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Teamwork Among Doctors
from Dr. Park -- One of the qualities that I see in patients that are highly successful at managing their sleep apnea condition is their ability to surround themselves with a team of trusted advisors. This can include a sleep doctor, a dentist, an ENT surgeon, a CPAP equipment specialist, and their medical doctor. Since there's no comprehensive sleep apnea center that incorporates all these specialists such as what we have for cancer, this is the next best alternative.
Regardless of how you were diagnosed or which doctor you were diagnosed by, eventually, you'll need to interact in the future with one or more of the above mentioned people. What I'll describe below are the roles that each specialist can play and how to make the best use of their skills and expertise towards helping you achieve your dreams (literally).
The sleep medicine doctor is typically a fellowship trained, board certified physician or PhD that interprets your sleep study results, as well as help manage all the medical aspects of your various sleep conditions. Although obstructive sleep apnea is the most common condition that's seen, they also deal with various other sleep issues such as sleepwalking, night terrors, and limb movement disorders. The American Board of Sleep Medicine was recently reorganized and is now jointly sponsored by the fields of pulmonology, psychiatry, neurology, ENT, and pediatrics. Anyone certified in these fields, or PhDs in health related fields can undergo further training and become certified in sleep medicine.
Dentists are now an integral part of any sleep medicine team. They have a unique perspective and understanding of sleep-breathing problems, as well as facial pain, headaches and TMJ issues, as they are all related to abnormalities of jaw formation and position. Dentists can make mandibular advancement devices which pulls the lower jaw forward, opening up the space behind the tongue. The American Academy of Sleep Medicine recently stated that CPAP and oral appliances are equally first line options for people with mild to moderate obstructive sleep apnea. Certain dentists are members of the American Academy of Dental Sleep Medicine, and specialize in making these type of devices.
Orthodontists and oro-maxillo-facial surgeons may also be called in to help. Young children with various bite deformities may benefit from rapid palatal expansion (RPE), and oral surgeons are able to perform maxillo-mandibular advancement, which has a 90-95% chance of success treating obstructive sleep apnea.
An ENT surgeon (or otolaryngologist - head & neck surgeon) is responsible for managing the medical and surgical aspects of the upper airway. In appropriate situations, ENTs can help open various areas of obstruction, especially clogged or stuffy noses. They also perform palatal and tongue base procedures for people who can't tolerate CPAP or dental devices. Different ENTs have various levels of expertise in dealing with sleep apnea surgery.
If you use CPAP, it's important to have a good relationship with the CPAP durable medical equipment vendor. These are the people in the front lines, dealing with routine matters regarding your CPAP, such as technical issue, compliance, and equipment.
Last, but not least, your medical doctor should be involved and coordinate your sleep apnea condition as part of a comprehensive approach to your medical care.
It's also important to bring in other health-related professionals when necessary, such as nutritionists, fitness trainers, yoga teachers, and others.
No matter what type of medical problem you have, you can't do everything on your own. It may take some time and a lot of patience, but eventually you'll find professionals that can not only help you manage and control your sleep apnea condition, but also help you literally to dream again.
Besides CPAP or oral appliances, one option that's not very well understood is surgery for sleep apnea. For a free report on "The Truth About Obstructive Sleep Apnea Surgery," go to http://www.thetruthaboutosasurgery.com Dr. Steven Y. Park is an otolaryngologist and author of Sleep, Interrupted: A physician reveals the #1 reason why so many of us are sick and tired. It was endorsed by New York Times best-selling authors Christiane Northrup, M.D., Dean Ornish, M.D., Mark Liponis, M.D., Mary Shomon, and many others. http://www.sleepinterrupted.com
excerpted from http://ezinearticles.com/?id=2528378
Regardless of how you were diagnosed or which doctor you were diagnosed by, eventually, you'll need to interact in the future with one or more of the above mentioned people. What I'll describe below are the roles that each specialist can play and how to make the best use of their skills and expertise towards helping you achieve your dreams (literally).
The sleep medicine doctor is typically a fellowship trained, board certified physician or PhD that interprets your sleep study results, as well as help manage all the medical aspects of your various sleep conditions. Although obstructive sleep apnea is the most common condition that's seen, they also deal with various other sleep issues such as sleepwalking, night terrors, and limb movement disorders. The American Board of Sleep Medicine was recently reorganized and is now jointly sponsored by the fields of pulmonology, psychiatry, neurology, ENT, and pediatrics. Anyone certified in these fields, or PhDs in health related fields can undergo further training and become certified in sleep medicine.
Dentists are now an integral part of any sleep medicine team. They have a unique perspective and understanding of sleep-breathing problems, as well as facial pain, headaches and TMJ issues, as they are all related to abnormalities of jaw formation and position. Dentists can make mandibular advancement devices which pulls the lower jaw forward, opening up the space behind the tongue. The American Academy of Sleep Medicine recently stated that CPAP and oral appliances are equally first line options for people with mild to moderate obstructive sleep apnea. Certain dentists are members of the American Academy of Dental Sleep Medicine, and specialize in making these type of devices.
Orthodontists and oro-maxillo-facial surgeons may also be called in to help. Young children with various bite deformities may benefit from rapid palatal expansion (RPE), and oral surgeons are able to perform maxillo-mandibular advancement, which has a 90-95% chance of success treating obstructive sleep apnea.
