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SLEEP APNEA DIAGNOSIS AND TREATMENT: American College of Chest Physicians to Meet in San Diego
The American College of Chest Physicians is set to meet next week in San Diego. San Diego is also home to Dr James Loye a dentist who treats sleep apnea with comfortable oral appliances in lieu of CPAP treatment.
Dr Loye is a member of http://www.ihatecpap.com a website that stresses the serious nature of sleep apnea and the need for treatment and follow-up with medical specialists in sleep medicine. He is a member of The American Academy of Dental Sleep Medicine (AADSM) an trained with I HATE CPAP LLC founder Dr Ira L Shapira.
Dr Loye can be contacted thru his website http://www.sandiego.ihatecpap.com/
Treatment of Sleep Apnea and Snoring has become a major aspect of Dr Loye's office. Dr Loye states he used to be a dentist who treated sleep apnea and snoring in his dental practice, but his practice has morphed into a Dental Sleep Medicine practice that also does exceptional dental work including Neuromuscular Dental Treatment of TMJ disorders and chronic headaches and migraines.
The NHLBI, National Heart Lung and Blood Institue has an excellent report: "CARDIOVASCULAR AND SLEEP RELATED CONSEQUENCES OF TMJ DISORDERS" available at http://www.nhlbi.nih.gov/
Dr Ira L Shapira is a Chicago, Illinois Sleep Apnea Dentist who created www.ihatecpap.com and has recently released his new program for headaches sufferers seeking treatment, http://www.ihateheadaches.org to help patients with Migraines, Tension Type headaches, chronic daily headaches and other disorders related to theTrigeminal Nervous System. The site concentrates on the major role of Neuromuscular Dentistry in treatment of these disorders.
A portio of the NHLBI report has been reproduced from the NHLBI site below for your convenience and information. While the information can be confusing it helps explains how sleep and TMJ disorders are related and are both destructive to health.
"It is well established that as upper airway obstruction increases during sleep, there is increased collapsibility of the airways. It has been found that patients with SDB have anatomically smaller airways and it is believed that this activates negative pressure reflexes leading to increased muscle activity. Combined with their abnormal anatomy, SDB patients generate negative pressure that activates upper airway muscles and reduces collapsibility."
" ... because chronic craniofacial deep tissue pain and central neural plasticity are
characteristic of these patients and it is known that neuromuscular activity
importantly modulates upper airway collapsibility, it is likely that TMD patients would exhibit
elevations in collapsibility and hence the co-morbid consequences of SDB."
Injury to peripheral tissues following trauma or surgery often results in hyperalgesia that is
characterized by increased sensitivity to painful stimuli. This is a common problem in patients with TMD. Until recently, it was thought that the increase in pain was due to changes at the site of injury but it is now known that it involves central nervous system hyper-excitability leading to long-term changes in the nervous system. Animal models of hyperalgesia produced by inflammation or nerve injury that mimic persistent pain conditions have shown that an increased neuronal barrage into the central nervous system (CNS) leads to central sensitization involving activation of excitatory amino acid transmitters and their receptors. The activation of N-methyl- D-aspartate (NMDA) receptors leads to influx of calcium into neurons, the activation of protein kinases, and phosphorylation of receptors. The net effect of these responses is increased gene expression of NMDA receptors, an alteration in the sensitivity of receptors, increased excitability, and an amplification of pain. These responses appear to be most robust in response to deep tissue injury such as occurs in TMD patients. "
"central sensitization appears to be a prominent component in patients suffering from deep pain conditions such as TMD and fibromyalgia. It is believed that the diffuse nature and amplification of pain is in part due to this imbalance and that these findings have important functional implications relevant to the survival of the organism in response to the presence of persistent tissue injury. It is therefore now believed that persistent pain can be attacked both at the site of injury and where it is elaborated in the nervous system. "
"Alteration in Baroreceptor Activity - Impact on Pain, Autonomic Function, Motor Output, andSleep: Evidence has emerged that several regions of the CNS interact in complex ways to integrate sensory perception, autonomic function, motor output, and sleep architecture. The outcomes of a number of recent studies also suggest that several of the signs and symptoms associated with TMD may result, at least in part, from impairments in neural networks that coordinate the interplay between sensory systems, autonomic function, motor output, and sleep architecture. Many of the central pathways that are critically involved with the integration of these systems are regulated by visceral afferent input, including input from cardiopulmonary, carotid sinus, and aortic arch baroreceptors. In addition, abnormalities in the function and central integration of baroreceptor afferent information has been associated with abnormalities in pain perception, autonomic function, motor output, and sleep architecture, and thus may contribute to the development and maintenance of TMD and other related disorders (e.g., fibromyalgia)
"Cardiovascular and Sleep-Related Consequences of TMD
Nearly 12% of the general population, primarily women, exhibits symptoms of TMD. These
subjects are characterized by pain, restricted range of mandibular motion, altered jaw
relationships including retrognathia, and the impact of pain on jaw motor function. The effects of chronic pain upon upper airways resistance and SDB are largely unknown but a close association is plausible. Based on current understanding of neural pathways, it is evident that there exist important central interactions between pain pathways and the motor control of respiration, swallowing, and cardiovascular (CV) functions. However, the precise relationships and the manner of integration of these complex pathways are poorly understood at this time. "
"Subjects with SDB exhibit increased risk for cardiovascular diseases that is, to some extent,
related to repetitive episodes of nocturnal hypoxemia. However, to the extent that increased
cardiovascular risk in patients with SDB is related to factors other than hypoxemia, such as
sleep disruption, it is possible that subjects with TMD would be similarly predisposed to
increased risk of CV diseases, including hypertension, heart failure and stroke."
"Epidemiological data are needed to determine the level of increased risk for cardiovascular
diseases and carefully designed basic studies are required to determine the mechanisms
responsible for these events. "
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information on sleep apnea, sleep apnea treatment and cpap alternatives are available at www.ihatecpap.com This is the premiere site for the promotion of Dental Sleep Medicine and Sleep Apnea Dentisits. Http://www.ihateheadaches.org supplies information about the diagnosis and treatment of headaches and explains the major role of Neuromuscular Dentistry in providing headache relief.