Sedative-hypnotics for Sleep

Sleep medications can be dangerous in more ways than one.  I have seen patient’s come in my office on sedative-hypnotics, and other sleep medications for sleeplessness.  What happened was that they went to M.D.’s office for a particular medical concern and the physician spent as much time as he needed to determine the proper treatment for that concern.  As the doctor was leaving the room in a hurry to get to the next patient, the patient says “oh by the way I’m tired all of the time, is there anything you can give me for that.”  Or they may say “I’m not sleeping very well.”  The doctor turns around and writes some prescription for a sedative-hypnotic and off he goes and the patient goes home, takes these medications and sleeps better. 

However this can be a very dangerous situation.  The reason why, is because if the patient has obstructive sleep apnea, this could make this obstruction worse.  The  process of compensating for a collapsing airway happens when the tongue falls back into the throat during the deep sleep.  The brain compensates by detecting a drop in the oxygen by increasing the effort to breathe.  The process ends up being and increase the clenching and bruxing at night in order to open up the airway (bring the tongue forward) as well as increase the respiratory effort.  All this is an attempt to get the blood oxygen back up to normal.  If the person is given a sedative hypnotic, this compensatory mechanism is suppressed because the brain is sedated.  Therefore the ability to compensate for this drop in oxygen will be much less and therefore the oxygen would drop more, thereby creating a life-threatening situation in some people.  There is a role for sedative-hypnotics such as Ambien, Lunesta, Rozerem, or Sonata in sleeplessness and insomnia. However it has to be within the certain protocol which I will discuss in a later date. But just to give these drugs with the only symptom of “insomnia” can be a very dangerous situation until the actual reason for the insomnia is determined.

 

God Bless,

Dr. Ron Prehn

Mainstream Medical Knowledge

Mainstream medical science is a good thing.  It is a deep well of human thought and endeavor as individual people collectively put their minds towards single subjects and issues of our human existence.  It is like a large pool of academia for people who treat medical conditions as they are able to draw from it as the situation applies to each individual patient.  This pool of academic knowledge on certain medical subjects has certain standards by which you can enter knowledge into this pool.  There are standards of validation of scientific theory and process.  In order to validate certain ideas, these ideas or “hypothesizes” have to be put to the test with a study that is  based on the scientific theory of logic (the well established “scientific method”).  It is then submitted to the academia and either accepted or rejected based on its merit.  As medical practitioners like a dentist or a physician, it is important for them to go to this pool in order to decide what treatments need to be done for certain patients. 

What happens when a practicing medical professional stops going to this pool to this resource?  He starts looking to his own ideas and maybe an idea of one or two others as he starts implementing that into his practice.  I call these groups of medical practioners “fringe sects”.  These are areas of medical science both in medicine and dentistry, that you will find practicing medical providers doing things that have not really been accepted by the mainstream academia.  So is this a bad thing or good thing?  It is good in a way that it drives innovative and new ideas and different approaches to medical problems that mainstream academia have been unable to provide or solve.  It is a bad thing when that practitioner takes these thoughts and ideas and applies it to all situations in his practice.  It is shaky ground for a practicing medical provider to be doing things that are not accepted by the mainstream.  He exposes himself to a significant amount of medical legal liability and can endanger the patient.  So where is the balance in this?  If this way of practicing generates new and innovative ideas in thinking, then how should it be done in the context of medical science?  I do not have the answer to this, but I think medicine needs to figure out how to deal with this problem.  The patients are left wondering what to do in situations like this.  Who can they trust and what standard of care is there for their condition? 

A medical provider is putting himself in danger by doing these procedures that are not validated by medical science.  It is a concern for patients and for medical science altogether.  It seems like there are more fringe sects in medical science with issues that are difficult to treat such as cancer and chronic pain.  TMD is a type of chronic pain condition and therefore very susceptible to these fringe sects.  Every medical provider needs to figure out for himself how far into these fringe type of ideas and treatments that he is willing to go and if he is endangering the patient with these treatments. 

The approach that I have taken is that I stay mainstream in all with my patients.  Anything I do is validated by medical studies that are accepted by mainstream academia.  With that been said, I do give an ear to the fringe sects’ ideas and determine if they fit into my philosophy and what I know to be true. Oftentimes there are some aspects of truth in many of these new approaches and innovative ideas; however, they have not been refined or validated.  So, I take precaution in looking at these fringe sects; however, when I look at these ideas, I want to understand what they are trying to say as they are trying to present truth as they see it. Then I can augment certain aspects of those ideas into the mainstream as I believe they apply to situations, being carful not to leave the mainstream medical knowledge base already established.  But every practitioner really needs to figure this out for himself and it is my desire that some day, this will be taught in the schools and how to do this so that this too can be standardized and validated.

 

God Bless,

Dr. Ron Prehn