Issuu

Official Publication of The American Sleep And Breathing Academy

COMPLIMENTARY WAITING ROOM EDITION

SUMMER 2016

INSIDE THIS ISSUE

Sports Stars Spread Sleep Awareness

Breakfast with Congress

ASBA Seeks Support For Dental Sleep Medicine

A Sleep Apnea

Event To Remember

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, D’ASBA

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

Sleep & Wellness-Summer 2016

From The Editor Sleep now, O Sleep now Sleep now, O sleep now, O you unquiet heart! A voice crying "Sleep now" Is heard in my heart. The voice of the winter

ne of the tenets 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. The Academy facilitates the improvement of professional networking within the field by expanding the scope of involvement to all healthcare professionals and administrators involved

Is heard at the door.

in sleep health and wellness. Sleep & Wellness magazine is a consumer-orientated publication

O sleep, for the winter

distributed to more than 110,000 dental and medical practices, as a complimentary copy for

Is crying "Sleep no more."

waiting room patients.

My kiss will give peace now

Our patient education, in addition to public sleep and wellness campaigns, will further assist

And quiet to your heart

you with the patient tools you need to be a leading sleep care provider. The ASBA hosts an

Sleep on in peace now,

annual convention every April for its membership and all interested sleep professionals. This

O you unquiet heart!

year, attendees enjoyed an incredible opportunity to learn more about treating sleep disordered breathing patients—either with oral appliance therapy or CPAP. All ASBA members are eligible to attend. Ensure that you are able to attend in 2017 by joining ASBA.

-Alan HickeyManaging Editor

James Joyce

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.

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: 714.296.5151 E-MAIL: info@myasba.com www.americansleepandbreathingacademy.com

Building Relationships: More than a series of Seminars, this Academy will help you build business plans using our proven methods to expand you practice. The ASBA hosts regular meetings with the goal to revolutionize the your practice. Peer training by Dentists who have built sleep practices with annual revenue over $1.5 M. This study club format is unique, very affordable, and designed to give you the tools to perform at the level of the mentors.

September 23, 2016 - September 24, 2016 Pointe Hilton Tapatio Cliffs Resort, 11111 N 7th St Phoenix, AZ 85020 United States

Table

of Con

tents

Mystery Sleeper

An Enemy Called Sleep

A Sleep Apnea Event To Remember

Breakfast with Congress ASBA Seeks Support For Dental Sleep Medicine

Q&A with Dr. Neuhaus

You Snooze, You Lose (infographic)

Q&A with Dr. Lauren Gerson

Blindness And Sleep

Sports Stars Spread Sleep Awareness

Lobby Like A Pro

Sleep Health

Hence The Alliance

Sleep Positions

Tax Planning

MOS T OF MY LIFE I HAV E BEEN A BIG PERS ON. FIRS T A BIG KID, THEN A LARGE ADULT. IT W ORKED W ELL ON THE PLAYGROUND, IN S PORTS , AND THEN IN COLLEGE. I S TARTED A PROFES S IONAL LIFE, PAID MY TAXES —FOR THE MOS T PART, JUS T BECAME A RES PECTABLE MEMBER OF S OCIETY.

BY LOUD U. SNORER

SOMEWHERE A LONG THE WA Y, PEOPLE STA RTED C OMMENTING ON MY NIGHTTIME RUC KUS. I wasn’t aware of it at first because, of course, I was asleep. But the complaints became louder and more frequent. T hey were often directed at my wife, who would hear things such as, “H ow do you sleep at night with that racket?” My wife was nice at first. She put up with it. I would occasionally get a jab in the ribs that would abruptly bring me out of whatever sleep I was enjoying to hear, “Quit snoring!” Do you think any of us who snore can stop just because someone asks us to?

Sleep & Wellness-Summer 2016

My s t e r y

Sle e pe r

CONTI NUED H

So this has been my life and my marriage for the past 25 years. Yes, I know I snore, but I don’t know what to do about it. My parents have been using these machines for ten years now. I just kind of looked at them with disdain. “N ot me,” I said. “I will never use a C PAP machine. T hat’s the silliest thing I have ever seen. I t’s just another fad, along with chin supports, aromas, and whatever else they sell at carnivals to stop snoring. I used to tell people I just do not need much sleep. I had seen a reporter mention that Bill C linton only slept a couple of hours a night. T homas Edison only slept a couple of hours a night. I figured I was one of the lucky ones who only required a couple of hours of sleep at night. W hile I thought sleeping just a little at night was all right, sleeping during the day was an issue. I would fall asleep as soon as I sat down. Forget watching a movie. I remember often going to a movie with my kids and not getting through the previews. I ’d wake up at the end of the movie. “At least it was a dollar movie,” I would comment. L ater, I went back to school to get my doctorate. School meant long hours of class, study, and writing that dissertation. I did not have time to sleep. H owever, one day I was driving home from classes and felt my head bob. W here wa s I ? H a d I been asleep, and if so, for how long? I could have hit someone or

I realized I had to deal with my sleep problem— and soon. I would force myself to get more sleep, I promised.”

“

even killed someone. T hat was unacceptable. I realized I had to deal with my sleep problem—and soon. I would force myself to get more sleep, I promised. For the next year, I really did try to get more sleep. But though I slept more, I did not feel rested. I n fact, I was still nodding o in movies and whenever I had a quiet moment. I realized I was su ering from sleep apnea. By this time, the science was there: apnea is bad. H eart disease, diabetes, and so many of the diseases often attributed to aging also can be associated with sleep apnea. After accepting that I had sleep apnea, I had to decide what to do about it. I t’s important to note that I make my living flying airplanes. I have been doing it for many years, and I am not about to give it up. Pilots have to pass a medical exam; if they have a medical issue, they must disclose it. Pilots who have medical issues that can a ect the safety of passengers are grounded. For me, that was a big reason to avoid being diagnosed with sleep apnea! I figured the bottom line was, I was not getting enough sleep. I resigned myself to using a C PAP machine. I thought I ’d just go buy one. T hen I learned that’s not possible. A person needs to have a medical exam, be diagnosed with sleep apnea o cially, and then get a prescription before he can buy a C PAP machine. A re you kidding? C learly everyone, including yours truly, can see or hear that I am su ering from sleep apnea. S&W

YOUCAN READMORE OF THE MYSTERY SLEEPER’S STORY IN THE NEXT EDITION OF SLEEP & WELLNESS MAGAZINE.

ENEMY

CALLED SLEEP Little did Dr. Kevin Mueller know in 1980 when he walked across the stage to get his dental diploma that much of what he had just been taught would be turned upside- down. Why was tooth enamel that is capable of lasting 300 years wearing out in as little as 1 to 2 decades for so many people? What he began to learn was that there was far more insidious villain in the dental universe than tooth decay. And that’s where the story begins....

