Severe Apnea Treatment With Oral Appliances. A New Study from The University of Texas Health Science Center at San Antonio Shows Successful Treatment of Severe Apnea with TAP Appliance

    GURNEE, IL, March 08, 2009 /24-7PressRelease/ -- Treatment of obstructive sleep apnea has historically relied on CPAP as the first line treatment. This changed in December of 2005 when the American Academy of Sleep Medicine endorsed oral appliances as a first line treatment for mild to moderate sleep apnea along with CPAP. It was recommended that oral appliances be considered as an alternative treatment to CPAP for severe apnea when patients do not tolerate CPAP. CPAP intolerance is the major problem with CPAP with significantly less than half of patients tolerating CPAP. CPAP is considered the Gold Standard of treatment because it is almost 100% effective when used. Studies have shown that only 23-45% of patients actually use their CPAP machines on a regular basis and that even patients who regularly use CPAP average only 4-5 hours per day not the recommended 7 1/2 hours per day.

Sleep apnea is a serious medical condition that effects at least 18-20 million Americans and as many as 90% of sufferers are undiagnosed.. Patients with untreated apnea experience choking, gasping and loud disruptive snoring. They frequently wake with morning headaches, dry mouth, and sore throats and have a six-fold increase in risks for heart attacks and strokes. Their wives and families suffer as snoring and concern for their loved ones destroy the sleep of spouses and loved ones.

The lead investigator of an 18-month study involving sleep apnea patients at the South Texas Veterans Health Care System, Audie Murphy Division is Paul McLornan, B.D.S., assistant professor in the Department of Prosthodontics. The Researchers used the Thornton Adjustable Positioner (TAP) to treat those suffering from moderate to severe sleep apnea. The TAP appliance is one of many oral appliances used in Dental Sleep Medicine.

The researchers found that their patients, like other patients around the world were not using their CPAP machines. Although the CPAP is considered to be the gold standard in treating sleep apnea and is very effective, Dr. McLornan said compliance by patients is well below 50 percent.

There are many reasons why patients do not use their CPAP machines. Some report severe problems with dry eyes, dry mouth or dry mucous membranes in their nose or sinuses, the noise or the cumbersome masks and hoses bother others. There are also frequent complaints of sore throats, bronchitis, sinus infections and other disabilities. Interestingly, a small percentage of CPAP users immediately adapt to CPAP use and love it and use it faithfully from the time they first receive it. Studies have shown that that is, at most a quarter of the patients. Patients who do well with CPAP in the beginning seem to do well with it long term. Patients who have problems early on rarely learn to love their CPAP though some do manage to tolerate it. This explains why so many do not use this lifesaving technology at all or only use it 4-5 hours on average per night.

Dr. McLornan's study proved that the TAP device, which is much smaller and fits in a patient's mouth, is now an option for patients with severe sleep apnea. "It was previously thought that treatment for patients suffering from severe sleep apnea was limited to use of the CPAP or surgery," Dr. McLornan said. "Our study added to the body of medical and dental research literature by showing that oral appliances can be effective in treating people with severe sleep apnea. As an added advantage, the device is less cumbersome, is better tolerated by patients, and is much less invasive and costly than the CPAP or surgery."

In general patients prefer oral appliances to CPAP when given a choice of treatments. Dr Ira L Shapira is a Chicago dentist who has been using oral appliances for over 25 years to treat sleep apnea and snoring. He frequently heard from patients "I HATE CPAP!" and that led him to creating a company to help patients suffering from sleep apnea. His company I HATE CPAP! LLC is dedicated to helping patients with sleep apnea find information about their disorder and therapeutic treatments that they will use. Dr Shapira is a pioneer in the field of Dental Sleep Medicine and was one of 20 original members of the first meeting of the Sleep Disorder Dental Society 18 years ago. Dr Shapira was an Assistant Professor at the Sleep Center of Rush University where he worked with Dr Rosalind Cartwright the single person most responsible for Dental Sleep Medicine's current prominence in obstructive sleep apnea treatment.

Dr Shapira created www.ihatecpap.com to inform the public about the dangers of sleep apnea and to help patients find help thru Dental Sleep Medicine and the use of comfortable oral appliances.

Dr Shapira has long believed that many severe apnea patients can be treated with oral appliances and has used the TAP appliance as a first choice for severe apnea. "It is the only appliance that is easily titrated while the patient sleeps" according to Dr Shapira. Dr Shapira has been teaching sleep centers around Chicago and across the country his titration protocols for many years and even Keith Thornton, the inventor of the TAP line of appliances requested a copy of his protocols for TAP titration.

