By Richard L. Gaw, Staff Writer

At at the time Dr. Avi Weiner was studying to become a dentist, helping those afflicted with obstructive sleep apnea was one of the furthest things from his mind.

Weiner was right in the middle of a post-graduate residency in General Dentistry at the Montefiore Medical Center in New York City, when his father, Dr. Mark Weiner, a well-respected neurologist in Boston, had become a board certified sleep physician. One of the things the elder Dr. Weiner saw in his patients was that some – not all – were not responding to the Continuous Positive Airway Pressure machine, commonly known as a CPAP, which has generally been considered the gold standard of sleep apnea treatments for several years.

"My father called me and said, 'You're a dentist, Avi. I've heard that there could be some kind of dental treatment for sleep apnea. Why don't you look into it?" Weiner said. "It was early in my training, and I told him, 'Dad, I'm learning how to do fillings and crowns. I can't deal with that right now. Maybe later on.'"

Three years ago, Weiner's father was diagnosed with an advanced stage of brain cancer, and was forced to close his practice. As the younger Weiner advanced through dental training, the idea to learn more about obstructive sleep apnea began to take root. For more than a year while his father recuperated -- between chemotherapy treatments and radiation -- the two learned all they could about the connection between sleep apnea and dentistry.

Soon after he joined Dr. William Cummings at Avondale Family & Cosmetic Dentistry a year-and-a-half ago, Weiner approached Dr. Cummings about incorporating a sleep program into the practice. Dr. Cummings overwhelmingly approved the idea.

This initiative couldn't have come at a better time. Currently, more than 25 million adults in the United States have obstructive sleep apnea, a condition which can cause them to stop breathing hundreds of times a night for anywhere from a few seconds to more than a minute. Sleep apnea is a chronic condition that occurs when muscles relax during sleep, allowing soft tissue to collapse and block the airway. As a result, repeated breathing pauses occur, which often reduce your oxygen levels. These breathing pauses are followed by brief awakenings that disturb sleep.
Common signs of sleep apnea include snoring and gasping or choking sounds during sleep. Like snoring, sleep apnea is more common in men, but it also occurs in women, especially during and after menopause. Untreated sleep apnea raises the risk for serious health problems, such as high blood pressure, stroke, heart disease, diabetes, chronic acid reflux and erectile dysfunction. In addition, it causes excessive daytime sleepiness or fatigue, as well as morning headaches and memory loss. Sleep apnea also is a threat to your safety as it increases the risk of drowsy driving and workplace accidents.

"The issue with obstructive sleep apnea is that the body is giving itself these sudden arousals through the night, and they're creating a 'fight or flight' system in the body," he said. "There is a relaxation in the muscles in the neck and throat, to the point where these muscles are actually falling up against the throat and blocking the airway. It leads to a flapping of the muscles as the air is trying to pass through the throat."

For years, CPAP therapy has been the front-line treatment for obstructive sleep apnea. It includes a small machine that supplies a constant and steady air pressure to the patient while he or she sleeps, through a hose, mask or nose piece. It is often used for patients who have severe respiratory or cardiac failure and acute chronic obstructive pulmonary disease (COPD) and asthma. As a result of the CPAP, patients receive a greater amount of oxygen to their lungs.

The problem with CPAP, many wearers tell their physicians, is that hooking up to the machine and a mask every night is clumsy and restrictive, and several patients have reported dizziness, sinus infections, bronchitis, dry eyes, mucous tissue irritation, ear pain and nasal congestion.

Enter oral appliance therapy, demonstrated chiefly through the use of the mandibular advancement device, an effective alternative for those obstructive sleep apnea patients who are not responding to their CPAP therapy. Worn only during sleep, the two-piece appliance fits like a sports mouth guard or an orthodontic retainer, and supports the jaw in a forward position to help maintain an open upper airway.

For some of the sleep apnea patients at Avondale Family & Cosmetic Dentistry, it's the answer they've been looking for.

"The device physically moves all of the muscles in the throat open, so that when your body comes to a full relaxation of sleep, the muscles are not totally resting against the back of the throat," Weiner said.

Although the sleep apnea program is still relatively new at Avondale Family & Cosmetic Dentistry, Weiner said that several of his patients have gone from having no alternatives to treat their sleep apnea, to success with the oral appliance alternative. Their introduction to the device is a slow and gradual one; after being fitted, the patient has his or her device adjusted over the course of two or three months, in order to bring the patient's jaw forward, which allows more air to be inhaled.

"We've gotten a really good response from these patients," Weiner said. "They tell us that they're sleeping better. In particular, the wife of a sleep apnea patient of mine was in for a cleaning recently, and she told us that she had moved back into their bedroom with her husband for the first time in many years. That made me feel great."

The advancement of oral appliance therapy, Weiner said, is a result of the open lines of communication between the medical health and dental health fields. A patient comes to Weiner for objective sleep apnea through a referral and diagnosis from the patient's primary physician, usually after taking part in a sleep study.

"If someone's physician recommends a CPAP machine, I always tell the patient to follow what their treating physician says," Weiner said. "If they are unable to continue the treatment that the physician is describing, then hopefully I can work with the doctor to tell them different types of options that are available for the patient.

"We think of ourselves as a team, and we are helping to treat the patient, and achieve the treatment goals that they want and deserve. Many times, we'll have patients who are referred from a physician to us, and many times, we'll make referrals to a physician."

Weiner said that the eventual goal of the program will be to have its sleep apnea patients take part in a sleep study done with their oral appliance, in order to document numbers that measure the improvement in their sleep apnea – data that will then be shared with the patients' primary physicians.

Dr. Mark Weiner is now is recuperating from surgery and radiation, and he is well on the road to recovery. He and his son talk on the phone nearly very day about the cases Avi works on.

"Sometimes my father tells me, 'What a great thing you're able to offer this patient, because that patient would have never had their sleep apnea treated, and who knows what would have happened?'" Weiner said. "This program is really a tribute to him, because it's helping treat patients he now is unable to treat. He has dedicated his life to helping people."

In his hands, Weiner held a demonstration model of the device that is helping some of his patient's lives. "He's definitely in this," he said of his father. "Ultimately, the most important thing is treating the patient with obstructive sleep apnea, and having the best treatment for the patient. Be it through the CPAP machine or through the mandibular advancement device, it doesn't matter to me. I'm just happy to be able to offer an option for the patient, especially at a time when they think they've run out of options."

To learn more about oral appliance therapy and the mandibular advancement device, visit www.aadsm.org/oralappliances.

To contact Staff Writer Richard L. Gaw, e-mail [email protected] .