Sleep & Wellness-Summer 2016

After graduating with his DMD degree, Dr. Mueller performed a one-year residency at St. Mary’s Hospital in Southern Illinois where he began feeling disillusioned with the shortcomings of his dental degree. Why were there so many failures in dentistry? Was it poor education, materials, technique, or the technology being employed – or perhaps something else? It was in 1984 when he attended the Pankey Institute that his eyes were opened to the world of occlusion (how teeth contact the teeth in the opposing jaw). This is where he was introduced to the process and philosophy of centric relation dentistry (how teeth contact or slide when not perfectly centered over the opposing jaw).This is where he learned about the relationship with bite, headaches and jaw pain, and how these factors affect wear on teeth and dental restorations. Like a seismologist who just learned how to predict an earthquake, Dr. Mueller was now able to restore the esthetics and function of the teeth given the challenges well below the surface that were not predicted until the damage was done. As his journey continued, he found even more signals of future damage in the Temporal Mandibular Joint (TMJ).The TMJ is the only joint in the human body that is not a ball and socket. Its complex anatomy (diarthrodial) allows us to eat and drink and is perfectly designed for speech.This joint also has specialized connective tissue cartilage that does not occur in other movable joints. But because of its sensitive complexity, the TMJ is susceptible to severe wear and tear from traumatic movement including popping and clicking.This eventually is accompanied by jaw and muscle pain, locking, tooth wear and erosion, and often manifests itself as sleep disorder breathing. Each new discovery opened up whole new realms that sent his passion and career on a new trajectory. He took more courses at the Spear and Dawson Institutes, and he began to see how occlusions and TMJ should be the starting point in dentistry – not an afterthought. In early 2000, Dr. Mueller joined the American Academy of Craniofacial Pain (AACP), where he earned his fellowship, and studied with everyone possible to learn even more on the subject of occlusion,TMJ and facial pain. Dr. Mueller was growing closer to predicting earthquakes. He was connecting the dots, but were they the source, or were they pointing to the source? It was then he joined the academy of Dental Sleep Medicine (ADSM) and where his understanding of the actual source deepened, the tectonic plates that control everything above them – AIRWAY AND SLEEP. It was here he discovered that the dental issues that contribute to tooth loss: decay, periodontal disease and bone loss, in many patients, can be directly related to sleep disorders. A recent publication of a John Hopkins University study, it was reported that 83% of all TMJ patients suffered some type of sleep disorder. So the dots were now connected and put in order: sleep disorder,TMJ, occlusions, and these manifest on the surface as teeth are worn down and dental restorations are torn apart.

Often, dental patients requested “night guards” to protect worn teeth, but unfortunately, it was discovered in a study, this appliance actually worsened the airway in 60% of the patients who wore them. Consider former Arizona Cardinals tight end Mark Walczak. After years of suffering from untreated sleep apnea and multiple traumas to the head, neck and teeth brought on from the rigors of being a pro football player, he desperately searched for help. Mark’s smile was fading as his teeth were breaking down. He was referred to Dr. Mueller to see what could be done to restore his smile and his conﬁdence. After several appointments, which included diagnostics and addressing the underlying airway and sleep problems, Mark not only got his beautiful smile back, but also had his sleep apnea, malocclusion and jaw problems addressed. In Mark’s own words (and with his new movie star smile) he says: “My life has forever been changed due to the incredible work of Dr. Kevin Mueller. He is truly a master at the science of dentistry. His restorative work was nothing less than miraculous and an overwhelming blessing in my life. He dramatically improved my physical and mental health in ways words alone can’t describe. My aggressive wear and fracturing was from years of college and professional football as well as severe sleep apnea and night time grinding and bruxing. I am so thankful to Dr. Mueller and I’m honored to call him my friend.” - Mark Walczak-

Mark Walczak (Before and After)

Sleep & Wellness Summer-2016

“Breathing through your mouth may keep you alive, but it won’t keep you healthy.” -Dr. MuellerDr. Mueller is often quoted as saying “Breathing through your mouth may keep you alive, but it won’t keep you healthy.” His practice is a showcase of the most advanced dental and sleep technology. He and his staff are committed to mastering the science of sleep as it relates to the dental world. And he knows that these skills will take a lifetime to master, but it will be a life well invested since he sees such consistent results – especially in the children. One of his most recent challenges is studying and identifying obstructive airways issues in children. Children’s early symptoms include nighttime teeth grinding, snoring, bed wetting and attention deficit problems. These signs, if addressed early, can help eliminate a lifetime of troubled smiles and low self-esteem. Once a person has reached adulthood, unfortunately, “the horse is out of the barn” as Dr. Mueller says. We can only prevent collapse-ability of airway, tearing up natural teeth and treat apnea when caught early in life. After that, only further damage control can be offered. Dr. Mueller’s passion has also led him to effectively connect the dental and medical models through evaluating his patient’s bite force, jaw function through joint vibration analysis, and airway and breathing obstructions to gain insight on patient’s occlusal challenges. Dr. Mueller acknowledges that it takes 10 years to master anything in this field. He has now spent 30 years in dentistry, 20 studying TMJ disorders and the last 10 years learning sleep disordered breathing. He is confident that all practices in the future will need a full complement of airway and sleep evaluations as part of their practice for proper preventative and restorative programs. Dr. Mueller now has them all under one roof.

About Dr. Kevin Mueller, Fellow, American Academy of Craniofacial Pain FAACP, Diplomate, American Board of Cranio-Dental Sleep Medicine DABCDSM, Diplomate American Sleep and Breathing Academy D’ASBA: Dr. Mueller owns Arizona Smile Design and the TMJ and Sleep Therapy Centre Phoenix West, in Sun City West Arizona. He graduated From Southern Illinois University School of Dental Medicine and is an associate professor at the Midwestern School of Dental Medicine in Glendale Arizona. His education includes the institutes of L.D. Pankey, Dawson, Spear and Hornbrook, as well as the TMJ & Sleep Research Therapy and The Center for Advanced Restorative Dentistry (CARD). Dr. Mueller can be contacted at: AZ Smile Design (623) 474-3343

Dr. Mueller Presenting Treatment

Roy Green Former Arizona Cardinal

Mark Brnovich Attorney General, AZ

Big Red Ofﬁcial Mascot

A SLEEP APNEA EVENT

TO REMEMBER Sleep apnea affects more than 20% of the US population, and elevated body mass is a big

part of the condition. Americans took particular note of sleep apnea when it contributed to the death of 43-year-old NFL defensive lineman Reggie White more than a decade ago.

White was a 13-time pro bowler who weighed nearly 300 pounds—placing him squarely

in a group that is particularly susceptible to sleep apnea. A study in the New England

Journal of Medicine found that football linemen accounted for 85% of sleep apnea cases

among the more than 300 NFL players tested. Sleep apnea is considered by some to be an occupational hazard for NFL linemen.

As owner of Gergen’s Sleep Appliance Lab, and

As a result, these superstar athletes become more

executive director of the American Sleep and

than just patients, but every day people who

Breathing Academy, I formed an organization with

publicly support and spread the awareness of OSA

Hall of Famer Mike Haynes, Roy Green, Derek

at events across the nation. With the combined

Kennard, and Mark Walczak, known as the Pro Player

effort of former NFL greats, local establishments and

Health Alliance (PPHA). The PPHA, where I serve as

public ﬁgures, the community as a whole can unite

president, is an organization dedicated to helping

to direct potential patients toward dental/medical

treat former NFL players who suffer from obstructive

professionals who can help.

sleep apnea (OSA).

