2017 ISSS Meeting Addresses Important Topics in Sleep Surgery

On May 5-6, 2017, the 8th meeting of the International Surgical Sleep Society was held at the University of Southern California.  It was a true pleasure to organize the meeting with invaluable input from many colleagues.  The conference covered a broad spectrum of interesting and relevant topics in the surgical evaluation and treatment of snoring and obstructive sleep apnea.  Here is the final program.  It was a full, thought-provoking two days.  The speakers and moderators did an incredible job providing a combination of the latest research and their own experiences and insight, and everyone contributed to the outstanding discussion sessions that were some of the meeting highlights. What to Do if You Missed This Sleep Surgery Conference For the first time, we video recorded the entire meeting.  There were some individuals who could not attend but paid registration fees for the meeting to assist with the expense of this recording.  We will be obtaining the recording soon and are in the process of deciding how we will store and provide access to it.  All attendees will be able to watch the video, which will be useful because there were two […]

2017 ISSS Meeting Addresses Important Topics in Sleep Surgery

International Surgical Sleep Society Meeting on May 5-6, 2017

Final preparations are in place for the 8th International Surgical Sleep Society Meeting in Los Angeles on May 5-6, 2017.  The conference program includes virtually all of the international leaders in sleep surgery, and I am excited for it.  The International Surgical Sleep Society is the world’s main organization dedicated to the surgical evaluation and treatment of snoring and obstructive sleep apnea.  Our members from all continents come together every 1-2 years for these scientific meetings where we share experiences and insight on surgery for snoring and obstructive sleep apnea.  One of the really nice things about this conference is the inclusion of substantial time for discussion on a series of lectures and a controversial topic related to each group of lectures. Where can I find more information and register? Registration is done through the conference website.  However, anyone with questions can contact or the coordinating team at the Office of Continuing Medical Education at the Keck School of Medicine of USC.  Of note, members of the International Surgical Sleep Society receive a discount of $100 on the registration fees, and this amount is equal to the $100 organizational dues. Will I […]

International Surgical Sleep Society Meeting on May 5-6, 2017

Sleep Apnea Surgery Research: Improving Results

When I chose to focus my career on snoring and sleep apnea surgery, one key factor in my decision was the idea that this was a new field with many unanswered questions and a need for more sleep apnea surgery research.  There was so much to learn when it came to surgery for snoring and obstructive sleep apnea, and I wanted to be part of helping these patients through high-quality research.  Fifteen years later, performing research has allowed me to improve the results for sleep apnea and snoring surgery in my own patients and to share these advances with other surgeons. Currently I perform a wide range of research studies that I describe on the Research page of my main website.  Here I want to write about 3 major research areas of sleep apnea surgery research in which I include my own patients.  These studies do not cover the major costs of medical care, for example the costs of surgery, but there are some tests that may be included. Sleep apnea surgery evaluation: DISE and MRI Throughout my entire career, the primary focus of my research has been improving patient […]

Sleep Apnea Surgery Research: Improving Results

2017 Advances in Sleep Apnea and Snoring Course

We have just finished our 23rd annual Advances in Diagnosis and Treatment of Sleep Apnea and Snoring course in Orlando, Florida.  This is one of my favorite events of the year because it includes a combination of surgical and nonsurgical topics and incorporates the true advances in sleep apnea and snoring.  My talks focused on sleep apnea and snoring surgery, but I really enjoy the opportunity to learn from some of the world’s experts in sleep medicine when they discuss nonsurgical evaluation and treatment.  This year was no different, and here are some highlights of the course, primarily the nonsurgical presentations. As in most fields of medicine, there is substantial use of complementary and alternative medicine, particularly in the treatment of insomnia.  Nalaka Gooneratne of the University of Pennsylvania spoke again on this topic.  Some of the most common treatments in this category are chamomile, melatonin, .  Melatonin is interesting because it is available over-the-counter in the United States, although there is wide variation in the availability of melatonin in these various supplements; he recommended melatonin from Life Extension Foundation as being of higher quality (note: I have no financial connection […]

2017 Advances in Sleep Apnea and Snoring Course

International Surgical Sleep Society 2017 Conference Program

One of the true privileges of being President of the International Surgical Sleep Society (ISSS) is the opportunity to organize our upcoming meeting.  This will be held on May 5-6, 2017, at the University of Southern California in Los Angeles.  The ISSS is the world’s primary organization dedicated to the surgical evaluation and treatment of obstructive sleep apnea and snoring.  This will be the eighth meeting of our young organization, and it will bring together almost all of the world’s leaders in the field.  For a surgeon interested in sleep surgery, it should be the best conference of the year. After months of planning, I have posted the conference program on the ISSS website.  The goals in program development were to cover the full spectrum of treatments for obstructive sleep apnea and snoring.  The program includes a combination of outstanding expert lectures and sufficient discussion time to allow surgeons from around the world to share their perspectives and experiences with others.  Credit goes to everyone who contributed, including the ISSS Board of Directors and the Organizing Committee (listed on our Save the Date card).  With all of the effort to develop the program, I […]

International Surgical Sleep Society 2017 Conference Program

Tonsillectomy for Sleep Apnea as First-Line Treatment in Adults

For adults with obstructive sleep apnea, the standard treatment is positive airway pressure therapy (such as CPAP, BPAP, or APAP).  Surgery is reserved for patients who are unable to tolerate or benefit from positive airway pressure therapy.  For children, adenoidectomy and/or tonsillectomy for sleep apnea is the standard treatment.  Positive airway pressure therapy is not an ideal treatment for most children.  This is due to concerns over effects on facial growth and difficulty that children may have with tolerating it through the night.  It is reassuring that surgical outcomes in children–while by no means perfect–are relatively good, especially when the tonsils or adenoids are enlarged and when the child is not considered substantially overweight. What about tonsillectomy for sleep apnea as first-line treatment in adults? Just like in children, adults with enlarged tonsils also do better after sleep apnea surgery that includes tonsillectomy.  One reason seems to be that the physical removal of the enlarged tonsils immediately opens up space for breathing and improves the sleep apnea.  Many have wondered whether adults with sleep apnea and markedly enlarged tonsils should be treated with surgery that includes tonsillectomy. The December 2016 […]

