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Last week I discussed children and sleep and mentioned something called sleep hygiene. I promised I would give a list of sleep hygiene rules. When speaking about it at the office this week, someone looked at me like I was crazy when I said “sleep hygiene.” So, let me explain: Sleep hygiene is anything that helps you maintain a restful sleep pattern. Sleep is as important as eating and exercise in staying healthy, and many people have developed bad habits over the years that lead to poor sleep. Sleep hygiene “rules” are just guidelines. They are mostly common sense, but like most things in life, we forget or ignore what our mother used to tell us. 12 RULES TO BETTER SLEEP HYGIENE Sleep hygiene is a way to develop healthy sleep habits that lead to consistent, restful, restorative sleep. 1. Sleep as much — at night – as needed to feel refreshed and healthy during the following day. Aim for a standard number of hours of sleep every single night. Excessively long times in bed seem related to fragmented and shallow sleep. 2. Avoid daytime napping. If needed, nap for less than an hour and before 3 p.m. 3. Have a regular wake-up time in the morning. This seems to strengthen circadian cycling and leads to waking up in the morning on your own without the use of an alarm. 4. A steady daily amount of exercise helps deepen sleep in the long run, but occasional one-shot exercise does not directly influence sleep during the following night. 5. Give yourself a wind-down time each day. Use this time to tie up the day’s loose ends and organize tomorrow. It is better to do this when you are awake and alert than to wait until the lights are out and your head has hit the pillow! Anxiety about things you can do nothing about at night interferes with sleep. Give yourself a scheduled, routine 30-60 minutes to do this end-of-the-day. 6. Create a structure to your day (even week-ends) that requires you to do certain things at certain times. Eating and taking medication at the same time helps to maintain your body’s internal clock. 7. You should associate your bed with sleep. Avoid using your bed to watch TV, eat, talk on the phone or work on a laptop. 8. Avoid sleeping pills or use them sparingly. They may be of some benefit, when properly prescribed by your physician, but the constant use of sleeping pills is ineffective at most and detrimental in some insomniacs. It is better to understand why your body is not sleeping, and to correct the root cause. 9. Avoid caffeine and alcohol before bed. Be aware of the many hidden sources of caffeine, ex: Mountain Dew, chocolate. Alcohol does help tense people fall asleep fast, but the ensuing sleep is then fragmented. Alcohol also suppresses REM (dreaming) sleep. 10. If you’re not asleep in 20-30 minutes, get up and do something that will relax you, but definitely with very dim light. 11. Your bedroom should encourage sleep. Everyone has their own image of comfortable – just be sure your bedroom is ideal for you. Regarding temperature, don’t have the room too hot or too cold. 12. Think about light and dark: Get as much exposure to light as you can during the daytime and as much darkness you can during the nighttime. Look at the amount of “extra” light in your bedroom from things like alarm clocks and consider wearing an eye mask to block out all light. Adapted from the 2012 American Academy of Dental Sleep Medicine Annual Meeting
Don’t get too excited – I don’t have the answer for getting a baby to go to sleep. This is part two of my report from the recent American Academy of Dental Sleep Medicine conference. There was actually a lot of interesting discussion on children and teenagers sleep patterns and snoring in children. Here are the interesting things that were reviewed: 1. There are an increasing number of infants, children and teenagers being diagnosed with obstructive sleep apnea (OSA), a disorder where breathing is interrupted during sleep. Many of these children may have been incorrectly diagnosed with ADHD. The reason for the increase in OSA is unclear, but the following things may help identify those who have it: *snoring more than three times a week *allergies, frequent colds or habitual mouth breathing *large tonsils and adenoids *being born prematurely *obesity *long narrow faces and crowding in the front teeth *daytime sleepiness *bedwetting If your child snores, you should discuss the situation with their pediatrician, an ear-nose-throat specialist or a dentist who understands sleep disturbances. Many times a combination of tonsillectomy and adenoid removal along with jaw expansion is successful at eliminating snoring, creating changes in the jaw and face, expanding the nasal passages and reducing daytime sleepiness. 2. There was discussion about teenagers and how their natural sleep patterns vary from adults. The average adolescent requires 10 hours of sleep per night, however, at least two-thirds of those adolescents get less than an average of seven hours of sleep. Many sleep very little during the school week and then make up their lost sleep by sleeping extra hours on the weekend just to get to seven hours. 3. One reason teenagers suffer from sleep disturbances is because their circadian rhythms (their internal clock that regulates sleep) does not coincide with their school pattern. Teenagers are naturally programmed to sleep late in the morning and not go to bed until very late at night. However, when school starts early, it requires teenagers to wake before their final REM phase has completed. This final REM phase is critical because memory consolidation and other important functions occur in it. This constant interruption in sleep can cause issues with school performance, lead to daytime sleepiness and affect growth and development. While many of the signs of lack of sleep like excessive irritability, mood swings and difficulty concentrating can be mistaken for just being a teenager, it is important to be aware of the signs. When the previous signs are coupled with a craving for carbohydrates, sudden shifts in feeling hot and cold, or odd sensations of having things crawling on their skin, you might begin to suspect a sleep disturbance in a teenager. 4. OSA, narcolepsy and delayed sleep pattern are the three most common sleep disorders found in teenagers. As with snoring in children, if you suspect a sleep problem, seek professional help. There are many local sleep centers with specially trained sleep physicians that diagnose and treat sleep issues. 5. The final topic that is worthy of mentioning is sleep hygiene. While it sounds like a strange term, it refers to developing and following healthy sleep habits. Many teenagers, and adults alike, sleep poorly due to overstimulation from TV, phones and computers prior to sleep. For example, the light from computers is a stimulant that wakes you, like mimicking daylight in the morning, so using a computer or texting before bedtime can interfere with the time it takes to fall asleep. Next week I will post 12 Rules for Sleep Hygiene. Remember, if you or a loved one snores or suffers from daytime sleepiness, speak to a professional to determine possible causes and treatment.
