SCN). The SCN monitors how much traffic is going through the optic nerves. At night, there is little activity going through the optic nerves. With morning, electric impulses start cruising down in the optic nerves, and the SCN figures it must be daytime and synchronizes itself.

24-YEAR-OLD MALE WHO HAS BEEN BLIND SINCE BIRTH HAS A LONG HISTORY OF DIFFIC U LT Y WITH HIS SLEEP S C H E D U L E . It seems like it takes longer and longer for him to fall asleep with each night that passes, and he feels like he needs to sleep in later and later. His sleep/wake periods will become progressively more delayed, such that after nearly a month, his sleep schedule will have delayed hour by hour until he is right back where he started.

Question: Is blindness the culprit in this patient? Why does this happen? Blindness is the cause of the progressive delay in the patient’s sleep schedule. To get an idea of what is going on, let’s first look at some basics with the internal clock in the brain. It is often referred to as the circadian clock. The prefix “circa” means around, and the suffix “dian” means day, so circadian literally means around the day. Our circadian clock isn’t exactly 24 hours; it is a bit longer, closer to 25 hours. If you had a watch that ran fast, you would have to set it back occasionally to keep it on schedule. Because our internal clocks “run fast,” we have to have a way to synchronize our clocks as the earth rotates once every 24 hours. Can you think of a good cue that tells our brains when a new day begins a particular location on earth? How about the rising of the sun? Is it possible that somehow our internal clocks can be synchronized by the rising of the sun?

In our patient, the SCN isn’t getting the signals through the optic nerves that synchronize it with the world around it, so the patient’s clock tells him to wake up about an hour later each day. Question: Does this daily sleep delay happen to all blind people? Let’s pose some scenarios and see what we can determine. Let’s say that the patient has horrible focus and can’t make out any detail because everything is so blurry. Would there be the same progressively delayed sleep schedule?

No, because light is still causing activity in the optic nerve. How about if a person had a stroke which wiped out vision processing at the back of the brain resulting in blindness? If the eyes are working and the optic nerve is transmitting, the SCN still gets the word that there is light and synchronization occurs, even though that person may not be able to see.

TREATMENT Stimulating melatonin receptors is another way to signal the body that time for sleep is approaching. Melatonin is produced by the pineal gland which sits near the SCN. Melatonin production is suppressed by light, but as light decreases, levels of melatonin in the bloodstream rise. The melatonin helps regulate the circadian clock. Oral melatonin, or a new prescription medication (tasimelteon), stimulate melatonin receptors and help regulate the sleep/wake cycle. Problems related to the circadian clock are fascinating. If you desire to learn more, you might want to research some other disorders related to the circadian clock, including delayed sleep phase disorder, advanced sleep phase disorder, shiftwork sleep disorder, and jet-lag. S&W

Dr. Seth Wallace is a native of Utah. He earned an undergraduate degree from Weber State University and received his MD from Tulane University in New Orleans. He is board-certified in sleep medicine and family medicine. Dr. Wallace is also interested in aviation and aviation medicine. He is an FAA-designated aviation medical examiner and an instrument-rated private pilot. Dr. Wallace resides in South Jordan, Utah.

Seth Wallace, MD

Sleep & Wellness-Winter 2015 FA L L 2 0 1 4 • S L E E P & W E L L N E S S M A G A Z I N E

INFOGRAPHIC

Sleep & Wellness Winter-2015 S L E E P & W E L L N E S S M A G A Z I N E • FA L L 2 0 1 4

SLEEP & WELLNESS MAGAZINE // SUMMER 2012

SLEEP Sydney Risser, P.T.

positions

SLEEP & WELLNESS MAGAZINE // SUMMER 2012

DID YOU KNOW...