Tonsillectomy for Sleep Apnea as First-Line Treatment in Adults

Latera, a new treatment for nasal obstruction

Nasal obstruction, or trouble breathing through the nose, can be challenging to treat because there are multiple potential causes.  Each of these causes has their own series of treatments, and often multiple treatments for nasal obstruction may be required in the same patient.  One common source of nasal obstruction is collapse of the sides of the nose during breathing, a phenomenon also called nasal valve collapse.  The Latera implant was recently approved by the United States Food and Drug Administration for the treatment of nasal obstruction and is an exciting new development in the field.  As a new device, relatively few surgeons are certified to use the Latera implant, and I am excited to offer it to my patients. Patients with collapse of the sides of the nose while breathing can use a nasal dilator, such as the Breathe Right strip.  This can address collapse of the sides of the nose while it is worn, but there can be some problems: the strips can fail to stick to the nasal skin or, conversely, can irritate the skin of the nose it is generally only worn at night, leaving a patient with […]

Latera, a new treatment for nasal obstruction

Surgery AND an Oral Appliance for Sleep Apnea or Snoring

This past Friday, I had the privilege of speaking to the Western Los Angeles Dental Society about the surgical evaluation and treatment of obstructive sleep apnea and snoring during an educational course about sleep dentistry.  My grandfather was a dentist in Los Angeles who practiced for over 50 years, and I have always had tremendous respect for dentists.  A sleep dentist plays an important role in providing special mouthpieces (called oral appliances, mandibular repositioning appliances, or mandibular advancement devices) that hold the lower jaw (mandible) in a forward position during sleep.  Studies have shown that an oral appliance for sleep apnea or snoring can work well in some patients.  I see many patients who have been treated with an oral appliance for sleep apnea or snoring in my practice.  While some patients have had real success with oral appliances, others may have trouble tolerating them or may simply not achieve enough of an improvement.  It is the last group of patients where surgeons and dentists can do better. Surgeons and Dentists Working Together to Improve Results Whenever I give talks to dentists, I stress the often-overlooked complementary role that dentists and […]

Surgery AND an Oral Appliance for Sleep Apnea or Snoring

American Sleep Association: Improving Awareness of Snoring and Sleep Apnea Treatment Options

I was recently invited to join the Advisory Board of the American Sleep Association.  Because of their dedication to increasing awareness about the importance of sleep and sleep disorders, I agreed to this position and contributed website content related to surgical treatment of snoring and obstructive sleep apnea.  Here are links to those pages: Snoring Surgery Sleep Apnea Surgery Palate Surgery for Sleep Apnea Hypopharyngeal Surgery and Jaw Advancement for Sleep Apnea Upper Airway Stimulation          

American Sleep Association: Improving Awareness of Snoring and Sleep Apnea Treatment Options

Inspire Upper Airway Stimulation for Sleep Apnea–Role of Experience

Inspire Upper Airway Stimulation for sleep apnea is a powerful and exciting treatment for many patients who do not succeed with positive airway pressure therapy (for example, CPAP or BPAP).  Inspire Upper Airway Stimulation for sleep apnea is a system that involves a surgical procedure to implant 3 components.  These components work together to deliver stimulation to the nerve that controls tongue movement (hypoglossal nerve) during sleep.  I have been involved with hypoglossal nerve stimulation for the treatment of obstructive sleep apnea for over 7 years and have witnessed the major improvement in sleep apnea that can occur.  We draw heavily on that experience in treating patients with sleep apnea, especially those who are treated with Inspire Upper Airway Stimulation for sleep apnea.  I have written multiple times on this blog about Upper Airway Stimulation, including the following topics: how drug-induced sleep endoscopy is essential to selection of patients who will respond well to Inspire Upper Airway Stimulation results for Upper Airway Stimulation remain consistent, with a recent study following patients for 3 years because the benefits are substantial, the tradeoff between costs and benefits (called cost-effectiveness) is well within the range seen […]

Inspire Upper Airway Stimulation for Sleep Apnea–Role of Experience

Snoring and Sleepy but No Sleep Apnea–What to Do?

As a snoring and sleep apnea surgeon, I see patients all the time who snore and report being sleepy.  We will order a sleep study, assuming that they have obstructive sleep apnea.  However, the sleep study may show no evidence of obstructive sleep apnea.  This can be both good and bad news.  The good news is that the patient does not have obstructive sleep apnea and its association with some significant health concerns.  The bad news is that most medical insurance plans in the United States do not cover treatment for snoring without obstructive sleep apnea.  The patient is therefore tired and not covered for medical treatment. Am I the only person who is snoring and sleepy without having sleep apnea? In short…No!  A study in the July 2016 issue of the medical journal The Laryngoscope sheds more light on this all-too-common situation.  Of 307 patients without sleep apnea, almost one-third (101) were sleepy, based on a high Epworth Sleepiness Scale score.  The Epworth Sleepiness Scale measures how likely it is for someone to fall asleep during the day in a range of situations.  In addition, the study found that […]

Snoring and Sleepy but No Sleep Apnea–What to Do?

How Much Should My Child Sleep?

Last year, I shared the findings of a consensus panel indicating that adults should sleep at least 7 hours per night on a regular basis to promote optimal health.  The American Academy of Sleep Medicine has followed this with a similar expert panel to develop recommendations for sleep for children.  I treat adults with sleep disorders but do not treat many children or adolescents.  However, as a parent, I am often asked for advice by other parents who ask, “How much should my child sleep?” I have read a number of studies related to healthy sleep in children but would never consider myself an expert.  Therefore, I will defer to the panel and simply restate their findings on the recommended amount of sleep for children. AASM Panel Recommendations for Healthy Sleep in Children To promote optimal health, children should sleep the following amounts on a regular basis: Infants* 4 months to 12 months should sleep 12 to 16 hours per 24 hours (including naps). Children 1 to 2 years of age should sleep 11 to 14 hours per 24 hours (including naps). Children 3 to 5 years of age should sleep 10 […]

How Much Should My Child Sleep?

