Center for Sleep Medicine4265 Johns Creek Pkwy, Suite ASuwanee, Georgia 30024phone 678 990 3962fax 678 990 3966For additional information visit www.fusionsleep.com

We are nationally accredited by the American Academy of Sleep Medicine, the benchmark for excellence in the field of Sleep Medicine.

Sleep Medicine Bulletin 2 - March Issue 2008Many Teens Suffer fromChronic InsomniaA recent study published in the journal Sleep (vol. 31; No. 2, 2008, p.177) examined the incidence, chronicity, and remission of symptoms of insomnia in adolescents...Introducing Oral Appliance TherapyOral Appliance Therapy (OAT) has become a well documented alternative treatment for Snoring and Obstructive Sleep Apnea (OSA)...Sleep in Art & CultureFrancisco Goya (1746-1828) was a Spanish painter and printmaker. He created a series of artwork called The Caprichos, depicting nighttime creatures such as bats, owls...

Center for Sleep Disorders4265 Johns Creek Pkwy, Suite ASuwanee, Georgia 30024phone 678 990 3962fax 678 990 3966For additional information visit www.fusionsleep.com

We are nationally accredited by the American Academy of Sleep Medicine, the benchmark for excellence in the field of Sleep Medicine.

We diagnose and treat all sleep disorders in children, adolescents and adults.• Sleep Disordered Breathing• Sleep Apnea• Snoring• Restless Legs Syndrome• Narcolepsy• Parasomnias• Insomnia• Circadian Rhythm DisordersProfessional Services:• Comprehensive Evaluations• All Levels of Sleep Testing• Prompt Results• Effective & Immediate Treatment Options• Comprehensive Followup• Personalized Attention & Warm Welcome• PAP Therapy Equipment• Oral Appliance Therapy• Broad Insurance Coverage• Board Certified Sleep Physicians

Center for Sleep MedicineFusion Sleep welcomes your feedback. To enquire regarding references orto provide your comments, please call or e-mail to reception@fusionsleep.com0525

7595100

Sleep Medicine Bulletin - March 2008 - CoverFriday, February 22, 2008 9:37:10 AM

Many Teens Suffer From Chronic Insomnia

A recent study published in the journal Sleep (Vol. 31; No. 2, 2008, p. 177) examined the incidence, chronicity, and remission of symptoms of insomnia in adolescents aged 11 to 17 years of age. The study was conducted by Dr. Robert E. Roberts and colleagues from the University of Texas Health Science Center at Houston. The authors assessed information collected from 3,134 boys and girls, who had all participated in Teen Health 2000, which was a study involving youths in HMOs in the metropolitan Houston Area. Participants answered computer-based questionnaires and were interviewed at baseline and one year later.

One in four teens showed significant symptoms of insomnia every day for a month

The symptoms of insomnia were separated into several categories: Nonrestorative sleep, Trouble falling asleep, Nighttime waking with difficulty getting back to sleep again, Nighttime waking without difficulty returning to sleep, and Early morning awakenings.

One-year incidence was 13.9% for at least one of the above symptoms and 5.5% for symptoms with added daytime sleepiness. This indicates that insomnia is as common among adolescents as mood and anxiety disorders, as well as substance abuse.

The results of the study found that one in four youths reported 1 or more symptoms of insomnia every day for a month. When studied a year later, nearly half of those respondents (45.8%) had one or more of the above symptoms and more than a third, or 34.7%, had at least one symptom in addition to fatigue and sleepiness. The addition of fatigue and sleepiness suggests a progression of their condition.

Predictors of insomnia include gender, physical health and stress

As part of the Teen Health 2000 study, the authors analyzed numerous background variables that could be risk factors for insomnia. These included age, gender, family income, ethnic status, physical health, mental health and life stress (school, neighborhood, or family). Anxiety disorders,

mood disorders, behavioral disorders, eating disorders and substance abuse were also included.

By excluding mood, anxiety and substance use disorders, the authors found 23.6% of teenagers to suffer from chronic insomnia. They also found independent predictors of insomnia to include being female, having poorer health, in addition to increased life stress, such as dealing with issues at home and at school.

These findings suggest that insomnia is a great public health problem and a major chronic disease affecting a large portion of teenagers in the United States. Insomnia is a symptom that may result from common sleep disorders, such as apnea or RLS, which were not evaluated in this study and require additional testing and treatment.

Introducing Oral Appliance Therapy

Oral Appliance Therapy (OAT) is a well documented alternative treatment for snoring and Obstructive Sleep Apnea (OSA). Although Continuous Positive Airway Pressure or CPAP therapy is the most common treatment for OSA, Oral Appliances are a non-invasive, comfortable and effective therapeutic option. Additionally, Oral Appliances are very convenient for travel.

Oral Appliance for the Treatment of Snoring and Sleep Apnea

Similar in feel to retainers or sports mouth guards, Oral Appliances prevent the collapse of the tongue and soft tissues into the throat during sleep, eliminating OSA.