Dr Romano received the “Extra Mile Award” last night at the Annual Chamber of Commerce Awards Dinner. We are all so proud of him. He is honored and humbled to receive this outstanding award! Dr Romano is a compassionate man who always goes that extra mile not only for his patients but for his entire team. As you can see his 84 year old mother Caroline Romano and his Aunt Rose Ferdinand are also very proud of him. These three Madisonians share in their vision to go the Extra Mile to make Madison the town that it is and always has been. Thank you Dr Romano for always going the Extra Mile! The award is given to a Madison Business or employee who is chosen by the community to receive the Extra Mile Award for outstanding customer service. Patients were able to nominate him and the nominations included some of the following comments: http://www.drsamromano.com/the-extra-mile-award/
I just got back from the annual American Academy of Dental Sleep Medicine conference and was amazed at the amount of new research being done regarding sleep. I took a ton of notes and want to share everything I learned with you, but I think it will be too overwhelming for one blog so I am going to divide it up over the next few weeks. I'm going to do a series that addresses the following topics: • general information related to sleep • children and sleep • geriatrics and sleep • diseases associated with sleep disturbances First, I'll answer the question that many people ask me: why, as a dentist, do you even care about sleep? Very simply, we all need sleep and when it's interrupted, for whatever reason, it affects our overall health dramatically. Because our practice focuses on prevention and education, we discuss sleep with our patients. Additionally, dentists are in a unique position to work with sleep physicians in making oral appliances that eliminate snoring and treat obstructive sleep apnea (OSA). One of the most common sleep disorders is obstructive sleep apnea, a condition where breathing is interrupted many times a night due to a blockage or collapse of the airway. People may stop breathing for 10-60 seconds, hundreds of time a night. This stoppage leads to problems in many areas of the body and is linked with an increased risk for: high blood pressure, depression, stroke, diabetes, metabolic syndrome, heart failure and impotence. OSA is treated with either a mask called CPAP that blows air and prevents collapse of the airway or an oral appliance that repositions the jaw and opens the airway. Interesting new research shows: • OSA patients treated with either oral appliance therapy or CPAP were able to reduce their high blood pressure medications after one year of use. Because high blood pressure is common with OSA, I always suggest that patients with it evaluate their sleep to determine if they have OSA. • Custom-made oral appliances to treat both snoring and sleep apnea fit better and, therefore, are more comfortable. The reason this is important is because the more comfortable the appliance, the more compliant a person will be in wearing the appliance. • People who suffer from sleep disorders are more sensitive to pain. This is especially important for chronic pain sufferers - perhaps correcting sleep patterns will decrease pain levels. • Excessive wear on front teeth can happen at night while a patient is struggling to sleep. Many people deny being aware of grinding their teeth but still have wear. OSA may be the cause. OSA is not the only sleep disorder that exists and without an evaluation by sleep physician, and many times an overnight sleep study, it is impossible to diagnose what is wrong. Other sleep disorders include restless leg syndrome, insomnia, delayed sleep response and chronic partial sleep deprivation. Some signs that point to a sleep disturbance are: • Difficulty falling asleep or staying asleep • Daytime sleepiness • Depression • Loud snoring that disturbs the sleep of others • Difficulty concentrating • Gasping for air during sleep • Waking up with a bad taste in your mouth • Chronic morning headaches If you believe you have issues with sleep, I suggest contacting a sleep physician or discussing your concerns with your doctor. For more information, visit: http://www.aadsm.org/whatisdentalsleepmedicine.aspx, http://www.ahsleepcenters.com/ For any additional questions, please contact our office at 973-377-6500 or email@example.com.
