White Paper on Multidisciplinary Approach to Obstructive Sleep Apnea - Sleep Balance Academy
Dr. Joseph Zelk
Multidisciplinary Approach to Sleep Medicine - Sleep Physiology
Dr. Joseph Zelk
Benefits of adding Sleep Services to your Practice:
There is an unmet need in addressing issues with sleep and breathing while asleep. Your office can make a difference in your patients health outcomes by knowing some important issues related to sleep disorders.
The following reflects the importance of good health outcomes connections with good sleep duration and quality.
1. CDC has stated that getting sufficient sleep should be thought of as a vital sign of good health. Insufficient sleep is linked to motor vehicle accidents, industrial disasters, occupational errors and medical comorbidities, such as cardiovascular diseases, type 2 diabetes, depression and obesity as well as having reduced quality of life and increased mortality.
2. Sleep-disordered breathing (SDB), and the disruption or fragmentation in nightly sleep it causes, speeds up the aging process, according to preliminary research. SDB is a common disorder that results in oxidative stress and inflammation and is associated with several age-related health disorders. Recent research has linked sleep-disordered breathing with epigenetic age acceleration.
3. Obstructive sleep apnea (OSA) is a common, widely underdiagnosed condition that is associated with significant morbidity and mortality. Due to intermittent anatomical blockage of the upper airway, reduction or cessation of airflow occurs during sleep, resulting in recurrent oxygen desaturation and sympathetic neural activation, with resultant nighttime hypertension and cortical arousal. This cycle results in sleep fragmentation and limits the amount of time spent in deeper sleep stages. Common symptoms include snoring, restless sleep, daytime fatigue, and morning headaches. If not treated, OSA is associated with an increased risk of cardiac, respiratory, and metabolic conditions, including hypertension, stroke, congestive heart failure, and sudden death.
4. The prevalence of OSA as defined by an apnea-hypopnea index (AHI) of 5 or higher is considerably higher and may include up to 24% of males and 9% of females. The vast majority of these patients snore. Approximately 80–90% of patients with OSA remain undiagnosed. Insomnia and Obstructive Sleep Apnea are the two most common sleep disorders. It is estimated that 12% of adults suffer from OSA and that 80% of the patient population is undiagnosed. A recent European study found the prevalence in a middle-aged general population of 43.1% or 19% when looking at only moderate and severe OSA.
5. Sleep is important for maintenance of the brain's white matter. Sleep promotes myelination and proliferation of oligodentrocyte precursor cells in the central nervous system. SDB and poor sleep quality have been linked to changes in gray matter also. The negative impact of SDB on white matter microstructure changes has recently been connected. Research has recently supported that inadequate sleep and greater daytime sleepiness in older, middle-aged, versus cognitively normal persons is associated with cerebrospinal fluid (CSF) biomarkers of amyloid deposition in combination with tau pathology, axonal degeneration, and neuroinflammation.
6. Those with moderate and severe OSA have elevated inflammatory markers, such as high-sensitivity C-reactive protein, homocysteine, and hematocrit. Studies have also indicated that intermittent hypoxia sustains inflammation through the activation of transcription of nuclear factor kappa B and hypoxia-inducible factor-1, which is activated by a high burden of intermittent hypoxia, and it increases systemic inflammation by modifying the levels of inflammation mediators (eg, tumor necrosis factor alpha and interleukin-8) and prolongs the natural life of myeloid cells. Moreover, through the reduction of serum oxygen levels, OSA increases inflammatory cell adhesion to the vascular endothelium, and at the same time it promotes the activation of pro-inflammatory cytokines and other inflammation markers involved in atherosclerosis. C-reactive protein, homocysteine, and B-type natriuretic peptide play a key role. Those with short sleep duration had increased asthma attacks and elevated blood pressure. Dyslipidemia may be associated with sleep-disordered breathing (obstructive sleep apnea), due to alterations in fundamental biochemical processes like intermittent hypoxia (IH). Oxidative stress can generate dysfunctional oxidized lipids and reduce the capacity of high-density lipoproteins to prevent low density lipoprotein oxidation. Current evidence has demonstrated that a causal relationship between OSA and metabolic syndrome may be due to alterations in fundamental biochemical processes, such as increased sympathetic activity, oxidative stress, insulin resistance and endothelial dysfunction
7. The first step in treating insomnia is diagnosing it. With proper training and a little time, clinicians make a relatively straightforward diagnosis. 4 things to look for: The first, and most obvious, is that the patient has difficulty falling asleep or staying asleep. Second, some kind of morbidity needs to be associated with sleep problems—if a person has trouble sleeping but is in otherwise good mental and physical health, there is probably nothing to treat. The third factor has to do with the length of time the patient has been struggling, as the American Academy of Sleep Medicine defines chronic insomnia as trouble sleeping at least 3 nights per week for at least 3 months. Finally, the patient must have adequate opportunity and circumstances to sleep.