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Patients with mild to moderately severe sleep apnea will benefit

Oral Appliance Therapy is applicable for individuals with primary snoring and non-severe OSA, who do not respond to other treatments such as weight loss and position change, or who do not tolerate CPAP.

This treatment option should also be considered for those who have not achieved the relief expected following a surgical intervention.

Oral Appliances reposition the lower jaw to prevent snoring and apnea

The key function of the Oral Appliance is to comfortably reposition the mandibular (lower jaw) to a minimally protruded or forward position during sleep. This opens up the airway by indirectly pulling the tongue and airway muscles forward, stimulating activity of these muscles, resulting in a stronger and more stable airway.

Oral Appliances are effective in reducing snoring as well as sleep apnea because the most common sites of obstruction in the upper airway are just below the base of the tongue and soft palate (termed the oro- and hypopharynx). By positioning and stabilizing the lower jaw, the oro- and hypopharynx increase in size and allow for improved breathing during sleep.

Oral Appliances are customized by sleep medicine dentists

Dentists with training in Oral Appliance Therapy are familiar with the various designs and applications of different appliances. Board certification by the American Academy of Dental Sleep Medicine insures the highest qualification in this field. Many dentists work with board certified sleep specialists as part of a complete medical team in the diagnosis, treatment and management of the sleep-disordered breathing. Determination of the effectiveness of the treatment is best made through the close collaboration of a dentist with their sleep medicine colleagues.

The process for receiving an Oral Appliance begins with proper diagnosis (usually requiring laboratory testing to demonstrate the presence of sleep-disordered breathing). Evaluation by a sleep medicine specialist and qualified dentist to determine the most appropriate device is the next step. Soon after this, the patient is fitted with a device, customized to the bite and structure of the teeth and jaw. Fine tuning therapy with subsequent

home-based testing and occasional clinical evaluations insures continued success over time.

Insurance covers Oral Appliances

Oral Appliance Therapy is covered by most insurance carriers and necessitates diagnosis of OSA by overnight testing. An attempt, or failure, to treat OSA with CPAP therapy is sometimes necessary prior to insurance coverage.

Sleep in Art & Culture

Francisco José de Goya y Lucientes (1746-1828) was a Spanish painter and printmaker, who has both been considered one of the last “Old Masters”, as well as one of the first modern artists.

The Sleep of Reason Produces Monsters. Francisco Goya (1799)

In the 1790s he created a series of artwork called The Caprichos. The series consisted of aquatinted etchings, many of which were bleak visions. In this etching the subject is leaning forward, sleeping on a table, surrounded by nighttime creatures such as bats, owls and a cat. The dreamscape may serve as a metaphor for imagination, where irrational thoughts may emerge.

Center for Sleep Medicine4265 Johns Creek Pkwy, Suite ASuwanee, Georgia 30024phone 678 990 3962fax 678 990 3966For additional information visit www.fusionsleep.com

We are nationally accredited by the American Academy of Sleep Medicine, the benchmark for excellence in the field of Sleep Medicine.

Sleep Medicine Bulletin 2 - March Issue 2008Many Teens Suffer fromChronic InsomniaA recent study published in the journal Sleep (vol. 31; No. 2, 2008, p.177) examined the incidence, chronicity, and remission of symptoms of insomnia in adolescents...Introducing Oral Appliance TherapyOral Appliance Therapy (OAT) has become a well documented alternative treatment for Snoring and Obstructive Sleep Apnea (OSA)...Sleep in Art & CultureFrancisco Goya (1746-1828) was a Spanish painter and printmaker. He created a series of artwork called The Caprichos, depicting nighttime creatures such as bats, owls...

Center for Sleep Disorders4265 Johns Creek Pkwy, Suite ASuwanee, Georgia 30024phone 678 990 3962fax 678 990 3966For additional information visit www.fusionsleep.com

We are nationally accredited by the American Academy of Sleep Medicine, the benchmark for excellence in the field of Sleep Medicine.

We diagnose and treat all sleep disorders in children, adolescents and adults.• Sleep Disordered Breathing• Sleep Apnea• Snoring• Restless Legs Syndrome• Narcolepsy• Parasomnias• Insomnia• Circadian Rhythm DisordersProfessional Services:• Comprehensive Evaluations• All Levels of Sleep Testing• Prompt Results• Effective & Immediate Treatment Options• Comprehensive Followup• Personalized Attention & Warm Welcome• PAP Therapy Equipment• Oral Appliance Therapy• Broad Insurance Coverage• Board Certified Sleep Physicians

Center for Sleep MedicineFusion Sleep welcomes your feedback. To enquire regarding references orto provide your comments, please call or e-mail to reception@fusionsleep.com0525

7595100

Sleep Medicine Bulletin - March 2008 - CoverFriday, February 22, 2008 9:37:10 AM