Sleep On It! An SGS Powered Dental Sleep Medicine Newsletter

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Sleep On It!

A Sleep Group Solutions powered Dental Sleep Medicine newsletter

Obstructive Sleep Apnea Has No Regard for Age, Gender, or Fame.

Last month we reported on the National Hockey League (NHL) getting into the game with Sleep Apnea Awareness. Now we follow it up with a current NFL (National Football League) story.

Legendary Dolphins coach Don Shula was hospitalized and treated because of sleep apnea and fluid retention according to his wife Mary Anne Shula.

Shula is the winningest coach in NFL history (with 347 regular-season and playoff victories) and a Pro Football Hall of Famer. He is also the owner of a successful chain of steakhouses throughout the country.

The 86-year-old was treated and released at a Florida hospital last month. Dr. Barry Freydberg, a Dental Sleep Medicine expert and lecturer for Sleep Group Solutions, who screens and treats patients for snoring and sleep apnea says, “I am glad to hear his sleep apnea was treated. Nearly 18 million people remain undiagnosed with sleep apnea.

We are glad to see that there is an increasing awareness and action among professional sports teams about the seriousness of Obstructive Sleep Apnea.


Is it ADHD, or does your child have Sleep Apnea?

By: Dr. Charles Kravitz

The Stanford School of Medicine states that about 10% of children 10 years of age and younger snore and, of those children who snore, about 20% will have obstructive sleep apnea. Snoring can be a sign that your child has sleep apnea as it indicates, at the very least, that their airway is partially obstructed during sleep. Sleep apnea is a serious medical condition that can interrupt or stop your child’s breathing, prevent a normal night’s sleep, impair growth, and lead to a lower quality of life. It also can cause serious fatigue during the day which is why it is so often confused with ADHD. Sleep-disordered breathing such as snoring and obstructive sleep apnea (OSA) have long been associated with ADHD (Attention Deficit Hyperactivity Disorder). You should know that not every child diagnosed with sleep apnea has ADHD, just as not every child diagnosed with ADHD has sleep apnea. However, many studies have been performed indicating a significant correlation between OSA and behavioral issues. Children with obstructive sleep apnea do not get restful sleep, and as a result may complain of morning headaches, be irritable and have difficulty concentrating. Children with sleep apnea may complain of being tired during the day and, at the same time, exhibit hyperactive behavior or act impulsively. Herein lays the confusion of separating sleep apnea from ADHD because many of the classic symptoms of ADHD are often exhibited in children with OSA. So, as a parent of a child diagnosed with ADHD, what do you do?”

“It will be in your child’s best interest if you dig a little deeper into the root of what may be causing these behaviors. Watch your child sleep at night – and even record it if you can. Check for restlessness, mouth breathing, snoring, or breathing pauses. If they occur, have your child evaluated for possible sleep apnea to ensure the proper diagnosis and treatment. Figuring out if your child has sleep apnea or ADHD may seem quite complex but it doesn’t have to be. Consult with a sleep apnea doctor if you can answer ‘yes’ to any or some of the following questions: – Does your child snore? – Does your child stop breathing for a few seconds at night? – Does your child frequently mouth breathe? – Does your child sleep through the night or is it a restless sleep? – Is there frequent bedwetting? – Does your child seem irritable during the day? Is there difficulty focusing? Are there periods of hyperactivity?”

“The good news is that sleep apnea is treatable. Enlarged tonsils and adenoids are the most common causes of sleep apnea in children. An Ear, Nose and Throat specialist can determine if your child’s tonsils and adenoids are enlarged and possibly blocking the airway at night.   A tonsillectomy and adenoidectomy can successfully treat sleep apnea by removing the obstruction in the airway resulting in a complete elimination of symptoms in 80-90% of children.”