8. Initiatives undertaken by the National Sleep Foundation (NSF) to create awareness about the importance of good healthy sleep will further augment the industry growth.
9. The Respiratory Care Devices Market is Projected to Reach USD 31.8 Billion by 2024 from USD 20.6 Billion in 2019, at a CAGR of 9.1% (CPAP machines and oral appliance therapy)
10. Anti-Snoring Treatment Market to Cross $18 Bn by 2025
THE BENEFITS OF RESTORATIVE SLEEP
● Heal All Tissue Faster (Brain, Muscle, Ligaments, Tendons, Skin, Bone)
● Improved Recovery & Healing
● Increased Performance Capacity
● Decrease Systemic Inflammation
● Trigger Neuroprotective Genes
● Build New Blood Vessels For Improved Circulation
● Increase Mitochondrial Density
● Increase Mitochondrial Efficiency
● Improved Metabolism
● Improved Focus and Concentration
● Reduced Anxiety and improved Mood
● Improved Insulin sensitivity
● Reduced serum Cortisol levels
● Reduced Blood Pressure
● Controls weight gain and facilitates weight loss efforts
● Improves child ADHD misdiagnosed cases.
● Improves child school performance
● Improves teeth bruxism issues
● Improves dry mouth issues
● Decreases prescription drug need
● Improves child growth and normal face development
● Reduces forward neck posture
● Reduces abnormal kyphosis and lordosis
● Improves longer term spinal manipulation stabilization
● Decreases cancer susceptibility
● Improves sleep partner health
Multidisciplinary Team Approach to Sleep Disorders
A multidisciplinary team approach starts with a screening test performed through the dentist, chiropractor or functional medicine office, followed by a clinical diagnosis by a board certified sleep specialist on the team. Those patients who have untreated OSA are offered therapy choices like side sleep therapy (ie, Snooor device), oral appliance therapy offered through the dental or trained chiropractic or ENT office as the therapy of choice. Many providers can be trained to treat loud snoring as well. Telemedicine myofunctional therapy is offered nationally. Follow-up tests with therapy can be administered by the multidisciplinary practice. These results can be shared over the cloud with the sleep specialist on the team and the patient is much more likely to stay compliant on therapy if he/she feels the benefit of the therapy.
The multidisciplinary group training is offered through: Continuing education credits and sleep certification are available.
https://www.dentalchirocollaborative.com
This training portal is a membership portal that will offer continuing education credits and provider standardized training in the treatment of Obstructive Sleep Apnea and Insomnia.
The sister site dental sleep balance has resources for dental sleep education and for safe disinfection procedures for the healthcare setting.
Sleep Testing can be ordered online by the patient or by the healthcare practitioner
www.sleepbalanceacademy.com
Oral Appliances for Snoring and Sleep Apnea
EMA Device
Sleep APP ADV Device
www.sleepbalanceacademy.com
Combination Therapy
Oxygen screening ring wearable
Nasal Dilator with EPAP therapy
The Bongo RX is an FDA-cleared sleep apnea therapy device for people with mild to moderate obstructive sleep apnea and can be used as an alternative to traditional CPAP therapy. It is unique since it opens the external nasal passage to improve nasal function and applies exhalation pressure to open the airway like a CPAP machine without using a machine.