Positive airway pressure after sleep apnea surgery: Catch-22

I just returned from giving lectures at the 13th Annual Middle East Update in Otolaryngology conference in Dubai, United Arab Emirates.  I had never visited Dubai before, and it was wonderful to share experiences with colleagues from throughout the Middle East and beyond while having the additional bonus of seeing a new part of the world.  Beyond the conference, it was amazing to go snowboarding at Ski Dubai, an indoor, snow-covered slope inside a Dubai mall, right in the middle of the desert! Last month, we had a tremendously successful 7th scientific meeting of the International Surgical Sleep Society.  We had over 250 surgeons in Sao Paulo, Brazil, and the meeting covered a broad range of topics in the surgical evaluation and treatment of snoring and obstructive sleep apnea.  It is an honor to serve as the President of this organization, and I am excited to be planning the next meeting that will be held on May 5-6, 2017 at the University of Southern California in Los Angeles. My goal with blog posts is to share the latest research findings, typically finding these in recent publications or presentations at scientific meetings.  Sometimes, however, there are papers that […]

Positive airway pressure after sleep apnea surgery: Catch-22

ISSS Sao Paulo: sharing experiences in sleep surgery to help patients

On April 15-16, 2016, the seventh scientific meeting of the International Surgical Sleep Society was held in Sao Paulo, Brazil.  The ISSS Sao Paulo meeting was the largest and most-comprehensive meeting of our organization.  As a co-organizer, we took the opportunity to expand the program, especially the discussions focused on pediatric sleep surgery and treatment with maxillofacial surgery and oral appliances.  Brazil is in the midst of an extremely difficult time–economically and politically–but Brazilian colleagues and people welcomed us with their typical incredible warmth and hospitality.  It was a fantastic meeting, and those of us in attendance did our best to contribute proudly to the good stories of the ISSS. Growing interest and tackling challenges in sleep surgery The ISSS was founded in 2006 to advance the field of sleep surgery.  From the beginning, ISSS meetings have included leaders in sleep surgery research from around the world.  We have all benefited from the freedom to share experiences and the latest developments.  These conferences have always provided the opportunity for people to share positive and negative outcomes and respectful disagreements so that we can all learn from each other and benefit.  Over the past decade, […]

ISSS Sao Paulo: sharing experiences in sleep surgery to help patients

Does nasal surgery for snoring work?

This past weekend, I gave a lecture at the USC Advanced Endoscopic Sinus Surgery Course on the impact of nasal surgery for snoring and obstructive sleep apnea.  A previous blog post examined recent research showing that studies show that nasal surgery, by itself, does not alleviate sleep apnea in most patients but that it can improve sleep quality and symptoms like sleepiness.  I want to expand on that previous post to discuss the role of nasal surgery for snoring. Snoring surgery success depends on determining what areas of the breathing passages are causing the snoring, whether in the Nasal, Palate, or Tongue Regions that I outline on my main website: sleep-doctor.com.  Often an individual will have more than one of these Regions involved, leading to my recommendation of a combination of surgical procedures.  One of the most common questions I face with my patients is how much benefit a more-limited approach that focuses on the nose only would offer for curing snoring. Why should someone consider nasal surgery for snoring? There are 3 reasons to undergo nasal surgery as snoring treatment: Improving nasal breathing, helpful someone breathe better during the day and […]

Does nasal surgery for snoring work?

Our snoring and sleep apnea course: Day 2 highlights

Our snoring and sleep apnea course continued today with talks on a wide range of sleep apnea treatment, especially weight loss and surgical evaluation and treatment. Allan Pack, MBChB, PhD from the University of Pennsylvania started the day, speaking on key papers from the past year in the field of sleep medicine.  The prevailing wisdom has been that the development of electricity and artificial light has led to a decline in the amount of time that people are sleeping.  Two studies have examined human populations who have not had access to electricity and showed that, in fact, this does not appear to be true.  The typical range of sleep varies in these groups between 5.7-7.1 hours per night, with slightly more sleep during the winter than the summer.  Sleep generally started around 3.3 hours after sunset, and people awakened as ambient temperature reached its lowest point during the day.  Other papers reviewed the evidence related to sleep apnea and risks of cancer and kidney disease.  They showed that sleep apnea, especially the degree of drops in oxygen levels, increased the development of a number of different types of cancer that […]

Our snoring and sleep apnea course: Day 2 highlights

Our snoring and sleep apnea course: Day 1 Highlights

I wanted to share highlights from our 22nd Annual Advances in Diagnosis and Treatment of Sleep Apnea and Snoring course in San Francisco.  I am admittedly biased as a Co-Director of the course, but I think this is one of the best available, especially for surgeons.  The snoring and sleep apnea course program includes lectures in sleep medicine (non-surgical) as well as surgical and dental topics.  We again drew about 175 physicians to San Francisco, where I had a chance to connect with long-time friends from my time on the faculty at the University of California, San Francisco. Atul Malhotra, MD from the University of California, San Diego gave another interesting lecture on the factors that contribute to sleep apnea.  Atul has performed excellent research in this area for many years with colleagues both at UCSD and in his previous position at Brigham and Women’s Hospital in Boston.  One of the most enjoyable aspects of this sleep apnea course is the opportunity to come together with long-time colleagues and friends and discuss cutting-edge concepts in the field.  Atul spoke about the constellation of abnormal anatomy, control of muscles and breathing, […]

Our snoring and sleep apnea course: Day 1 Highlights

3-Year Outcomes for Inspire Medical Upper Airway Stimulation

Excellent outcomes at 3 years after implantation of the Inspire Medical Upper Airway Stimulation system were reported in the January 2016 issue of the medical journal Otolaryngology–Head and Neck Surgery.  Many types of sleep apnea surgery have solid research evidence demonstrating multiple benefits, from improvements in health and sleep quality (treating sleepiness and quality of life) to reductions in snoring.  However, one of the limitations of sleep apnea surgery research–like all fields of medicine–is that most studies are performed over focused periods of time, examining patients typically at 3-6 months following surgery. This study followed patients receiving Upper Airway Stimulation through the STAR Trial.  It showed that the benefits of Inspire Medical Upper Airway Stimulation seen at 1 year after implantation remain unchanged over a 3 year period.  This is an important finding because we obviously want patients to continue receiving the benefit of any sleep apnea surgery over long periods of time.  In this study, the results at 3 years were, if anything, slightly better than those reported in the previous study of 1 year outcomes.  The results are shown below and indicate that Upper Airway Stimulation achieves meaningful, lasting improvements […]

3-Year Outcomes for Inspire Medical Upper Airway Stimulation

Sleep apnea surgery experts at next ISSS meeting

The International Surgical Sleep Society is the world’s major organization dedicated to snoring and sleep apnea surgery.  I am honored to be the current President of the ISSS and am excited with new developments that we have recently announced. Next ISSS Meeting: Sao Paulo, Brazil in April 2016 The ISSS has focused their efforts on major scientific meetings that bring together the world’s experts in snoring and sleep apnea surgery.  The 7th ISSS meeting that will be held in Sao Paulo, Brazil on April 15-16, 2016, and will build on the tremendous successes of previous meetings. Details and registration information are available at the conference website.  Some of the highlights are: Outstanding faculty from around the world, including both the speakers and moderators leading the discussion in each session Two lecture rooms running simultaneously, enhancing the program and enabling substantial time for discussion that should be one of the best parts of the meeting Expanded coverage of a full spectrum of topics in sleep surgery, including airway evaluation, surgical techniques, pediatric sleep surgery, oral and maxillofacial surgery, and oral appliances Oral and poster research presentations: online abstract submission, with deadline January 20, […]

Sleep apnea surgery experts at next ISSS meeting

Sleep apnea and unable to use CPAP? Consider sleep apnea surgery!

