AHI- Apnea-Hypopnea Index

The Apnea-Hypopnea Index (AHI) is a diagnostic tool used to assess the severity of sleep apnea, a sleep disorder characterized by pauses in breathing or periods of shallow breathing during sleep. The AHI measures the number of apnea (complete pauses in breathing) and hypopnea (partial reductions in breathing) episodes that occur per hour of sleep. It is calculated based on data collected during a sleep study, known as polysomnography.

Here’s how the AHI is categorized in terms of sleep apnea severity:

-0-5 is considered none to mild.
-5-15 is moderate.
-15+ is considered severe apnea.
-UAR: Upper Airway Resistance – blockage in the upper airway.
-MSLT- Multiple Sleep Latency Test – naps to see sleep efficiency.
-OSA: This is obstructive sleep apnea.
-PSG: Polysomnograph – the sleep apnea test.
-Multiple leads are placed over various muscles to see how they react while asleep.

Visible and Audio Symptoms for Adults and Children

If a spouse or parent sees or hears a person snoring, gasping or waking up a lot, then the HST, Home Sleep Test, is indicated to determine if apnea is present. Look for big circles under the eyes. Subjective symptoms include the following:

-Tiredness during the day and daytime drowsiness.
-Overwhelming urge to take naps.
-Difficulty falling or staying asleep.
-Unusual breathing patterns and movement patterns while falling or during sleep.

Epworth Sleepiness Scale Questionnaire

The Epworth Sleepiness Scale (ESS) is a questionnaire used to assess daytime sleepiness. It provides a measure of a person’s general level of daytime sleepiness or their average sleep propensity in daily life. The scale was introduced by Dr. Murray Johns in 1991 as a simple, self-administered questionnaire.

The ESS consists of eight questions, each asking the respondent to rate, on a scale from 0 to 3, their likelihood of dozing off or falling asleep in different common situations that vary in terms of their somnolence-inducing potential. The situations include passive activities such as sitting and reading, watching TV, sitting inactive in a public place, being a passenger in a car for an hour without a break, lying down to rest in the afternoon, sitting and talking to someone, sitting quietly after a lunch without alcohol, and being in a car while stopped for a few minutes in traffic.

-0-7 is unlikely abnormally sleepy.
-8-9 is the average daytime sleepiness.
-10-15 is excessively sleepy, depending on the situation.
-16-24 is continual, excessive sleepiness.

The Breathing Triangle?

The “Breathing Triangle” refers to three key areas of the face that are essential for optimal breathing: the two nostrils and the mouth. This concept is often discussed in the context of health and wellness, specifically in relation to sleep and breathing disorders such as obstructive sleep apnea (OSA). This involves both nostrils and the throat and the two points make up the inverted triangle. If the top of the triangle is blocked (the nostrils) then the breathing is compromised.

(MSLT) Multiple Sleep Latency Test

The Multiple Sleep Latency Test (MSLT) is a diagnostic tool used in sleep medicine to measure the speed at which a person falls asleep in quiet daytime situations. It is often used to diagnose narcolepsy and other disorders associated with excessive daytime sleepiness.

Your Sleep Visit

We take your vitals, note neck measurements, etc. At the initial visit, the vitals are the same as TMD: BP, Oxygenation, Pulse, Neck measurement, BMI, and pH. At each visit, the ROM (range of motion) is measured, discuss your symptoms, mostly subjective on how you feel you are sleeping with the appliance. If your spouse is present, we will ask if snoring still occurs.

At the 3-12 Month Markers From Delivery

At three months we run a new HST (home sleep test) and titer the appliance forward by 0.5mm and Dr. Jeffrey Brown will adjust the strap. The HST will be performed again six months after the last visit until no more apnea or snoring is reflected. The 12-month check after the last visit will be more of a review, then once each year thereafter with a new sleep test every 2-3 years.

As you can see, Dr. Brown and our team take your sleep health seriously. If you would like to read more, check out our Sleep Apnea Therapy page. If you would like to schedule an appointment, please call 703-821-1103 to speak with a friendly member of our team!

The post What You Should Know About Your Sleep Numbers first appeared on Sleep & TMJ Therapy.

There are so many issues involved with SDB that it would take pages to explain, so in this short blog, we will review some of the major players in the equation.

The symptoms of SDB include morning headaches, night terrors, teeth grinding, polyuria (lots of bathroom visits at night), mood changes (irritability during the day), cognitive difficulties, restless sleep, gasping/snorting while asleep, and periods of outright cessation of breathing. As you can see, SDB is a very serious matter and needs to be addressed.

