Pittsburgh Dentist - An Interview with Dr. Robert Rogers
Q. Tell us about yourself and your practice
A. I am a general dentist and have practiced for 30 years until retiring from general dentistry four years ago. For the last 20 years of my general practice I also pioneered and practiced the new dental field of Dental Sleep Medicine (see attached Bio) and presently limit my practice to the exclusive treatment of snoring and obstructive sleep apnea with oral appliances (Dental Sleep Medicine). We accept patients upon referral from primary care physicians medical sleep specialists sleep laboratories dentists and other medical specialties. (Please see my website at www.pittsburghdentalsleepmedicine.com). We see approximately 40 to 50 new patients each month. We utilize small oral appliances to comfortably reposition the lower jaw forward during sleep in an effort to prevent breathing passages from collapsing during sleep.
Q. What is the minimum age you take patients?
A. The ages of our patients range from teenagers to people in their 80s. It is well known that people of all ages suffer from snoring and obstructive sleep apnea (termed Sleep-Disordered Breathing) and need to be treated due to the medical and social consequences of untreated snoring and obstructive sleep apnea.
Q. What is sleep apnea?
A. Snoring and obstructive sleep apnea both occur when a person s breathing passage in their throat collapses during sleep. When the breathing passage partially collapses the tissues in the throat vibrate creating the noise we call snoring. As the patient drops into deeper sleep the breathing passage completely collapses (obstructive sleep apnea) preventing any air at all from getting into or out of the lungs. When this happens the oxygen in the blood falls while the CO2 in the blood begins to accumulate and the patient begins to suffocate. The brain senses this problem and activates the body&rsquo s sympathetic nervous system (&ldquo fight or flight system&rdquo ) which causes the heart to beat very quickly the blood pressure to rise suddenly and the brain to shift from deep refreshing sleep into a lighter non-refreshing sleep. As the brain goes into a lighter sleep the muscles in the breathing passage automatically stiffen and open usually with a gasp or snort. Once the breathing passage is open breathing resumes and the oxygen and CO2 levels in the blood normalize. Unfortunately the brain is very sleepy and wants to go back into the deep refreshing sleep stages which once again cause the airway to collapse giving rise to snoring and then obstructive sleep apnea. This cycles over and over sometimes hundreds of times per night. The result is that the patient is deprived of most of their deep refreshing sleep each night and so they are tired and fatigued during the day. In addition the constant rising and falling of oxygen and CO2 in the blood cause cardiovascular problems. And the obnoxious snoring noise irritates the bed partner night after night disrupting their sleep.
Q. How does sleep apnea affect a person?
A. Snoring is an obnoxious noise that can disrupt the sleep of the bed partner causing them to be sleep deprived. Sleep deprivation of the bed partner can lead to irritability during the day and increased risk of illness. This has been termed &ldquo second hand snoring&rdquo . In addition snoring is socially unacceptable and embarrassing. The most recent research is suggesting that snoring alone can negatively impact the health of those who snore. Obstructive sleep apnea can disrupt sleep leading to sleepiness and fatigue during the day as described above. Also the periodic racing of the heart spiking of blood pressure and the rising and falling of oxygen and CO2 in the blood numerous times each night lead to cardiovascular problems such as daytime high blood pressure and increased risk of heart attack and stroke. The sleep deprivation that the apnea causes can lead to increased risk for depression diabetes decrease in sexual libido/impotence increased appetite and others. The bottom line is that sleeping and breathing are critical for healthy living.
Q. Describe your success in treating sleep apnea patients?
A. Oral appliances to prevent upper airway collapse have been utilized for at least 25 years beginning in the mid-1980s. Since that time a fair amount of scientific research has been published illustrating the effectiveness of oral appliances to treat snoring and obstructive sleep apnea. The research shows us that oral appliances are effective in treating mild and moderate obstructive sleep apnea 75% of the time. Severe obstructive sleep apnea is successfully treated approximately 50% of the time or less and is unpredictable. I have been practicing Dental Sleep Medicine since 1990 and have found this to be the case in my own personal experience.
Q. Describe your appliances you use in treating patients?
A. The appliances we use fit into the mouth and comfortably advance the lower jaw forward slightly during sleep. This forward motion of the lower jaw allows the tissues in the back of the throat to open allowing for healthy breathing and sleep during the night. The appliances look like an orthodontic retainer and easily fit over the top and bottom teeth. Treatment with oral appliances is termed Oral Appliance Therapy.
Q. What other treatments do you specialize in?
A. Alternative treatment methods for obstructive sleep apnea include Continuous Positive Airway Pressure (CPAP) which is very effective but difficult to tolerate for many people. There are also surgical options to treat obstructive sleep apnea.
Q. How can one receive treatment for such cases?
A. Patients can receive Oral Appliance Therapy to treat their snoring or obstructive sleep apnea by calling our office at 724-935-6670. Our website is very informative and patients should review it at www.pittsburghdentalsleepmedicine.com. Prior to receiving an oral appliance all patient should have a diagnostic sleep test to see if they have obstructive sleep apnea or not. No patients will be treated without a sleep test. Sleep tests are easy to get by simply visiting the family doctor and describing the symptoms of snoring and daytime sleepiness. The physician will order a sleep test to see if obstructive sleep apnea is present. If it is the patient will most likely be offered a CPAP for treatment. In cases of severe sleep apnea the patient will be treated best by CPAP. Other mild and moderate cases may do very well with Oral Appliance Therapy.
Q. What payment options do you offer?
A. Most insurance companies will cover the vast majority of the costs for Oral Appliance Therapy. The patient generally has very little out-of-pocket expense when treated by a competent clinician who is in their insurance network. However many dentists may not participate in-network. It is important for the patient to find a dentist with the proper education and experience. Of note it should be known that the oral appliances offered over the Internet or on TV should be avoided. It is very important that the oral appliance be custom made by a properly educated and trained sleep-disorders dentist who works in tandem with medical sleep specialists to treat snoring and obstructive sleep apnea. The crude non-custom &ldquo boil and bite&rdquo appliances offered on television are bulky ill fitting and are not managed under the guidance of a trained medical/dental professional. As a result they are seldom affective. A recently published research article comparing non-custom &ldquo boil and bite&rdquo appliances with a good custom-made appliance managed by a properly trained dentists showed that the custom-made appliances were much more effective and preferred by the patients overall. It went on to show that most of the patients who were failures with the &ldquo boil and bite&rdquo appliances were in fact treated successfully whenever the appliance was changed to a custom-made appliance managed by a dentist. In addition the American Academy of Sleep Medicine recently published their official Guidelines for the Treatment of Adult Obstructive Sleep Apnea and specifically noted that custom-made appliances should be used.
