Gastro esophageal reflux disease, GERD, a.k.a. acid reflux is one of the most common comorbidities of sleep apnea. Although very common in senior adults it still occurs frequently in younger people.Poor little GERD was so under-appreciated in our poll.

How it happens:   During the nocturnal cessations of breathing the body will increase its efforts to take in air. Abdominal contractions are exaggerated and increase until breathing resumes.
The contractions squeeze the stomach and force acid up the esophagus.
The efforts to breathe also increase a negative pressure in the esophagus which also pull up acid.

New Tag

Acid reflux


Study Club and Dental Society Members:

It’s November and you probably have your  CE credits locked in for this year.
Here’s how to get fast and easy CE credits for next year and score even greater benefits:
Have your Dental Study Club or local Dental Association schedule a speaker for a Dental Sleep Medicine presentation. We will provide a nationally known DSM speaker, all materials, CE credits and most importantly, a valuable introduction to Dental Sleep Medicine.
 Hands-on training
4-20-13 GELB 3
 Presentation Outline
These DSM presentations include:
  • analysis of patients’ symptoms and how to screen for them
  • scripts for an effective patient interview
  • how to motivate the Dental team to commit their patients
  • how to get your patients to “own” their disease
  • the morphology of the airway
  • comorbidities to look out for
  • the effects on the systemic organs
  • the reimbursement strategy and insurance billing using dental and medical coding.
Dentists who attended our DSM presentations have gone on to secure huge rewards for their patients and their practices. Email me at <> to find an available date for a presentation to your study club or dental society meeting.

The Medical Role of Hygienists in Dental Sleep Medicine

Is there anyone in a better position than the Hygienist to discover the signs and symptoms of Obstructive Sleep Apnea? Your field of operations is right there at the opening of the airway. 

You can’t miss the signs.
You can see if a large tongue is blocking the passageway to the pharynx. You can see if the sides of the tongue show a scalloping which is indicative of a forceful gasping for precious air. Is the airway blocked laterally by large fauces or tonsils?  You can’t miss the patient’s Mallampati score.


Do the occlusal surfaces of the posterior teeth show evidence of bruxism? Are the incisal edges of the anterior teeth worn down?
Does your patient have acid reflux? TMJ pain? A severely receded (retrognathic) chin?

And in your interview with your patient do you learn that your patient has daytime sleepiness, often dozes off while watching TV or at the movies, and even worse, feels sleepy while driving?
Were you informed that the patient’s spouse complains about loud snoring?
Do you see an overweight patient with a large diameter neck? 
Listen to the alert! 
These are some of the more common signs and symptoms of obstructive sleep apnea. They are so easy to see. These warning signs are sitting right there in the hygienist’s field of operations and they are screaming out, “Notice us. We are here to destroy your patient”.  “We can cancel out all the good that you do for this patient.”
For a diligent Hygienist to miss these warnings would be to surrender a great opportunity to help patients enjoy a better quality of life and, in fact, to save lives. The rewards to you, your practice, and your patients are considerable-  both emotionally and financially.  
Take action! 
Become a member of the LinkedIn discussion group RDH SLEEP SOLUTIONS and enter the discussion to learn to incorporate Dental Sleep Medicine into your practice.  



The TMJ- Sleep Apnea Connection

Charles Kravitz DDS
Patients have asked me,”I snore and grind my teeth at night and my jaw clicks,  Do you think I have Sleep Apnea?”


Headaches, clicking jaw, malocclusion (misalignment of teeth), and mandibular (lower jaw) displacement are all associated with temporomandibular joint disorder (TMD). However, these symptoms often occur in patients with Obstructive Sleep Apnea (OSA) as well. Research in The Journal of Sleep determined in 1993 that nocturnal headaches may be caused by temporomandibular joint disorder or triggered by Sleep Disordered Breathing—“ with very similar clinical manifestations but very different therapeutic implications.”


The temporal muscles of the forehead play an important part in the positioning and closing of the jaw. If your occlusion (bite) is not correct, it can lead to abnormal tension in these muscles – and cause tension type headaches, toothaches, and Temporomandibular Joint Disorder (TMD) .

TMJ    2-2-15 TMJ.cropt


TMD is called “The Great Impostor.” The symptoms can both overlap and mimic those of Obstructive Sleep Apnea. Some dentists believe that TMD is partly the existence of a TMJ problem and partly the manifestation of a Sleep Disordered Breathing problem, such as Sleep Apnea. The simplest way to understand the connection: the bruxism (teeth grinding) or jaw shifting associated with Sleep Disordered Breathing occurs when sleeping patients are trying unconsciously to find the best possible positioning of their airway. These motions may inflame the temporomandibular joint or exacerbate a problem with the joint that was pre-existing.