Let’s start with how to measure SDB. To get somewhat of a handle on the problem, a fairly simple test called the PSG (Polysomnogram) can be done. The PSG produces a number that allows an assessment of how serious sleep apnea might be. It’s sort of similar to getting a blood pressure number. For sleep apnea, if the number goes above 5-15, the apnea is considered to be moderate. Anything over 15 is generally considered severe apnea and needs to be addressed right away. A CPAP is usually the first course of treatment, and if a patient cannot handle wearing the CPAP, a dental sleep appliance usually works quite well.

As part of a good sleep analysis, the Vitamin D3 level should be analyzed carefully. The reason for this is that D3 is not really a vitamin, it is actually a hormone that regulates your sleep. If the D3 number is around 30 ng/ml or below, you are running really low and should address the problem. The proper number for good healing and good sleep is around 60-80 ng/ml. If you maintain a very low D3 level over time, eventually your body stops the ability to process D3 and you will have lots of problems with sleep later in life.

Snoring is another SDB issue that is very common in our society. Snoring is created by a harsh sound that occurs when the tissue is vibrating as you breath. This can turn into a chronic problem causing a vibration of the carotid artery, and this can cause damage to the artery to the point where your body sends plaque to fill in the damaged areas. If a plaque loosens and goes to your heart, then a cardiovascular event, even death, can occur. Snoring can be caused by a condition having fat deposition in the throat and tongue, nasal congestion, deviated septum, or even enlarged tonsils and adenoids. These factors can lead to snoring and prevent a good night’s sleep.

Another important aspect of good sleep is a very much ignored thing called sleep hygiene. That’s right; how clean, how good is your sleep pattern? What this means is that if you can program your body into going to bed at a regular time each night, your body will get used to that pattern and sleep more effectively and efficiently. Good sleep can be prevented by other factors such as:

-Sleep Disturbance: This is mostly caused by stress, insomnia and even excessive screen time.

-Poor Diet: Food is obviously a very important part of fuel for our body. With a poor diet, nutritional deficiencies become present, like the vitamins and minerals your body needs.

-Dehydration: This affects the function of your body’s organs and blood volume. The effect makes you feel tired.

-Psychological: This could be stress from work or a traumatic event causing a considerable degree of uneasiness leading to your mental health and exhaustion.

As you can see, when sleep is poor, you will be tired. It’s as simple as that.

If you are experiencing any of these symptoms, Dr. Jeffrey Brown and our team are here to help. We offer sleep apnea therapy in Falls Church, VA. Please give us a call if you would like to learn more, or to schedule a consultation. Just call our office at 703-821-1103. Better sleep awaits you!

The post Why am I Always Tired? first appeared on Sleep & TMJ Therapy.

One of the best things, just for starters, is to consume enough water to keep your cells functioning as best as possible. The rule of thumb is that whatever your body weight is, cut that in half and that is how many ounces of water you need daily just to survive. For example: a 140-pound person needs at least 70 ounces of water per day. The water from your refrigerator filter is usually the best unless you can afford the fancy glass bottles at exorbitant rates.

Another factor in good sleep is getting enough Vitamin D3. You see, D3 is not a vitamin. It is actually a hormone that regulates your sleep. Vitamin D receptors, together with the activating enzymes (hydroxylase) control the activation and degradation (waste) being expressed during the sleep cycle. This is also an important item to help produce melatonin. This hormone is involved with the circadian rhythm, an important aspect of the sleep cycle. If your D is too low, you simply cannot sleep. The D level is determined by drawing blood and then the lab analysis is done. The results will tell you what level you have. Generally, 30 ng/ml is the bare bones minimum. Most people are either below or pretty close to that. If you are low then the recommendation is to take 5000 IUs of D-3 with K2 per day and then re-assess in three months.

Vitamin D3 and K2 are taken together for best absorption in the body. Vitamin K2 is generally not produced in sufficient amounts within our bodies. Achieving a healthy level of vitamin K2 will support our heart, blood circulation and bones. While vitamin D is well understood, the importance of K2 is not so known.

