OVERCOMINGSNORINGANDSLEEPAPNEA

WITHORALAPPLIANCETHERAPY

ARestfulNight’sSleepMystery:Unmasked,Untangled

UnhookedAguidetounderstandingsleep,snoring,sleepapnea

andhowitcanbetreated.

Copyright2018AllRightsReservedAuthor:RashmiK.Parmar,DMD,D-ABDSMThisbookisprotectedundertheuniformcopyrightactandcannotbereproducedfullyorinpartwithouttheexpresswrittenconsentoftheauthorandhercompany.

Sleep-As Critical to Life as Breathing. Itmattersandonlyyoucanprioritizeit!UnderstandingWhyYourBodyNeedsSleepNowadayswecannotpickupamagazineoranewspaper,browseonline,gotosocialeventsorlookatadsorappswithouthearingabouthowtogetsomeshuteye.Yet,themoreobsessedweareaboutit,themoreiteludesus.Thisbookiswrittentobringenlightenmenttothehypesurroundingsleep,snoring,sleepapneaandtreatmentchoices.Wespendapproximately1/3rdofourlifeasleep,sonaturemusthavesomereasonforthat.Weforgetthatsleepisabasichumanneed,fundamentaltoourhealthandwell-being,justlikeair,waterandfood.However,sleepdoesnotgetmuchrespect.Theprevailingimpressionisthatsleepislazyandunproductive,usuallylost/deadtimeorapassiveactivity,butinrealityitisthemostactivestateforyourbrainandbody.Sleepisarebootforourbodies.Whenwesleep,ourbodygoesthroughahealingprocess-itrepairs,refreshesandrestartsitself.Sciencehasproventhatthebodyneedssleepforavarietyofreasons.Itisnecessaryfortheoptimalperformanceofcognitivefunctionslikememory,thinkingandlearning,forphysiologicalfunctioningsuchasthecardiovascular,metabolicandimmunesystemsaswellasforemotionalwell-being.Sleepiswhenthebrain

goesinhousekeepingmode-themetabolicbi-productsthatareasideeffectoftheperiodswhenyouareawake,getcleanedupwhenyouarecatchinguponyourzzz’s.Whenwesleep,wecyclethroughfourstages.Stages1,2and3arecalledNREMandStage4isREM,theperiodofdeepsleep.Thiscycleisrepeated4-5timesanight,eachtakingapproximately90-120minutesonaverage.Gettingshuteyeforrightamountoftimeenhancesthequalityofeverymomentwespendwithoureyesopen.AccordingtoNationalSleepFoundation-adultsonanaverageneed7hrsofqualitysleep.Peoplewhodonotgetenoughsleepfindthemselvesfightingavarietyofhealthproblems.Here are a few things that good sleep does for you:

• Improvesandrevitalizesmemory.Givesthebrainachancetoreorganizedataandprocessnewlylearnedinformation.Thatiswhymanypeoplereportthataftertakinganapduringtheday,theyareabletobemoreproductivefortherestoftheday.

• HelpsfightDementiaandAlzheimer’s.Promotesbrainhealthandgivesittheopportunitytomakecertainneuronalconnections.

• Helpsourimmunesystemgetstronger.• Slowsyourenergyconsumptionandlowersthe

stressonyourcardiovascularsystem.Sleepcanloweryourbloodpressureandheartrateby20to30percent.

• Helpstoreplacechemicalsthebodyneedstofunctionandrepairmuscles.

• Helpsfightweightgainwithhungerhormonebalancing.

• Helpsfightanxiety,depressionandfatigue.

SnoringisNature’sAlarmBellYourbodyistellingyousomethingiswrongwithyourbreathing!

YourLoudSnoringCouldbeASignofaSeriousConditionCalledSleepApnea

Snoring at a physiological level is the unpleasant sounds created by the vibration of your soft palate (back top portion of mouth) due to obstructed air movement during breathing while sleeping. The loud sound you hear is due to turbulence- caused by the same amount of air you always breathe being forced through a narrower space like a straw or stirrer rather than a wide hosepipe. Snoring is the thunder (warning) before the storm (Apnea) which kills. It is an alarm bell that nature gave us to tell us that something is wrong with our breathing.