Snooor Device - Consumer Product
A Programmable Vibration Sleep positional training and position monitoring wearable device with phone app data collection
These are devices that attach to your body and vibrate when they detect that you are sleeping on your back – the automated equivalent of a nudge in the ribs from your sleep-deprived bed partner. They can be programmed to train any sleep position or turn off vibration for whole night sleep position monitoring.
Clinician introduction to the impact of sleep disorders on optimal health outcomes for your patients.
You can improve sleep in your patients by a simple screening of oximetry (Circul Ring) to rule out OSA in your adrenal fatigue clients and those that report issues with their sleep quality and daytime functioning. There is misinformation in the popular health sphere that OSA is caused by obesity. It is true that obesity can worsen OSA, but much of snoring and OSA is related to narrower or smaller upper airways. 30% of OSA patients have OSA unrelated to obesity.
My own story begins as an allergy-plagued child in Florida, not aware of my sensitivity to likely mold spores and poor indoor air quality as well as, refined food diet. Frequent ear infections, nasal congestion, oral breathing habit, and chronic antibiotic exposure provide a strong case for sleep disordered breathing if reported in a patient's medical history. Many children may never be overweight, but unhealthy nonetheless. I am part of the deficient airway cohort suffering from Upper Airway Resistance and deficient nasal volumetric anatomy due to my compromised childhood health. I am 9% body fat, so weight is not the issue and for many of us weight gain has simply made the sleep breathing problem more obvious; but not the cause.
Relating to OSA or Obstructive Sleep Apnea Hypopnea Syndrome a frame of reference may need to be formed to better identify with this issue. Picture as a clinician a more accurate description, sleep suffocation. Sleep breathing compromise is largely ignored by Primary Care Physicians, let alone the guys that should be investigating it, which should be the cardiologists.
30 percent of OSA patients have no obesity contributing to the problem but have craniofacial development deficiencies. The other 70 percent or so end up developing “sleep suffocation” as obesity sets in. Nearly 80 percent of moderate and severe OSA cases are undiagnosed still today. This is the lion's share of what the sleep specialists deal with every day. The insomnia cases, ASPS, DSPS, jet lag, RLS, PLMD, narcolepsy and the other sleep disorders take a back seat to this OSA issue. You can't address sleep issues thoroughly without thoughtful discussion regarding OSA.
Undergoing training with our group you'll also discover:
-Why many sleep monitoring devices and wearables simply aren't accurate.
-What a sleep physiology should look like when it comes to deep sleep vs. light sleep.
-How you get OSA, especially if you're a lean active person who eats healthy.
-Why more people don't know about OSA, especially physicians
-Sleep is the one and only physiologic drive that does not improve in response to a hormetic stimulus; learn why.
-What you can do to treat OSA in your patients
-Are there ways/technologies to measure pulse oximetry all night while you're sleeping (Circul Ring)?
Resources - membership and continue education site: https://www.sleepbalanceacademy.com
Modern Perception of Sleep and Breathing
I jest with most of my patients' on the initial consultation and ask them, “What is the most important vitamin?” I have logged an extensive list of answers over the years. In my opinion the most important Vitamin, is Vitamin O. Most folks give me a confused look when hearing this comment. Then a light bulb goes off and they realize I am referring to oxygen. For all aspects of metabolism the central Vitamin is in fact, one we do not ingest, but we in fact breathe. But of course, Oxygen is not a vitamin due to the fact it is inorganic. But, by all other criteria it is the central player in the need for essential vitamins, thus it is the ultra-vitamin. All we have to do to obtain sufficient quantities of this essential nutrient is to be good breathers both while awake and asleep. It appears we may be falling short in both of these states of consciousness with predominantly stress driven unconscious breathing during the day and likely sleep suffocation at night.