Instructor Spotlight:

Dr. George Jones

How I successfully market Sleep Disordered Breathing in my practice

It seems that many dentists fall into the trap of thinking that marketing is in poor taste, or something sleazy. They feel that to market a procedure or service means to stoop to the level of used car salesman using “hard sell” techniques. Thus they never maximize their true office potential for that service.


For me marketing is simply a way to bring awareness to our services and to ultimately start a conversation. When I began treating Sleep Disordered Breathing in my office the first thing I did was to create a word document using information I had culled from my Sleep Group Solutions seminar notes. I included information on the risk factors, signs and symptoms, comorbidities, and what we at Sunset Dental were doing about it. I added a couple of pictures and then I took this document to a local printer and had it printed into a poster.


We framed it and hung it in our lobby so our patients would read it and begin asking the staff questions (Marketing). Questions frequently asked by my patients: “What can a dentist do to treat Snoring and Sleep Apnea?”, “Does the oral appliance replace a CPAP?”, “My husband has many of these symptoms! How would we know if he has sleep apnea?”

It is important to note that for this to be effective my staff had to be trained to properly answer these questions. This poster, a subtle silent educator was wildly effective in bringing an entry level of awareness to our patients because we had begun screening all patients as they presented for their hygiene appointments. I think the total cost of my poster was less than $120 and it hangs there in my lobby today. My poster is certainly a more effective promotion than a pretty art poster.


I made a simple excel spreadsheet, using my patients, showing the Before and After results- tracking such things as AHI, Oxygen Saturation Nadirs, Time spent below 90% SaO2, etc. I then met with the local Primary Care Physicians whenever we had a mutual patient that was either recently diagnosed or demonstrated that they were high risk. My approach was simple: call them on the phone and ask if we could arrange a 5-10 minute meeting regarding a mutual patient. How could they refuse that? Most were very accommodating. I typically would ask to come by at lunch or on my day off- promising this would be to the point and beneficial to the patient.

During the meeting I would take great care to explain that we were interested in the overall health and wellness of our patients. That we were not trying to talk patients into switching from their CPAP over to oral appliances.

But with every meeting I had 3 things I wanted to emphasize:

  1. I made a point to show them my documentation, as many PCPs were not aware how effective appliance therapy could be.
  2. I asked them to consider using my office and Appliance Therapy for any CPAP noncompliant patient they saw.
  3. I would treat them, their spouse or any staff member in their office free, so they could “experience” our process, and the benefits of Appliance Therapy. With or without insurance I would do the whole case as a professional courtesy for them to see how professionally and effectively we would treat any referred patient.

Points 1 and 2 cost me only a little of my free time and an occasional lunch. Point 3 had the potential to cost me about $300-500 per “free patient”. But I felt I would gain a potential referral source or just to build some general “good will” in the local medical community. And it certainly did that. Most were shocked at the gracious offer! Do you care to guess how many have actually taken me up on my offer? In over 4 years only 1 doctor has taken me up on my offer. He and his partners are one of my best referral sources now. From a total cost about $500 the ROI was 300% after his first referred patient! He’s since sent me dozens of them!

Lastly, consider taking some pictures and thoroughly documenting one of your successful cases. Use the documentation to present a “case study” to the local medical community. Present them with the following information:
Pretreatment AHI, SpO2 spent below 90%, SpO2 nadir, mean heart rate, maximum heart rate.

Then show them the post treatment values of the variables mentioned above. Take the time to explain the method for finding the appropriate bite that maximizes the airway opening (pharyngometer), the appliance you chose and any other information that makes the case interesting. Be sure to provide your practice contact information, have the case printed in color and simply mail to the local medical community.


Invite key members of the medical community for a DSM presentation after hours in your office. ALSO invite city officials and the public. Let them all know who they will meet at this educational networking event. The town mayor, chiefs of police and fire departments will see the meeting as beneficial to their public standing and some health care professionals will see it as an opportunity to raise their image (and maybe learn something). You will be recognized as a “thought leader” and a caring public servant.