Do we hear it? Sure! Do we try to figure out what it means? Probably not, but we definitely have learned to live with it. Loud chronic snoring is not harmless; it could be a symptom of a serious, even life-threatening condition known as Obstructive Sleep Apnea (OSA). Snoring is no joking matter, with patients often coming in for treatment simply to appease their annoyed spouse. Heavy snoring is a risk factor for carotid (neck) artery fatty deposits which may progress into a stroke. “Think of snoring as the fire alarm and Sleep Apnea as the fire.” The analogies are endless. Nevertheless, if a fire alarm goes off and someone simply disconnects it or ignores it, it does not mean they put out the actual fire.

Sleep Apnea- Not so Silent Killer. TherehasbeenalotinthenewsaboutSleepApneaanditsharmfuleffects.Wehearofathletes,newscasters,andofcourse,thecommoneverydaypersonhavingit.However,thescaryfactisthat80%-85%percentofthosewhosufferwithSleepApneaareundiagnosed!Youareprobablysaying“wow!”rightaboutnow.ManyofthosesufferingwithSleepApneadonotknowit-theyonlyseekouthelpiftheirpartnercannotsleep.Instead,theyaregoingtothedoctorforthingslikehighbloodpressure,weightgain,andtiredness.Then,whentheycannotseemtofigureoutwhytheseproblemsarenotsuccessfullybeingregulatedormanaged,theygetfrustrated.ItcouldbebecausethetrueunderlyingproblemandcauseisSleepApneaandtherestarejustsymptoms.

So, What Is Sleep Apnea? SleepApnea,adisorderthataffectsabout22millionAmericans,ischaracterizedbybreathpausesduringsleep,whichmaylastfor10secondsormore.SleepApneaepisodesusuallyhappenfiveto100timesinanhourandmaycausesleepdisturbances.Snorting,choking,andsnoringaretypicaltopeoplewithSleepApnea.Itiscommontoall-children,menandwomen-therearenoageorgenderrestrictions.Becauseofthenatureofthecondition,peoplewithSleepApneaarenormallynotawareoftheirsleepingirregularities.Infact,itissaidthat80to85%ofpeoplewithSleepApneaareundiagnosed.SleepApneasufferersnevergetthebenefitsofdeepeststagesofsleep,whichiswhatreversestheagingprocessandrepairstissuedamage.

Types of Sleep Apnea TherearetwomaintypesofSleepApnea.

1. ObstructiveSleepApnea:

ThemostcommontypeiscalledObstructiveSleepApnea(OSA)whichinvolvesablockedairway.Thisblockagecanresultfromover-relaxedthroatmuscles,thetonguefallingback,obesity,and/orfacialorbonestructuredeformities.Oncetheairwayisblocked,aircannotenterthelungs,andbreathingstops.Duringthistime,theperson’soxygenleveldecreases,whilecarbondioxide

levelincreases.Thisleadstosortofa“911”calltothebraintowakethepersonupandthepersondoessowithaloudsnore,gasporsnort.Thisthenstimulatesthebraintonormalizethebreathingprocessandpromptsthepersontowakeupandtoopentheairwaybyadjustingthetongueandthroatmuscles.Inthisnighttimebattlebetweensleepandsurvival,naturekeepsyoualiveandbreathingsoyoudonotdieinyoursleepbutthequalityofyoursleepgetscompromisedintheprocess.Thisnightlydisruptionputsextraordinarywearandtearonthebodywiththeemotionaltollsofgoingintofightorflightmodeseveraltimeseachnight.Theperson,however,maynotevenrememberbeingawakeforashorttimenorbeawareoftheirgaspsforair.

2. CentralSleepApnea:TheothertypeofSleepApneaiscalledCentralSleepApnea,whichiscausedbythebrain’sdelayedsignalstothebreathingmuscles.Breathingstopsandoxygenlevelbeginstodrop.UnlikeObstructiveSleepApnea,CentralSleepApneaislesscommon.Itisacentralnervoussystemdisorderandcanresultfromaninjuryordiseasethatinvolvesthebrainstem.Thiscanbeintheformofstrokeorbraintumor,amongotherthings.ThoughpeoplewithcentralSleepApneamaynottypicallysnore,theymayexperienceshortnessofbreath.BothtypesofSleepApneahavedifferentcauses,buttheireffectsarethesame:lowlevelsofoxygeninthebrain,poorsleep,excessivedaytimesleepiness,fatigue,andevendepression.Theycanalsocontributetohighbloodpressureandheartirregularitieswhentheoxygenreachesadangerouslylowlevel.