THAT NEARLY ONE THIRD OF OUR LIVES ARE SPENT IN BED? With so many hours reclined, what’s the best position to keep us comfortable, ensure a restful night and minimize some of those morning aches and pains? To understand the best support for your body, you need to first understand the spine. If you look at the spine from the side you’ll see four graceful primary curves: the cervical (neck) curve, the thoracic (rib cage) curve, the lumbar (low back) and the sacral (pelvis) curves. When the spine is in its proper alignment and viewed from the side, the ears should align directly over the shoulders, the hips and finally over the ankles. This alignment of our curves is called neutral spine. Whether you view the neutral spine position from the back, front or side, you’ll see a nice straight line. The same concept applies to our sleep position. No matter what position we sleep in--whether on our back or side--the goal is the same: to align in neutral spine. The neutral spine alignment always falls in the same straight line--ears to shoulders and hips to heels, no matter if on our side or back. Now that you understand the goal of neutral spine positioning, let’s start with the most basic support-the mattress. The question many seem perplexed by is, “How firm should my mattress be?” Too soft of a mattress allows your spine to sag out of neutral causing our spine to look like a crooked line. However, the old mattress adage, “firmer is better” is no

Sleep & Wellness Winter-2015

longer true. Too firm a mattress won’t accommodate our body shapes, again throwing us out of neutral and causing pressure points.

You want to choose a mattress that will contour to your body. One that is soft enough to give or compress to our wider bony areas such as hips and shoulders but firm enough to fill in support to our narrower areas like the waist and neck. In other words, a mattress that will support you in neutral spine. If you were to lie on your side on a properly supporting mattress, your spine would look like a straight line. If you have low back pain, you may want to consider putting a pillow between your legs. Make sure the pillow supports both your knee and your foot. This will stabilize your legs and pelvis, eliminating any rotation of the low back out of neutral. The pillow should be big enough so that your knee and foot are level with that sharp-feeling front hip bone. Add a pillow to support your top arm and you should be cozy and comfortable. A long body pillow can support both the arm and the leg.

The next question is typically about the pillow. Like the mattress, the concept is the same--to support the spine in neutral. When lying on your side, if the pillow is just right, your nose should be horizontal. If your pillow

Sleep & Wellness-Winter 2015

is too high, your nose will slope downward toward the floor; too low and the nose will point upward toward the ceiling. When lying on your back, the curve of the pillow should again just fill the curve of your neck. If too big, your nose will slope down toward your chest. Too high, and your nose will point up toward the ceiling. You want the ear to align with the shoulder so, you guessed it, the spine is in neutral. Tired of hearing it yet?

If you have a pre-shaped cervical pillow, the thing to remember is that there are two different sized curves on each end of a cervical pillow. The small curve is to support your neck when lying on your back. The large curve supports your neck in side-lying. So, if you change positions in the middle of the night, say from your back to your side, you need to rotate your pillow as well. Keep in mind that cervical pillows need to fit your build. A large man will not have the same pillow as a petite

SLEEP & WELLNESS MAGAZINE // SUMMER 2012 woman. The pillow needs to fit your size, so that when lying on your side, the large curve fits into the space between the mattress, your shoulders and your neck and holds your spine to--you guessed it--neutral. If you have certain physical conditions, such as severe arthritis or a disc herniation, you may want to meet with your physical therapist to adapt the position to meet your individual needs. And know that even if the position is perfect, if it’s not the position you are accustomed to sleeping in, your body and brain won’t like it. It won’t say “sleep time” to you and it may not feel natural even if it’s good. When this happens you have to retrain the brain! Try resting in the correct position for at least five minutes and then don’t worry about it. Eventually, in about three weeks, your brain will stop rebelling and recognize it as the position that signals sleep time and you’ll wake in the morning with a few less aches and pains.

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CREATING A CULTURE OF

EXCELLENCE Improving patient experiences and increasing overall health. Story by Meghann Finn Sepulveda

Put People First & People Get Healthy. That’s been the mission at Arrowhead Health Centers for 18 years. Guided by a core commitment to providing positive patient experiences at all entry points, the team of dedicated health care professionals is focused on lowering health care costs and keeping patients healthy. Engaging Patients and Staff Leaders at Arrowhead Health Centers have adopted the Triple Aim principals, set forth by the Centers for Medicare and Medicaid Services (CMS), and applied the concept that consists of lower health care costs, healthier patients and great customer experience, to their practice. “We work hard to create the perfect patient experience so that when the patient leaves our facility, he or she is inspired to tell the Arrowhead story,” said Ken Levin, CEO of Arrowhead Health Centers. “It is our hope that our patients have such a positive experience and that they are highly engaged in their personal health plan, ultimately producing better outcomes resulting in healthier people.”