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The phenomena of sleep is both loved and hated by the modern American. Look at many of the common catch phrases that have been indelibly etched in the modern psyche, including…
“Sleep is a symptom of caffeine deprivation.”
“I can sleep when I am dead.”
“Sleep is a luxury I can’t afford.”
The CDC reports that 30 percent of adults admit to less than 6 hours of sleep a night. The myth of getting by with less sleep to get ahead has been around only a short time though, since the early 1900s. The graveyard shift was invented to ramp up manufacturing during World War II. Thomas Edison, a notorious short sleeper, famously described his optimal day as working for 18 hours a day and getting by with 4 to 5 hours of sleep per night. In comparison, in his era, the average American slept just over 8.5 hours a night.
It is amazing how quickly our priority for sleep has eroded. Some medical researchers have found a connection with an increase in autoimmune disorders, in part due to the lack of opportunity to restore one’s health through sufficient sleep. But like autoimmune disorders, insufficient sleep is not considered a disease, but rather the body somehow “short-circuiting”, and some kind of a self-inflicted problem. The definition of insufficient sleep is succinct: a neurologic disorder in which individuals persistently fail to obtain enough sleep to support normal wakefulness, and perhaps one day it may include in the definition, fail to obtain enough sleep to optimally support the immune system as well.
Epidemiologists have demonstrated the stark decline in average nightly sleep duration for Americans over the last few generations, in 1950 – 8.5 hours, in 1970 – 7.5 hours – in 2000 – 6.25 hours, and so on.
So what does this mean to someone who wants to stay at their optimal health? What has research shown is the detriment of not getting enough sleep? How much does a healthy person, let alone an athlete need to be at their peak?
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Sleep Deprivation and Immunity
Animal studies have demonstrated a sleep-promoting factor contained in the cerebrospinal fluid. This factor is called adenosine. So I always ask my patients…
…what is the most commonly used medication in the world?
I preface by telling them it is neither over-the-counter nor a prescription. The medication is a blocker of adenosine and that medication is caffeine, often in the morning, mid-morning, afternoon, and perhaps mid-afternoon or evening cup of coffee.
But like any medication, caffeine has a toxic dose, and one big reason for this is because it can block adenosine. This is because adenosine is essentially the exhaust fuel of the brain’s metabolism.
Here's how it works: when the glial cells of the brain are running low on ATP (adenosine is the “A” in this adenosine triphosphate) to breakdown from stored glycogen (glucose storage) that 2 ADP (adenosine diphosphate) can be used to make an extra ATP and a leftover adenosine molecule. So excess caffeine intake can actually strip the brain of necessary fuel, especially when glial cell ATP is already low from lack of sleep.
Let's use the case of coffee, ATP depletion and lack of sleep to see how this has a profound effect on your immune system, the development of immunological memory and other inflammatory homeostatic functions.
The immune cascade in response to infection involves the activation of neutrophils, monocytes and macrophages (white blood cells are the soldiers of the immune system). These are the cells that produce inflammatory cytokines (proteins that serve as messengers between cells) such as IL-beta, IL-6, TNF-alpha, which stimulate hepatic production of C-reactive protein (hs-CRP is an inflammatory marker used by doctors to predict the risk of heart disease or general inflammation). These cytokines are elevated the morning after as little as a single night of four hours of sleep restriction. Inflammatory mediators participate in the CNS (central nervous system) regulation of sleep. I am hopeful that with time there will be biohacks that may help mitigate the inflammation related to sleep deprivation. But for now the best medicine is simply choosing to avoid the inflammation in the first place.
During experimental sleep deprivation of healthy volunteers, blood pressure and other indicators of sympathetic output have been found to increase. This increase in sympathetic (the fight or flight nervous system) output results in increased pro-coagulatory (blood clotting factors) markers produced by stimulating vascular endothelium (the lining of the arterial wall which normally is extremely slippery when healthy). This alteration can increase shear stresses associated with increased blood pressure, and this can activate inflammatory mediators.