KeyPointsaboutSleepApneaLoudchronicsnoringisn’tnormal-orweallwouldbedoingit.SleepApneaisachronic,ongoing,downwardspiralingdisease.Enemy#1oftheSleepApneadiseaseisthelackofawareness.Itisoneofthemostunderdiagnosedandundertreateddiseasesintoday’sage.25%ofmenand9%ofwomenintheirmiddle-ages(30-49)sufferfromOSA.Additionally,43%ofmenand27%ofwomenaged50-70areestimatedtohaveOSA.THEPREVALENCEofCHILDHOODOSAis3%innon-snoringchildrenandashighas10to20%inthosethathavehabitualsnoring.IfyouhaveSleepApnea,thenyourspousedoestoo.Wearenottalkingaboutactuallyphysicallyhavingitbutrather,theysufferalongwithyou,especiallyifyousnore.SnoringisthemostcommonsignofSleepApneaandyourspousewillbethefirsttonotice.BedpartnersofsnorersandOSApatientslose62minutesofsleeppernightonaverageduetotheirpartner’scondition.So,whenyougotmarriedandtookthevowstobewitheachotherinsicknessandinhealth,youmeantitnotintendingbutratherdraggingyourpartnerintothistoo.Marriagecounselorsandpastorslistsnoring,behindmoneyissues,asthesecondmostcontentiousissue

amongcouples.Preventingyourspousefromgettingagoodnight'ssleepandwakinguptireddayafterdaycancauseeventhebestrelationshipstogodownhill.NottomentionthemoodswingsandbadtempersomeSleepApneasufferershave. SleepApneadisruptssleepandleadsto:Nighttimesymptomsofloudsnoring,chokingandgasping,clenchingandgrindingteeth,stopbreathingwhilesleeping,awakenfrequently,wakeupseveraltimestousethebathroom.DaytimeSymptoms:Notwakinguprefreshed,excessivedaytimesleepiness,moodswings,daytimetirednessandfatigue,morningheadaches,memoryfogandmemoryproblems,sleepyatwheels,meetings,churchservices,movies.SleepApneaAt-RiskChecklist:Youareathighriskofsleepapneaifyouareoverweightorobese,necksize>17formenand>16forwomen,havehighbloodpressure,diabetes,heartdisease,atrialfibrillation,congestiveheartfailure.SleepApneasufferersnevergetthebenefitsofthedeepeststagesofsleep,whichhelpsinhealingthebody,balancinghormonesetc.Afterjustonenightlackingthedeepsleepthatthebodyneedsandcraves,oneawakesinadamagedstate.

Cumulativedamageeventuallycouldleadtohighbloodpressure,heartdisease,diabetes,depression,mooddisorders,weightgain,Dementia,Alzheimer’s,suppressionoftheimmunesystem,cancerandevendeathifleftuntreated.AIRWAYISKING!KEYPOINT:Thehumanbodyisamazingatcompensatingtomakesurenumberonepriorityofsurvivalairismadeavailablenomatterwhatthecostuntilitcannolongerpaytheprice.Thereasonthissleepdisorderisunderandundiagnosedisbecausedoctorsarenotabletodetecttheproblemduringroutineclinicvisits.Noformofblood,urine,orstooltestcouldpointoutpresenceoftheproblem.Itisrecommendedtobeproactiveaboutbringingthepotentialproblemtoyourdoctor’sattentionifyouhaveanyoftheabovesymptoms.IfyouhaveSleepApnea,youare:

7xmorelikelytohavemotorvehicleaccident,4xaslikelytohaveaheartattack,4xmorelikelytohaveastroke,3xmorelikelytohavediabetes,and2xaslikelytodieinyoursleep.

SleepApneaisadangerousdisease.Itcanleadtootherdiseasesifitisnottreatedandcontrolled.Ifyouarediagnosedwiththecondition,itwouldbewisetobetreatedforyourownsakeaswellasothers’.

Availabletreatmentoptionscouldhelpimproveyouroverallhealthandqualityofsleep.ThebasicoptionsavailabletotreatSleepApneaaremouthpieces,breathingdevices,lifestyleadjustments,andsurgicaloperations.Youalwayshavethefreedomtochoosewhichtreatmentoptiontotakebasedonyourcomfort,budget,andpreference.

Do You Think You Might Have It?

Answerafewofthesequestions:

1. Doyousnoreloudly(loudenoughtobeheardthroughcloseddoorsorthatyourbedpartnerelbowsyouforsnoringatnight)?

2. Doyouoftenfeeltired,fatiguedorsleepyduringthedaytime(suchasfallingasleepduringdriving,watchingTV,inmeetingsorwhiletalkingtosomeone)?