I see patients all the time who are coming in for the first time to see someone for an evaluation of snoring and possible sleep apnea.  After I explain what sleep apnea is and order a sleep study, they almost always have a few questions: If I have sleep apnea, what are my treatment options? You mentioned this mask and treatment called CPAP.  How can you expect me to sleep with that mask on my face? Can’t we just do surgery and take care of the problem right away? The answers I give are those that I offer to my own family and friends.  For patients with moderate to severe sleep apnea, CPAP remains the first-line therapy.  Patients who do well with it love it.  I had a close friend visiting me last month who offered to be on any public service announcement I might have because he has had such a dramatic improvement with CPAP and has been able to use it comfortably all night, every night. On the other hand, multiple studies have shown that about half of all patients with sleep apnea are unable to tolerate positive […]

Sleep apnea and unable to use CPAP?  Consider sleep apnea surgery!

Sleep Apnea Surgery Research Updates from 2015 AAO-HNS Annual Meeting

The 2015 Annual Meeting of the American Academy of Otolaryngology–Head and Neck Surgery was just held in Dallas from September 27-30.  Although I typically give several talks related to sleep apnea surgery, whether focused on drug-induced sleep endoscopy or sleep apnea procedures related to the Palate Region or Tongue Region, one of the most enjoyable and interesting parts of the conference is sharing experiences and findings with colleagues.  This occurs informally as well as during formal sessions devoted to research presentations.  This year, there were a number of interesting research studies that were presented. Dr. Ryan Soose from the University of Pittsburgh spoke about the STAR Trial that demonstrated the benefits of the Inspire Upper Airway Stimulation system for treatment of obstructive sleep apnea.   The study screened over 1000 individuals who were unable tolerate positive airway pressure therapy (such as CPAP).  Interestingly, many of them initially did well enough with positive airway pressure therapy to keep trying, as only 28% abandoned it completely within a year, but the problem was that more people were unable to continue with it as time passed.  The same was true for oral appliances.  18% of the […]

Sleep Apnea Surgery Research Updates from 2015 AAO-HNS Annual Meeting

Is nasal surgery a solution for sleep apnea?

Surgical treatment of obstructive sleep apnea depends on determining where blockage of breathing is occurring during sleep, whether in the Nasal, Palate, or Tongue Regions that I outline on my main website: sleep-doctor.com.  Often an individual will have more than one of these Regions involved, leading to my recommendation of a combination of surgical procedures.  One of the most common questions I receive is whether a more-limited approach would be successful in treating sleep apnea, particularly surgery focused only on the nose. Why should someone with sleep apnea consider nasal surgery? There are 3 reasons to undergo nasal surgery (after an unsuccessful trial of medications) if someone has obstructive sleep apnea: Improving nasal obstruction broadly Improving nasal obstruction during the night so that other treatments such as positive airway pressure therapy (for example, CPAP) and oral appliances will work better To improve sleep apnea with surgery as a primary treatment There are many studies showing that nasal surgery–whether of the nasal septum, turbinates, sinuses, or the outside of the nose–can improve nasal obstruction and other related problems.  In addition, improving nasal obstruction is one of the few things that has been shown to […]

Is nasal surgery a solution for sleep apnea?

Is your oral appliance for sleep apnea not working?

I have written extensively on this blog and my main website that there is no single surgery for sleep apnea and snoring.  The recurring theme is that different treatments work differently in different patients, meaning that a cookie-cutter approach to sleep apnea surgery is doomed to failure.  Even with our best efforts to apply this personalized medicine philosophy, surgery is by no means universally successful.  Because of my focus in surgery for sleep apnea and snoring, I see a large number of patients that have not achieved the desired results after surgery–whether performed by other surgeons or me. While many physicians tend to shy away from those with bad results because they make us feel bad, a long time ago I saw that my mentors had patients with suboptimal outcomes returning to their office more often than the happiest patients.  If I want to do everything possible to help patients, I want to understand why some do not have success with sleep apnea surgery so that I can improve results in those patients and others that I will treat in the future.  My evaluation for patients with poor results after […]

Is your oral appliance for sleep apnea not working?

DISE and Results in Sleep Apnea Surgery

Sleep surgeons are always looking for ways to achieve consistent, predictable results.  Our best efforts use a combination of careful patient examination, precise surgical technique, and constant reflection and experience.  While we have seen major advances in surgical techniques and treatments, I would argue that we have just as much to offer in the improvements in patient examination that are available.  Drug-induced sleep endoscopy (DISE) was first described almost 25 years ago, but in some ways it is still in its infancy. The VOTE Classification DISE is based on the idea that we want to know what structures surrounding the throat are causing the blockage in breathing that occurs in sleep apnea.  Winfried Hohenhorst, Nico de Vries, and I developed the VOTE Classification in 2011 to provide a systematic approach to documenting the findings of DISE.  Using the VOTE Classification, recent papers have evaluated the association between DISE findings and surgical outcomes–namely, whether DISE can predict results of sleep apnea surgery.  Through the International Surgical Sleep Society, I am leading a research study that will bring together many surgeons and their patients to answer questions like this in more detail.  Those […]

DISE and Results in Sleep Apnea Surgery

How Much Should I Sleep?

Sleep is increasingly being recognized for its importance in health and quality of life.  In fact, in March 2015 the US Department of Health and Human Services published Health Objectives 2020, identifying the goal of increasing the proportion of adults who obtain sufficient sleep.  Numerous studies have examined the association between sleep duration (the number of hours of sleep) and health, and the American Academy of Sleep Medicine and Sleep Research Society collected experts in this area to answer the question: How much should adults sleep? I was not part of this group but have been part of other similar panels.  Unfortunately, the recommendations produced from these group meetings tend to be almost too complete, in that they are lengthy and sometimes unclear for readers.  Because these were so simple and direct, I will just repeat the entire Consensus Statement that was published in the June 2015 issue of the medical journal SLEEP.  They certainly answer a question I am asked all the time (and echo my usual advice to patients, family, and friends).   The Recommendations for Healthy Sleep Adults should sleep 7 or more hours per night on a regular basis […]

How Much Should I Sleep?

