The complicated patient is often one of misinformation or miscommunication. 

Today was a fun day where I had a patient come in for a foIlow-up visit. I have been trying to dial in a titration and get him to wear his Herbst appliance for more than an hour and a half each night.

Yesterday we sent the patient home with a home sleep tester because I wanted to know what was happening during his 1 hour of sleep.

The patient showed up with the sleep tester and stating that the appliance does not work and can't keep it in and breath.  We downloaded the sleep study and when reviewing the patient informed me he was awake the whole time the tester was on and was goofing around the house.

The interesting part was there were oxygen desaturations and the breathing was reduced and stopped a few times even when there was activity.  How could this be? I started talking with the patient and said the only way this could be possible is with COPD.  At that moment the patient inform me he has mild COPD. 

COPD is a contra-indication for an oral appliance.  No matter what we do we can't treat him. He needs to have a BIPAP or O2 all the time.  After I explained this he then said the pulmonologist told him the same thing and that is why he hid it from me.

Now he will wear the Herbst appliance and his BIPAP, and O2 during the day.

This is why we have to keep talking to the patients and dig out the real story.  Complications are usually due to something else and not the appliance.  Keep on your toes.

​Becoming a diplomate in a recognized association or board conveys a better knowledge of dental sleep medicine and sleep medicine. This also shows a higher level of training and commitment. The medical community will have more trust in you, as most physicians have completed specialty training and have achieved diplomate status. Since there is no recognized specialty in dental sleep medicine, it is the closest thing to a residency and specialization.
Hundreds of people teach courses in dental sleep medicine, with many different styles and focus. There also are a few mini-residencies in dental schools and private groups, and many small groups or organizations have their own credentialing and marketing focus. The top three associations for dental sleep medicine are the AADSM, ACSDD, and ASBA.

The American Academy of Dental Sleep Medicine (AADSM) is the largest association for dental sleep medicine. It offers continuing education, conventions, publications, lobbying for dental sleep providers, facility accreditation, policies and procedures standards, and more. This association is located within and as part of the American Association of Sleep Medicine (AASM), the largest association of sleep physicians and their sleep lab accreditation credentialing arm. They set the standard in sleep medicine specialty and practice. I personally recommend joining this association to everyone doing dental sleep medicine.
The AADSM also offers the Qualified Dentists designation. It is the credential for having the minimum skills and qualifications necessary for recognition in dental sleep medicine. They require twenty-five hours of approved continuing education in dental sleep medicine.

The American Board of Dental Sleep Medicine (ABDSM) is part of the AADSM and is the diplomate credentialing arm of the AADSM and AASM. It is currently the most recognized credentialing group within the dental sleep medicine world and is by far the most respected by sleep physicians. I am a diplomate with the ABDSM, and I recommend working toward diplomate status with the ABDSM for everyone doing dental sleep medicine.
To obtain credentials with the ABDSM, you need the following:
fifty hours of continuing education in dental sleep medicine. After 2017, those hours must come from a nonprofit continuing education program or a dental school. two letters of recommendation from two board-certified sleep physicians ten hours of observation at a board-certified sleep center and a signed letter stating that from a board-certified sleep physician. a 200-question proctored examination and submission of fifteen cases with documentation for evaluation

The Academy of Clinical Sleep Disorders (ACSD is a smaller association, and it’s relatively expensive to receive diplomate credentials. To receive their credentials, you need to take their training (forty-five hours), their proctored examination, and submit twenty cases for review.

American Sleep and Breathing Academy (ASBA) is a newer association that offers continuing education and credentialing. It requires forty hours of continuing education, ten cases for review, and a one-hundred-question proctored exam.
With the choices for association membership and credentialing, it is becoming more difficult to obtain diplomate credentials.  


 
Facility Accreditation with the AADSM
I was the first in Arizona to achieve facility accreditation, but I have let my facility accreditation expire.
. I was also on the committee for approving facility accreditation. The process of applying made my office sleep program better and helped me to make clear standards and objectives. I think it is wise to go through the steps for application because it will improve the way you maintain your charts and policies. It’s beneficial to get facility accreditation first if you need more time to get the diplomate status; getting facility accreditation is easier than the diplomate status.

 

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After a few weeks in Asia and traveling long distances across several time zones in an Airplane I suffered from Jet lag.

Jet lag is where the circadian rhythm or internal body clock that regulates the 24 hour cycle of the biological process has be altered.

What are some ways to help with jet lag? Drink plenty of water when flying. Staying hydrated is essential Too much caffeine or alcohol can make you dehydrated. Wear sunglasses or an eye cover when trying to sleep on a plane.  Avoid sleeping pills as that does not help and may hurt the biological clock.

What I like to tell my patients is to start taking 3-6 mg of melatonin a day before flying and the day of the flight.  You may need to continue for several days after you return home. Melatonin is so good for helping adjust the internal clock.  

I also recommend melatonin for  shift workers that have their circadian rhythm altered.

Getting jet lag under control is important for people with sleep apnea because it just makes the condition worse and the patient more agitated.