Sleep & Wellness-Summer 2016

Larry FitzGerald Larry FitzGerald Arizona Cardinals Arizona Cardinals

Chief of Police Joseph Yahner Phoenix Police Department

Law Enforcement and Sleep Apnea After Studying 5,296 law enforcement officers in North America, a Harvard Medical school group reported that 40% of active duty officers suffered from sleep abnormalities. These include apnea, insomnia, shift work disorders, restless legs syndrome, and narcolepsy. Yet sleep disorders in police officers often go undiagnosed and largely untreated, according to Dr. Rudi Ferrate. For example, “almost half the individuals diagnosed with obstructive sleep apnea [a dangerous condition in which impaired breathing can lead to a heart attack or stroke] do not regularly take treatment,” he says.

A January 2016 Phoenix-based sleep apnea event at Padre Murphy’s turned out to be a triumph of timing and execution. The Arizona Cardinals football team, and its owner Nicole Bidwill, who was honored by the FBI last year, chose to cosponsor the public sleep apnea awareness event in conjunction with the PPHA and the Phoenix Police foundation. The publicity for the event was electric, driven by a season that saw the Cardinals win a franchise high 13 regular season games and a third NFC West division title. Cardinal superstar Larry Fitzgerald, and retired Cardinal Roy Green, lead the event with David Gergen.

Sleep & Wellness Summer-2016

Lieutenant James Holmes Phoenix Police Department

Dr. Brad Eli mentioned, “I have been attending sleep

Inside the event, everyone was excited to see Larry

apnea events for over 20 years and have never seen

Fitzgerald and Roy Green. In my role as master of

more than 400 people (and that was a PPHA event

ceremonies, I was moving things along and the crowd

in Tacoma, Washington). Imagine my surprise when I

seemed to really be enjoying themselves especially

arrived at the event in Phoenix and saw crowd control

when they had the opportunity to get an autograph,

in the parking lot and out on the street. There was a

or participate in the phoenix Police Foundation

huge parking lot overﬂowing with cars and people

auction (which offered many great autographed

thronging into Padre Murphy’s Sports Grill. The

items).

Phoenix Police reported that there were over 3000

A few of my favorite moments were when

people in attendance. The main area was so packed

Phoenix Police Chief Joseph Yahner presented Larry

that people were being turned away at the door. At a

Fitzgerald and Roy Green with honorary Police ofﬁcer

certain point entrance to the parking lot was blocked

awards. The crowd yelled Larry…Larry…Larry and

off to new trafﬁc.”

surged forward, sparking some concerned glances by security—however, the mood was great and everyone was having a great time.

Sleep & Wellness-Summer 2016

David Gergen PPHA and ASBA

Mark Brnovich Attorney General, AZ

Eric Dickerson Former Los Angeles Ram

Legendary running back Eric Dickerson, who still

Many American Sleep and Breathing Academy

holds the NFL’s single season rushing record, inspired

members were impressed to learn that eight of the 40

attendees when he put his hand on my shoulder and

Phoenix police ofﬁcers, and 42 other attendees, made

said to the crowd, “I want to thank David Gergen for

appointments with ASBA Diplomate Dr. Mark Castle at

waking up the world to the dangers of sleep apnea.”

Koala of Arrowhead, to be treated for their sleep apnea.

Politicians, Public Safety, and the Next PPHA Event Mark Brnovich, attorney general for the state of Arizona, who wears an oral appliance for his sleep apnea, and Alberto Gutier, secretary of Transportation, were also in attendance and wanted to make sure that everyone understood the perils of sleepy driving, and the public safety benefits of a good and restful night’s sleep. They were impressed with the Sleep Herbst as an alternative to CPAP for commercial drivers and emergency response personnel.

Ultimately, the event proved to be an important milestone in the education of the public. Current and retired NFL players were invaluable in spreading the message. Roy Green, NFL legend and former Cardinals WR/ DB has said, “If I had met David Gergen years ago, I’m conﬁdent I would not have had to experience having a heart attack, let alone three heart attacks and two strokes. I am extremely grateful for what he’s done for me and my former teammates, and I’m glad to be a part of spreading awareness on sleep apnea so others don’t have to go through what I did.”

Sleep & Wellness Summer-2016

Over the years, more and more retired NFL greats have

Make Plans for Next PPHA Event

contacted me regarding their sleep apnea. I am happy

The next PPHA event, in collaboration with the American

to refer them to an ASBA dentist, to ensure the quality of

Sleep and Breathing Academy, will be aimed at

treatment remains at the highest level. I was fully aware

improving awareness and understanding of sleep related

of what was happening in America regarding sleep

disorders in the general public. It will be the ﬁrst ofﬁcial

disorders, but I knew connecting patients with NFL icons

celebration to kick off the new season for the Arizona

would bring awareness to a whole new level.

Cardinals, and will also serve as a fundraiser for the

Roy Green and I decided to help the retired players

Phoenix Police Foundation.

and improve awareness of sleep disorders by promoting these large public events. I can’t wait to see the results

Location and time of the public awareness event and

from the Sept 6th Padre Murphy’s event. We were

fundraiser for the Phoenix Police Foundation will be

overwhelmed by the number of people who attended

Tuesday, Sept 6, 2016, at 6:30 p.m. to close, at Padre

the previous event, and could not handle it; this time we

Murphy’s, 4338 West Bell Road, Phoenix, Arizona 85308.

will be prepared and have ASBA Diplomates Dr. Beth

It is expected that this event will draw more than

Hamann and Dr. Mark Castle of Koala Biltmore and Koala

5,000 attendees.

Arrowhead with us.

Dr. Elliott J. Alpher

receives support from Congresswoman

Anna

Eshoo on screening and tracking compliance for OSA

in highway and rail transportation personnel

WASHINGTON, D.C.— Dr. Elliott J. Alpher, Diplomate to and representing the American Sleep and Breathing Academy, Former Congressman Marty Russo (D-IL.), and Congresswoman Anna G. Eshoo (D-Calif.), Ranking Member of the Energy and Commerce Committee’s Subcommittee on Communications and Technology for the 114th Congress met today to ask her support on proposed rulemaking for screening, diagnosing, treating and tracking compliance of Obstructive Sleep Apnea (OSA) in individuals occupying sensitive positions in highway and rail transportation.