Some Sleep Apnea Highlights from the American Thoracic Society 2015 Meeting

  I had the opportunity to participate in the American Thoracic Society 2015 meeting over the past few days as part of two sessions: a day-long course on the connection between anesthesia and sleep (especially obstructive sleep apnea) and a symposium on personalized medicine for sleep apnea.  My talks focused on the personalized medicine approach to the selection of surgical procedures to treat sleep apnea, including drug-induced sleep endoscopy.  I will share some brief highlights from other talks at these sessions, as I have discussed many of these themes in other blog posts and elsewhere on my website.  An important note is that this post is not meant to provide an exhaustive list of meeting highlights because there is so much outstanding science on a wide range of disorders and diseases. Sleep apnea phenotypes: different people with sleep apnea are different Multiple factors contribute to sleep apnea, including abnormal anatomy (the target of surgery and the most important factor), reflex muscle activation in the throat, control of breathing, and low arousal threshold.  Different factors are more important in some people than others, and it is important that up to 70% of […]

Some Sleep Apnea Highlights from the American Thoracic Society 2015 Meeting

Upper Airway Stimulation: Expensive but Worth It?

Many medical treatments have high initial costs but are considered worthwhile expenses because of the benefits, both direct (improved health and quality of life) and indirect (decreased healthcare spending from avoidance of complications).  For treatments such as kidney dialysis, cardiac pacemakers, and organ transplantation, we as a society are willing to pay for treatments with high costs as long as they provide substantial benefits.  Cost-effectiveness analysis is a common technique to weigh costs and effectiveness and evaluate whether a treatment that might be expensive has impacts that are large enough to justify the costs, so to speak. Cost-effectiveness analysis allows comparison of different types of treatments by using a measure of effectiveness called quality-adjusted life-years (QALYs), combining additional years of life (decreased mortality) with increased quality of life (avoiding health complications or motor vehicle crashes, for example).  The cost per QALY measures the cost that is associated with each additional year of life with perfect health.  This is not the same as adding another year of life, as it incorporates not only the additional years of life and the quality of those additional years.  For example, if a treatment allows […]

Upper Airway Stimulation: Expensive but Worth It?

International Surgical Sleep Society: The Benefits of Membership

My previous blog post briefly discussed the International Surgical Sleep Society, the world’s preeminent organization dedicated to the surgical evaluation and treatment of obstructive sleep apnea and snoring.  Founded in 2006, the ISSS has organized six scientific meetings to bring together experts in sleep surgery from around the world, facilitating the sharing of experiences and ideas to advance our relatively new field.  I am honored to be the President and have worked hard with the Board and Website Editor to redesign the website and develop some new offerings.  These include our first newsletter that shares highlights from the most recent ISSS meeting in October 2014, discusses two research studies that are ISSS collaborations, and an interesting case discussion about a topic that plagues us all: when to resume CPAP in a patient undergoing endoscopic sinus surgery. The website also includes a section for information regarding the ISSS meetings.  We have added the programs from previous conferences and are excited to announce the dates and location for our next two meetings.  On April 15-16, 2016, we will hold a meeting at the Centro de Convencoes Reboucas in Sao Paulo, Brazil.  The Chairs are Michel Cahali, […]

International Surgical Sleep Society: The Benefits of Membership

So how do I become an expert in snoring and sleep apnea surgery?

The subspecialty of snoring and sleep apnea surgery is relatively young, and people ask me all the time how I was drawn to the field.  I was fortunate enough to have my own interest sparked as a medical student at the University of Pennsylvania.  As medical students, we were all a little sleep-deprived (and more able to understand the problems associated with sleep issues), and some lectures about sleep disorders caught my attention.  From there, I was drawn to snoring and sleep apnea surgery and had the benefit of having incredible mentors during medical school, residency in otolaryngology–head and neck surgery, and a fellowship in sleep surgery. When I finished my training, there were still very few dedicated sleep surgeons in the country.  It has been wonderful to see the growth in the field over the past 10-15 years.  I receive many requests from surgeons in this country and from abroad who would like to become an expert in snoring and sleep apnea surgery who are asking for advice.  My first instinct is to ask how much they would like to focus on sleep surgery, as anyone who really wants […]

So how do I become an expert in snoring and sleep apnea surgery?

Days 2 and 3 Highlights–Sleep Apnea and Snoring Course

Here are some highlights from Days 2 and 3 of our sleep apnea and snoring course: Gary Foster, PhD, a long-time faculty member at Temple University and more recently the C0-Chief Scientific Officer at Weight Watchers, showed new studies evaluating the benefits of weight loss in improving moderate to severe obstructive sleep apnea, providing evidence that is more relevant than early studies that were done mainly in people without sleep apnea or mild sleep apnea.  Interestingly, the benefit for sleep apnea seems to hold up well, even in patients who regain some of their lost weight.  A study published just last year suggested that weight loss may be more beneficial than CPAP alone in obese patients with sleep apnea, although the combination seems to improve blood pressure more than weight loss alone.  The bottom line is that weight loss can be very helpful in obese patients, with a 10% weight loss improving many health conditions (especially diabetes) and obstructive sleep apnea.  The exciting thing is that there are more behavioral programs and medication options that can make a difference and help someone achieve weight loss. Neil Freedman, MD discussed the […]

Days 2 and 3 Highlights–Sleep Apnea and Snoring Course

Highlights from Day 1 of the 21st Annual Advances in Diagnosis and Treatment of Sleep Apnea and Snoring course

I am writing from Orlando and the 21st Annual Advances in Diagnosis and Treatment of Sleep Apnea and Snoring course, for which I am a Co-Director.  We were so happy to have close to 200 attendees for the 3 day meeting, reflecting the strong interest in sleep apnea and snoring among physicians and dentists from a wide variety of fields: internal medicine, pulmonology, otolaryngology – head & neck surgery, and oral and maxillofacial surgery. Instead of summarizing all the lectures, I wanted to share some of the key points that I took away from the course, many of them not involving surgery at all.  The course combines a wide range of topics important to sleep apnea, snoring, and other sleep disorders, and the first day is not related specifically to surgery–so the highlights are not specifically related to surgery. Nalaka Gooneratne, MD from the University of Pennsylvania spoke about treatment of sleep apnea in older adults (age 60 years and older).  Nalaka reinforced but also added to my understanding of what I think is a fascinating topic.  In short, there are a number of studies suggesting that sleep apnea in older […]

Highlights from Day 1 of the 21st Annual Advances in Diagnosis and Treatment of Sleep Apnea and Snoring course

Oral appliances for snoring or sleep apnea have important potential dental side effects