These ideas are a little time consuming to put together but cost very little. So it doesn’t take much to see a very significant ROI with this marketing plan.



You know that a hole in the appointment schedule is very damaging to
your monthly finances. It’s even more costly when that opening was caused by a cancellation or no-show by a patient who left you because they found a dentist who can give them a service that you don’t have.

What is the key service that will make you stand out and bring you new patients… and show your current patients that they need you? A study shows that 34 percent of your patients have symptoms of sleep disorder- Obstructive Sleep Apnea.

Patients today are seeking dentists who can help them with their Sleep Apnea. They are learning that the dentist is the doctor that can treat them with an effective and convenient modality- the intra-oral appliance. Oral appliance therapy (OAT) is not for everyone but for appropriate candidates it is the preferred treatment. It is the treatment offered by dentists, and an increasing number of dentists have learned how to serve their patients by

offering OAT.

You don’t have to lose your patients to a dentist who can screen and treat victims of Obstructive Sleep Apnea. Get the training so you’ll be able to help the people who need you while you are growing your “bottom line”. Find out how at:



Henry Thompson works 10 hours a day and gets 6 hours of sleep each night. He would like to reverse that and work 6 hours and sleep 10. But he is providing for his three children and wife and has increasing expenses. The oldest child is hoping to get admitted to college.

Henry has high blood pressure and he snores loudly all night long. He suspects he has sleep apnea and he is beginning to worry about it. His friend Tony told him about the sleep clinic in the hospital. He has to find time to get to the sleep center to meet with a doctor for evaluation, schedule a sleep study, and take a night out of the house to sleep in the lab, then meet again with the doctor to discuss prognosis and treatment options. The hospital is a 1 1/2 hour drive for Henry. Henry felt that he just could not take off work that much, even for something as important as his health.

And then he heard about “home sleep tests” that could be ordered by a dentist. He found a dentist, near his

home, who had been trained in dental sleep medicine by Sleep Group Solutions. He made an appointment – Lorem Ipsum

with that dentist, had an overnight sleep test in the comfort of his own bed, was treated by that dentist, and Henry’s story had a happy ending. Henry slept happy and healthy ever after.

Home sleep studies, like those offered by InterpStudies, a division of Sleep Group Solutions, sends a report by a board certified Sleep Medicine Physician within five business days to a sleep trained dentist.

According to the Mayo Clinic, “These tests usually involve measuring your heart rate, blood oxygen level, airflow and breathing patterns. If you have sleep apnea, the test results will show drops in your oxygen level during apneas and subsequent rises with awakenings.” The information the HST collects may also
include snoring sounds and head and neck movements.

The American Academy of Sleep Medicine (AASM) approves the use of home sleep tests. criteria must be met:

• You are between 18 and 65 years of age.
• You have a high risk of moderate-to-severe sleep apnea.

• You have no other major medical problems.
• You have no other sleep disorders.

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You also may be eligible for a home sleep test if health or safety concerns prevent you from being able to leave home for a night. A HST also may be used to evaluate your response to some sleep apnea treatments, including oral appliances, surgery, and weight loss.

But what if the nearest sleep center is hours away or booked up for months? Or what if a disability, or dependents, or a job makes a night in a lab too difficult? In cases such as these, a sleep dentist might prescribe a home-testing kit.

USA TODAY Reports:

Home sleep studies uses a less-expensive test that’s gaining ground across the nation, thanks largely to a push by insurance companies and mounting evidence of its effectiveness.

“You get to sleep in your own bed with your own pillow,” said Dr. Laddie Tackett, medical director for Anthem Blue Cross and Blue Shield in Kentucky. “It makes testing more accessible. It makes it more affordable. It makes it more convenient.” They are less than half the price — up to $400 for a home test, compared with as much as $1,300 in a hospital.

The advantages of a Home Sleep Study are many: comfort, convenience, time, travel and cost.


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