Sleep Disorders

Excessive daytime sleepiness, Waking up gasping for air, Depression, High blood pressure, Morning headaches, Poor memory, Neck size over 17, Poor sleep quality, Loud snoring

At The Gelb Center of NYC and White Plains, New York, a thorough evaluation is performed by our NYC Sleep Specialist doctors.  The anatomical structures which can contribute to sleep disorders and/or sleep apnea including the:

• Tonsils
• Tongue
• Soft Palate
• Uvula
• Adenoids
• Upper jaw
• Lower jaw
• Turbinates
• Deviated Septum
• Nasal polyps
• Clenching muscles
• TMJ
• Sinuses

There are several treatment options that our NYC and White Plains, NYC sleep specialist doctors may prescribe for your sleep disorder. Some sleep disorders treatments may include:

• Continuous Positive Airway Pressure (CPAP) Machine: For those patients suffering from sleep apnea, a CPAP machine is often used as a treatment option. With the CPAP Machine, users will experience a continuous level of positive airway pressure while they sleep.
• Polysomnogram (PSG) or Sleep Study: Many patients come to The Gelb Center with a copy of their PSG and a diagnosis of sleep apnea. The American Academy of Sleep Medicine (AASM) recommends oral appliances as a primary treatment for mild and moderate sleep apnea. The PSG measures how many obstructive breathing events occur each hour as well as oxygen desaturation levels throughout the night. The percent of the night in Stage 1, 2, 3, 4 NREM as well as REM is measured. Patients who snore and obstruct while laying on their back do better with oral appliance therapy. Lack of stage 3 and 4 NREM can lead to fatigue and widespread muscle pain. Restorative sleep is when repair and regeneration occur and a human growth hormone is released.
• Nose Remedies: Air is warmed, filtered and humidified by the nose before it descends in to the lungs. Blockage can occur from enlarged turbinates, nasal polyps or a deviated septum. An ENT doctor or allergist should be consulted if nasal congestion persists. In allergy season or during a cold, snoring worsens because the nose is congested. Rhinometry and Cone Beam CT (CBCT) are helpful diagnostically to determine the cause of nasal congestion.
• Oral Appliances: The Gelb Center has been using and developing oral appliances for sleep medicine for over 20 years. Oral appliances work by maintaining a forward position of the tongue and soft palate as well as widening the lateral pharyngeal walls. It accomplishes this feat mechanically as well as by stimulating the oropharyngeal muscles. Oral appliances are titrated to an optimal position to alleviate fatigue and snoring and to reduce apneas and hypopneas. Follow up home sleep studies are routinely used to ensure effectiveness of treatment. Oral appliances may include: Norad™ appliance,  Full Breath Solution™ , or Respire™
• Bruxism Treatments: Bruxism refers to clenching and grinding of the teeth. The Gelb Center offers advanced treatment of bruxism in NYC and White Plains, New York. Bruxism is a stereotyped movement disorder which occurs during sleep. It is typically accompanied by grinding of the teeth and clenching of the jaw. It can, therefore, overload the TMJ  as a repetitive strain injury and exacerbate muscle pain as well.  The treatment of sleep bruxism continues to evolve. At The Gelb Center we use 3 approaches:
• Oral appliances
• Medication
• Botox Injections
• Risk Factors For Sleep Bruxism: The number one risk factor for sleep bruxism is obstructive sleep apnea. Sleep bruxism is common in the general population and represents the third most frequent parasomnia. It has numerous consequences, which are not limited to dental or muscular problems. Among the associated risk factors, patients with anxiety and sleep disordered breathing have a higher number of risk factors for sleep bruxism, and an educational effort to raise awareness of dentists and physicians about this pathology is necessary. We realize that sleep bruxism is a central nervous system phenomena. Certain SSRI medications actually worsen bruxism.

At The Gelb Center our modern technology allows our Sleep Specialists / Sleep Doctors to visualizes the nose, sinuses, jaw bone, TMJ, tongue, and palate in 3 dimensions:

1. CBCT: (Cone Beam Ct)allows 3 dimensional visualization of the airway, and ENT analysis of the nose and sinuses.
2. Pharyngometry and Rhinometry: Acoustic eccovision allows volumetric measurement of the tissue in the nose and throat which can block the airway. With this technology, ideal jaw positioning can be achieved.
3. EndoPat 2000: This Itamar Medical device allows the doctors at The Gelb Center to measure endothelial dysfunction which is the most dangerous risk factor for cardiovascular disease. ED can be corrected with CPAP and oral appliance treatment.
4. Home Sleep Studies: At The Gelb Center, home sleep studies are used to monitor the effectiveness of our various oral appliances. These studies measure apneas and hypopneas per hour of sleep as well as oxygen saturation levels throughout the night. Some units even measure the amount of deep and REM sleep. We can titrate the oral appliances with multi-night home studies. Examples of home sleep monitors include: the ARES, Watch Pat 200, Braebon, Embletta, and Nox T3.

Options for Sleep Apnea Patients at our NYC and White Plains, New York offices:

• A continuous positive airway pressure (CPAP) machine may be prescribed for the treatment of sleep apnea at home. The CPAP machine, by delivering a stream of compressed air through a hose to a device such as a nasal pillow, nose mask or full-face mask, splints the airway (keeping it open under air pressure) so that unobstructed breathing becomes possible. These result in a reduction or prevention of waking episodes called apneas and hypopneas. CPAP is generally prescribed for severe apneics with an AHI greater than 30.
• For those who suffer from mild to moderate apnea there are other options. Oral appliance therapy is a first line or primary treatment for mild to moderate apnea. This is where The Gelb Center is considered a Center of Excellence.
• ENT evaluation may be helpful in diagnosing obstruction to allow better outcomes in all types of apnea and snoring.
• Orthognathic jaw surgery is an option in more extreme situations where the jaws are more retruded.