Surgery for snoring and sleep apnea has potential risks and side effects.  As a surgeon writing this post, I feel like I have to emphasize that I know that these risks and side effects exist.  In fact, my previous blog post cited the research I have done showing that the risk of serious medical complication after sleep apnea surgery is 1.6%, mainly in those with major medical problems before surgery.  The goal of a surgeon and their team is to minimize those risks and discuss them with patients, who can weigh the benefits and risks of surgery.  A key part of that discussion is having quality knowledge of surgical risks so that a discussion can be based on accurate information. Oral appliances for snoring or sleep apnea have risks too Oral appliances are a possible treatment for snoring and obstructive sleep apnea that work by holding the lower jaw in a forward position during sleep.  Studies have shown that they can work well for some patients.  In fact, I refer a number of patients to my dental colleagues, whether based on my office examination or drug-induced sleep endoscopy.  Before referring […]

Oral appliances for snoring or sleep apnea have important potential dental side effects

Reducing the risks of surgery in patients with obstructive sleep apnea

Last week, I gave a lecture to our residents about the risks of medical complications after surgery in patients with obstructive sleep apnea.  It brought back memories of some studies about the risks of surgery in which I was involved and highlighted two recent studies of the risks of surgery published last month in journals from the field of anesthesiology.  There are a number of small studies out there about medical complications, but many of them focus on trivial issues like a 5-second drop in the oxygen level to 85% while someone is in the recovery room immediately after surgery.  That is not really relevant to anyone, so I prefer to focus on complications that have potential health implications, from as relatively minor as having the patient remain intubated (leaving in the breathing tube during placed during surgery for another day, for example) to more-substantial (pneumonia or emergency need for placement of a breathing tube).  I will describe findings that have been shown in two groups of patients with potential risks: those undergoing surgery for sleep apnea and those who have sleep apnea but are undergoing surgery unrelated to sleep apnea. […]

Reducing the risks of surgery in patients with obstructive sleep apnea

Inspire Upper Airway Stimulation: Randomized Withdrawal Study Results

This study and others are included in my video discussion of the Inspire Medical Systems Upper Airway Stimulation system that I have posted on Youtube. One of the distinctive aspects of the Inspire Medical Systems STAR Trial was the short-term withdrawal of therapy from some patients.  The November 2014 issue of the medical journal Otolaryngology–Head and Neck Surgery reported results of this randomized withdrawal study.  This withdrawal study that took the first 46 patients who responded well to the Inspire Upper Airway Stimulation 12 months after receiving the system and stopped treatment for a month in half of them.  They then tested everyone a month later (with half of these patients having their system off for the month) and then turned the system back on in everyone and retested everyone a total of 18 months after receiving the system. The study included the broad evaluation of patients, using sleep study results (such as the apnea-hypopnea index that measures the number of times per hour with blockage of breathing) and questionnaires to measure sleepiness and quality of life.  There were a couple of important findings.  The image below shows the results for the apnea-hypopnea index at […]

Inspire Upper Airway Stimulation: Randomized Withdrawal Study Results

Inspire Upper Airway Stimulation: my informational video now posted on Youtube

At the Keck Medical Center of USC, we have become an active center offering the Inspire Medical Systems Upper Airway Stimulation system for the treatment of obstructive sleep apnea.  With greater awareness of patients about health conditions and cutting-edge therapies, I have received many requests for information.  Based on these requests, I have developed a Youtube video describing Upper Airway Stimulation with answers to some of the most common and important questions I receive. As I mention in the video, please do not hesitate to contact me at eric.kezirian@med.usc.edu with any questions or if you would like to schedule an appointment or refer a patient.

Inspire Upper Airway Stimulation: my informational video now posted on Youtube

2014 International Surgical Sleep Society Meeting–Coming Together to Advance Sleep Surgery

I am writing from Detroit and Henry Ford Hospital, the site of the 2014 International Surgical Sleep Society meeting.  The meeting brings together leaders from around the world, discussing the latest topics related to surgical and many non-surgical treatments other than positive airway pressure therapy (such as CPAP) and oral appliances.  This was the 6th meeting, and the program incorporated outstanding talks as well as lively discussions among those dedicated to sleep surgery.  The sessions focused on adult and pediatric sleep apnea, from preoperative evaluation to management to the procedures themselves as well as new therapies.  It is hard to single out specific talks, as I enjoyed and learned from all of the speakers. Instead, I want to highlight is the meeting devoted to research that occurred immediately prior to the conference.  Like all fields of medicine, the more we have learned in sleep surgery, the more we find out that we do not yet know.  We convened a number of us who are actively engaged in sleep surgery research and developed a plan to move forward with high-quality studies.  This was not meant to exclude others, as any surgeon […]

2014 International Surgical Sleep Society Meeting–Coming Together to Advance Sleep Surgery

Does my tongue look fat?

This month (October 2014) I wrote an editorial in the medical journal SLEEP about a research study that appeared in the same issue.  The study is fascinating because it provides a deeper explanation not only of why weight gain is associated with worse sleep apnea and poorer outcomes for many sleep apnea treatments but why not all people develop sleep apnea when they gain weight.  Here is a summary of my editorial: In today’s society that overemphasizes physical beauty and thinness, few have escaped the dreaded experience of a spouse or friend inquiring about their appearance, typically when wearing a new article of clothing.  Many have learned the hard way that there are no correct answers in the interrogation that can ensue, and it is usually best to avoid the question at all costs.  In contrast, in the current issue of SLEEP,  a study published by Richard Schwab and his team at the University of Pennsylvania demonstrate that answering the slightly-different question posed in the title may provide valuable information to patients at risk for obstructive sleep apnea (OSA). Exploring the link between weight gain and sleep apnea Weight gain and […]

Does my tongue look fat?