3. Hasanyoneobservedyoustopbreathingorchoking/gaspingduringyoursleep?

4. Areyoubeingtreatedforhighbloodpressure,heartdisease,diabetesordepressionandareyouonmedication?

5. Areyoumorethan50yearsold?6. Isyournecksizelargerthan17inches?7. Areyouamale?8. Doyoufindyourselfhavingmoodswings?

It is rather hard for a person to know whether they have Sleep Apnea, since the condition manifests only during sleep. However, if you suspect you may have the condition, especially if you answer yes to one or more of the above questions, you may be at high risk. ThebestandmostabsolutewayofdiagnosingSleepApneaishavingaSleepStudydone.Thesecanbedoneinsleepcenterwithasleepdoctororyoucanevengetanin-hometestwhichmanyprefer.

TreatmentOptions

Option1:CPAPTherapyforTreatingSleepApneaThemostcommonbreathingdeviceusedforSleepApneatreatmentisCPAPorContinuousPositiveAirwayPressure.ThisdevicehasbeenthegoldstandardforyearsandismostlyrecommendedforpeoplewhoaresufferingfrommoderateorsevereSleepApnea.Thedeviceusesaspecialmaskthatiscustomizedtofitoveraperson’snoseandmouth.Itworksbygentlyblowingairintothethroat,aidingtheentryandpassageofairintotheairways.Throughthisaction,airispressedagainsttheairwaywall.Atthesametime,airpressureisalsosetsoitwouldbejustenoughtostopandpreventblockagesandnarrowingofairwaysduringsleep.

Insimplewords-theCPAPisavacuumcleanerblowingairintheoppositedirectionoraleafblowerwithadjustableairpressure.PeoplewhosufferwithSleepApneaarefacedwithalotofphysicalandemotionalchallenges.Someareoverwhelmedwithhealthissuesthattheyjustcannotseemtogetcontrolof.Theyputonweightandhavetodealwithpeoplecriticizingthemforbeingoverweightandassumingthatitisbecausetheyeattoomuch.TheythenfindouttheyhaveSleepApneaandtheyareprescribedCPAPtherapy.Thinkingthatitisaquickfixandeverythingisgoingtobeallbetternow,theytrytowearitforaweekorsobutsoonbecomefrustratedwiththehoses,thenoiseandthefeelingofbeingclosedintothepointtheytakethemachineandthrowitintheclosetorunderthebed.TheirSleepApneacontinuestogountreatedandtheyfallrightbackintoaviciouscycleofhealthproblemsandgettingnorest.

PeoplewhoareprescribedCPAPusuallyareturnedoffbyseveralcomponents.

• Complexity.BecauseCPAPcouldbecomplexequipment,thereisaneedtocallatechniciantosetup,install,andadjusttheequipmentintothemouthornose.Thetechnicianwouldneedtomakespecificadjustmentsbasedontheordersofthedoctor.Afteraninitialsetupsession,youmaystillneedtocallbackthetechniciansothatthedevicecouldbeappropriatelyadjustedforbestresults.

• SideEffects.AnothersetbackisthepossiblesideeffectsofusingCPAP.Suchunlikelyeffectsincludestuffingordryingofthenose,onsetofsoreeyes,irritationoffacialskin,andheadaches.Ifthedeviceisnotproperlysetup,installed,oradjusted,itcouldcausestomachbloatingandunnecessarydiscomfort.Ifanyofthesideeffectsappear,itisbestiftheCPAPuserwouldapproachaspecialist,anursingstaff,oraCPAPtechnician.Sideeffectscouldbereducedoreliminateduponthecorrectionofanyerror.Asforstuffyandrunnynose,nasalspraysmayprovideinstantandmoreeffectiverelief.

• Distractions.Further,mostpeoplejustdon’tlikethenoise,thehoses,andtheweightedfeelingaroundtheirneckfromtheCPAPmachine.

ThemostimportantthingtorememberisthatSleepApneaproblemscouldreturnwhenuseofCPAPisstoppedorwhenitusedincorrectly.Todate,thereareseveraltypesofCPAPmasksandmachinesavailableinthemarket.Itwouldbebestifyouwouldapproachyour