Sleep hygiene is a sort of new term that is in vogue these days. What this basically involves is your body’s ability to sleep efficiently. This involves your behavioral practices and environmental influences to obtain a healthy habit of falling asleep. Some sleep problems are caused by bad habits but to start the change a person needs to go to bed around the same time each day and wake up around the same time the next morning. If the bad habits have been reinforced over many years, then a better night’s sleep may take longer to be affected. Proper hygiene also means not drinking caffeine in the late afternoon and not consuming too much alcohol in the evening hours. A rule I tell my patients is to follow the 10,3,2,1 Rule:

-10 Hours Before Bed: No More Caffeine

-3 Hours Before Bed: No More Food or Alcohol

-2 Hours before Bed: No More Work

-1 Hour Before Bed: No More Screen Time (phones, TVs, Computers, etc)

As one leader of a campaign for sleep and mental well-being asserted, supported by the Mental Health Foundation, the author created the 5 principles of good sleep health: Value, Prioritize, Personalize, Trust and Protect one’s sleep.

In cases where the sleep apnea index (the AHI) is sky-high, the gold standard for treatment is the CPAP (Continuous Positive Airway Pressure). This is a device that forces the air down your throat and into the lungs to make sure you are breathing. It is quite effective in lowering the apnea index but can cause stomach bloating and even dry mouth or eyes. For most people, if they commit to wearing it, they can greatly benefit. For other folks, the CPAP is quite difficult to wear and since it really inhibits your movements at night, it can be a real bother.

A new device that just came on the market is the hypoglossal nerve stimulator. It basically involves a surgical procedure to embed a small shock wire into the hypoglossal muscle in your tongue and if and when the tongue falls back at night and closes your airway, it shocks the tongue into popping out of your mouth and thus opens the airway. Shocking, to say the least.

A much better approach to treating apnea is the Panthera device. It is made by a dentist and is an anti-snoring and opening airway device by bringing your chin forward (just like in doing CPR) to widen the breathing passage allowing for more air. This in turn reduces the potential of snoring. This appliance is customized to your mouth and is also adjustable. It is very effective and easy to wear. For most people, it does the job as well as a CPAP and, in some cases, even better.

There are many other ways to deal with apnea, and most of these are surgical, but the above ideas are simple and generally quite easy to implement for most people. If you would like to learn more about Sleep apnea and your oral health, please give our Sleep & TMJ Therapy team a call at 703-821-1103. Our dedicated dentist in Falls Church, Virginia, Dr. Jeffrey Brown, has been successfully helping patients with sleep apnea get a great night’s sleep!

The post What To Do About Lack of Sleep first appeared on Sleep & TMJ Therapy.

If you snore or wake up gasping in the middle of the night, you really should consider having at least a HST-Home Sleep Test- done to see if you are in the range of sleep apnea. In most cases, you would do the home test to get the basic indicators to see if there is more of a problem than meets the eye. The test will reveal a number called the AHI-Apnea Hypopnea Index. If that number is between 0 and 5, there is a very low risk of apnea. If the number is over 15, then it is usually labeled as moderate to severe apnea. AHI refers to how many times you either stopped or slowed breathing each hour of the night.

The problem with sleep apnea is that your brain does not get enough oxidation to function properly. Often this can manifest as a morning headache. Other manifestations of apnea include cardiovascular disease, high blood pressure, stroke, diabetes and even some cancers. When the brain and body do not receive proper oxygen supply, systems in the body begin to shut down. This is when disease processes can set in and now you have to deal with daily meds for diabetes or high blood pressure. Many times, some of these meds prevent the good, deep sleep that we need for better health. Painkillers are notorious for allowing us to fall asleep, yet they prevent the deeper, restorative sleep that is critical to good health.

So, what are some of the warning signs that you might have sleep apnea? One clear sign of potential OSA (Obstructive Sleep Apnea) is waking up with a headache regularly. This oftentimes means that your brain is not getting enough oxygen and it lets you know by making your head hurt when you first wake up. This is serious stuff – deal with it. Other indicators include restless legs and even gasping for air in the middle of the night. Your brain jolts you into waking up so that you can breathe and get some oxygen into the body. Other signs include waking with a dry mouth or even a sore throat.

A really strong sign of OSA is excessive daytime sleepiness. Again, your body is warning you of a potential problem and you really need to listen. Another symptom is trouble focusing during the day. As you can see, OSA is a serious problem and it’s wise to deal with it. Get the proper help you need from someone who understands sleep apnea. Please call our team in Falls Church, Virginia to schedule a visit with Dr. Brown. Call 703-821-1103 today!

The post Do You Have Sleep Apnea? first appeared on Sleep & TMJ Therapy.