Sleep & Wellness-Summer 2016

“OSA is a prevalent disorder among workers, which increases the risk of occupational accidents and has a significant impact on public safety. Fortunately, many of these accidents could be prevented by screening and treating sleep-disordered breathing with the resources and technology available... we are grateful to have Congresswoman Eshoo’s support on this matter,” -Dr. Alpher-

Sleep & Wellness Summer-2016 The Federal Motor Carrier Safety Administration (FMCSA) and Federal Railroad Administration (FRA) have requested data and information concerning the prevalence of moderate-to-severe obstructive sleep apnea (OSA) among individuals occupying safety sensitive positions in highway and rail transportation, and on its potential consequences for the safety of rail and highway transportation. Many mental functions are reduced when an individual experiences fatigue and sleepiness. It is estimated that 20% of accidents are caused by drivers’ inattention and sleepiness, and the occurrence of drowsiness when driving is a major risk factor for dangerous accidents. Chronic excessive sleepiness and sleepdisordered breathing are common in commercial vehicles drivers. “OSA is a prevalent disorder among workers, which increases the risk of occupational accidents and has a signiﬁcant impact on public safety. Fortunately, many of these accidents could be prevented by screening and treating sleep-disordered breathing with the resources and technology available...we are grateful to have Congresswoman Eshoo’s support on this matter,” says Dr. Alpher. View Comments for FMCSA-2015-0419 “In the Matter of Medical Certiﬁcation of Transportation Workers in Safety Sensitive Positions; Individuals Exhibiting Risk Factors for Moderate-to-Severe Obstructive Sleep Apnea”

Dr. Alpher, one of the District’s most experienced specialists for sleep and jaw disorders, on staff at George Washington University Hospital and Georgetown University Hospital, has been known as a leader in the treatment of sleep disorders and jaw pain for 25 years. Dr. Alpher has pioneered a conservative, non-invasive approach utilizing computerized and veriﬁable diagnostic methods to treat TMD, snoring and sleep apnea.This method of treatment has proven to be greatly successful and is highly regarded as the ﬁrst method of choice by physicians and patients. Dr. Alpher was also recently responsible for heading a delegation to the Federal Motor Carrier Safety Administration (FMCSA) and Medical Advisory Board (MAB) to introduce the new technology of micro recorder compliance in oral appliances to treat and monitor sleep apnea and snoring of truckers and other transportation personnel. In addition, he earned the status of Diplomate of the American Board of Craniofacial Pain & Dental Sleep Medicine in October 2013 and serves as a board member. Dr. Alpher is a Diplomate of the American Academy of Pain Management, Life Member of both the American Dental Association and the District of Columbia Dental Society. Dr. Alpher is also a board member and Diplomate to the Board of the American Sleep and Breathing Academy. americansleepandbreathingacademy.com/

https://www.regulations.gov/#!docketDetail;D=FMCSA-2015-0419

About Dr. Elliott Alpher Dr. Elliott Alpher is a pioneer and recognized national authority in both sleep disorders and jaw pain issues. He is one of the most sought after specialists in these areas. Here’s why: With more than 30 years of experience and significant credentials, Dr. Alpher continues to demonstrate his ongoing commitment to improving outcomes. He continues to take accredited continuing courses, conduct research and participate in practice workshops with colleagues. Dr. Alpher takes the time required with each patient to understand the problem and pinpoint the best jaw pain or sleep disorder treatment. Dr. Alpher uses conservative, non-surgical methods for treating jaw pain and sleep disorders with a 97% success rate.

James Gandolﬁni

Dr. Jay Neuhaus

with Dr. Neuhaus

The busy New York dental practice of Jay Neuhaus, DDS, managed to thrive for many years in the ultra competitive Manhattan environment. Practicing in an ofﬁce half a block from Park Avenue, complete with a view of the city’s iconic Chrysler tower, Neuhaus’ Gramercy Dental Arts successfully treated pain and temporomandibular joint (TMJ or TMD) disorders, in addition to traditional restorative dentistry for over 36 years. Dr. Neuhaus graduated NYU Dental School in 1975, and then went on to an internship at Jacobi Albert Einstein Hospital in New York. In 1978, he bought a practice in Gramercy Park, Manhattan, where he operated for 35 years. In August 2015, Neuhaus moved to new digs in the Grand Central area of Park Ave and 40th St, also in Manhattan, and focuses mainly on Sleep Apnea, under the name of Sleepwell Orthotics, LLC. After many years of general dentistry, Dr. Neuhaus became involved in treating TMJ/TMD pain back in 2000, ultimately evolving toward “full mouth rehabilitation” and exploring the connection between improved airways and the burgeoning ﬁeld of sleep medicine. Sleep & Wellness visited with Dr. Neuhaus to talk about his vast experience and how it has all helped to foster better dental sleep medicine in today’s world. How has your level of TMJ expertise led to improved dental sleep medicine? Most dentists deal with single tooth restoration. The whole idea of changing someone’s bite doesn’t come into play at all when doing a single tooth, and that’s probably what 80% to 90 % of dentists out there do. But when you’re dealing with an entire mouth, and changing somebody’s entire arch, you have to take into account the TMJ and the muscles, and the comfort and the proper balance of the entire mouth or you’re just doomed to failure. In doing full mouth at LVI (Las Vegas Institute for Advanced Dental Studies), I got very much involved in their neuromuscular TMJ courses with the use of computerized instruments and verifying bites and getting patients built—getting their mouths built—at the proper location, and the proper bite setting. Proper jaw placement is crucial to keep the TMJ joint healthy and functioning well and pain free, and to keep the restorations from fracturing.

How did your work with TMJ lead to dental sleep medicine? Once I started getting involved with TMJ and placing the jaw in various advanced positions, I started reading a lot about sleep apnea. At that point, LVI did not have any sleep apnea courses. That has deﬁnitely changed. I furthered my education through a lot of dental sleep medicine courses, way back, I’d say, in the early 2000s. I started taking courses and really understanding how many bite issues and clenching and bruxism issues are totally related to the way a person sleeps at night, or doesn’t sleep at night. I took many many sleep courses and got involved in sleep medicine—working on my own patients back in early 2000. I found it fascinating how I was helping people stay alive.

Sleep & Wellness-Summer 2016

What raised your level of interest in dental sleep medicine? It was just coming to the forefront of the news back in the 2000s. The public was starting to hear the words ‘sleep apnea’ that only a few people had heard previously. It was definitely never taught to us in dental school, and many of my physician colleagues also had never heard of it during their time in medical school. With so many people suffering from sleep apnea, it was coming to the forefront at that point, and it just made sense to me. I remember my father, may he rest in peace, and how the walls of the apartment shook when he went to sleep, supposedly, with his gasping and snorting. Who knows if we could have extended a few extra years to his life if anyone knew about sleep apnea back then. What did you start to notice with your own patients? I started to notice how many of the heavier set patients were falling asleep in the waiting room, or in my chair, between procedures. I would notice the snoring and the gasping but at the time never realized that, oh my God, their oxygen level is dropping; it’s affecting their organs, their body.The more I learned and saw; I was just fascinated by it. I personally, had a test done on myself at one of my earlier courses and I discovered that I had sleep apnea. I started wearing an appliance way back in the 2000s, and it immediately helped me. So it was something I truly believed in, from my heart, that there was a way to combat this rampant epidemic in our society. Tell us about treating James Gandolfini It was in the year 2009, and a member of my staff said, ‘You know, someone just called and wants to come in for a consultation on TMJ, and he said his name was James Gandolfini.’ From 20002008,The Sopranos was an American crime drama television series, revolving around the fictional character and family of New Jersey-based Italian American mobster Tony Soprano played by James Gandolfini. I didn’t know if he was kidding or what. He wasn’t referred by anybody. He just found my name by searching google for a local TMJ dentist. So we just waited, and we were all nervous the day of the appointment to see who was going to come walking in and, sure enough, James Gandolfini came in.The thing that stands out the most to me is he came on a motorcycle—this was in Manhattan—and comes into my office. I saw his helmet sitting on one of the seats, and he’s sitting in the other seat. I mean, literally, I have never seen a helmet that size. It took up the entire seat. This was a big man. He came in, and it was a TMJ problem he was having, and I took him through the TMJ protocol and treated him for a few months. While he was in my chair, again, I couldn’t help but notice his size, and his falling asleep in the chair and pretty early on I said to him, ‘James, I suspect you have sleep apnea.’ And he said, ‘Nah, leave me alone.’You know, he puts on that act, but he’s truly a