doctorandtellthemyourconcernsordesiretopursueotheroptions.OthertreatmentoptionsforSleepApneacouldbemorecomfortableforyou.Fearnot!ThereisanotheroptioncalledOralApplianceTherapy. Option2:OralApplianceTherapyOralApplianceTherapyisacustommadedevicethatisfittedtoyourmouthanditrepositionsyourjawslightlyforwardinordertoopenyourairwayandkeepitstableandstopitfromfallingbacktolettheairthrough.Asweexplainedabove,mostOSAiscausedbyanobstructionintheairwaywhichistypicallythetongueorsoftpalatefallingbackandobstructingairflow.OralApplianceTherapyissimple,comfortableandcosteffective.Bestofall-therearenohoses,electricity,noiseorcondensationtodealwith.ItistruefreedomdeviceforstoppingsnoringandtreatingSleepApnea.Thisisnottobeconfusedwiththe“boilandbites”youseeadvertisedontelevisionorinalocaldrugstoresimilartosportingmouthguards.Thisisabsolutelynotthesame.Thekindyouseeonsometelevisionadsarenot

nearlyaseffectiveandarenotadjustableliketheoralapplianceadministeredbyadentalsleepphysician.ManypatientsreportgettingthebestresttheyhavehadinyearsandmanysaytheyhavedreamedforthefirsttimeinalongtimeafterreceivingOralApplianceTherapy.That’sit…OralApplianceTherapyisjustthat-simpleandeffective.

Frequently Asked Questions about Oral Appliances: WhatisOralApplianceTherapy?Anoralapplianceisasmall,custom-fitteddevicewhichisworninthemouthduringsleeptopreventthetongueandthroattissuesfromclosingtheairwayduringsleep.Someappliancesholdthelowerjawforwardduringsleepwhileothershavedirecteffectontongueposition.OralappliancesrelievesnoringandtreatOSAbyrealigningthejawand/ortongueinforwardposition.HowdoesOralApplianceTherapywork?Theoraldevicemovesthetongueandsoftpalateforwardtostabilizethem.Italsoreopenstheclosedairwaybyincreasingsizeoftheairwaybehindthesoftpalateandtongue.HowdoIknowifOralApplianceTherapywillworkforme?Itworksformostpatients.Ifnotalone,thenincombinationwithaCPAP.Afteracomprehensiveexaminationandreviewofyoursleepstudy,aSleepApneadoctorwilldetermineifyouareacandidateforanoralappliance,CPAPorcombination.Oncetheapplianceiscustommadeforyourmouth,itwillbeslowlyadjustedtomaximizeresults.Successmaycomeinaslittleasonenightorslowlyafterseveraladjustmentstoreachahealthyoutcome.Onceyoustarttofeelbetter,truesuccessofanyofthesetreatmentscanonlybemeasured

withafollowupsleepstudy.WithOralApplianceTherapy,thefollowupsleepstudyisdonewhilewearingtheappliance.NomedicaltreatmentincludingCPAP,surgery,orOralApplianceTherapycanguaranteethatyourapneawillbeeliminated.Theonlywaytotreatapneaistotryoneofthesetreatments.DoesOralApplianceTherapyWork?YES!OralappliancesworkbetterduetobettercompliancethanCPAP.Accordingtotheliterature,OralApplianceTherapy(OAT)is84.0%effectiveintreatmentofnon-severeObstructiveSleepApneacasesand69.2%effectiveforseverecases.SometimescombinationwithCPAPisneededforseverepatients.Inanycase,oralappliancetreatmentisbetterthannotreatment.

IsOralApplianceTherapyComfortable?Yes.StudieshaverevealedthatoralappliancesareverycomfortableforObstructiveSleepApneapatients.Infact,manypatientspreferoralappliancestoCPAPtherapyanduseitforlongerhourseachnight.Formostpatients,thismeansfeelingbetterthroughouttheday,aswellasimprovedhealthoutcomesinthelongrun.HowmuchdoesOralApplianceTherapyCost?Totalcostrangesfrom$3K-6Kforadevicethatlastsfor3-5yrs.ThisisequivalenttothecostofaCPAPwithitsrecurringsupplycostforthesametimeframe.DoesInsuranceCoverOralApplianceTherapy?Yes.Mostmedical(notdental)insuranceplanscoverOralApplianceTherapyforObstructiveSleepApneabecauseitcanremedyamedicalconditionwithseriousconsequencesifleftuntreated.Howmuchinsurancecoverswilldependoneachperson’smedicalpolicycoverage.HowlongdoesOralApplianceTherapytreatmenttake?Thetreatmenttimeisnormally3-6months,exceptinseverecaseswhenitmaytakeayearormoreforbestresults.Theusualnumberofappointmentsneededare5-6visitsset3-4weeksapart.HowlongdoestheOralAppliancedevicelast?Onanaverage,deviceslastfor3-5years.However,dependingonindividualhabitssuchas-teethgrinding,jawmuscleactivity,howcarefulyouarewhentheOralApplianceisoutofyourmouth-weestimate3yearsasanaveragelengthofservice.

