Wednesday, June 28, 2017

Getting Enough Sleep Isn't Enough

Dr. Mark Burhenne, DDS, The 8-Hour Sleep Paradox: How We Are Sleeping Our Way to Fatigue, Disease, & Unhappiness

Snoring isn’t cute. Despite adorable viral videos of snoring babies, puppies, and grannies, snoring is a serious health issue. By now, with the prevalence of CPAP machines and mandibular advancement devices, we’re probably all somewhat familiar with sleep apnea. But Mark Burhenne insists this is only one form of “sleep-disordered breathing,” a category of breathing illnesses that can have cascading effects on your health, happiness, and quality of life.

Burhenne is one of a developing class of dentistry, specializing in sleep disorders. Many warning signs of sleep-disordered breathing, he writes, manifest in the mouth. This may include crowded teeth and recessed jaw, damage from chronic teeth grinding, and others. However, the signs he identifies still need quantified by MD sleep specialists before treatment can begin, or be compensated by insurance. That, he says, is where things become tricky.

The 8-Hour Sleep Paradox, Burhenne writes, is assuming counting the hours you spend asleep and assuming, as Mother probably taught you, that eight hours equals a good night. But simply being unconscious isn’t the same as getting a good night’s sleep. Citing multiple sources, Burhenne suggests that anywhere from half to four-fifths of Americans aren’t getting enough deep, restorative sleep, and lack of air is the most common reason.

Worse, we have a tendency to minimize or dismiss real problems. I say “we,” meaning the general population, but Burhenne writes, that includes medical professionals too. Patients diagnosed with “mild” sleep apnea often get sent home with best wishes and little more, but even mild apnea means a person’s airways close. And that means the person comes partway awake to breathe, and therefore isn’t getting necessary Stage-4 and REM sleep.

Mark Burhenne, DDS
This book’s first few chapters explain the warning signs in themselves. These include now-familiar signs of sleep problems, like obesity and chronic fatigue. It also includes, but isn’t limited to, signs of poor sleep, like needing caffeine and frequent naps (guilty); or waking up with dry mouth or headaches, signs you’ve spent the night gasping for air. But if you’re browsing this book, you already know you need to change.

But Burhenne avoids the most common shortcoming of self-help books, encouraging readers to diagnose themselves. Rather, after just two chapters on recognizing signs of sleep-disordered breathing, the largest portion of the book focuses on working with a sleep specialist to get an actual diagnosis that leads to treatment. This is difficult, Burhenne admits, because sleep studies are expensive, and insurance companies incentivize doctors to avoid costly tests.

Getting an appointment with a sleep specialist usually requires a recommendation from your GP. And if you aren’t middle-aged and overweight, Burhenne writes, many GPs won’t make that recommendation. So he provides tools to increase your doctor’s cooperation in the fifteen minutes you usually have, including the Epworth Sleepiness Scale and the STOP-BANG questionnaire. He also includes important questions to ask, and important information to provide.

After going through all that, patients have no guarantee their insurance will actually cover the procedures. Burhenne copiously expounds how to navigate the paperwork necessary to get treatments covered. This includes how to convince your insurance provider that you need some treatment other than CPAP, which is the most commonly used anti-apnea technology, but doesn’t work for everybody. Getting the right treatment takes effort, apparently, but it’s worth it.

Burhenne does provide life hacks that patients can apply individually. To give just two examples, this includes mouth taping, which is exactly what the name implies. If you have only a mildly obstructed airway, closing your mouth overnight with surgical tape can ensure you breathe through your nose for maximum efficiency. It also includes certain non-steroidal nasal sprays to keep airways open, again, for nose breathing, like your body prefers.

Nevertheless, Burhenne doesn’t mainly emphasize these internet-friendly hacks. He primarily keeps focus on medical science, including the most recent discoveries (as of when this book was written), and the information you need to get best results from your physician. A certain distrust for the medical establishment lingers beneath Burhenne’s prose. Though admittedly, this makes sense, considering the ideas he describes are still controversial in certain circles.

Medical pundits tell patients to watch our weight, manage our stress, and get our eight hours nightly. But we can’t do these if we’re tired from lack of deep, restorative sleep. It’s surprising to read this advice from a dentist, and I admit, I needed some convincing, but Burhenne certainly provides that. If, like me, you need not just more but better sleep, start here.

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