Levin credits the success of this approach to the staff at Arrowhead Health Centers. “Our goal is to not only have engaged patients but also engaged employees,” Levin said. “It is critical that our staff is vested in the organization and is very clear about their roles and responsibilities while respecting our core values and maintaining the same end game in mind.” This proves true for employees like Ernesto Meza, satellite clinic rehabilitation lead. “From the moment we all walk into an Arrowhead Health Centers location, patients are put first,” he said. “By the time the patient has been called back for an appointment, we have already discussed the care path including diagnosis and rehabilitation.

Sleep & Wellness-Winter 2015

We all work as a team to make sure each patient is comfortable and satisfied with their time here.” As part of the employee engagement effort, Arrowhead Health Centers have implemented an internal social network platform that recognizes employees who demonstrate the organization’s core values.

“This leads to better outcomes and ultimately lower costs.”

“It’s my job to really listen to my patients during each visit to understand where he or she is coming from and do everything I can to help alleviate pain.”

“Employees who give and receive a ‘nudge’ show better work performance, have increased productivity and feel a sense of pride and validation,” Levin said.

Providing Healthcare at a Reasonable Cost The Triple Aim principals are thought to be the significant contributing factor that successfully lowers health care costs. “Patients who are engaged in their health care are more compliant with the care plan,” Levin said.

The team at Arrowhead Health Centers recognizes it is the organization that also plays a significant role in getting patients healthy and has committed to creating an outstanding patient experience during every single visit.

Attracting and Retaining an Optimal Workforce

Caring for people is done by people; our Employees. To get and keep the best employees, an Employer needs to practice its values in all ways. One way Arrowhead puts its money where its mouth is by offering Free Healthcare to our employees and their families. This is absolutely unprecedented in the Valley or anywhere as far as we know. We can do this because we look at healthcare as an asset to the organization and expect to realize a 2 to 3 times return on the investment by attracting and retaining the highest quality workforce possible.

» Measuring Success Arrowhead Health Centers considers Net Promoter Scores to be indicative of how well the organization is doing when caring for patients. It is up to the staff to encourage patients to share their story. If a score is ever below a 6, a member from Arrowhead Health Centers reaches out to the patient within 48 hours to try and rectify the situation if necessary, and find out what could be done better next time. Leaders are always brainstorming ways to improve the patient experience. “We have constant communication with doctors and medical assistants to make sure patients are taken care of,” said Meza. “Each department is works together to discuss which treatment plan best suits that patient.” There is no need for patients at Arrowhead Health Centers to obtain a second option who can receive top notch care and reassurance from medical experts in one convenient location. “We have a virtual rehabilitation program where we can monitor patients without having them come in to the facility several times per week,” Meza added. “It is all tracked through a program and discussed with the patient over the phone or via email. It’s very convenient for the patient.”

Sleep & Wellness Winter-2015

Positively Reacting to Patient Needs The physicians and staff at Arrowhead Health Centers have embraced this culture, which was implemented by David Berg, D.C., and founder of the organization. It was that environment and the guidance he received from Dr. Berg that inspired Rob Byrne to pursue his chiropractic career at Arrowhead Health Centers. “It’s my job to really listen to my patients during each visit to understand where he or she is coming from and do everything I can to help alleviate pain,” said Rob Byrne, D.C., a chiropractic and osteoarthritis expert at Arrowhead Health Centers. “We treat everyone as an individual and try to reinforce the fact that our patients aren’t a number and won’t get lost in the system.” Dr. Byrne likes getting to know his patients on a personal level which helps him grasp a better idea of where each patient stands from a health perspective. “I enjoy hearing about their lives and sharing details of mine,” he said. “It helps me connect with my patients on a higher level.” •