Whatarethesideeffectsofthetreatment?Thethreeprimarysideeffectsaretoothdiscomfort,TMJ(jawjoint)ormusculardiscomfort,andtoothmovementorbitechanges.Otherminorcomplicationsarepossiblesuchassalivationchangesanddrylips.Aswithanymedicaltreatment,therearepossiblecomplicationsorsideeffectstodentalsleeptherapy.Consideringthewell-documentedhealthrisksofleavingObstructiveSleepApnea(OSA)untreated,mostofthesideeffectsofusingoraldevices/therapyareconsideredminor.However,mostpatient’ssideeffectswillsubsideafterthefirstweekortwo.

HowlongwillIneedtobeintherapy?Lifetime.ObstructiveSleepApneaisatreatablebutnotcurablediseaseforlife.Similartohowdiabetesorhighbloodpressurearecontrolledwithmedication,SleepApneaiscontrolledwithoraldevicetherapy.ThereisnocureforSleepApnea,onlytreatmentoptionstocontrolthedisease.Dotheover-the-counterdeviceoroneoninternetdothesame?WhynotjustbuyanoralsleepapplianceovertheInternet?Tomosteffectivelytreatsnoringand/orObstructiveSleepApnea,adiagnosisisneededfromaPhysiciantrainedinsleepmedicine.Oncethedecisiontotreatwithanoraldeviceismade,thetraineddentalsleepphysiciancanfabricateacustom-fitsleepappliancespecificallyforyou.Thisoffersunmatchedcomfort,stabilityandeffectiveness.Inaddition,oralappliancesneedtobeadjustedperiodicallyinordertomeetyourcurrentneeds.Buyingaone-size-fits-allplasticguardisnotcomfortable,causessideeffectsthatarenotmonitoredandmaynotprovideatherapeuticresult.Sleepdisorderswillcontinuetocausedisruptedsleepifyoutrytoself-solvetheproblemwithanoverthecounterdevice.Boilandbitedevicesarenotrecommendedbymedicalprofessionalstotreattheseriouslife-threateningdiseaseofSleepApnea.

What’s Your Next Step? ..IfYou’veBeenDiagnosedIfyouhavebeendiagnosed,thencallSleepBetterMarylandat410-531-5639orlookonlineforwww.SleepBetterMaryland.com.MakeanappointmentandifaSleepStudyhasbeendone,besuretobringthatstudywithyouinorderforthemtofullyunderstandhowsevereyourSleepApneais.Ifithasbeenawhilesinceyouhadasleepstudy,theymayrecommendyouhavingacurrentonedoneinordertobeabletotreatyourSleepApneainthemostoptimalwaypossible.…IfYouHaven’tBeenDiagnosed,ButThinkYouMightHaveSleepApneaIfyouthinkyoumighthaveSleepApnea,letusjustgooverafewsignsandsymptomsonemoretime:

• Loudorchronicsnoring• Choking,snortingorgaspingforbreathduring

sleep• Longpausesinyourbreathing• Daytimesleepinessnomatterhowmuchtimeyou

spendinbed• Youwakeupwithadrymouthorasorethroat• Havemorningheadaches• Restlessorfitfulsleep• Insomniaornighttimeawakenings• Frequentlygoingtothebathroomduringthe

night

• Wakingupandfeelingoutofbreath• Forgetfulnessandnotbeingabletoconcentrate• Moodiness,irritability,depression,changesin

temperamentIfyouareexperiencingsomeorallofthese,youcouldhaveSleepApnea.YourfirststepistogetasleepstudytodeterminejusthowsevereyourSleepApneamaybe.

Don’thesitatetotakeaction.SleepApneashouldn’tbetakenlightly.Treatyourselfto:RestfulSleep-RefreshedandRejuvenated!Daytimealertness-FocusedandProductive!Improvedhealth-Enjoyinglifeatitsbestwithhealth!

Haveyoufoundthisinformative?Callusforconsultation.SleepBetterMarylandRashmiK.Parmar,DMD,D-ABDSM12620ClarksvillePikeClarksville,MD20129410-531-5639www.sleepbettermaryland.comYouwillnotregrettakingthatstep.Disclaimer…Thisbookisnotintendedtoreplacethemedicaladviceofadoctororacertifiedsleepdentist.IfyouthinkyouhaveSleepApnea,contactaphysicianforhelp.