gentle teddy bear once you get to know him. But he loves to come on like he’s Tony Soprano. So anyways, he said, ‘Leave me alone. I sleep fine. I came here for my TMJ, so just do my TMJ and that’s it.’ As we’re nearing the end of treatment, getting his jaw comfortable, I say, ‘Listen I’m making you this appliance.’You knew he wouldn’t get tested, so I said, ‘I’m making you this appliance. I’m not charging you, but please just wear it.’ He says, ‘Do whatever you want.’ Eventually, he puts the appliance in his mouth, takes it out right away, throws it on the ground, and says, ‘No way in hell I’m wearing this f****** thing.’ But I put this idea in his head that he had sleep apnea, and I was happy about that because, shortly after he moved to California, I transferred his records to a colleague of mine out there and, lo and behold, a few years later, his physician insisted that he get tested. He did get tested. He had sleep apnea and was given a CPAP machine. Who knows? I’m hoping he used it a lot—every day. Perhaps, if he were diagnosed at a much earlier age and treated properly, we may still have this great actor and person here with us today. For those who don’t know, Gandolfini died in 2013 at the age of 51 from a heart attack. Did Gandolfini’s death change your opinion about how you should practice dental sleep medicine, or your level of training or commitment to it? Absolutely. My assistant and I were at the funeral. It was such a sad day, and a loss for the world that day. It made me realize that it’s not just what most people think of as snoring, which seems like a funny problem that people have, but it’s not funny, it so serious that it takes lives. When I read about these train crashes in my area—the Amtrak train that crashed because the engineer had sleep apnea, and the deaths; that’s the sensational death that we hear about, but what we don’t hear about are the thousands of people who are dying prematurely from other diseases that could have been helped if they treated their sleep apnea. It made me want to learn more and become more involved. I undertook extensive training, joining boards on societies, and trying to advance the whole screening process throughout the Country.There are so many people who require treatment, the public just does not know enough about this problem.They are not educated about the severity of the issue, and we rely on sleep physicians to help as many people as possible become aware of it. Along with Dentists we need more physicians to become involved in spreading awareness for the good of society. I’m presently helping a 12-physician group of Cardiologists, Pulmonologists, Endocrinologists & Internists screen all of their patients for sleep apnea. Our statistics show that 50% of the patients seen by these secondary care physicians screen positive for sleep apnea.The amazing thing is how their comorbidities are being helped by treating their sleep apnea.

Sleep & Wellness Summer-2016

Dr. Jay Neuhaus DDS graduated from the New York University College of Dentistry in 1975, and then completed his residency at the Albert Einstein College of Medicine Hospital. He is one of only a few hundred neuromuscular dental practitioners in this country to have achieved the “fellowship” level of post-graduate training at the prestigious Las Vegas Institute School for Advanced Dental Studies, where his sole focus was full mouth dental cosmetics and reconstruction, sleep apnea, and TMJ. He has also served as director of Dentistry at Morrisania Hospital New York, acting as a mentor to dental residents. With over 40 years of experience, Neuhaus has changed his patients’ lives by eliminating the symptoms of TMJ, such as headaches, back and neck pain, and by creating beautiful smiles. For the past ﬁfteen years, Neuhaus has concentrated on saving and prolonging lives of countless patients suffering from sleep apnea and loud disruptive snoring. www.gramercydentalarts.com www.sleepwellorthotics.com

Sleep & Wellness-Summer 2016

INFOGRAPHIC 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

Sleep & Wellness Summer-2016 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

Dr. Lauren Gerson is a nationally-recognized researcher and caregiver in the ﬁeld of general gastroenterology including colorectal cancer screening, gastroesophageal reﬂux disease (GERD), gastrointestinal motility disorders, capsule endoscopy and gastrointestinal bleeding.

with Dr. Lauren Gerson

Those who struggle with gastroesophageal reflux disease (GERD) and suffer from painful acidic regurgitation and sleep disruption may be looking to explore new ways to treat their conditions. We spoke to Lauren Gerson, MD, a gastroenterologist at California Pacific Medical Center in San Francisco, to elaborate on the influence GERD may have on sleep management and options GERD patients can look to improve their condition in the near future. Is there a medical explanation as to why severe GERD symptoms occur at night? When patients lie down and go to sleep, the three mechanisms normally used to help reduce GERD symptoms during the day change.These mechanisms include reduced production of saliva (that normally neutralizes acid), reduced muscle contractions of the swallowing pipe known as peristalsis (helps keep acid out of the esophagus) and decreased gravity (since the patient is lying down and not upright). GERD can also become more severe in the evening or night if patients eat dinner within three hours of bedtime. Particularly if the meal is high in fat, the fat content can delay the stomach from emptying which then can cause more reflux symptoms. For this reason, it’s advised that patients eat heavier meals during the day, consume a lighter dinner and eat light snacks if needed before bedtime.

Please explain why sleep deprivation can agitate GERD. Also, how does it impact a sleep-deprived patient with this condition’s health and recovery? Lack of sleep quality and fatigue may aggravate sensory receptors and worsen patient’s perception of acid reflux and esophageal pain. Patients with heartburn waking them from sleep can be significantly affected in terms of their overall energy levels, capacity to function the next day, and ability to work productively. See attached publication from Gerson and Fass (2009).1 Why are GERD patients who experience nighttime acid reflux more subject to sleep disorders? Based on the 2009 review, we were unable to show a cause and effect relationship between GERD and sleep apnea. We believe that they are both very common conditions that appear to co-exist in patients alongside obesity, another risk factor. What non-surgical methods are available to treat GERD? What are the most commonly prescribed treatment methods for this condition? Most patients are commonly treated with antireflux medications. If patients have night-time heartburn it’s important to take these drugs 30-60 minutes before dinner for maximum effect. Patients can also add on H2-blockers like Pepcid at nighttime if needed. The efficacy of the proton pump inhibitor drugs like omeprazole are significantly reduced if taken after meals. Patients can also try sleeping with their head elevated with a 6-8 inch wedge.