Sleep apnea is a condition with multiple symptoms and even more treatment options. When a person sleeps at night, they should stay asleep all night with minimal movement and there should be no snoring. Unfortunately, many people these days snore and have little control over this. Snoring can be a symptom of obesity or might be present in even the slimmest people – there is no true rhyme or reason here. The best way to diagnose the problem is to do a sleep study – a polysomnogram. This requires wearing all sorts of wires across the head and neck for a two-night study in most cases. Then a board-certified sleep MD reads the results. Without getting too technical, the measurement achieved is called the AHI – Apnea Hypopnea Index. If the AHI is quite high, then the usual first measure is to wear a CPAP – continuous positive airway pressure – to force the air into the lungs. For some people, it really works well,  yet for others, it just cannot be tolerated.

Depending on who the doctor is,  the next level of treatment is usually a dentist-fabricated device that opens the jaw and brings it more forward – just like if you did CPR on a person. The dental sleep device is a very good way to help open the airway in most mild to moderate apnea cases. Sometimes the device is used along with the CPAP to allow the machine to use less pressure to get the air into the lungs.

There are many other techniques to help sleep apnea cases – they involve surgery to cut away the palatal area – often referred to as UPPP (Uvula Palatal Pharyngeal Plasty) or even balloon plasty to just temporarily open the airway. Another surgery is called MMA -Maxillary Mandibular Advancement. This effectively brings the upper and lower jaws forward permanently. Beware of these surgeries as they might disrupt the TM joints. Other techniques include various medications that serve many different purposes.

Recently, HNS (Hypoglossal Nerve Stimulation) has been developed. This involves putting, for lack of a better word, an electrical ‘shock’ wire into the hypoglossal nerve in the tongue, then running a wire down the inside of the neck to a battery pack under the skin just below the collar bone. As with any surgical procedure to do an implanted device, there are risks associated with the procedure. Once the therapy is turned on, what happens next is when the patient has an apneic event, the sensor detects this and sends a ‘shock’ and in turn the tongue begins jutting forward to open the throat. Some people seem to tolerate this technique fairly well, others not so much. Some patients may experience discomfort from the stimulation, notice tongue abrasion, experience mouth dryness, or experience discomfort from the presence of the device. Overall, this is a relatively simple technique. The question brought up there is some concern that after a year or two the tongue may no longer be responsive to the shock wire.

Overall, there are many treatments for sleep apnea and no one system of therapy is right for every patient.  Based on the AHI, the most non-invasive treatment, a dental sleep appliance,  does still work and is highly recommended.

The post Does Sleep Apnea ‘Inspire’ You? first appeared on Sleep & TMJ Therapy.

Why is sleep important? When the body does not sleep well, it is far more likely that disease processes can begin. As anyone knows, when your body is just tired all the time, it is far more likely you will catch the flu and infections are far more likely to set in. This is the case with cancer as well. When your body is debilitated from lack of sleep it is easier for cancer to set in.  There is now plenty of research to support this. If you simply Google ‘cancer from sleep apnea’ you will find that with moderate to severe sleep apnea, you are two and a half times more likely to develop cancer and three times more likely to die from cancer. This is a serious statement. What this means is that if you are not sleeping well, you are far more likely to contract kidney cancer, melanoma, breast cancer, and uterine cancer. Even though the risk of lung or colorectal cancers is less, it is just not worth the risk when you do not sleep well. TMJ disorder affects not only your joints but impacts the quality of sleep. A confirmation from UVA hospital’s research is that good sleep has been confirmed to be key to good health. With good sleep, the lymphatic system is regulated, and in turn, helps regulates many immune systems.

So, what is the message of this little blog? The message is to pay attention to your body. If the jaw joints are causing pain – headaches, neck or back pain, or even dizziness and tremors – then pay attention and have it looked at by someone who understands the situation. And this has now opened up another proverbial can of worms: Who do I see? TMJ disorder is so poorly understood that there is no consistency in diagnosis or treatment. So please stay tuned as the next blog will delve into the devious world of diagnosis and treatment.

The post Oral Cancer and TMD- Coincidence or Correlation? first appeared on Sleep & TMJ Therapy.

Did you know that your tongue can hold fat deposits, just like your belly? If you were ever overweight in the past, your tongue would likely have fat deposits in it, and these are kind of hard to lose. The tongue, like any other muscle in the human body, needs to exercise. But like most patients who are referred to a myofunctional therapist, they don’t go, they won’t do it. It costs money and time, and they feel like it’s kind of silly to exercise this area of the body. Well, folks, it does work and does make lots of sense, so get out there and start exercising that tongue!