Dr Shapra teaches dentists across the country courses in Dental Sleep Medicine. Unlike most courses taught to dentists around the country in large lecture format Dr Shapira limits his classes to a maximum of six dentists and their teams. His course is probably the most expensive course in the country for dentists wishing to learn Dental Sleep Medicine. He does allow dentists to repeat audits of his course for a small fee. He provides several hours of consultation time to each dentist taking his course. His "I Hate CPAP!" website is also a powerful marketing tool for Dental Sleep Medicine and receives over 9400 unique visitors every month. His partners in Marketing are Mike Hamilton and Ken Saunderson of Hamiton/Saunderson Advertising out of Seattle. Page 1 Solutions created the site and does search engine optimization resulting in tens of thousands first pages on search engines. In spite of the tremendous exposure in search engines 15% of patients coming to the website actually type in: www.ihatecpap.com Dr Shapira is a constant student as well as educator. His Dental Sleep Marketing program follows advice he received from Marty Neumrier in his book ZAG The #1 Strategy of High-Performance Brands. While most dental marketing is aimed at snoring and treatment of snoring Dr Shapira concentrates on a very specific group of patients who already have been diagnosed with sleep apnea and have rejected CPAP. These patients are anxious for a therapy to improve their life. CPAP Failure, CPAP Intolerance and CPAP Haters are drawn to the site because they are looking for treatment they can live with. Malcolm Glidwell's book Blink describe the instantaneous affection for the "I HATE CPAP!" site that patients feel because it expresses their emotions about CPAP therapy. Dr Shapira believes that www.ihatecpap.com is reaching the TIPPING POINT (another Glidwell book) and that the I HATE CPAP! brand will become as well known as "PEARL VISION" is for getting glasses; Lasix is for laser eye surgery or Kleenix is for facial tissues.

The I HATE CPAP website has become a phenomenon that is saving lives across the country. It has become a powerhouse because it speaks to the emotions patients feel when they cannot tolerate CPAP. Dr Shapira emphasizes that he does not HATE CPAP but that his site is there for patients who do not and will not use their CPAP. Oral appliances are more successful than surgery at treating CPAP but that does not mean they are a panacea. Dr Shapira emphasizes that for some patients CPAP is the best alternative, for others surgery is the best alternative but oral appliances are the first choice among patients given an option.

Additional information about Dental Sleep Medicine can be found at the following links to stories in Sleep and Health Journal:

http://sleepandhealth.com/modules.php?name=News&file=article&sid=55&tid=22

http://sleepandhealth.com/modules.php?name=News&file=article&sid=130&tid=22

http://sleepandhealth.com/modules.php?name=News&file=article&sid=237&tid=22

http://sleepandhealth.com/modules.php?name=News&file=article&sid=280&tid=22

http://sleepandhealth.com/modules.php?name=News&file=article&sid=279&tid=22

Dr Shapira applauds the work of Dr. McLornan. Dr McLorman stated that in his study "We asked the patients to tell us when they reached a point in the adjustments that felt comfortable and when they felt they were able to sleep without snoring or gasping," "We then evaluated patients using standard sleep studies to determine whether or not their sleep had indeed improved."

Dr. McLornan said "We saw patients who began the study with severe sleep apnea end the study with very mild or no sleep apnea. They reported sleeping better, feeling more rested in the morning and altogether healthier."

Dr. McLornan said this research is vital to both the medical and dental communities. Dr Shapira believes that this work will also help patients receive easier reimbursement from insurance companies. "Most insurance companies will cover oral appliances" according to Christy Russo at Dr Shapira's office "but it is often a long and complicated proposal often requiring multiple insurance company interactions"

According to Dr. McLornan "Sleep apnea is a growing and serious problem for people of all ages and all ethnic groups," Dr. McLornan said. "If left untreated, it becomes progressively worse. People suffering from sleep apnea are at increased risk for high blood pressure, heart attacks, strokes, obesity and diabetes. It takes both dentists and medical professionals working together to control this potentially deadly disorder. The TAP gives patients another viable treatment alternative."

Dr. McLornan and Dr Shapira agree that patients who think they may suffer from sleep apnea should consult their family physician and undergo a standard sleep study in a lab. Costs of Polysomnography or sleep tests are normally covered by medical insurance.

"The American Academy of Sleep Medicine, the professional society that sets the standards for and promotes excellence in sleep medicine, now recommends that oral appliances can be the first line of treatment for people with mild to moderate sleep apnea. Dr. McLornan's study demonstrates it can be used for patients with severe problems as well." The American Academy of Dental Sleep Medicine's member's section is the source of many of the above quotes. The AADSM supports the AASM recommendations on oral appliances. The National Sleep Foundation declared in their national magazine SLEEPMATTERS that "oral appliance therapy is a treatment whose time has come.

If you Hate CPAP or you know someone who hates their CPAP or does not use it regularly refer them to www.ihatecpap.com. They will find valuable information there that may save their life.

About Dr Ira L Shapira

Dr Ira L Shapira is an author and section editor of Sleep and Health Journal, President of I HATE CPAP LLC, President Dato-TECH, and has a Dental Practice with his partner Dr Mark Amidei. He has recently formed Chicagoland Dental Sleep Medicine Associates. He is a Regent of ICCMO and its representative to the TMD Alliance, He was a founding and certified member of the Sleep Disorder Dental Society which became the American Academy of Dental Sleep Medicine, A founding member of DOSA the Dental Organization for Sleep Apnea. He is a Diplomate of the American Board of Dental Sleep Medicine, A Diplomat of the American Academy of Pain Management, a graduate of LVI. He is a former assistant professor at Rush Medical School's Sleep Service where he worked with Dr Rosalind Cartwright who is a founder of Sleep Medicine and Dental Sleep Medicine. Dr Shapira is a consultant to numerous sleep centers and teaches courses in Dental Sleep Medicine in his office to doctors from around the U.S. He is the Founder of I HATE CPAP LLC and http://www.ihatecpap.com Dr Shapira also holds several patents on methods and devices for the prophylactic minimally invasive early removal of wisdom teeth and collection of bone marrow and stem cells. Dr Shapira is a licensed general dentist in Illinois and Wisconsin.

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