our health: SLEEP
When It’s Been A
Hard Day’s Night
Working in tandem, a local doctor and dentist
strive to help end fitful and unhealthy sleep.
BY MEL W. RHODES
S
PA R K E R C O U N T Y T O D AY
collaborative effort to help treat “the
whole patient.” As a dentist involved
with sleep therapy, she said part of
her job is to know the condition of
a patient’s oral airway, to discern
whether there may be conditions
which could be problematic. If such
conditions are discovered, she refers
the patient to a sleep doctor. But she
often receives referrals from doctors,
particularly Dr. Olusegun Oseni
of Lung and Sleep Specialists of
North Texas in Weatherford, who is
board-certified in Internal Medicine,
Pulmonary, Critical Care and Sleep
Medicine.
According to Dr. Oseni, “Because
it is still unrecognized and most
people do not appreciate the
consequences of sleep apnea on
their health,” OSA is one of the most
undiagnosed and untreated medical
conditions of the day.
Asked how a typical case might
unfold, Dr. Romack replied: “Say
a patient realizes they probably do
have a problem — they snore; are
excessively fatigued; or someone
has told them they gasp and choke
during sleep — and they go to see
Dr. Oseni. He runs them through a
sleep test — it could be an overnight
sleep test, it could be a home sleep
test — and consults with them.”
“I prescribe MRDs to patients who
have mild-moderate OSA who are
unable to tolerate or decline CPAP
therapy. It works and has helped
a lot of my patient’s symptoms,”
said Dr. Oseni. “I like [the] MRD
because it is better tolerated and not
as overbearing compared to CPAP
therapy. CPAP therapy; however,
still remains the [preferred] therapy
… with patients that have more than
MARCH 2016
leep. We spend a third of our lives
doing it, but do we realize just
how critical a good night’s sleep is to
overall well-being?
“It’s really crazy how much our
sleep impacts our entire body …
everything about our body,” said
Dr. Deborah Romack, DDS, a local
specialist in dental sleep medicine
who upon graduating Baylor College
of Dentistry in Dallas in 1998 moved
to Weatherford and joined Cosmetic
Family Dentistry. According to her,
sleep disorders cause or contribute
to a long litany of ailments,
hypertension, heart attacks, even
sudden cardiac death.
“But there are also direct
connections with Obstructive Sleep
Apnea (OSA) and memory issues,”
she explained. “Forgetfulness. A
feeling of fuzziness and not being
able to think correctly. There’s a
connection with diabetes. There’s
actually a connection, believe it or
not, with glaucoma ….”
Sleep apnea, or temporary
cessation of breathing during sleep
— lasting at least 10 seconds — long
has been treated by the wearing of
a CPAP (Continuous Positive Airway
Pressure) mask worn by the troubled
sleeper at night. Dr. Romack referred
to the CPAP as the “gold standard”
in OSA therapy, but she is obviously
very enthusiastic about a relatively
new therapeutic device, an “oral
appliance” sometimes called a MRD
(Mandibular Repositioning Device)
that for many patients makes sleep
therapy more convenient, more
comfortable.
Dr. Romack’s work in the sleep
disorder field is actually done in
tandem with local sleep doctors — a
moderate-severe OSA.”
Dr. Oseni explains the
condition and various treatments
or therapies used to address the
problem and, based on knowledge
obtained during the sleep tests
and resulting consultations, makes
recommendations. If patients chose
oral appliance therapy, Dr. Romack
receives copies of tests, etc., and
Dr. Oseni’s prescription for the
appliance. She brings the patient in
for examination and consultation.
Once satisfied he or she is a suitable
candidate for the oral appliance,
“We go ahead and fabricate the oral
appliance,” said Dr. Romack.
To ensure the appliance fits
perfectly, she measures the oral
airway with Echo Vision (EV).
“We take impressions, send it off
to the laboratory and about three
weeks later, their custom-made oral
appliance comes back, and I have
them in and seat it in their mouth,”
Dr. Romack said.
Over a period of about six months
she sees the patient to adjust and
further calibrate his or her new oral
appliance, fine tunes the fit. Once Dr.
Romack feels the person and device
are more or less in sync, she refers
the patient back to Dr. Oseni who
may perform more sleep tests.
There are over 120 different
oral appliances or MRDs currently
being marketed, Dr. Romack said.
However, “only a select few” are
both FDA-approved and Medicarecleared — and according to her,
that’s big. It means the research is
there and the devices she uses have
undergone rigorous testing. It also
means the therapy is more affordable
for many people.
“I’ve been doing this since
2003,” explained Dr. Romack, “and
just recently — over the last two
years — have really picked up steam
with it. And that is because of the
Medicare clearance — Medicare
pays for it and medical insurance is
helping with the cost as well.” This,
she said, includes Tricare military
insurance.
The oral appliance — designed to
help specialists like Drs. Romack and
Oseni correct underlying problems
associated with sleep apnea — is a
two-piece device held together by
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