Other data supports a connection with increased pain perception and sleep loss. Inflammatory markers, including prostaglandins and pro-inflammatory cytokines, have been shown to sensitize nociceptors (pain receptors), contributing to the development of spontaneous pain and hyperalgesia (increased pain).
In addition, animal trials have noted reduced bone density in sleep deprived rats. Dr. Everson’s sleep research found rat hematopoietic stem cells are half as effective after 10 days of sleep deprivation. This decreased cell activity was related to impaired migration capability of the bone stem cells.
Human trials have demonstrated with vaccination experiments to assess antibody creation in response to the flu vaccine a reduced immunity in sleep deprived subjects. These subjects had ½ the antibody response to the vaccine after volunteers were sleep deprived to 4 hours a night for 6 days. This impairment persisted for a full month after recovery sleep was allowed. Natural killer cells attack viruses and tumor cells. Research has found that healthy volunteers subjected to 4 hours of sleep loss were found to have a 73 percent reduction in natural killer cells.
So from stripped brain fuel, to increased pain perception, to lower bone density, to a reduction in natural killer cells, to an increase in blood pressure and an increase in inflammation, we now know that a lack of sleep has profound effects on your immune system – even if you're able to be awake and function.
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Sleep Deprivation and Glucose Metabolism
Current data point to three pathways that link sleep restriction with diabetes risk and obesity:
1. alterations in glucose metabolism;
2. upregulation of appetite;
3. decreased energy expenditure.
The role of sleep in glucose regulation has been recognized for over a decade. Initial studies on sleep curtailment were experimentally testing short periods of total sleep restriction. These studies found that despite significant negative metabolic derangements in hormone and glucose utilization, given the opportunity to have recovery sleep, these derangements were quickly reversed. The human physiology tolerates one night of total sleep restriction well…given the opportunity to catch up. But the more relevant experiments are the ones that test the effect of partial sleep restriction over several days or longer.
The mechanisms affecting glucose metabolism following recurrent partial sleep restriction are believed to be multifactorial. The acute reduction in insulin release could be due to increased sympathetic nervous activity at the level of the pancreatic beta-cell. Cardiac sympatho-vagal (this is the balance between the rest/digest and the fight/or flight autonomic nervous system) balance is affected, as evidenced by reduced heart rate variability when sleep is restricted. Secretion of counter-regulatory hormones, Growth Hormone and cortisol, may contribute to the alterations in glucose regulation noted during sleep loss. Subjects tested during the peak of sleep loss were found to take 40 percent longer than normal to regulate blood glucose levels, and the ability to secrete insulin decreased by approximately 30 percent.
The imbalance of catabolic (biochemical reactions that break down molecules in metabolism) and anabolic (biochemical reactions that stimulate protein synthesis and muscle growth, and insulin) hormones leads to a dysregulation of the arcuate nucleus of the hypothalamus where there is opposing sets of neurons, appetite stimulating and appetite inhibiting.
Epidemiological data show an association between short sleep and irregular eating habits, snacking between meals, excessive food seasoning and reduced consumption of vegetables. The Wisconsin Sleep Cohort Study found evidence that sleep loss may alter the ability of leptin and ghrelin to accurately signal caloric need. This imbalance produces an internal perception of insufficient energy availability despite an increase in caloric intake. Dr. Carol Everson found in rats that were subjected to sleep restriction for 10 days a persistent 20 percent increase in food intake, despite the opportunity for recovery sleep.
The Nurse’s Heart Health Study followed 80,000 women observed an association between sleep duration and Body Mass Index (BMI) where the lowest mean BMI was observed among those nurses reporting sleep 7-8 hours a night. Recent research was performed on healthy controls that comprised 12 months of 30 minutes of sleep restriction per night. This cumulative sleep debt resulted in increased adipose tissue and insulin resistance. The study results extrapolated that this mild sleep debt increased the risk of obesity by 72% [15].
It's important to emphasize here that cumulative lack of sleep is the issue, and it's a serious issue when it comes to blood sugar control, appetite and fat loss.