Gerson LB, Fass R. A systematic review of the deﬁnitions, prevalence, and response to treatment of nocturnal gastroesophageal reﬂux disease. Clin Gastroenterol Hepatol. 2009;7(4):372-8.

Sleep & Wellness-Summer 2016

Other solutions include endoscopic therapy, which can provide relief for frequently reoccurring symptoms.The TIF (transoral incisionless fundoplication) procedure, a minimally invasive approach done without incisions, is one such solution. During the procedure, the surgeon or endoscopist places an instrument into the stomach, advances a trocar into the tissue of the esophagogastric junction, tightens the valve, and then deploys plastic pieces through the valve to keep it tightened.

A pH study should also be done to conﬁrm the diagnosis of GERD if no erosions are present.These tests should be done in centers with esophageal expertise and read by gastroenterologists with training in esophageal disorders. Are there a large number of facilities currently utilizing the TIF procedure? The TIF procedure is widely available throughout the U.S.To ﬁnd a center nearest you, please go to www.GERDhelp.com to the “physician locator” tool.

Is there a treatment that has been found to be most effective for GERD patients?

As GERD may be a contributing factor to sleep disorders, what are the implications for sleep medicine professionals (such as recommendations for patient diagnosis and treatment)?

Proton pump inhibitors (PPIs) are very effective in terms of healing of esophagitis in 70-80% of patients with providing symptom relief in 60-70%.They are safe to use as needed or daily if needed for control of the patient’s acid reﬂux symptoms but they do not address the underlying problem like the TIF procedure does by ﬁxing the anatomy.

We have been unable to prove that GERD directly causes sleep apnea but they are both common conditions, and CPAP may improve this condition. Atypical symptoms including chronic sinus infections, cough, or even asthma may be triggered by the presence of underlying acid reﬂux, therefore, sleep medicine doctors should evaluate for the presence of GERD as well.

What are the benefits and disadvantages for patients of the new treatment TIF procedure? The TIF procedure is incisionless, minimally invasive, and does not run the risk of causing “gas-bloat syndrome” because the 270 degree wrap it creates around the esophagus is not as severe as the wrap created with Nissen fundoplication.The procedure also does not have the long-term side effects commonly associated with traditional antireflux surgery, such as trouble swallowing and increased flatulence. The TIF procedure also has a strong safety profile, with over 17,000 patients treated to date with fewer adverse events and complications than traditional antireflux surgery.

Do you have anything else you’d like to add regarding this topic? Doctors should ask GERD patients about the specifics of when and how their symptoms surface.These questions should include when the heartburn symptoms occur. Some patients only report daytime acid reflux, while others only note the symptoms after dinner or when lying down. Other important questions include whether patients wake up with heartburn and/or acid in the throat. Finally based on pH monitoring some patients reflux at night but do not feel this occurring and this subset of patients may be more prone to development of complications like esophagitis and/or Barrett’s esophagus.

Some disadvantages include the duration of the procedure is not completely known. Currently, there is data showing durability up to two to three years. U.S. registry data shows that long-term GERD sufferers who underwent the TIF procedure maintained symptom relief without the need to take PPI medication for two years. So far outcomes data have suggested that it is as effective as a Nissen surgery.

Medical therapy should be adjusted appropriately according to their answers. Patients may not appreciate the connection of atypical symptoms to anatomical defects and so do not typically volunteer this information to their physicians. I It’s important for medical professionals to prompt them about typical and atypical GERD symptoms to provide them with the best care.

How can a medical professional determine who is an appropriate candidate for the TIF procedure? Ideal candidates for the TIF procedure regularly experience GERD symptoms, and either no longer respond adequately and/or are dissatisﬁed with their current treatment. Patients need to undergo endoscopy to determine if they have esophagitis and a hiatal hernia. If the hernia is larger than 2 cm, it is likely contributing to GERD and needs to be repaired as part of an overall treatment plan.The TIF procedure is indicated to reduce hiatal hernias 2 cm or less. In addition, patients should undergo esophageal manometry to determine if they are suited for the TIF procedure and to exclude other conditions.

For more information on GERD and how you can become more pro-active in your dental practice, visit Dr. Gerson’s website at http://www.laurengerson.com or go to www.GERDHelp.com

Bell RCW, Barnes WE, Carter BJ, Sewell RW. Mavrelis PG, Ihde GM, Hoddinott KM, Fox MA, Freeman KD, Gunsberger T, Hausmann MG, Dargis D, Gill BD, Wilson E,Trad KS Amer Surg 2014

Sleep & Wellness Summer-2016

S LEEP & W ELLN ES S MAGAZINE • SPRIN 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

No Matter the Arena Sleep Boosts Performance

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.

Sleep & Wellness-Summer 2016

Recently the news has been lled 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 o ce 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 o ce. Now we’re passing the ball o 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 ZQuiet- SA 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 di erent 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 e ectively. 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.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 eld’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 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 su er the same fate, put these two related issues together and changed the course of his life’s work.

Sleep & Wellness Summer-2016

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 e ective 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 e ect 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 docs.

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 t the same pro le found across the country in countless dental o ces – people at risk for sleep breathing problems, diagnosed but given only one solution. What was required was a high- quality solution.

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 a ected 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 ght against sleep apnea. Roy Green says, “It all begins with eight simple questions, now, that’s not too painful, is it?”

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.

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

Sleep & Wellness-Summer 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 Summer-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.

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

LOBBY “ T h e r e a s o n g r o u p s h i r e p r o f e s s i o n a l lobbyists i s th a t t h e fe d e r al g ove r n m e n t i s h u g e a n d i t 's a big

job to stay informed on an issue.”