An ENT surgeon (or otolaryngologist - head & neck surgeon) is responsible for managing the medical and surgical aspects of the upper airway. In appropriate situations, ENTs can help open various areas of obstruction, especially clogged or stuffy noses. They also perform palatal and tongue base procedures for people who can't tolerate CPAP or dental devices. Different ENTs have various levels of expertise in dealing with sleep apnea surgery.
If you use CPAP, it's important to have a good relationship with the CPAP durable medical equipment vendor. These are the people in the front lines, dealing with routine matters regarding your CPAP, such as technical issue, compliance, and equipment.
Last, but not least, your medical doctor should be involved and coordinate your sleep apnea condition as part of a comprehensive approach to your medical care.
It's also important to bring in other health-related professionals when necessary, such as nutritionists, fitness trainers, yoga teachers, and others.
No matter what type of medical problem you have, you can't do everything on your own. It may take some time and a lot of patience, but eventually you'll find professionals that can not only help you manage and control your sleep apnea condition, but also help you literally to dream again.
Besides CPAP or oral appliances, one option that's not very well understood is surgery for sleep apnea. For a free report on "The Truth About Obstructive Sleep Apnea Surgery," go to http://www.thetruthaboutosasurgery.com Dr. Steven Y. Park is an otolaryngologist and author of Sleep, Interrupted: A physician reveals the #1 reason why so many of us are sick and tired. It was endorsed by New York Times best-selling authors Christiane Northrup, M.D., Dean Ornish, M.D., Mark Liponis, M.D., Mary Shomon, and many others. http://www.sleepinterrupted.com
excerpted from http://ezinearticles.com/?id=2528378
Views: 13
Replies to This Discussion
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Permalink Reply by Judy on
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Mike wrote:
Orthodontists and oro-maxillo-facial surgeons may also be called in to help. Young children with various bite deformities may benefit from rapid palatal expansion (RPE), and oral surgeons are able to perform maxillo-mandibular advancement, which has a 90-95% chance of success treating obstructive sleep apnea.
As I understand it this information was originally from Dr Park?? Its not clear to me whether MMA's 90%-95% success rate applies only to children or does it apply to adults as well?? That sounds like an extremely positive result for an adult!!! I can accept it for children but am a bit skeptical of that high a success rate in adults.
However, I sooooo agreee w/the need for teamwork amongs our doctors. I insist that my family doctor be kept aware of every procedure, results, etc. ordered by my specialists. It is frustrating that so many specialists do NOT keep the family doctor informed and who use HIPAA as the reason. If HIPAA is their excuse than an ROI signed the patient is sufficient to open up that channel of communication to the family doctor and STILL so many specialists will refuse to take advantage of the patient signed ROI. The specialist gets paid considerably more than my family doctor, let them spend some of that extra monies on keeping my family doctor properly informed. As it is, since I can't trust them to do so "I" make sure I get copies and provide them to my family doctor. BUT that doesn't make my family doctor privvy to the specialists' office notes which torques my jaws. One of my specialists sends a FAX of his notes after each of my visits to my family doctor and I so appreciate that!!
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j n k said:
With the loss of dental and vision care benefits for the GM and Chrysler workers and retirees dentists are in for a noticeable decline in patient numbers and procedures.... If dentists would bring their prices down and decrease turnaround time, that idea would be one step closer to being workable and could result in A LOT of business.
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Permalink Reply by RockRpsgt on
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I just hope that these dentist are discussing all of the options with their pts. I also hope that they are quoting success rates on using the oral appliance by itself. I have done several follow up studies using the appliances. The only one that was successful was the one that used the appliance in conjunction with PAP therapy. The other studies either showed little improvement or none at all. One actually got worse.
jnk I think that they are forgetting that by themselves these appliances only work if the obstruction is caused by the tongue. If not mild moderate, or severe I do not believe that an oral appliance can help obstruction that occurs in the throat.
j n k said:I find this statement interesting: "Oral appliances are equally first line options for people with mild to moderate obstructive sleep apnea." Maybe SOME people with mild to moderate apnea. Maybe. And I feel strongly that the efficacy of the device, for each patient, should be proved in a follow-up PSG, which would make that option much more expensive than PAP, not to mention less versatile.
My opinion is even more radical than that, though. I believe that everyone, and I do mean everyone, with OSA should be fitted for a mandibular advancement device to use in conjunction with PAP therapy before titration. Not only would it keep the patient's jaw forward (perhaps lessening pressure needs a tad for some) but it would also keep the mouth closed, making nasal masks and nasal pillows easier to use and more effective by helping to prevent mouth-breathing.
If dentists would bring their prices down and decrease turnaround time, that idea would be one step closer to being workable and could result in A LOT of business. Not instead of PAP, in conjunction with PAP. Now THAT would be teamwork!
Let's get on that one, OK, AASM?! :-)
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Yah, and are those dental guys seeing to it that their patients have an in-lab PSG "after" the surgery or the device as PROOF of success??? W/o the in-lab PSG follow-up their claim of success is totally off-base and unwarranted. Where's the PROOF of the pudding?
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