I had a new patient in yesterday who works at a big pharmaceutical company and is involved with sustainability at their company. It made me think about what, if anything, we do to support sustainability. At first, all I could think of was recycling our paper and plastic, and I was a bit embarrassed. But the more I thought about, I realized that small changes we’ve made over the years have been “green”: • Digital x-rays – I think this is the single biggest change because it is such a win-win for everybody. Using digital allows us to dramatically reduce radiation exposure for patients. Also, the system has a reusable sensor which eliminates the need for film and its lead lining. Finally, no chemicals are needed to develop the film. • Appointment reminders – we decided a few years ago that we wanted to reduce the amount of paper we use at the office, so we switched to an email or text appointment reminder system. We no longer send out postcards which saves paper and printer ink. • Communication – let’s face it, no office will ever completely eliminate paper use, but little changes make an impact. We use email now to communicate with doctors, labs and patients. All referral letters and x-rays are sent over the internet instead of being printed and mailed. The additional plus side is that I’m amazed at how little stationary I need to purchase! • Plastic containers – our sterilizers require distilled water and each week we would go through at least five plastic jugs. Installing an automatic distilled water system in the office has eliminated the waste of plastic (and makes my assistants happy because they don’t have to lug jugs of water around). • Construction – we recently renovated a building for our office and although we made big changes, I tried as much as possible to reuse or maintain building materials. Windows and wood trim could have been replaced, but we chose to keep them. When we purchased things for the building, we looked for sustainable or energy efficient supplies like fluorescent lighting, Energy Star® products, and products made with recycled materials. While I’m sure there are more things we could do at the office, I’m pleased that we’ve done some things to make an impact. I encourage everyone, home and business alike, to spend some time recognizing the changes you’ve already made and considering the additional things you can do to improve sustainability.
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Madison Dentist Now Screening & Treating Patients For Obstructive Sleep Apnea Madison, NJ — New Jersey dentist Dr. Samuel Romano, who’s office is located at 120 Park Avenue, is treating patients with obstructive sleep apnea. Patients now have the opportunity to be screened for this disease in the luxury of their own home. Obstructive Sleep Apnea, or “OSA” for short, is a chronic sleep disorder that is characterized by abnormal pauses during breathing. Those affected with OSA can stop breathing hundreds of times throughout the night, depending on the severity of their condition. Symptoms of OSA include: snoring, excessive daytime fatigue, morning headaches, forgetfulness, insomnia, moodiness and irritability, difficulty concentrating and gastrointestinal reflux. As the untreated sleep apnea progresses, it may lead to more serious medical conditions including: cardiovascular disease, stroke, diabetes, and heart attacks. Dr. Sam Romano can treat the overall health of his patients with the help of state of the art technology. With diagnostic testing, personal evaluation and sleep study results, Dr. Sam Romano can customize an oral appliance designed specifically for you. After your sleep study has been evaluated, Dr. Sam Romano will know the degree of your obstructive sleep apnea. Based upon your test results, if appropriate, Dr. Sam Romano then fabricates an oral appliance for patients to wear at night, to maintain optimum oxygen levels. This appliance is designed to keep the airway from collapsing. Patients are highly compliant with oral appliance therapy because of the ease of use and immediate relief it provides. The sleep study is then repeated with the use of oral appliance therapy, to demonstrate the effectiveness of the device. The resulting report gives us affirmation that the appliance in place is effectively treating the OSA. Dr. Sam Romano, DMD: “My vision is to change the way you perceive dentistry and to improve your quality of life”, Dr. Sam Romano states. “The addition of sleep apnea therapy into my practice gives me the opportunity to enhance my patients overall health, which is very important to me.” Dr. Sam Romano has been in practice for 27 years at the same location-120 Park Avenue, in Madison. Dr. Sam Romano can be reached at 973-377-7088, via his website: www.drsamromano.com or you can visit his facebook page at: www.facebook.com/drsamromano. Dr. Sam Romano is a member of the American Academy of Cosmetic Dentistry. He is also a clinical instructor at the world renowned Kois Center, a state of the art, post graduate, dental teaching facility, in Seattle, Washington. Dr. Sam Romano enjoys teaching dentists, from all over the world, advanced techniques in general, restorative, and cosmetic dentistry. He is a lifelong resident of Madison where he resides with his wife and two children. Dr. Sam Romano is an active member of his community.