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

LIKE A PRO ✒ BY

MARTY RUSSO, FORMER CONGRESSMAN

I FIRST BECAME AWARE OF THE WIDE-RANGING IMPACT OF SLEEP DISORDERS WHILE I FIRST BECAMEWITH AWARE OF APPLIANCE THE WIDE-RANGING OF SLEEP DISORDERS WHILE BEING TREATED ORAL THERAPYIMPACT BY DR. ELLIOTT ALPHER OF THE BEING TREATED WITH ORAL APPLIANCE THERAPY AT THE ALPHER CENTER IN WASHALPHER CENTER IN WASHINGTON, D.C. WHILE I WAS BEING FITTED FOR THIS NEW TECHINGTON,FOR D.C. SLEEP I HEARD ABOUT THE WAYS GOVERNMENT GETTING NOLOGY APNEA, DR.ALL ALPHER GAVETHE ME FEDERAL A RUNDOWN OF ALL THEWAS WAYS THE INVOLVED IN REGULATING SLEEP DISORDERS. FEDERAL GOVERNMENT WAS GETTING INVOLVED IN REGULATING SLEEP DISORDERS. THE U.S. DEPARTMENT OF TRANSPORTATION WAS LOOKING AT THE TRUCKING INDUSTRY THEHOW U.S. DEPARTMENT OFSAFETY TRANSPORTATION WAS LOOKING AT THETRANSPORTATION TRUCKING INDUSTRY AND SLEEP IMPACTS ON OUR ROADS. THE NATIONAL AND HOW SLEEP IMPACTS SAFETY ON OUR ROADS. THE NATIONAL TRANSPORTATION SAFETY BOARD WAS INVESTIGATING AIRLINE AND TRAIN ACCIDENTS TO DETERMINE IF SAFETY DUE BOARD AIRLINE AND TRAIN ACCIDENTS TO DETERMINE IF FATIGUE TO WAS LACKINVESTIGATING OF SLEEP PLAYED A ROLE. FATIGUE DUE TO LACK OF SLEEP PLAYED A ROLE. DR. ALPHER HAD A MISSION TO GET THE LATEST SCIENCE ON TREATING SLEEP DISORI LEARNED THAT IT WASOF ALL PART OF A MISSION TO SO GETTHAT THE LATEST SCIENCE ON TREATDERS INTO THE HANDS FEDERAL POLICYMAKERS THEIR DECISIONS COULD ING SLEEP DISORDERS INTO THE HANDS OF FEDERAL POLICYMAKERS SO THAT THEIR BE MADE BASED ON FACTS AND NEW CUTTING EDGE TECHNOLOGY. DECISIONS COULD BE MADE BASED ON FACTS AND CUTTING EDGE TECHNOLOGY.

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LOBBY LIKE A PRO

I spent 18 years of my career in Congress and the past 22 years as a lobbyist, and I had no idea that sleep issues were so hot at the federal level. I dug a little deeper and discovered that the Veterans Administration is very concerned about sleep for returning veterans who experience PTSD. The Center for Medicare Services is looking closely at how to reduce the high cost of treating health issues that result from sleep disorders and fatigue. In fact, throughout the federal government there are many agencies that are waking up to sleep disorders. What does this mean for sleep specialists? I can tell you from years in Washington, D.C., that when the federal government starts investigating an issue, the people who care about that issue need to be ready. A famous saying is, "If you're not at the table, you're on the menu." This means that the sleep community needs to get active and take its seat at the table so that federal actions will help the cause, not hurt it. As a Democrat, I think the government has a role in helping people. But as a lobbyist I know that federal policymakers often do not have the information they need to make good decisions. As a lobbyist, I was frequently hired to help a business dig out of a hole created by the unintended consequences of a federal action. Whether you are a sleep expert or just a person who has learned first-hand the dangers of sleep disorders, my message is, "Get involved. You can make a difference."

HERE ARE SOME FOOTBALL ANALOGIES TO INSPIRE YOU TO RUN OUT ONTO THE FIELD AND MOVE THE BALL FORWARD ON SLEEP DISORDER AWARENESS: • Scout. Research what is happening in the federal agencies and who in the sleep community is already involved. Who agrees with you? Who is opposed? Where are good sources of information? • Team up. Professional lobbyists don't go it alone. They build up a groundswell of support from stakeholders. Talk to colleagues, professional medical and dental academies, trade associations, local officials, healthcare leaders, and people who care. Tell them your mission and ask for help in getting your message out.

Marty Russo, Former Congressman A native of Chicago, Former Congressman Marty Russo has spent a career navigating the maze of federal institutions in Washington, D.C. First elected to Congress at the age of 30, Marty served his constituents for nine terms alongside legendary Congressional leaders and Presidents from both political parties. Marty believes in taking an active role to make our government and country a better place. As part of a capstone to a successful career as a top lobbyist, he speaks to audiences about how to have more influence so your voice can be heard to make a difference in Washington.

• Train. Develop your message points in a clear, easy to digest format, and keep your team informed. Meet with your member of Congress. Send your materials ahead of time (one-page summary with technical documentation as needed). Educate the Congressman on sleep disorders in a brief, focused meeting. Let him or her know that you are available as a resource. Send updates on scientific advances and federal activity. I tell people that developing an ongoing relationship with your Congressman and Congressional staff before you ask for help is the single best action you can take. • Play Defense. Educate regulators before they act. Comment on a proposed policy. Write a letter. Make sure there is an abundance of good information in the right hands so that when someone puts the regulatory ball in play, your message is already ingrained in the system. • Play Offense. Sometimes agencies get it wrong. When the Federal Aviation Administration issued a policy on pilot fatigue that caught the sleep community off guard, there was so much uproar that the policy was reversed within a week. When you hear of movement taking place, deploy your team, get your message out, contact your Congressman and have your voice heard. • Stay in the game. Most important, stay involved. It takes time and effort to move the ball up the field. Don’t expect a score every time you touch the ball. The reason groups hire professional lobbyists is that the federal government is huge and it's a big job to stay informed on an issue and then know when, where, and how to make your move.

The advantage you have is that you care about sleep and want the government to make smart decisions when making policy. That’s worth all your effort. You may save a life. S&W

Sleep & Wellness-Summer 2016

SPRING 2014 • S LEEP & WELLN ESS MAGAZIN E

SLEEP HEALTH WRITTEN BY RAYMOND HALL, MD SLEEP SCIENCE EXPERT, INVENTOR, AND SPORTS MEDICINE CHIROPRACTOR OF PACIFIC COAST SPORTS MEDICINE, LA

• Tired in the afternoon? Take a nap or siesta! Napping has been shown to improve productivity, improve alertness, reduce stress and the risk of heart disease, and reduce accidents at work and on the road. Even a work-friendly, 10- to 20-minute nap should be enough to set you up for a productive afternoon.

ORE THAN 40 MILLION AMERICANS SUFFER FROM CHRONIC SLEEP DISORDERS W I T H D E VA S TAT I N G C O N S E Q U E N C E S .

Sleep health has been neglected for so long, we’ve become a nation that is carrying the weight of increased obesity, auto accidents caused by drowsy driving (even more than texting), increased neck pain and even advanced signs of aging through poor quality and disrupted sleep.

Proper sleep hygiene, which is the routine that promotes healthy sleep patterns, can prevent the development of sleep problems and disorders as well as being an important factor in the quest to stay looking and feeling as young as possible throughout your life. Here are recommendations to take control of your sleep health and live your optimal life:

• Be consistent with sleep. Sleep is as important to a person as fuel is to a car, both in terms of quality and quantity. You need proper sleep to run your physiological engine. Poor quality sleep is like water in your fuel tank. You can’t store extra deep sleep or REM sleep, so approach your sleep health with balance and respect. It takes approximately 90 minutes to complete one sleep cycle, and a good night’s rest includes about five full cycles. Allowing yourself enough rest has great benefits during the daytime, as you will feel rejuvenated and alert and will be less prone to illness.

• Reduce pain and improve healing responses. After 29 years of treating headaches, neck and back injuries, as well as chronic muscle and joint pain, I firmly believe that sleep disruptions or sleep deprivation can have a major impact on pain as well as healing. Disruptive sleep due to abnormal breathing patterns can literally change oxygen concentrations in the bloodstream, which can also lead to headaches and poor healing.