If you believe you have Temporomandibular Joint Disorder, I suggest you find a dentist to screen you for Obstructive Sleep Apnea. Find one who has taken dental CE courses and is trained in Dental Sleep Medicine. Don’t let “the Great Impostor” trick you into believing that your problem is solely a TMD one. It may not be.

“Oral Appliances should be fitted by qualified dental personnel who are trained and experienced in the overall care of oral health, the temporomandibular joint, dental occlusion and associated oral structures.”     – American Academy of Sleep Medicine.



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. The oldest child is graduating high school next month and 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. Tony explained the routine-  Finding time to get to a sleep center to meet with a doctor for evaluation, schedule a sleep study, 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 “home sleep tests” could be ordered by dentists.     
 He found a dentist, near his home, who had been trained in dental sleep medicine by  Sleep Group Solutions. He made an appointment 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 happily 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.   The following 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.
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 home sleep test 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 use 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.  





Legendary Dolphins coach Don Shula was hospitalized and treated because of sleep apnea and fluid retention, said 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 Tuesday from the Aventura Hospital and Medical Center. 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.”

Sleep apnea contributed to the premature death of star Green Bay Packers defensive end Reggie White in 2004.


5-20-12 HUMAN PYR

Here is how you can gain respect as a thought leader, generate New Patients, and provide a great public service.

Select a topic that will draw an audience. The “hottest” topic today is Sleep Apnea. Just google into the internet and you will see the widespread interest in Obstructive Sleep Apnea. People are becoming very aware of the dangers caused by the stoppage of breathing while they are asleep. They are looking for answers and very few Dentists are prepared to help them. Take a training course or a seminar, become knowledgeable in the signs and symptoms, the risk factors, and in the various treatment options. Sharpen your expertise.
6-2-12 BRAIN
Here’s how you do it:
Present a free seminar in your Reception Room. Select a date at least one month out so you and your invitees will be able to get it into your schedules.
How to Announce and Promote it:
  • Have a “sign-up sheet in your office
  • Send out email announcements to patients of record; ask them to assure their place by return email.
  • Let each invitee know they may invite two friends or relatives.
  • Place a large colorful poster in your Reception Room.
  • Distribute flyers to local businesses and professional offices.
  • Place a small display ad in your local newspaper.

Some Tips for your Seminar
  • Present it in the largest room in your office- usually the Reception Room
  • Prevent any interruptions – turn off phone ringers, etc.
  • Have a “Welcome Table” with some juices and other beverages (sugarless, of course).
  • Have your flyers, brochures, and business cards on the “Welcome Table”.
  • Prepare a power point presentation with video.
  • Subjects like Sleep Apnea are serious, but to keep the audience entertained, infuse some humor.
  • Encourage interactive participation. Invite questions from the audience.
  • Prepare some hand-outs for the participants to take home.
  • These are just a few ideas. I am sure you will think of a lot more.

Objectives and Outcomes

You will be respected as a Leader and Educator.

You will generate New Patient leads.

You will provide a needed and valuable public service.

If you want some help with any of this you may email me: cskdoc@



“I’m thinking of doing it…..”
How many great ideas have you had in your life that were exciting… seemed like “sure things”… that had to be done… that could improve the world….that could improve YOUR world?  You thought about it, talked to a confidant about it, and then, fssst! Gone! Forgotten, or worse, watched someone else do it and get the credit for it. You’re in good company; we are all procrastinators to some degree.  Me, too.
When there’s a good idea, it’s in “the air”. A lot of people will think of it at the same time; but the person that takes action will be called the genius.
 “Action speaks louder than words but not nearly as often.”
Mark Twain
What have YOU been “thinking” of doing? Find a piece of paper right now and make the list. Were you “thinking” of getting that laser… registering for Dental Sleep Medicine training… writing an Office Manual… going to Italy for two weeks? Make the list and put in target dates for completion.  Then get it done! You’ll feel so good about your self.
Procrastination is the bad habit of putting off until the day after tomorrow what should have been done the day before yesterday.”
Napoleon Hill


Sleep Group Solutions wishes to thank Dr. Nazir and all the members of the Raleigh Wake County Dental Society for the awesome welcome given to our speaker Dr. George Jones.  
For all members who wish to continue your Dental Sleep Medicine education, you may attend our two day training seminar in Raleigh on June 19-20 with a discounted tuition. Register her with code RWCDS15.



Yom Ha’atzmaut is celebrated on the 5th day of Iyar (ה’ באייר) in the Hebrew calendar, the anniversary of the day in which Israel independence was proclaimed, when David Ben-Gurion publicly read the Israeli Declaration of Independence. The corresponding Gregorian date was 14 May 1948.

In 2015 the Gregorian date for Yom Ha’atzmaut is 23 April 2015, advanced one day to Iyar 4  

This Florida celebration is on Sunday, May 3, 2015