In so many cases where a patient has sleep apnea, the tongue is quite large and is full of fat tissue. This can readily be seen on an X-ray that shows the tongue and what can be seen is that the tongue is elevated because it is thick due to fat deposition. Like so many areas of the human body, if you exercise the tongue and surrounding tissues, the fat will decrease over time which will effectively open the airway for better breathing. Snoring usually reduces as well as the tongue becomes smaller and tighter. The tissues around the tongue also become more toned with these exercises so if you have sleep apnea, it might reduce as you exercise this area over time. In fact, in many of the dental sleep medicine training programs, it is taught that myofunctional exercises are mandatory to improve a patient’s health.

There are other obvious benefits to exercising your tongue.  Your speech and articulation of words are improved, caused by the weakness in the tongue. If you have Dysphagia (trouble swallowing), your ability to develop a stronger tongue able to move more easily and then swallowing becomes easier. Finally, another plus is the jawline. Tongue exercises include the muscles groups below the chin and toning of the jawline begins.

So once again, dear reader, consider sticking out your tongue and making it work like it has never worked before. Get that tongue at attention! Get that tongue out there into the real world! Make that tongue healthier, happier, and improve your life!

The post The Case for Tongue Exercises – REALLY? first appeared on Sleep & TMJ Therapy.

TMJ and sleep disorders are very common but not really understood.  This can explain why myths or misconceptions are out there.  The other side of this coin is this is also commonly misdiagnosed because symptoms vary from person to person and are similar to other problems.  One example of similarities is with Lyme Disease.  This is caused by a tick bite and the symptoms could be chronic headaches or migraines, jaw pain and tingling in the hand or fingers, notable symptoms of TMJ disorder. The big difference is Lyme disease does not have the clicking and popping or vertigo symptoms of TMJ disorder.  There are other examples as well; migraines, Trigeminal Neuralgia (short, sharp pain from touching of the jaw joint), or even a Ganglion Cyst (on the TM joint causing swelling and jaw pain).

Just remember all of us get sore muscles from time to time. The big difference is when the muscles in your jaw joints get sore and the soreness does not go away.  This is when you should ask your dentist for a referral. Otherwise, you could be prolonging the unnecessary pain or soreness and allowing the disc to possibly become further damaged.  TMJ disorder does affect other parts of your body. The myth of no popping or clicking means no TMJ disorder is not true.  These displaced discs can cause other symptoms of neck pain, backache, loss of balance, or hearing loss without the clicking or popping.

Another common myth is that TMJ disorder is harmless and that living with it will not cause problems.  It is true this condition is non-life-threatening but at the same time, it should be addressed.  Some possible development would be bruxism.  This process causes grinding of your teeth and clenching, wearing down your tooth’s enamel, and can cause sleep issues.  If the tooth enamel is worn down, then the potential of decay or tooth loss becomes greater.

For the sleep side of things, sleep can be interrupted by the clenching and grinding of your teeth.  Interrupted sleep or waking up unrefreshed is a symptom of both TMJ disorder and sleep apnea. It is not considered just a sleep issue.  The myth of sleep issues coming with age is not exactly true.  The aging process does decrease the tone in muscles and the airway muscles are not immune to this. The muscles in the airway no longer hold the jaw in the correct place and in turn, the airway becomes restricted. Your body is now fighting harder to breathe.  The use of a CPAP as the only treatment for sleep apnea is another myth.  The American Academy of Sleep Medicine has determined that an oral sleep appliance is very effective for mild to moderate apnea index.  This index tells us how many times your sleep is interrupted within a night.  The Epworth scale (tiredness level) in conjunction with the apnea index can determine if the oral appliance will be effective.

An interesting myth, sleeping on your side cures sleep apnea, actually helps with sleep apnea but does not cure it. By sleeping on your side, the tongue is not relaxed enough to obstruct the airway by falling back into the throat creating a blockage.  The tongue is off to the side allowing air to pass through the airway.  This is noted with mild cases of sleep apnea.  The side sleeping is most definitely not a cure but is recommended a lot for “positional apnea”.

There are so many more myths out there for both TMJ and sleep disorders.  Always consult with your dentist or physician when it comes to these issues.  You do want to address these symptoms because both these conditions will affect your brain and in turn affect cognitive functions, generating higher stress, and possible memory loss.

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