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There is little research on the effect of sleep loss on female sex hormones, but for male sex hormones there is some strong support. Recently, the National Heart, Lung and Blood Institute funded a sleep deprivation trial. This trial was performed on 24 year old males. When deprived of sleep their testosterone levels dropped by 10-15 %. The reason for this drop has been postulated to be related to changes in LH (luteinizing hormone – a hormone produced in the anterior pituitary gland). In light of this new information, one might plan on adding more sleep time to their health regimen and reassess testosterone levels a month later.
Don’t forget the power of melatonin (circadian – 24 hour cycle – sleep hormone) on overall health. Research on the effect of exogenous (supplement form of melatonin) may not have near the same effect as simply adding more sleep to one’s nightly habit. The natural secretion of this hormone initiates a cascade of biological processes. The general public is familiar with melatonin as a sleep related hormone, but many may not be aware of its impact on brain glutathione (a major endogenous antioxidant produced by the cells) and its powerful antioxidant effects. It is considered more powerful than vitamin C, E, A and the carotenoids.
Unfortunately, melatonin is a terminal antioxidant, meaning it does not undergo redox cycling, which is the repeated reduction and oxidation to regain its antioxidant properties. Thus, sleep is required to regenerate this master antioxidant. If sleep is a health promoting process in our 24 hour cycle, then it is logical that a major player in sleep promotion would be a powerful antioxidant.
Here is how it works: when melatonin is produced, it can work as an antioxidant to free up glutathione. Why is this important? When we are low in antioxidant in general or low in any one specific cofactors then glutathione takes on the role of eliminating free radicals. Once this happens, supplies of glutathione become depleted and slows down all the other roles that glutathione plays in the body, including detoxification, DNA repair, antioxidant recycling, mitochondrial energy support and immune system regulation.
The best way to promote sleep physiology relating to melatonin secretion is likely by avoiding light pollution experienced by most people in the evening hours. Avoiding bright light sources, especially blue wave length can support natural production of melatonin in the brain.
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Sleep Duration, Genetics and All-Cause Mortality
Finally, meta-analyses of population-based studies looking at the relationship between sleep duration and all-cause mortality reported a 10 and 12 percent increased all-cause-mortality in individuals with habitual short sleep duration.
But does everyone respond the same to sleep curtailment?
Recent twin studies have uncovered some genetic variations that may protect some people from sleep deprivation. The mutations that occur to the p.Tyr362His BHLHE41 gene appear to allow some to tolerate shorter sleep durations and maintain normal alertness and limited signs of inflammation.
Unfortunately, right now the average person is trying to function like Thomas Edison…which won’t end well for most genetically. My feeling is that Edison is probably one of those folks who may have had the p.Tyr362His BHLHE41 mutation (only an educated guess).
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Sleep Tips From A Sleep Doctor
Believe it or not, the most powerful non-medication intervention for insomnia is using the naturally occurring soporific neurotransmitters and getting in tune with one’s natural sleep rhythms. The body is made to be awake for approximately 16 hours of the day. This rhythm is entrained to ebb and flow with the natural increase and decrease in hormones throughout the day. If the schedule is interrupted, then the natural cycle of hormones will be disrupted as well, so you must maintain as normal of a wake time as possible. The reason for this is that if you go to sleep later and have an anchor of wake time, you will likely have more sleep pressure developing throughout the day, but you won’t disrupt the overall sleep/wake rhythm.
By using this strategy, the average sleeper will increase the sleep promoting neurotransmitter adenosine in the cerebrospinal fluid to allow for natural sleep onset. This will reduce the need to add in amino acid precursors for GABA neurotransmitters or add in exogenous melatonin.
You should also block high lux of light (intensity of light source) to below 80 lux after 6pm on a normal schedule. This is harder than it sounds, since most internal lights are well over 100 lux. Many electronics have high lux and blue wavelength of light, which suppresses melatonin production. Adding a blue wavelength blocking screen protector, software application or glasses may improve natural melatonin production.
