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Steven B. Ronsen updated their profile
Sep 15, 2018
A turf war is afoot in the Sleep Industry for control over the heart, mind and airway of the Sleep Apnea patient. The turf war pits the field of Sleep medicine, very much in its early, formative stages, but showing a lot of promise, against the established specialists like dentists, ENTs, pulmonologists and others. And although some of these specialists do a great job bringing along their patients with Sleep Apnea, and there certainly is a place for interdisciplinary action, we at SleepGuide have also noticed some overstepping in the specialists' struggles to stake out their territory.

Kathy is just one young woman I know who was an innocent victim. Kathy recently discussed with her dentist the possibility that her loud snoring and chronic fatigue might be sleep-apnea related. The dentist sidestepped a diagnosis of sleep apnea, and instead recommended that she wear an oral appliance during sleep. Since Kathy knows me, she asked the dentist about CPAP, and the dentist advised her against it, dismissing positive airway pressure as a treatment that very few people can tolerate. Kathy trusts her dentist more than me because, as she says, he is a doctor, so her mind is made up. CPAP is not an option. Nor would she consider it an option for her father, who she knows stops breathing at night, snores loudly, and has a history of diabetes and heart disease.

I have a friend who is a lobbyist in Washington D.C. for the American Dental Association, so I told her about Kathy's story. After doing an informal poll among her fellow lobbyists for the A.D.A., she reported back the results: "what I gather is the mask, while cumbersome, is more effective than the appliances." She also directed me to the resources the A.D.A. lobbyists use to inform their positions on Sleep Apnea: http://www.ada.org/prof/resources/ebd/reviews/apnea.asp

There seems to be unanimity among informed dentists that, as one study indicates, "the current first choice therapy is CPAP," with oral appliances as a fallback option. The same study warns that oral appliances "should not be considered as first choice therapy for obstructive sleep apnea where symptoms and sleep disruption are severe."

Which brings us to the dentist behind the IHateCpap.com website. In a video he features on his website, below, he implies the reason he got involved with Sleep Apnea and developed the oral appliance he markets was to help his 5-year old son, who was diagnosed with severe obstructive sleep apnea. But if the consensus among even the dental lobbying group is that oral appliances should not be a first choice therapy for severe obstructive sleep apnea, we believe the founder of IHateCPAP.com should urge his patients with severe OSA, including his 5-year old son, not to hate CPAP. After all, they shouldn't become innocent victims of a turf war.

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Comment by Laura Hand on July 20, 2009 at 11:53am
I must be an extremly lucky patient. It was actually my dentist who insisted I be seen by a sleep specialist. I have dental anxiety and he sedated me lightly for a procedure on two occasions. Both times he witnessed apnea episodes with BP and pulse spikes. He copied the data and sent me straight to be evaluated.
Comment by Steven Y. Park, MD on January 1, 2009 at 10:54pm
Your example about Kathy's dentist is not unique. This occurs in all the other specialities as well, including sleep medicine. There are always going to be professionals that are not up to date with current recommendations.

You may already know this but the field of sleep medicine was reborn as an independent medical board (it used to be a subspecialty of neurology). There are now 5 specialties that co-sponsor the American Board of Sleep Medicine: pulmonology, psychiatry, pediatrics, ENT, and neurology.

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