Sleep-Related Breathing Disorders

Letter to the Editor
By David E Lawler, DDS, D. ABDSM
Bloomington, IN


This week, I had the pleasure of being interviewed for an article in The Practice Solution Magazine by one of your research staff. As a result of this interview, I want to encourage you to step back and look at a different topic with a broader perspective.

You are a practice management magazine whose perspective should clearly be focused on that topic. However, there are opportunities in dentistry that are rarely looked at that, especially in these troubling economic times, should be more widely discussed.

The addition of sleep medicine to my practice of dentistry has been, not only the most rewarding professional thing that I have ever done, it has been a wonderful cushion in a time of economic down-turn. If the absence of pain, bleeding or swelling, a great deal of dental services are highly discretionary and can be delayed. However, people always need air and those people with sleep-breathing disorders have their air supply greatly reduced during the night as well as their quality of life during the day and their overall health. All they need is the proper information and a therapy that they can tolerate to accept treatment.

Last week I was asked to speak to the annual meeting of the Indiana Self-Insurers Association on the management of these sleep-breathing disorders with oral appliance therapy. This was a room full of people who are intimately aware of the cost of medical care. They were wide-eyed as I showed statistics showing the dramatic drop in medical costs associated with the proper management of these disorders. In addition, there were quite a few present that now know that the annoying sound coming from their bed partners as they sleep is the sound of these people fighting for their next breath.

Similarly, yesterday I spoke to a state-wide respiratory therapy conference at our local hospital on sleep-related breathing disorders like snoring, upper airway resistance syndrome and sleep apnea and their management with oral appliances. At the break following my discussion, I was surrounded by attendees at this conference who wanted to tell me that they now recognized in themselves or their spouses, the conditions that I had just talked about. These are people who are intimately and professionally familiar with the process of breathing but who were unaware of the many forms these disorders take that allow them to remain unrecognized. Similarly, there was a sizable number who knew they or a family member had a problem but were unaware that there was an alternative, patient friendly, therapy as a substitute to the traditional CPAP therapy that they could not tolerate.

These sleep-related breathing disorders are epidemic in our society, with as many as one in five adults having a sleep breathing problem significant enough to affect their health. Since these occur only during sleep, the vast percentage of people suffering from these disorders have no clue that they are affected. Occasionally a bed-partner will say something, but usually that is only to complain about the noise disturbing their own sleep. Even those people seeking regular medical care usually are undiagnosed, since only a very small number of physicians question their patients about sleep quality. Those people who are fortunate to get a diagnosis are routinely prescribed a therapy that as many as 50% refuse or fail within the first six months of use. Those who remain undiagnosed, or who are diagnosed and yet unmanaged because they cannot tolerate their prescribed therapy, go on to live shortened lives of diminished quality with medical expenses easily doubling those who are diagnosed and able to tolerate therapy.

Oral appliance therapy can offer life saving treatment to untold thousands of people if they only knew about it. Dentists would gladly add this therapy to their existing practice model if they knew how easy it was for them to recognize these problems in their existing patient base.

Sleep medicine is a very young field of medicine. Because of that, physicians are only now starting to connect the dots between these disorders and many of the problems that they commonly treat. What is necessary is more public recognition of these disorders and this is where I believe strongly you can play a role.

I was very impressed by the amount of time and the intensity in which researcher focused on his interview this week. I am fully convinced that he is more than qualified to develop this topic in order to give it the attention your readers deserve.

Thanks, in advance, for your consideration.

David E. Lawler DDS, D. ABDSM
Diplomate American Board of Dental Sleep Medicine
The Center for Sound Sleep
2909 Buick Cadillac Blvd.
Bloomington, IN 47401
812-339-6013 fax
Better health through restful sleep


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