The AHC Story Arrowhead Health Centers utilizes a custom publication, called The AHC Story Book, to outline company values, critical processes, and employee roles in a unique, engaging way. Read the story of how Arrowhead Health Centers was founded at arrowheadhealth.com

» Learn more about

Arrowhead Health Centers by calling 888-975-4146, or visiting their website at arrowheadhealth.com

Sleep & Wellness-Winter 2015

TIMING IS EVERYTHING GERGEN INTERVIEW

Sleep & Wellness Winter-2015

am David Gergen and I am the founder and President of the Pro Player Health Alliance. This organization was started to help retired National Football League players, who suffer from obstructive sleep apnea , find top of the line experienced dentists, in various cities across the United States, who can provide them with oral appliance therapy. In return, the players use their notoriety to get the word out to the public about the life threatening affects of obstructive sleep apnea, Hence the alliance. I have been involved in the dental field for 30 years. As an owner of one of the country’s largest orthodontic laboratories that specializes in the production of oral appliances for treating obstructive sleep apnea, I have seen it all. I have also had the privilege to have met great dedicated dentists from all around the country. I remember the first time I met Dr Neal Seltzer and Dr Jeffrey Rein. I was looking for qualified dentists to represent the New York City area as part of the Pro Player Health Alliance. One night, during the American Academy of Dental Sleep Medicine national meeting in Baltimore several years ago, I was introduced to two of the most qualified dentists in the world who treat patients with OSA. The person who introduced me , an icon in the industry, said , “ if you need quality care and professionalism in New York to handle your NFL players, Dr Seltzer and Dr Rein are your best choice.” After spending time with them throughout that weekend in Baltimore , we realized we knew a lot of fine dentists and technicians in common. One in particular linked our pasts and I knew right then and there that I had found my New York team. As we talked more and more , we came to learn that we were introduced into the sleep world about 25 years ago by a common iconic figure in dental sleep medicine , Dr Tom Meade. Tom is one of the founding fathers in the oral appliance field. As a young lab technician, I was the primary technician for building and developing his appliance. Little did I know back then that Dr Seltzer and Dr Rein started their illustrious career in sleep medicine using Tom’s device that I was involved with. Fate have it, 20 years later we would meet in Baltimore. It’s funny that we didn’t cross paths until then. Timing is everything. Shortly after our first meeting in Baltimore, I came out to New York to meet Neal and Jeff and their Long Island Dental Sleep Medicine team. My goal was to start setting up a public awareness event in Long Island , NY in the upcoming months in which local football greats could be treated and then share their experiences with the public. I was really impressed with the Long Island Dental Sleep Medicine Team . Their office was highly organized on all fronts and technologically state of the art. The entire staff was versed in sleep medicine and over the few days I was with them, I got a firsthand look at how efficient and professional the team handled patients from first meeting to final success after titrations. These dentists knew their stuff. Over the week that I was in New York , I came to learn that they were truly leaders in their field in this town. Most of the large hospitals, sleep clinics and a vast network of physicians in the area referred to them . I was impressed to hear from patients how many physicians considered them the “go to guys”. Around the country , whenever I have set up a Pro Player Health Alliance Team, the dentist usually draws retired players from the local city team. New York of course was unique. First of all there are two football teams in New York. The New York Giants and The New York Jets. In addition, there are retired players from all over the league who have settled in the BIg Apple. This made it even more exciting and increased the potential to help more players than usual. As my Pro Player Health Alliance football players and members of the New York NFL ALumni association began to come in for treatment, I was excited as I knew quality care was going to be guaranteed. Of course, as planned, NFL players made their way into the office , were treated successfully, and in turn we set up an event at a hotel on Long Island and were able to educate the public about apnea and oral appliance therapy. This was just the beginning of an even greater experience for Dr Seltzer and Dr Rein. A once in a lifetime opportunity followed the Long Island, New York event. As luck would have it, just a few months later New York city would host the Super Bowl that year and The Long Island Dental Sleep Medicine Team was invited to partake in a health screening for retired players during the week leading up to the game. Along with famed cardiac surgeon and one time NFL quarterback Dr Arthur “Archie” Roberts, who heads the Living Heart Foundation , Drs. Seltzer and Rein met with dozens of NFL legends at several venues around New York where they educated and helped screen these players for possible signs and symptoms of OSA. With the endorsement of the Pro Player Health Alliance and the NFL Players Association, Neal and Jeff were instant stars amongst these players. Grateful for the education they received and appreciative of the dedication these two have for helping others, players from teams around the league came to see them in their office and were successfully treated. Since then, their practice has continued to grow in leaps and bounds. They have done it the old fashioned way with hard work, honesty, integrity and lots of personal care for everyone that walks into their office. Amongst my colleagues in the industry they are known as two of the nicest and caring dentists in this field. Highly educated and respected by their peers , they are Diplomates of The American Board of Dental Sleep Medicine, The Academy of Clinical Sleep Disorder Disciplines, and The American Sleep and Breathing Academy. Their years of experience and passion for saving lives, be it a world famous athlete or the average person in their neighborhood, shows in all they do. They are industry leaders who I am proud to be associated with and now call my friends. If you or your loved ones suffer from Obstructive Sleep Apnea ; if you struggle with CPAP, or just need information about this life threatening condition, give Dr Neal Seltzer, Dr Jeffrey S. Rein , or the staff at Long Island Dental Sleep Medicine a call.

