Dr. William Langstaff: A bone that implants can be placed but this is a patient, there was a denture.
Mike Wiegenstein: Yeah. Okay, so this gentleman with no impendent denture on it without any implants, because there is no activity on the bone or in the bone per say, it's kind of like a muscle starts to atrophy, right?
Dr. William Langstaff: Absolutely.
Mike Wiegenstein: The second photo, this is a picture of - it's still got the little swoop in the front, but I notice now that it's very thin, it's almost gone, what is this?
Dr. William Langstaff: That's what happens to the jaw with the denture in for 20, 30 years; this is what happens to the bone.
Mike Wiegenstein: Now there is a little nerve that runs along that bone, is there not?
Dr. William Langstaff: Actually the nerve is in the middle of the bone, right in this area.
Mike Wiegenstein: The little dark spots we see running down the middle of the bone, that's the nerve, wouldn't a denture riding on that fuel?
Dr. William Langstaff: Absolutely, as a matter of face, I just found out very interesting static that in a rest home where there are old people that have dentures, 25% of the patients wear the dentures.
Mike Wiegenstein: The 75 don't?
Dr. William Langstaff: 75 don't, why?
Mike Wiegenstein: Is it painful?
Dr. William Langstaff: Because it hurts, because they look like this.
Mike Wiegenstein: Because they're weighted.
Dr. William Langstaff: Right.
Mike Wiegenstein: At this point, okay with that said, let's get into taking about sleep disorders, sleep apnea. Just to start, what are some of the biggest science that somebody should look for before we talk about the cures to maybe find out if they have sleep apnea or they have some sort to sleep disorder?
Dr. William Langstaff: Well, the first thing that is dangerous of course would be falling asleep at the wheel when you're driving.
Mike Wiegenstein: So if you're tired during the day.
Dr. William Langstaff: Tired during the day. People that have heart conditions also have sleep apnea.
Mike Wiegenstein: Now, tell me what you said to me about that. You told me that cardiologist?
Dr. William Langstaff: Well, it turns out that 50% of patients that go to heart specialists have sleep apnea. That means that 50% of the patients that have heart conditions, that are diagnosed with heart conditions have sleep apnea.
Mike Wiegenstein: Okay, now what about like snoring or you told me that the bruise in the ribs?
Dr. William Langstaff: That comes from the spouse. When people have sleep apnea, they make a lot of noise and hold their breath and there is a lot of activity that's occurring for the best part of the night time.
Mike Wiegenstein: And is it holding their breath, and basically what happens is they quit breathing.
Dr. William Langstaff: Yeah, they quit breathing.
Mike Wiegenstein: It's not that they mean to hold their breath, they just stop.
Dr. William Langstaff: They just stop breathing and then they wake up again. At that point, it scares their spouse and there spouses, quit that, wake up, wake up, breath.
Mike Wiegenstein: Alright Doc, I know you brought a video clip to kind of show or explain what sleep apnea is. Now this is the worse, this affects 10% of people with sleeping disorders. Let's watch the video real quick and kindly tell me what's going on?
Dr. William Langstaff: And notice how she held her breath right there and then she gasp for breath. What's happening there is her tongue collapsed against the back of her throat to cut off the airway space. When you reach a certain level or certain stage in sleep, your body becomes paralyzed and your muscles collapse.
Mike Wiegenstein: You just quit breathing.
Dr. William Langstaff: You quit breathing.
Mike Wiegenstein: And your body wakes you up to say, hey, you might die here or?
Dr. William Langstaff: Yeah, exactly right. What the body saying, breathe please?
Mike Wiegenstein: Now do they know -
Dr. William Langstaff: I need oxygen.
Mike Wiegenstein: Do they know they're going to quit breathing?
Dr. William Langstaff: Mostly not.
Mike Wiegenstein: They should know?
Dr. William Langstaff: No mostly not. The only way they will know is if their spouse lets them know and they have a little black and blue spot on the -
Mike Wiegenstein: or if they live by themselves, they are tired, restless, worn out all the time.
Dr. William Langstaff: Driving into things because they fall asleep at the wheel, all kinds of things, have heart conditions.
Mike Wiegenstein: Now you explain the heart conditions. Explain to me little bit and I know apnea is the worst, apnea is where they actually quit breathing during the night.
Dr. William Langstaff: Yes.
Mike Wiegenstein: We're going to talk a little bit about the treatments and diagnosis of it, but explain me a little bit about what the lack of oxygen during the night does to your body, you talked to me about getting into REM sleep, give me a little bit detail?
Dr. William Langstaff: Well, in order for our body to rejuvenate, the juices to allow us to continue to live, we need sleep. The most import part of sleep, the stage called REM, which is rapid eye movement. During this period that's when the fuel rejuvenation juices are released. For adults, it's nitric oxide, which allows the heart to clean itself out if you will. For children, it's the growth hormone. So children that have this condition don't grow, they have ADD, they have all kinds of problems.