Avoid electromagnetic frequencies that will disrupt slow wave sleep (SWS) generation and Rapid Eye Movement (REM) sleep. Don’t wait up to the last minute. Integrate some form of relaxation to the hour before bed; less light, sleep induction mat with acupressure points (my personal favorite), heart rate variability training, brainwave entrainment, deep slow breathing (box breathing), Tapping (EFT) and don’t go to bed until sleepy.
The worst thing someone with insomnia can do is to go to bed early and then lie there wide awake. One too many nights of this behavior and the unconscious brain will start associating the bed with being awake. The scary truth is that the brain will generate neurological pathways that reflect our average sleep habits, and so 5, 10 or 20 years of ignoring our sleep needs may possibly hardwire us when we are older to be poor sleepers. This is not helpful for the average 50 year old or older person, since we tend to have less solid sleep and less deep (SWS) as we age, compounding the challenges we face with the aging brain.
The data is becoming overwhelming regarding the importance of adequate sleep time. Savvy minded folks who are looking to improve performance or simply stay at their optimal health just can’t afford to ignore sleep health. Most people need a minimum of 7 hours to 8 hours of sleep a night (not time in bed).
As you can see, the rising tide of inflammation, immune system problems, weight gain, high blood pressure and hormonal imbalances the general public is attempting to address may be avoided by tapping into our natural healing resource – sleep.
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Ways to inform your patient on how they are meeting their goals for optimal sleep.
The simplest answer is to monitor your vigilance during the day.
If waking in the morning to an alarm clock is compulsory, or if you are falling asleep in the afternoon or during meetings or falling asleep in the evening in front of the television, you are not adequately rested. More quantified assessments of adequate sleep may include morning heart rate variability (HRV – the beat-to-beat alterations in heart rate) assessment.
Blood testing showing elevated CRP may represent sleep curtailment as well.
This measure would likely need to be assessed after a full week of recovery sleep, noting the long duration that CRP persists in the bloodstream.
Oximetry with wearables like the Circul Ring and monitoring HRV with Oura Ring are other strategies.
If you or a bed partner snore - tame the snoring and improve your breathing as a snorer and improve your bed partner's sleep with less exposure to “second-hand snoring noise”.
Emerging therapies like essential amino acid supplementation, creatine supplementation, low inflammatory personalized eating (for your personal susceptibility to trigger inflammation) peptide treatments and liposomal formulations of antioxidants are new options for the well-informed clinician.
Exercise, strength training is my preferred modality to maintain muscle mass.
Eating within your circadian rhythm and limiting meals to 1-2 meals a day with time restricted eating.
Add digestive enzymes daily to improve delivery of nutrition and rob the bad actors (opportunistic microbes) of nutrients.
Focus on nasal breathing and avoid mouth breathing with myofunctional therapy, addressing nasal restriction (allergies or anatomical anomalies), buteyko breathing and like methods.
Continuous glucose monitoring to identify suspect foods that may contribute to unknown postprandial glucose fluctuations. This will also help look for cortisol related glucose fluctuations related to “OSA - Sleep Suffocation”.
Avoid invisible environmental pollution, EMF pollution, high in-door particulate levels, mold spores and avoid exposure to VOCs and related chemicals in common cleaning products (especially now with the constant disinfection post-COVID19)
Clean water (ultrafiltration - www.toppenhealth.com - https://www.dentalsleepbalance.com/ resource websites) and possibly add hydrogen, ozonated, structured or deuterium-depleted water to your water choices and avoid sodas.
Our group is working toward forming a Functional Sleep Medicine Academy for customized, cutting-edge sleep tracking and testing, screening for obstructive sleep apnea or any other sleep enhancement or insomnia therapy needs.
To begin a sleep focused practice our group will teach our members the essential knowledge needed to:
● Screen patients for OSA
● Identify signs and symptoms
● Define the best testing pathway for your practice
● Determine which devices are indicated for which patients
● Consider the various medical billing options available
Go to www.sleepbalanceacademy.com to inquire.