Sleep surgery research at the American Academy of Otolaryngology–Head and Neck Surgery 2014 Annual Meeting

The 2014 Annual Meeting of the American Academy of Otolaryngology–Head and Neck Surgery was just held in Orlando from September 21-24.  It is always enjoyable and interesting to share experiences and findings with colleagues in several sessions and courses related to the surgical evaluation and treatment of snoring and obstructive sleep apnea.  This year, I spoke on a number of topics, including hypoglossal nerve stimulation, surgical treatment of the Tongue Region, and evaluation of patients to select procedure with drug-induced sleep endoscopy. There were a number of interesting research studies that were presented.  Chris Ayers and Boyd Gillespie,  from the Medical University of South Carolina, presented research evaluating the review of drug-induced sleep endoscopy videos to determine whether patients would be candidates for Upper Airway Stimulation.  I was one of the surgeons who reviewed videos for the research study, and I was happy to hear that we all had a relatively high rate of agreement on the key question: whether there was a pattern that is called complete concentric collapse related to the soft palate (roof of the mouth).  This finding excludes patients from receiving this treatment, and our agreement was […]

Sleep surgery research at the American Academy of Otolaryngology–Head and Neck Surgery 2014 Annual Meeting

Chin straps are not a solution for most patients with snoring or sleep apnea

The lay press can be quick to jump on reports in the medical literature, especially when it comes to snoring and obstructive sleep apnea.  This has positive and negative impacts, but one of the downsides is that the public can read an article and misunderstand the findings.  Companies with products described in medical articles can exaggerate the findings, leading many patients astray in the search for a simple, cure-all. Chin straps (shown below) are commonly used to treat patients with obstructive sleep apnea who open their mouth during use of positive airway pressure therapy.  Opening the mouth allows air to escape from the mouth when a patient is wearing a mask over their nose or with inserts that extend into the nostril (nasal pillows).  However, they are not used often as treatment by themselves.  An article published in 2007 in the Journal of Clinical Sleep Medicine showed that a single patient with sleep apnea experienced resolution with wearing a chin strap (shown below).  Since that time, I have seen a number of patients with sleep apnea come in and report that they have tried a chin strap after being unable to […]

Chin straps are not a solution for most patients with snoring or sleep apnea

DISE can change the treatment plan in obstructive sleep apnea surgery

Drug-induced sleep endoscopy (DISE) is an evaluation technique that can be performed for patients with obstructive sleep apnea who are unable to tolerate positive airway pressure therapy (e.g., CPAP or BiPAP).  The purpose of DISE is to improve the results of treatment with surgery and/or oral appliances.  There are many surgical procedures available to treat the different structures of the nose and throat that can play important roles in causing snoring and obstructive sleep apnea. Successful sleep apnea surgery is based on accurately identifying where the snoring and blockage in breathing is occurring and developing targeted, effective treatment.  DISE was developed in Europe over 20 years ago, and it allows surgeons to look inside the throat with a flexible fiberoptic endoscope while a patient is sedated in a way that is similar to natural sleep.  Once a patient is sedated but breathing on their own, the surgeon places the endoscope through one of their nostrils and into the throat to examine what are called the Palate and Tongue Regions in the image below.  The idea behind DISE is that determining what causes blockage of breathing during sleep will allow surgeons to choose […]

DISE can change the treatment plan in obstructive sleep apnea surgery

Oral Pressure Therapy (Winx): new research may explain why the results have not been as good as anticipated

One of the most interesting parts of my work is being involved in the development and evaluation of treatments for snoring and obstructive sleep apnea.  I have had the opportunity to work with many established and startup companies in their hard work creating and testing  new approaches,and I pride myself on being a harsh critic, playing devil’s advocate as I look to identify the potential problems with these ideas and scrutinize data from clinical trials. Of course, there are many companies with whom I have not worked, and I try to follow their work as closely as possible from a distance.  One such company is Apnicure, who has developed a device (sold as Winx) that treats obstructive sleep apnea using suction through a mouthpiece to pull forward structures inside the mouth and throat.  The mouthpiece is placed loosely over the upper teeth and has a suction port in the back, next to the soft palate.  The mouthpiece does not hold the lower jaw forward like oral appliances–and therefore avoids the potential side effects of TMJ problems, tooth movement, and tooth pain that oral appliances can cause.  Instead, a suction pump […]

Oral Pressure Therapy (Winx): new research may explain why the results have not been as good as anticipated

Sleep 2014 Conference: 18 month outcomes from the STAR Trial of Upper Airway Stimulation

At the Sleep 2014 scientific conference in Minneapolis earlier this month, Patrick J. Strollo, Jr., MD from the University of Pittsburgh and colleagues presented 18-month outcomes from the STAR trial of Upper Airway Stimulation for treatment of obstructive sleep apnea.  STAR Trial results at 12 months have been published in January 2014 in the New England Journal of Medicine, and this presentation showed that results at 18 months were similar to those at 12 months.  The median apnea-hypopnea index (meaning that half of all study participants had values higher and lower) decreased from 29.3 events/hour before receiving the device to 9.0 and 9.7 events/hour at 12 and 18 months, respectively.  The proportion who achieved a major reduction in the apnea-hypopnea index (a decrease of 50% to a value below 20) was stable at 69% (vs. 65% at 12 months). Why do these results matter for sleep apnea treatment? These results are important because any treatment for sleep apnea ideally shows consistent outcomes over time.  The United States Food and Drug Administration provided approval for the Upper Airway Stimulation System based on 12 month results (more than just what I have […]

Sleep 2014 Conference: 18 month outcomes from the STAR Trial of Upper Airway Stimulation

Entering the YouTube Era–Videos on Snoring and Sleep Apnea Surgery

Many colleagues and individuals have thanked me for developing my sleep-doctor.com main website and blog.  To be honest, it has required hundreds of hours of time for this amateur website developer.  All the same, it helps my patients and has allowed me to share information about snoring and obstructive sleep apnea.  I recognize that the content on my website is somewhat dense and difficult to follow, but I feel that explaining important topics with some technical language allows me to be precise and provide correct information.  I am regularly impressed with patients that understand these concepts clearly, owning a thorough understanding of snoring and sleep apnea surgery that can exceed that of many physicians. Over the past 2-3 years, I have worked to develop videos explaining the surgical evaluation and treatment of snoring and obstructive sleep apnea.  These videos are now available through my channel on YouTube.  My Facebook and Twitter pages provide broader distribution of the website and blog information, but videos allow interested individuals to find and learn about these important topics related to snoring and sleep apnea surgery in a visual and verbal format.  Instead of just […]

Entering the YouTube Era–Videos on Snoring and Sleep Apnea Surgery

Appeal that denied health insurance claim for a sleep study or treatment of sleep disorders!

A recent story on NPR News reported that half of all patients win their appeal of denials by health insurance companies.  They told the story of a patient with sleepiness and loud snoring who saw a doctor that recommended a sleep study.  The insurance company denied authorization for the sleep study.  The patient filed an appeal that overturned the decision, and now the patient is treated for sleep apnea and feeling much better.   The story reported findings from a 2011 report from the General Accounting Office showing successful appeals in 40-60% of cases, while another study from California had similar findings of about 50% success. If your insurance denies coverage for sleep apnea surgery, do not give up As someone who treats patients with sleep disorders all the time, I have the chance to speak with medical directors from many insurance companies often.  These medical directors are generally very reasonable, with favorable reviews of the cases most of the time.  Usually, the denials are related to our care not entirely fitting the guidelines that often are either outdated or written to cover only a limited range of procedures.  The appeal […]

Appeal that denied health insurance claim for a sleep study or treatment of sleep disorders!