Sleep & Wellness-Winter 2015

FA L L 2 0 1 4 • S L E E P & W E L L N E S S M A G A Z I N E

SPORTS’ SECRET SECRET SPORTS’

WEAPON: WEAPON:

SLEE SLEE

EP EP

Sleep & Wellness Winter-2015 S L E E P & W E L L N E S S M A G A Z I N E • FA L L 2 0 1 4

✒

BY MICHAEL J. BREUS, PH.D. (THE SLEEP DOCTOR™)

THE SEARCH FOR PERFORMANCE ENHANCEMENT LEADS SOME ATHLETES TO TURN SOME PRETTY DARK CORNERS. IT’S A SHAME, AND NOT JUST BECAUSE DOPING IS DANGEROUS, UNETHICAL, AND FREQUENTLY ILLEGAL. IT’S ALSO A SHAME BECAUSE ATHLETES AT ALL LEVELS OF PLAY HAVE ACCESS TO A POWERFUL TOOL TO IMPROVE THEIR PERFORMANCE, ONE THAT WON’T BREAK ANY LAWS OR PUT ANYONE’S HEALTH AT RISK. CONTINUED

FA L L 2 0 1 4 • S L E E P & W E L L N E S S M A G A Z I N E

CONTINUED

SPORTS’ SECRET WEAPON: SLEEP

WHAT’S THIS WONDER DRUG?

SLEEP. There’s been a welcome uptick in the attention paid by the media and athletic professionals to the benefits of sleep for competitive athletes, and to the research that shows just how sleep can improve physical performance in sports. The NY Jets brought sleep specialists into the locker room, signaling their intention to use sleep as part of their training strategy. At the other end of the spectrum, I was disappointed to read that Manchester United is addressing its players’ sleep problems by issuing sleeping pills. This strategy—and the coach’s seemingly cavalier attitude toward medicating players for sleep—is not what I recommend when I suggest that athletes and coaches pay more attention to sleep. In recent years, Stanford University’s Center for Sleep Sciences and Medicine has been at the leading edge of examining the sleep-sport performance connection. Researchers there have conducted studies with several groups of Stanford student-athletes, examining the effects of extended sleep on athletic performance.

“SLEEP PROMOTES MUSCLE RECOVERY. SLEEP IS A CRITICAL TIME FOR CELL REGENERA TION AND REPAIR IN THE BODY.”

