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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 Paul R on June 3, 2010 at 12:12pm
As far as I'm concerned, ENTs and Dentists need to get the heck out of the sleep medicine business. Years ago, when i knew I ws afflicted with apnea but had little clue what to do about it, an ENT tried to sell me on his surgery. I balked because the idea of them cleaning out my tonsils and uvula speeved me a bit. I procrastinated for another two years or so until I saw a sleep specialist who told me about CPAP.

Yes, it is cumbersome but if you haven't slept for the better part of 10 years, you dont mind it so much and you get used to it. Long story short, the machine saved my life overnight, literally, and Ive been using it every night for the last 13 years. In fact, you might even say I'm addicted. I literally cannot fall asleep without it anymore.

I am fed up with this nonsense about it being an impractical treatment. It depends on your severity. I'm sure dental appliances are fine for low to moderate forms of sleep apnea. Heck, surgery might even help. (Found out later that surgery for severe apnea like mine was maybe 40 percent successful. The ENT didn't want to tell me that.)

But the gold standard of treatment severe sleep apnea must always be CPAP. Anyone medical professional who recommends any other course of treatment should have his license taken away.
Comment by Judy on March 16, 2010 at 4:17pm
So .... after all is said and done, sleep medicine is still a sub-specialty and not necessarily a specialty in its own right.
Comment by D. W. Conn on March 16, 2010 at 2:39pm
I am afraid there will always be a turf war regarding sleep and apnea treatment. Even the Technologist weighs in to this war. Neuro based Technologist do not feel Respiratory Therapist need to be in the sleep field and Vice Versa,
Neurologist-Pulmonologist and Dentist will have to learn to work in tandem.
Comment by Larry Barsh, DMD on October 27, 2009 at 2:50pm
Just wanted to jump in to say hello (first time visitor) and introduce myself. I'm Dr. Larry Barsh Founder of SnoringingIsntSexy.com. As far as the dentists of our group are concerned, there is no turf war nor should there be. Snoring and Sleep Apnea are medical conditions which can be treated by a dental device as one option.

We are in the midst of an "epidemic" of sleep apnea that only promises to increase in intensity until obesity is brought under control. Every health profession, including dentistry, has an obligation to the public to be aware and screen all patients for sleep apnea and refer to the appropriate physician for a diagnosis. Then in joint consultation, determine what course of therapy should be recommended to the individual patient. CPAP, oral ppliances, surgery all play a role. Of critical importance is that the patient receives the most appropriate, most effective and most well-tolerated therapy for that individual.
Comment by Tanina Agosto on October 17, 2009 at 10:07am
Dr. Eng does have patients that utilize both the oral appliance and the CPAP if they have severe OSA. Also, the oral appliance is great for those patients that find the CPAP to cumbersome to travel with when going on vacation or a business trip. We believe the CPAP is a most effective method of treatment for OSA but the oral appliance is also a wonderful alternative for those who are non-compliant because the mask is too uncomfortable. Our only concern is that the patient receives treatment so they can become healthier.
Comment by 99 on October 9, 2009 at 3:36pm
why cannot the two devices be used at the same time
let us understand the problem
usually the person has a large neck small jaw
tipically and a collaping air way
i understand that mandibular devices widen the jaw a side effect is that you look youger the longer the useage
but cpap should be the primary souce of treatment as a first line of defence
Comment by Tanina Agosto on August 15, 2009 at 11:11am
Dr. Lily Eng works with a number of sleep specialists, ENT's, cardiologists & pulmonologists. She would not procede with Oral Appliance Therapy for a patient without a sleep study and a direct referral from one of the afore mentioned specialists. She's one the many dentists in the field of dental sleep medicine whose primary concern is for the overall well-being of her patients. It's imperative for all dental sleep medicine patient's to have a comprehensive study to address any and all medical issues in order to effectively determine whether or not they are a candidate for an oral appliance at all.
I want everyone in the online sleep community to understand that not all dentists, such as the one Kathy saw, feels that they are at war with sleep specialists. On the contrary, most dentists that I've had the pleasure of interacting with are all for working together as a team to do what's right for our patient's.
Comment by Awake In America (Dave J.) on August 3, 2009 at 7:34pm
Mike:
I've seen both types of dentists, and then a breed somewhere in the middle -- which must be akin to the brood of M.D. that remains ignorant of sleep disorders and naysayers or sleep apnea and xPAP devices.

The battle is a long one, and looking back at what diabetes had to grow through back in the 60s and 70s, even some in the 80s, sleep -- as a field of medicine -- is still in its infancy/toddler stage -- and has a long way to go before it has public awareness how many of us would like. I do presentations, travel and speak at various places, and work with elected and goverment officials at all levels about sleep and sleep disorders, and while it's nice to see things "coming along", there is still a long way to go.

Maybe, just maybe, in 10 or 15 years from, now -- hopefully sooner, but looking at things realistically -- dentists with their eye on a slice of the pie will realize that the field is big enough -- and tastes and needs are diverse enough for everyone in sleep medicine to get a slice of the proverbial pie.
Comment by Awake In America (Dave J.) on August 3, 2009 at 7:24pm
Judy:
taken from the American Board of Sleep Medicine's site, http://absm.org/credentials.htm, here's the solid answer to your question:

When noting this designation on letterhead or after a signature, Diplomates of the American Board of Sleep Medicine may use the following options: Diplomate, American Board of Sleep Medicine; Diplomate, ABSM or D, ABSM. Diplomates of the ABSM should only list the acronym “ABSM” as a credential. Using only "ABSM" is often confusing or misleading, as it infers that the individual is the ABSM or represents the ABSM.


Certified International Sleep Specialists may not use the designation of Diplomate of the ABSM or ABSM Certified Sleep Specialist when referring to their qualifications.

Comment by Judy on July 20, 2009 at 1:17pm
I knew there was an ABSM, Dr Park, but I did NOT realize that sleep medicine is now a specialty in and of itself! So what "initials" does one look for after a doctor's name to indicate that he is ABSM "accredited", "certified", whatever you call it. Do they then still practice their original specialty as well?

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