Another benefit of breastfeeding newborns: improved sleep for mothers

Here is an interesting study of direct personal relevance, given the recent birth of my daughter.   Numerous studies have demonstrated important benefits of breastfeeding for infants and mothers, but a study in the March 2014 issue of the Journal of Clinical Sleep Medicine has added one to the list.  Some of my former colleagues at the University of California, San Francisco compared the sleep patterns of 120 first-time mothers breastfeeding and using formula feeding at nighttime 1 month after the full-term birth of their children.  There was no difference in the groups, other than their method of feeding.  Interestingly, they found that the breastfeeding women had 30 minutes more sleep time at night (6.5 hours vs. 6 hours).  This compared to between 6.5 and 7 hours of sleep per night during the last month of pregnancy.  I believe this study’s findings, as the study had careful monitoring of sleep time, with a test called actigraphy that basically uses a wristwatch-sized device to determine sleep time (relying on measuring movement to distinguish wakefulness from sleep). Hitting close to home with a way to improve sleep I chose to work in […]

Another benefit of breastfeeding newborns: improved sleep for mothers

Practice Does Make (Closer to) Perfect

In the current era of health care reform, there has been a nationwide push to define and enhance the quality of health care.  To be clear, it is difficult, if not impossible, to define fully the concept of “quality” in health care.  While automobile manufacturing may characterize quality by acceleration, driving performance, need for repairs, costs, and customer satisfaction, the ideal metrics are not as clear in health care.  The most common quality measures in health care relate to surgical complications, outcomes, costs, and customer satisfaction. Numerous studies have demonstrated an association between health care quality measures and surgical volume, whether defined by the number of procedures performed by an individual surgeon or at an individual hospital.  These studies have considered joint replacement surgery, various types of cancer surgery, bariatric surgery, and cardiac surgery.  The first effort to understand the benefits of high-volume surgery was a Harvard Business School case study of the Shouldice Hernia Centre in Ontario, Canada, that specializes in surgical hernia repair.  The case study examined the benefits of standardizing processes before, during, and after surgery and the careful and critical review of patient outcomes to identify […]

Practice Does Make (Closer to) Perfect

Day 2–snoring, sleep apnea, and insight about sugar and its hazards

After a successful start to the course, Day 2 began with Allan Pack, MBChB, PhD of the University of Pennsylvania.  Allan had given the final talk of Day 1, in which he delivered a thought-provoking lecture on the future of the field of sleep medicine.  He has campaigned for a shift for the field, like many others in medicine, to move from performing tests to a more-comprehensive approach to disease management.  He persuasively argued for the development of networks to manage patients across the spectrum from initial evaluation to treatment, incorporating the practices of telemedicine and remote monitoring.  His talk this morning was a review of key publications over the past year in the field of sleep.  There have been studies suggesting a major increase in the prevalence of moderate to severe obstructive sleep apnea; providing insight into the importance of sleep in enabling our brain, heart, and lungs to repair themselves; the link between cancer and sleep apnea (those with frequent drops in blood oxygen levels during sleep); and the specific causes of obstructive sleep apnea that underscore the potential for personalized treatment. Clete Kushida, MD, PhD from Stanford […]

Day 2–snoring, sleep apnea, and insight about sugar and its hazards

Advances in Diagnosis and Treatment of Sleep Apnea and Snoring–Day 1

Another year has come and gone, and our 20th annual Advances in Diagnosis and Treatment of Sleep Apnea and Snoring course started today in San Francisco.  As a Co-Director, it is exciting to have close to 200 attendees again, a testament to the recognition of the importance of sleep apnea and snoring as well as the growing body of knowledge that keeps the course interesting and new every year.  Here are some of the highlights from today. Atul Malhotra, MD from the University of California, San Diego discussed the causes of sleep apnea.  Atul presented the fascinating work done with his teams in San Diego and when at Brigham and Women’s Hospital on the substantial differences between patients in the factors that contribute to sleep apnea (anatomy, muscle control, breathing control, arousal threshold, and lung volume).  In addition, he showed data published in the American Journal of Epidemiology, coming from the Wisconsin Sleep Cohort Study and a national survey in the United States (NHANES), indicating that 6% of women and 13% of men have at least moderate obstructive sleep apnea, defined by an apnea-hypopnea index of 15 or more events […]

Advances in Diagnosis and Treatment of Sleep Apnea and Snoring–Day 1

And now for something completely different…SleepAssure

Disclaimer: I am a paid consultant for Split Rock Scientific, a company that has developed the SleepAssure System that I discuss in this post.  I am a part owner of Split Rock Scientific and have been working with the company for the past 2 1/2 years on this project. The processes of innovation and research are some of the most interesting parts of my work life, as being around fresh ideas and new insights is exhilarating and energizing.  My personal involvement has centered on the sleep field, but it is impressive how often it is someone with no previous experience in a medical field that makes a tremendous breakthrough with their new perspective. This is the story of Split Rock Scientific and the SleepAssure System.  Dr. Chris Hermanson, an emergency medicine physician who has developed devices across a range of medical specialties, conceived of the idea of using our natural taste reflexes to improve sleep.  He has assembled a team of leaders in the field of sleep, dentistry, and taste science to develop the SleepAssure System.  The throat is effectively a tube surrounded by muscles, including the muscles that make […]

And now for something completely different…SleepAssure

Sleep Health–a new concept for the new year

The start of a new year is a time to reassess and undertake new directions.  The current era of explosive growth in scientific and medical knowledge has included an improved understanding of sleep and its importance to health.  The past few years has seen research showing a connection between poor sleep (not limited to sleep apnea) and health conditions ranging from early death to strokes and heart attacks to metabolic syndrome to cancer.  Science is clarifying how important and why getting enough quality, refreshing sleep is vital to happy and healthy lives. At the same time, public awareness is only now growing about the importance of sleep.  Many factors contribute to poor sleep, and at least some of them can be addressed with wider recognition of sleep’s role for health.  Sleep remains relatively low on most people’s priority list, and the result is that people do not address factors that harm sleep and are at least partially controllable: busy schedules, coping with stress, or weight gain.  It is time for us to pay more attention to sleep and modify our lifestyles to recognize the value of sleep. A provocative editorial […]

Sleep Health–a new concept for the new year