ALGONQUIN – The cumbersome machine that enabled Kathy Culhane to sleep, albeit fitfully, was wearing out its welcome.
"It really helped, but it was such an annoyance." said the Algonquin resident. "If you saw a picture I looked like Darth Vader."
Some people with sleep apnea, a serious sleep disorder, can be helped by nothing more than a Breathe Right strip. Others require a machine with a mask that creates positive airway pressure, or PAP. Also known as CPAP – the "C" stands for continuous – the machines can be noisy and difficult to use when traveling. But Culhane needed something. The 72-year-old had developed atrial fibrillation, an irregular heartbeat, and would stop breathing for periods during the night. Her snoring also drove her husband into a separate bedroom.
"I felt very fortunate. I was on that [CPAP] machine for a good year and a half," Culhane said. "Then I found out about the dental appliance."
Culhane visited Dr. Gene Sherman, a certified sleep dentist and owner of Dental Care of Algonquin and was fitted with a "mandibular advancement" mouth devices, which keep the tongue from sliding back and moves the jaw forward a little. The objective is keeping the airway open.
"You want to open things up a little bit so that enough air gets through the nose into the lungs," said Edward Grandi, executive director of the American Sleep Apnea Association in Washington, D.C. "The objective is you want to sleep on your side with your mouth closed."
Sherman, 57, of Crystal Lake, said interest in dental sleep medicine has grown "exponentially." His practice within a practice – the Snoring & Sleep Apnea Dental Treatment Center of Algonquin – represents about a quarter of his patients. He averages about 10 sleep-related cases a month.
Sleep dentistry focuses on the management of sleep-related breathing disorders including snoring and obstructive sleep apnea, with oral appliance therapy and upper airway surgery.
"It's my passion, really, but I try not to take away from general dentistry side," Sherman said. "Five years ago I heard about it and started learning about it. It's phenomenal what the need is."
Grandi said evidence suggests sleep apnea has been a huge problem for years, albeit somewhat misunderstood. An estimated 18 million Americans have sleep apnea severe enough to warrant treatment, and 75 percent of those adults are undiagnosed. As the population has aged, gotten heavier and has developed more breathing problems, sleep issues have increased exponentially. The inclusion of certified sleep dentists is yet another tool in the tool belt. And oral appliances, some of which resemble a fancy mouth guard, are less cumbersome.
"You would be surprised what people sleep with. ... It's not the kind of tired that you talk about when it's been a long day. They fall asleep at a traffic light," Grandi said. "PAP is the most effective for people. It's like turning on a vacuum cleaner in reverse. It blows everything out of its way to make sure there is air in the lungs. But there are some people , with slight or moderate sleep apnea, for which the pressure may be too much."
But for those in the middle, Grandi said, oral appliance therapy – using adjustable and fixed mouth devices – fit just right.
"It's like a double retainer," Sherman said. "A better way to think about it is it keeps the jaw from falling back and closing the airway."
Dr. Lydia Sosenko, a member of the American Academy of Dental Sleep Medicine and a practicing dentist in Naperville, said such devices have been around for 30 years. The problem, she said, is that some members of the medical community have been slow to embrace their value.
But over the years interest has continue to grow. She said there now are about 60 different models, but not all are accepted by Medicare. Also, dentists who fit patients with these acrylic devices need to follow strict protocols. Referrals from a pulmonologist, neurologist or sleep disorder physician are required.
"I'm one of only two dentists in the county that is board certified by the American Academy of Dental Sleep Medicine," Sherman said. "I feel it's important to do it by protocol, through a medical entity. ... You can get stuff on the Internet for $100, but I don't fool around with cheaper versions. I go the strict medical route. Patients must be referred by a doctor. They need an accredited sleep study so that it is covered by medical insurance."
Sherman said three to five appointments may be necessary since measurements, impressions and lab work are required. This labor-intensive process – which can modify the oral appliances for different ranges of motion, thicknesses (for teeth grinders) and temporomandibular joint disorders – can push the price to between $1,500 and $3,000 – comparable to the CPAP machine. While CPAP machines are the "gold standard," Sherman said, for the 25 to 40 percent of people who can't tolerate the machine for refuse to try it, this is a viable choice.
Rebecca Cleghorg, sleep care consultant at Dental Care of Algonquin, serves as a liaison between the dental sleep medicine practice and area doctors who refer CPAP-intolerant sleep apnea patients to the practice.
"We hear a lot of stories about why people hate them. They drip water. They are loud, so they can't sleep when they go on," Cleghorn said. "These devices are hard acrylic mouth guards but they are highly advanced. The labs that make them must be FDA approved."
Dr. Ted Lawrence, vice president of medical affairs for Centegra Health System, confirmed that Sherman was extended consulting privileges Monday in oral appliance therapy at Centegra Hospital – Woodstock. Lawrence said it is the natural next step in the hospital's relationship with dentists – which has expanded from oral and facial fractures in the emergency room to include chronic sleep apnea patients such as Culhane.
"I'm really lucky that I can use this. I know it works for me and I'm so happy," she said. "My therapy is not chemotherapy, but [the mouth appliance] is a pleasure after using the machine. It's so much easier. You can travel. You can visit friends. I feel very fortunate."
What is sleep apnea?
Sleep apnea is a serious sleep disorder. People who have sleep apnea stop breathing for 10 seconds to 30 seconds at a time while they are sleeping. These short stops in breathing can happen up to 400 times every night. If you have sleep apnea, periods of not breathing can disturb your sleep (even if they don't fully wake you up).
Is sleep apnea common?
It is estimated that more than 12 million Americans have sleep apnea. Men, people who are overweight, and people who are older than 40 years of age are more likely to have sleep apnea. For information, visit American Sleep Apnea Association's website at www.sleepapnea.org.
What causes sleep apnea?
There are two kinds of sleep apnea: obstructive and central. Nine out of 10 people who have sleep apnea have the obstructive version. If you have obstructive apnea, something is blocking the airway, or trachea, that brings air into your body. Your airway might be blocked by your tongue, tonsils or uvula (the little piece of flesh that hangs down in the back of your throat). It might also be blocked by a large amount of fatty tissue in the throat or by relaxed throat muscles. Those with 17-inch necks or larger especially may be at risk.
Central sleep apnea is less common. This type of sleep apnea is related to the function of the central nervous system. In this version, the muscles you use to breathe don't get the "go-ahead" signal from your brain. Either the brain doesn't send the signal, or the signal gets interrupted.
– Source: American Academy of Family Physicians
Dental Care of Algonquin:
285 Stonegate Road, Algonquin
Information: 847-658-3400; www.drdentalcare.com