HERE’S A SAMPLING OF THEIR RESULTS, WHICH SHOW IMPROVEMENTS ACROSS A VARIETY OF SPORTS:

SWIMMING

TENNIS

Five members of the Stanford men’s and women’s swimming teams increased their sleep goal to 10 hours per night for a period of 6-7 weeks. This led to improvements in speed, reaction time, turn times and kick strokes. Swimmers shaved an average of .51 seconds off a 15meter sprint, they left the blocks .15 seconds faster, shaved .10 seconds off their average turn time, and added an average of 5 kicks to their stroke frequency. Out of the water, swimmers reported reductions in their levels of daytime sleepiness, improvements to their mood, more energy and less fatigue.

Researchers asked five members of the women’s tennis team to increase their sleep goal to 10 hours per night for 5-6 weeks. Players improved their sprint times, dropping from an average of 19.12 to 17.56 seconds. They also increased their serve accuracy, going from an average of 12.6 valid serves to 15.61.

BASKETBALL For 5-7 weeks, 11 members of the university’s basketball team extended their nightly sleep to 10 hours. As a result, shooting accuracy among the players improved significantly: Free throw shooting improved 9%, and three-point shooting 9.2%.

FOOTBALL Seven players on the Stanford football team spent 7-8 weeks attempting to sleep for 10 hours per night. Their extended sleep resulted in improvements to their 20yard shuttle—average time decreased to 4.61 seconds from 4.71—and to their 40-yard dash, which dropped to an average of 4.89 from 4.99 seconds. (Both the shuttle and the dash are among the drills conducted at the NFL Scouting Combine.) Players also reported improvements to their daytime energy levels and mood, and reduced daytime fatigue.

S L E E P & W E L L N E S S M A G A Z I N E • FA L L 2 0 1 4

Sleep & Wellness Winter-2015

SO WHAT’S BEHIND THE PERFORMANCE BOOST FROM

SLEEP?

Sensing a pattern? Extending sleep times translated into significant improvements to critical game-day skills. Worth noting: not all athletes across these studies actually slept for 10 hours per night, but attempting to sleep for 10 hours per night got them additional sleep compared to their regular routine. According to researchers, many of these athletes came to their sleep-sport studies already sleep deprived. And that gets to the flipside of the advantages that additional sleep can give to athletes. Sleep deficiency can inhibit performance. Research shows lack of sleep can also affect the longevity of players’ careers. Two recent studies investigated the relationship between sleep and career duration and stability among NFL players and MLB players. The NFL study looked at 55 players from across the league. Those who reported higher levels of daytime sleepiness were

less likely to remain with the team that drafted them than those players who reported lower levels of daytime tiredness. And MLB players who reported higher levels of daytime tiredness had attrition rates far higher than league averages. There’s also evidence that sleep can increase the risk of injury among athletes. In this study of teenage student-athletes, those who slept at least eight hours per night were 68 percent less likely to injure themselves playing sports than those who slept less than eight hours nightly. Researchers examined the sleep patterns and sports-related injuries of 112 male and female athletes from grades 7-12. They discovered that sleep and age were the most significant factors in assessing injury risk. (In addition to being more injury-prone when short on sleep, students were also more likely to injure themselves as they moved to higher grade levels.)

Dr. Michael J. Breus This article was originally published on www.theinsomniablog.com on November 19, 2012, where you can see details of the research for this article. You can read more of Dr. Brues’ insights on his web site, www.thesleepdoctor.com, or by following him on Twitter @thesleepdoctor.

The cognitive benefits of sleep translate onto the field. Memory, learning, reaction time and focus: sleep is critical to the brain’s ability to perform these mental tasks efficiently and well. The brain uses sleep to consolidate memory into longer-term knowledge, clearing the area of the brain used for short-term memory in preparation to absorb new information. During sleep, the brain also works to prioritize the information it thinks will be important in the future. Sleep deprivation has well-studied negative effects on reaction times—and even a single night of sleep deprivation can slow quick response times. Sleep promotes muscle recovery. Sleep is a critical time for cell regeneration and repair in the body. During non-REM stages of sleep, cell division and regeneration actually becomes more active than during waking hours. Insufficient sleep, on the other hand, hinders muscle recovery. Sleep is a stress reducer. Sleep and stress have a tangled relationship—and both are dangerous to healthy immune function when we don’t get enough (sleep), or have too much (stress). Stress can interfere with sleep. This study ranked worry as the most common cause of sleeplessness among adults 34-79, but lack of sleep can also affect mood and make us more susceptible to stress and anxiety. Is sleep the next big thing in sports? I’d say it’s more than earned its shot in the big show. S&W

