Insomnia

Insomnia is a very insidious disorder in our society today.  The actual statistics vary, but most of them indicate that the rate of insomnia in America today is extremely high and the economic costs are in the billions.  The loss of life is very substantial because of drowsy driving.  So what exactly is insomnia?  There are two types of insomnia, there is sleep onset insomnia and sleep maintenance insomnia.  Sleep onset insomnia usually has to do with anxiety, as the person is unable to go to sleep because of uncontrollable thinking.  There are many types of sleep hygiene methods that can be learned by the patient, which would help in this concern.  Some sleep medications are beneficial such as sedative-hypnotics; however, these are to be done only after proper evaluation.  Cognitive behavioral therapy is an excellent way to deal with this problem without medication. 

Sleep maintenance insomnia is another issue.  In order to treat sleep maintenance insomnia, first many things have to be ruled out.  There are four basic reasons why people wake up at night.  Number one is the pain, number two is depression, number three is obstructive sleep apnea and periodic leg movements, and number four is external disturbances such as bed partner snoring or dog waking them up.  These are the four most common and there are others; so therefore, which of these causes must be determined before any medication is given.  Obstructive sleep apnea needs to be ruled out with a sleep study or by other signs and symptoms.  Depression must be determined to see if that is the cause.  Pain must be determined and dealt with.  External influences should be eliminated.  After all these things have been determined, then a sedative hypnotic such as Ambien or Lunesta could be very beneficial in trying to reestablish the proper sleep structure.  Once the sleep structure has been restored, then getting off these medications would be beneficial.

The real danger in giving sedative hypnotics for sleep comes when the patient has undiagnosed obstructive sleep apnea. If the arousals at night are because the mind is waking the patient up to breath, what will happen if that mechanism is suppressed by medications? That is right; the blood oxygen levels will be allowed to drop to dangerous levels. There are records of patients dying because of this. So the reason for insomnia and the need for a sleep study is necessary before treatment is initiated.  

God Bless,

Dr. Ron Prehn

The Dentist’s Role in Sleep Medicine

I have been trying to teach dentists about sleep medicine for several years now because I believe it is a critical medical concern in society today.  In fact I am out in Vegas this week speaking to a large group of dentists about the effects of bruxism and how it relates to sleep breathing disorders.  I believe that sleep disordered breathing at night has to do with the effects of the tongue on the airway as it relaxes and collapses against the airway.  In all of medical science, what profession is most trained and skilled with experience at dealing with tongue other than Dentistry?  It is incumbent upon a Dentist to learn about sleep disorder breathing and to be involved in the treatment of this ever growing disorder.  But it must be done properly at the highest-level of professional standards.  It is not just something for a dentist can fabricate a snore guard and think he is treating this disorder.  It needs to be done in conjunction with proper diagnostic modalities.  We need our physician colleagues at some level as we properly diagnose this disorder and determine that what type of appliance is to use.  Therefore, it is critical for dentist to learn about sleep and sleep disordered breathing like obstructive sleep apnea and snoring.  It is not just another profit center in a practice.  It is something that is going to make the practice of dentistry a more important in the eyes of medical science.  Dentistry has a real opportunity here to increase its influence in the medical profession as a whole.  Dentistry has always part of a medical profession.  My grandfather and my dad were dentists and their brothers were physicians as is mine.  Medicine and Dentistry will never be two distinct professions.  They are always part of the same profession in the medical treatment of the whole body.  Sleep medicine is another opportunity to bring the two aspects of medicine together.  Dentists may be resistance to this, for what reason I have no clue.  It is nothing but pure joy to work with my physician colleagues in treating these disorders. Therefore, I will continue to teach sleep disorder breathing to Dentists in hope that we can grow in our collaboration with physician colleagues in the treatment of sleep disorders.  The Dentist’s role in this area of medical pathology will increase as Dentist become more involved.  That is my hope.

 

God Bless,

Dr. Ron Prehn

Is there a cure for temporomandibular disorders?

To answer this question one must understand the nature of the degenerative process.  The day we are born, begins a degenerative road towards death.  Degenerative process will only end when we die or if Christ returns before that time.  Therefore all along the road of life, the human experience demands that our bodies degenerate as it tries to adapt to the existing environment.  Therefore when a patient comes in to the office with pain or loss of function, he is no longer is in the state of adaptation.  It is the duty of the medical practioner to determine where this patient is on this degenerative road.  When it pertains to the TM joint, the degenerative road in an orthopedic one and follows the orthopedic principles of all joints of the body.  Therefore one needs to understand where the patient is and the job of the health provider to intersect that point and intervene into this degenerative process with the goal of bringing the person back into the state of adaptation.  In order to do that, one has to identify all the risk factors that are driving the degenerative process.  When it comes to TMD there are several of which may include pain, loss of function, malocclusion, headaches, sleep disorders, anxiety, and other systemic arthritides. Once those are identified, one needs to determine the priority of intervention and a treatment plan is then formulated.  It is the goal of the medical practitioner not to cure TMD, which can never be done.  Rather the goal is to bring the patient back in the state of adaptation so they can adapt to the degenerative process and perhaps slow it down with certain types of intervention. The degenerative process is indentified and the patient is given tools to manage this process in order to be pain free and have normal function.

 

Have a belssed week,

Dr. Ron Prehn