Sleep & Wellness Summer-2016 SLEEP & WELLNESS MAGAZINE • SPRIN G 2014

• Stay young! Sleep affects every vital organ of our bodies in a profound way and can dramatically affect the aging process. Visible aging begins when the breakdown and oxidation of tissue exceeds the normal growth and maintenance of tissues within our bodies. Skin is the most visually dramatic and recognizable organ that expresses aging. Aim for optimal aging, or maximizing the body’s natural, daily healing process to rejuvenate and restore cellular tissue as well as actively minimize the breakdown and oxidation of all of the trillions of cells within your body. Good sleep hygiene is a critical factor in optimal aging.

• Improve mental alertness. Think of your sleep control mechanism as a variable dimmer switch that controls your lights. When you crawl into bed from a busy day, your dimmer switch is on high. You slowly lower the switch as you progress through the different stages of sleep; in stage 4, deep or delta sleep, your light is completely dark. Deep sleep is very important for hormone production and physiological regeneration. After about 50-60 minutes, your dimmer reverses itself, creating a brighter “light” and REM sleep kicks in. REM sleep is sometimes called paradoxical sleep because your muscles become essentially deactivated but your brain activity is similar to when you are awake. REM sleep lasts about 20-30 minutes and is said to be essential. We can consider REM sleep in computer terms: during REM sleep, you empty your recycle bin (decreasing some “mind clutter”) and transfer information from your memory to your hard drive. REM sleep has been scientifically proven to be a creative stage of sleep that can increase the associative networks in our brain and is linked to improved learning, focus and memory.

• Make wise choices about your sleep environment. Seek out a mattress that supports your body (not one that molds around you) and remains cool and breathable. Find a pillow that offers correct, anatomical support for your neck to open your airways and increase oxygenation. Your pillow should not push your head into a forward posture, similar to the posture you may assume during the day, with your shoulders curved and head and neck pushed forward over a computer or smartphone. When you sleep on your back or side, your pillow should support and lengthen your spine, encouraging more restful sleep, preventive health and improved beauty sleep. Sleeping on your back, with the correct contour for your neck, prevents wrinkles and promotes healthy sleep, naturally!

Remember, you’re in control of your sleep health, and making good choices will reap great results. S&W

HENCE HENCE THE THE

ALLIANCE ALLIANCE

I 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 .

Sleep & Wellness-Summer 2016

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.

We are always available to talk with you and address your concerns. Please feel free to contact us during the following hours through our ofﬁce phone number or e-mail address. After hours, you may contact us through our answering service. -Dr Seltzer and Dr ReinPhone: (516) 741-6202 | Fax: (516) 741-9620 Email: info@lidentalsleepmedicine.com Dr. Seltzer: nsdmd@longislandsmile.com Dr. Rein: drrein@ longislandsmile .com Long Island Dental Sleep Medicine 101 Hillside Ave. Suite A Williston Park, NY 11596

Sleep & Wellness Summer-2016

Dr. Rein and Dr. Seltzer

Bart Oates , Center, NY GIANTS 3 time superbowl champ being ﬁtted for Herbst

OJ Anderson NY GIANTS , Super Bowl MVP at ofﬁce for Oral Appliance Therapy with Staff

SLEEP & WELLNESS MAGAZINE // SUMMER 2012

SLEEP Sydney Risser, P.T.

positions

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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

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

www.sleepandwellness.net

Sleep & Wellness-Summer 2016

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

www.sleepandwellness.net

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.

TAX Sleep & Wellness Summer-2016

PLANNING The Dental Assistant Versus The Hygienist n the dental profession the roles of the dental assistant versus the dental hygienist are pretty clear. However, to the average consumer of dental services there is very little distinction. In our industry, tax planning, we see the same blurred lines amongst consumers. When it comes to tax planning services the average consumer is often not aware that there is a clear distinction between the role of a tax planning specialist and a CPA/tax preparer. First, let’s examine the definition of CPA, an individual who has passed the uniform CPA examination administered by the American Institute Of Certified Public Accountants, and who has received state certification to practice accounting. The primary functions performed by CPAs relate to assurance services. In assurance services, also known as financial audit services, CPAs attest to the reasonableness of disclosures, the freedom from material misstatement, and the adherence to the applicable generally accepted accounting principles (GAAP) in financial statements. There’s a myth floating around that Certified Public Accountants (CPAs) do tax planning. However, the CPA exam does not focus on the topic of tax planning. For your average CPA, tax planning is an independent subject, removed from accounting, tax preparation, financial reporting, audits and

consulting. But, the average consumer of tax services looks to the CPA/tax preparer for their tax planning needs. So, what is the difference between your CPA/ tax preparer and a ﬁrm specialized in tax planning strategies? PJS Services, a partner of Financial Gravity, has staff trained, and certiﬁed, to use the tax code to help you save money on your taxes. We have a proven and patented process that focuses on four key strategies. If you are a business owner and pay $20,000 in taxes we offer a free assessment. We can evaluate if you’re CPA/tax preparer is optimizing your tax savings, or if we can offer strategies that can save you money. Our process guarantees that we can save you over twice as much as the fee for our service or we will give you a refund. Remember, CPAs are generally not proactive tax planners. Typically they are bookkeepers and tax preparers. Their lack of proactive planning may be costing you money you could use for college tuition, or preparation for your retirement. On the other hand, PJS Services, a partner of Financial Gravity, are proactive tax planners with a proven track record of saving small and medium size business owners

Sleep & Wellness-Summer 2016

an average of $21,000 per year (year over year) in income taxes. CPA really stand for “Public,” as in a publicly-traded company or the general “public”. Either way, the CPA designation was created to teach general accounting principles, not to help business owners lower their taxes. This is a critical distinction. CPAs are not traditionally trained to help you lower your taxes. They are trained to be accountants; they are number historians.

“We can evaluate if you’re CPA/ tax preparer is optimizing your tax savings, or if we can offer strategies that can save you money on your taxes.”

At PJS Services, LLC we use your most recent tax return to analyze and implement four primary tax planning strategies that have saved our clients on average $21,000 per year. We call this our Tax Blueprint. Then we work with your CPA, or we can work for you separately, to implement these strategies. Do you believe your CPA is saving you enough money on your taxes? If not, see if we can … all you have to do is take our free 15 minute assessment to start the process. We will either let you know your taxes are optimized, or we will recommend strategies in our Tax Blueprint to save you money. You can visit our website for Tax Savings case studies, and speciﬁcally to learn more about Dr. Ron Perkins, who has been in practice for over 40 years, and saved over $50,000 on his Tax Blueprint. Let’s ﬁnd out how much money we can save you! You can call us at 800-316-3295 or email us at info@pjsservicesgroup.com to schedule an appointment. Also, please stop by and meet us at the Sleep & Wellness Conference.

The ASBA provides networking opportunities with other members and organizations, lobbying for improved reimbursements while seeking to lower ever escalating health care provider costs, and discounts on educational events, products and accreditations for its members. This organization will help members more affordably lead the way to a new frontier in sleep medicine with the end goal to improve patient care through education for sleep professionals, sleep centers, patients and the community at large.

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