Sleep & Wellness-Winter 2016

ARROWHEAD PRO SLEEP Changing the Landscape of Sleep Medicine in Arizona

bstructive sleep apnea is a serious sleep disorder characterized by pauses in breathing, with repeated stops and starts during sleep. According to the National Health Sleep Awareness Project, at least 25 million adults in the US are afﬂicted with obstructive sleep apnea, a chronic disease that increases the risk of high blood pressure, heart disease, Type 2 diabetes, stroke, depression, obesity and erectile dysfunction.

Sleep & Wellness Winter-2016

“Obstructive sleep apnea is destroying the health of millions of Americans, and the problem has only gotten worse over the last two decades,“according to Dr. Timothy Morgenthaler “Obstructive sleep apnea is destroying the health of millions of Americans, and the problem has only gotten worse over the last two decades, “according to Dr. Timothy Morgenthaler past president of the American Academy of Sleep Medicine. “The effective treatment of sleep apnea is one of the keys to success as our nation attempts to reduce health care spending and improve chronic disease management.” Despite the increasing prevalence of obstructive sleep apnea “OSA”, a large majority of patients with this ailment still remain undiagnosed. Arrowhead Pro Sleep, the ﬁrst sleep Center of Excellence to be recognized by the Arizona Cardinals is opening in February 2016 with a brand new model for screening and testing patients for OSA. The goals of Arrowhead Pro Sleep ‘APS’ are to address this need by initiating a screening process for all patients presenting to physicians’ ofﬁces, regardless of physician specialty, and to subsequently test and treat all patients who screen positive for OSA. APS is following the health model introduced to the medical world in 2012 by Dr. Avi Weisfogel owner of the Dental Sleep Masters ‘DSM’. Dr. Weisfogel and his various companies are responsible for treating thousands of patients with OSA and are also very involved in training dentists to help increase screening of patients across the country. The DSM model has been proven very effective and has led to a patient compliance rate of over 90% (the national compliance average is 43%). “It is our (APS) intention to change the way Sleep Medicine is being practiced in Arizona,” said Weisfogel. “For far too long sleep has been overlooked as most physicians receive limited training regarding sleep disorders and how to

screen for them. At APS we are going to work with our area physicians to screen every patient that walks into their practice and treat all patients who test positive for OSA and require treatment.” Gergen asked Kennard if he was feeling OK. Kennard followed by saying “I was just recently diagnosed with Sleep Apnea and the problem is I can’t wear that mask.” Gergen, who owns Gergen’s Orthodontic lab, the biggest manufacturer of dental oral appliances in the Country informed Kennard that there were other options such as an oral appliance. Kennard responded with “I will try anything.” Within one week of this conversation, Kennard was wearing an oral appliance and sleeping through the night. His Sleep Apnea, which was severe, was completely treated. A couple of weeks later, Kennard’s brother who also suffered from sleep apnea, passed away in his sleep with his CPAP sitting on his shelf (he couldn’t wear “the mask” either). Kennard called Gergen and told him about his brother saying, “ We can’t sit by and let this keep happening… so many people I know, including many of my brothers from the NFL, are suffering. We need to help them.” The PPHA was ofﬁcially formed the following week. To date the PPHA is responsible for treatment of over 250 athletes including, icons such as Charles Barkley an ex Phoenix Sun, Eric Dickerson [ex LA Rams, Indianpolis Colts Running back] and Roy Green [ex CARDINAL/EAGLES Wide Receiver & Cornerback]. This past May at the annual meeting of the American Academy of Dental Sleep Medicine in 2015, David Gergen was approached by Avi Weisfogel a Diplomate Dentist of the same Academy who wanted to learn more about Gergen’s laboratory in Phoenix, AZ, After talking for a few minutes on intense conversation Gergen and Weisfogel realized they had a lot in common and talked about the

