Combination Therapy

Dental devices utilize a very simple concept in the treatment of Obstructive Sleep Apnea.  The gentle, passive advancement of the mandible can maintain an open airway during sleep. These appliances are currently quite comfortable and can be very predictable when made by properly trained dentists--ones with significant CE hours on the subject under their belts. Side-effects have been minimized to the point of little or no concern when applied appropriately by well-trained clinicians.

Even with diligent patient-specific approach, including some hardware adjustments and ambulatory sleep monitoring to aid in maximizing effective titration, mandibular advancement therapy can fall short; leaving the patient who is usually CPAP intolerant to begin with, few other options.

Enter Combination Therapy.  Combining CPAP and oral devices is a very realistic and effective choice for those who 'fall off the ends' with either CPAP or Oral Appliance treatments alone.  Recent advances in the lab and at the manufacturing bench have provided patients a way to turn their CPAP pressures dramatically down, eliminating many side effects of pressure while also eliminating the need for cumbersome headgear with custom formed or stock masks affixed firmly via their solid custom dental appliances.  At least one of these appliances is currently made to slide directly into this role with some simple hardware changes; easily performed chairside along with proper anatomical mask fitting and fixation.

More information: 603-448-3800

Office Design

Sunday March 27

Every Monday morning reveals wonderful new surprise by our temporary artist-in-residence Elisabeth Cadle.  This week, we cant wait to see how she transformed Katies room (#10)  All of our original gallery paintings get shuffled as she plays with the visual layout.  Its always exciting, never boring; and really an amazing overall effect on the place.  Comments from patients on an hourly basis validate the talent and the effort to show the original artwork using meticulously chosen personal accent colors for each provider and their selection of wall hangings; all topped off by a subtle hand painted cloud-effects border.

innovative planning

Our office has spent 12 hours in formal yet innovative planning the last 2 days to bring the best in conscientious care to the people who need us.  Exceptional leadership by the Flannel people and Leeann over two days has really focused and strengthened our purpose and resolve as we continue to grow in ways that provide the absolute best across a broad population of patients and needs.

OSA, arrythmia and cardiac sudden death syndrome

I found this from the Itamar website, a well done summation;  A very significant connection coming to light

OSA + Heart Arrhythmias = A DEADLY COMBINATION

Q. What is the link between apnea and heart arrhythmias? A. Atrial fibrillation (AF), the most common arrhythmia (abnormal rhythm), is a rapid-fire beating of the heart’s upper chambers, called the atria, which then leads to an irregular and often rapid beating of the lower chambers, called the ventricles. While AF may cause bothersome symptoms for some, other people diagnosed with AF experience no symptoms whatsoever. Unlike ventricular arrhythmias—the rapid and controlled/uncontrolled beating that originates in the heart’s lower chambers (ventricles) that can cause sudden death—AF usually poses no immediate danger. However, for some older patients, and those with underlying heart disease, AF does present a risk for stroke if left untreated. While it’s not always possible—or even necessary—to restore the heart to normal rhythm, some physicians believe it’s logical to restore the normal tempo of a healthy heart.

Researchers taking part in the Sleep Heart Health Study reported that patients with severe sleep apnea are two to four times more likely to experience complex, abnormal heart rhythms while sleeping than individuals without the problem. The researchers reported that individuals with sleep-disordered breathing had four times the odds of atrial fibrillation and three times the odds of nonsustained ventricular tachycardia. Atrial fibrillation consists of very rapid contractions of the atria (the upper chambers of the heart), leading the ventricles (the lower chambers of the heart) to beat irregularly. This results in decreased heart output and potential for clot formation. Tachycardia is defined by abnormally rapid heartbeats—over 100 beats per minute in an adult. Similar findings were reported by researchers from St. Louis University who studied 134 patients with coronary heart disease who hadn’t been diagnosed with a sleep disorder. In the patients who had a type of an irregular heartbeat called ventricular premature contraction, more than 40% also had severe sleep apnea—and didn’t realize it. The real worry is that benign arrhythmia can be a harbinger of a much more serious—and lethal—heart rhythm disorder. While most people with the mild version of arrhythmia will be just fine, in some people it’s possible it can worsen during the night and lead to sudden death. The researchers reported that sleep apnea seemed to exacerbate ventricular premature contraction, especially during the dream stage, or REM, of sleep. That’s because there’s less oxygen being pumped through the body in REM than in other stages of sleep, and this can bring on arrhythmia. The brain is less alert, which is why people don’t simply wake up to solve the problem.