Most people don’t think their family dentist could save their life, but the truth is that they can. This year over 52,000 Americans will be newly diagnosed with oral and throat cancers. When detected in the early stages of disease, these cancers have an 80– 90% chance of survival. However, the reality is that most of the cancers won’t be diagnosed until later stages the person will not live longer than five years after the initial diagnoses. Since April is national Oral Cancer Awareness month, I thought it was important to review the risks and signs of oral cancer. It is important to know the risks for developing oral and throat cancers. The most obvious of risks are smoking and drinking alcohol over a long period of time. Another risk is the HPV-16 virus (human papilloma virus). This is the same virus associated with cervical cancer in women. If you or your partner/spouse has a history of HPV, your risk for developing throat cancer may increase. It is known that men have a three times greater chance of developing throat cancer due to the HPV virus than women. There are a small percentage of people (about 7%) who develop oral and throat cancers with no apparent cause. In these cases it is believed that a genetic predisposition may exist. There is no age discrimination when it comes to oral and throat cancer. These cancers can affect anyone at any age. The following list contains the signs and symptoms that can be associated with oral and throat cancer: - A sore or lesion that does not heal within two weeks - A white or red patch on the gums, tongue, tonsil, floor of the mouth, inside of the cheek - A lump or thickening of the cheek - Difficulty chewing or swallowing - Persistent sore throat, hoarseness, or changes in your voice - Difficulty moving the jaw or tongue - Swelling of the jaw that can cause a denture to fit poorly - Persistent swollen lymph nodes under the chin and along the sides of the neck Each year the death rate for these cancers continues to grow. By raising awareness and knowing your risks for developing the disease we can decrease the death rate and increase the survival rate. Please know your risk for developing oral and throat cancer. Discuss your risks with your dental team and ask your family dentist for a head and neck cancer screening at every visit that may include use of the VELscope, a special non-invasive light that evaluates the cells below the surface. Your dentist should exam your lips, tongue, throat, gums and feel your lymph nodes. It only takes 4 minutes and it could save you life.
He Snored Last Night! No! She Snored Last Night! No Snoring Please! As the father of a third grader, I try to use some of the teachings from my son’s homework and apply them to some of our everyday life’s teachings. Here is an acrostic poem to think about: A little test you or your snoring partner can take. S (Snore) Do you snore loudly, (louder than talking or loud enough to be heard through closed doors?) T (Tired) Do you often feel tired, fatigued, or sleepy during daytime? O (Observed) Has anyone observed you stop breathing during your sleep? P (Blood Pressure) Do you have or are you being treated for high blood pressure? B (BMI) BMI more than 35 kg/m? A (Age) Age over 50 yr old? N (Neck Circumference) Neck Circumference greater than 40 Cm (16 in)? G (Gender) Gender male? High risk of Obstructive Sleep Apnea: answered yes to three or more items Low risk of Obstructive Sleep Apnea: answered yes to less than three items Snoring is not to be Ignored.
I recently sent an email to my three children (ages 18, 19 and 26) with the subject line “An important topic no one wants to talk about” that had them jokingly saying they were going to mark future emails from me as Spam. The unpleasant topic was related to the correlation between HPV (human papillomavirus), oral cancer and oral sex. HPV is the broad term for a group of viruses, some of which are considered “low risk” and others which are “high risk” and cause genital cancers. HPV-16 is the strain that causes both genital and oral cancers. In the past, the “model” for oral cancer was an older man who had spent a lifetime of smoking and drinking. But now, young people without the risk factors of smoking and drinking are being diagnosed with oral cancer. It is suspected that oral sex, considered by many young adults to be “safer” than intercourse, is considered the culprit. According to the Journal of the American Medical Association, about 7 percent of men and women between the ages of 14 and 69 living in the United States carry HPV in their mouths. Advances in diagnosis have allowed researchers to test for viral DNA and have found HPV in many oral cancers. Even the location of HPV related oral cancer varies from the “traditional” oral cancers, with lesions being found primarily in the back of the throat and in the crypts, or crevices, of the tonsils. I advise all my patients to be aware of the potential signs and symptoms of oral cancer: A unexplained white or red lesion in the mouth that is present for more than two weeks. A swelling in the throat Difficulty or painful swallowing A change in your voice If you notice any of the above, call us for a complete evaluation. Oral sex is not the only cause of transmission; HPV infection increases with the number of partners you have and is transmissible by skin to skin contact. Not all infections with HPV will lead to cancer. Of the 150 related viruses, about 40 are sexually transmitted and only some of those will cause cancer. Most infections with HPV are cleared by the body without any long term consequences. If you would like additional information about HPV and cancer, visit our website at www.adamsdentalnj.com or contact our office at 973-377-6500. Additional information is available on the websites below. http://abcnews.go.com/Health/ReproductiveHealth/hpv-oral-cancers-rise-oral-sex-popular-spread/story?id=11916068#.T2Ozo8WPUTY http://www.cancer.gov/cancertopics/factsheet/Risk/HPV http://oralcancerfoundation.org/facts/index.htm