Sleep & Wellness-Winter 2016

possibilities of improving the way dentists and physicians communicate about sleep. Unbeknown to Weisfogel was that David Gergen’s business partner is no other than Roy “Jet Stream”Green. Green had suffered three heart attacks and two strokes and was never even asked about sleep apnea. “PPHA got me treated and I have had no health issues sincesleep is related to so many aspects of my health” said Green. Through introductions facilitated by Green, they met with Eric Dickerson, who told them how he had suffered with headaches for 8 years. “The PPHA treated my sleep apnea, and I have not had a headaches since said Dickerson. I am a big advocate of PPHA and oral appliance therapy.” In addition, Arrowhead Pro Sleep and PPHA hope to increase awareness of treatment options for patients with OSA. “95% of all patients diagnosed with OSA are just given a CPAP as their only option,” said Weisfogel. “Many patients such as Derek and Eric are simply not able to tolerate a CPAP. PPHA has done an incredible job of presenting the oral appliance as a great alternative for patients who cannot tolerate CPAP. We at APS are committed to doing the same.” In addition to his laboratory Gergen is also the CEO for the American Sleep and Breathing Academy. The Academy puts dentists and physicians together so they can work as a team toward one goal, successful patient treatment. “For too long the dentists and the oral appliance have been an afterthought in the world of sleep,” said Gergen. “At the Academy we are opening physicians eyes to the success rate of oral appliances. While CPAP has been the supposed gold standard for sleep treatment it is very widely rejected by many patients. There are so many incredible dental practitioners that we know who can help these patients who have been diagnosed and do not know of anything but a CPAP. Our job at the Academy is to help get these patients treated by letting physicians know that there is an alternative choice available to their patients. In fact in mild and moderate cases it is the preferred treatment.” Using the philosophy of mild/moderate OSA patients’, being treated with oral appliances before they ever try a CPAP is one of the keys to Dr. Weisfogel’s program. “Our programs are successful for a few reasons, “said Weisfogel. “Number one we educate the physicians and the patients as to

all the possibilities of sleep treatment. “Every patient is shown all his or her options. They are shown demo models of both CPAP and appliances. They are even given brochures on surgical possibilities. The patients have also been given a recommended treatment suggestion from a Boarded Sleep Physician. By letting the patient choose their treatment we have increased the likelihood of patient compliance.” Number two; we put in a strict follow up protocol where all patients are retested after six months of treatment. If their treatment is not deemed successful we change the treatment to a different modality. We keep doing this process until we have exhausted all of the options. This protocol has led to a documented success rate of over 90%.” Perhaps the most exciting thing for Arrowhead Pro Sleep is the ability to work with the Super Bowl Hopeful Arizona Cardinals. Weisfogel a lifelong self-declared “sports fanatic”, is ecstatic at the chance to help pro athletes. “Football players in particular are at risk for sleep apnea a lot of which can be traced to the average neck size of NFL players. Men whose neck size is 16.5 or larger are more than twice as likely to have sleep apnea as someone with a neck size smaller than 16.5 ( for women their neck size should be under 15.) “Being able to work with athletes such as Roy Green, Eric Dickerson, and Charles Barkley just to name a few is a dream come true for me,” said Weisfogel. “I have been a huge sports fan and grew up idolizing these guys. To be able to not only work with these incredible athletes but to actually help them become healthy has been an incredible experience for me. I am so grateful to Dave and Roy for all they have brought to my life in helping me on my quest to treat the 90% of the population who suffer from sleep apnea but are not even aware of it. We are going to work as hard as possible to ensure that screening is being done in as many physician ofﬁces across the country as we can.” Stay tuned throughout the year to hear about the progress of Arrowhead Pro Sleep

Sleep & Wellness Winter-2016

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Sleep & Wellness-Winter 2016

Sleep & Wellness Winter-2016

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