Mike Wiegenstein: Okay, this is something that you brought up to me that I was really -- so of course the child is small, maybe undersize, you said me, they continues to wet the bed, maybe little hyperactive, may mean they are not sleeping well?
Dr. William Langstaff: Absolutely. Not only not sleeping well, not getting enough oxygen to their system to be able to grow properly and to develop the way they're supposed to develop. Most the time, the cause of this, tonsils. Tonsils are huge, adenoids are huge, they just can't get enough air during the night time because at that REM sleep, all these tissues collapse, they can't breathe, then they wake up gasping, they just never stay in that REM stage of sleep to allow them to do what they need to do.
Mike Wiegenstein: Alright, now you brought a picture real quick just so that people can see the difference in what the back of their throat. So in your opinion, you have a child whose undersized, maybe still wets the bed, doesn't pay attention, you know all those things, can you just open up their mouth and look in and say, may be you need to go get and check?
Dr. William Langstaff: And say ah, if they say ah, you look inside and you don't see any opening.
Mike Wiegenstein: So class 1 is what you're looking for?
Dr. William Langstaff: That's right. If you see big bowling balls in the back of the throat called tonsils and you don't see much of a space there, that means that when they're asleep, that space totally closes up and that's why they don't breath in night time and that's why they don't grow, because the growth hormones are developed and -
Mike Wiegenstein: There is a reason I ask, because obviously all of this sounds like something I would take my child or I would go see a doctor, a medical doctor for, not a dental doctor, but you are a dentist and you deal with this and treat this all the time. Is this something that for some reason, isn't really paid much attention to in the medical community?
Dr. William Langstaff: Well, here is the deal. Dentists have the opportunity to see their patients once every six months or every three months or four months depending on the recall as there is continued care recalling in our office. In my office, we check for all these things for adults and for children. We check for their airway, we check their blood pressure, we do all these things routinely because we are their first line of protection for their health, that's the way we see it. In our office, we do cancer checks, we do all kinds of things, now then they come in for their continued care, this is part of it
Mike Wiegenstein: Prior to January '06, it's my understanding that this was purely considered a medical issue. You have to go with the standard CPAP machine that we're going to get into, but as of January '06, oral appliances are actually the preferred form of treatment, now are they?
Dr. William Langstaff: Well, according to the American academy of Sleep Medicine, the primary treatment for moderate to mild sleep apnea are oral appliances.
Mike Wiegenstein: Okay.
Dr. William Langstaff: Prior, it was CPAP.
Mike Wiegenstein: Alright, we're going to get into that. Let's take another quick break. When we come back, we're going to get into the diagnosis and the treatments that are now available for sleep apnea. We are in studio with Dr. Langstaff, we'll be right back.
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Mike Wiegenstein: Welcome back. We're in the studio with Dr. Langstaff discussing sleep disorders. Alright before we went to break, we were taking about sleep apnea, what it is, how it's caused, and other things. Until recently, the treatment for sleep apnea or the way to diagnose it is always been to go to get a sleep study?
Dr. William Langstaff: Right, right, polysomnography.
Mike Wiegenstein: Polysomnography, now that's it, I am going to bring up a picture real quick. This looks like a young gentleman having a polysomnography. Is this about what it looks like? They wire you up in a hospital?
Dr. William Langstaff: Pretty much in the sleep lab, they're trying to make it as comfortable as possible but it's a sleep lab, so it's a room with a bed and with the wires.
Mike Wiegenstein: And they are watching you while you try to get a normal night sleep.
Dr. William Langstaff: Yes.
Mike Wiegenstein: Yeah, then this picture, I just want to show because this gentleman, I don't know how he fell asleep, but you can see they have a CPAP next to him and you said that that's a study they do.
Dr. William Langstaff: A split study.
Mike Wiegenstein: Half and half.
Dr. William Langstaff: Right, so they will do half in night with regular.
Mike Wiegenstein: But how -- what are the odds you're going to sleep like you normally sleep, I mean, I know sleep is well in a hotel, I do. I only ask, we go to a hotel room.
Dr. William Langstaff: Well, apparently according to the research, you really don't sleep as well in a strange bed the first night, the second night you do, but not the first night.
Mike Wiegenstein: So these are done in the first night.
Dr. William Langstaff: Yes.
Mike Wiegenstein: You go in. Alright I go in, I have a sleep study done, I am diagnosed with sleep apnea. Up until recently if I am not mistaken, this is what I would get, this is a constant pressure airflow CPAP machine.
Dr. William Langstaff: CPAP, constant pressure airflow.
Mike Wiegenstein: And this is the way it was treated?
Dr. William Langstaff: Yes, still -- I mean this is a CPAP mask that's hooked up to holes that will go to machines, that pushes the air pressure in.
Mike Wiegenstein: Alright. I have friends that are having, which is part of the reason I brought you in today. I have friends who have this, whose lives depend on them wearing it, who don't wear it, because they say, it's cumbersome, it doesn't, you know, it's hard to -- the noise it makes --
Dr. William Langstaff: Well, no, no.
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