Treatments for sleep disorders generally can be grouped into four categories:
Behavioral and psychotherapeutic treatment
Rehabilitation and management
Medication
Other somatic treatment
None of these general approaches is sufficient for all patients with sleep disorders. Rather, the choice of a specific treatment depends on the patient's diagnosis, medical and psychiatric history, and preferences, as well as the expertise of the treating clinician. Often, behavioral/psychotherapeutic and pharmacological approaches are not incompatible and can effectively be combined to maximize therapeutic benefits. Management of sleep disturbances that are secondary to mental, medical, or substance abuse disorders should focus on the underlying conditions.
Medications and somatic treatments may provide the most rapid symptomatic relief from some sleep disturbances. Some disorders, such as narcolepsy, are best treated pharmacologically. Others, such as chronic and primary insomnia, may be more amenable to behavioral interventions, with more durable results.
Chronic sleep disorders in childhood, which affect some 70% of children with developmental or psychological disorders, are under-reported and under-treated. Sleep-phase disruption is also common among adolescents, whose school schedules are often incompatible with their natural circadian rhythm. Effective treatment begins with careful diagnosis using sleep diaries and perhaps sleep studies. Modifications in sleep hygiene may resolve the problem, but medical treatment is often warranted.
According to new research presented at the 19th Annual Meeting of the American Academy of Dental Sleep Medicine, the majority of U.S. dental schools have not adequately prepared their graduates to screen for sleep disorders, which affect more than 70 million adults in the U.S.
Researchers from the University of California - Los Angeles (UCLA) School of Dentistry surveyed each of the 58 U.S. dental schools to determine the average number of curriculum hours offered in dental sleep medicine (DSM). DSM focuses on the management of sleep-related breathing disorders, such as snoring and obstructive sleep apnea (OSA), with oral appliance therapy (OAT) and upper-airway surgery.
Forty-eight schools responded to the survey, indicating that dental students spend an average of 2.9 instruction hours during their four years of dental school studying sleep disorders.
According to lead author Michael Simmons, DMD, D. ABOP, part-time instructor at both UCLA and USC, sleep medicine is being introduced at the majority of U.S. dental schools, but the total hours taught are inadequate given the epidemic proportion of people with OSA.
More than 18 million Americans suffer from OSA. An estimated 80 to 90 percent of patients with OSA are undiagnosed and more go untreated. Untreated sleep apnea can raise a patients' risk for heart attack, stroke, hypertension, diabetes, and obesity, among other health problems and premature death.
The survey asked which sleep topics were taught, which treatments were covered, and which departments were responsible for the teaching of dental sleep medicine.
Results show that classroom topics covered diagnosis of obstructive sleep apnea, sleep bruxism, snoring and upper-airway resistance syndrome, and treatments including oral appliance therapy, continuous positive airway pressure and surgery. Eight schools also discussed at-home sleep tests, which dentists can use to monitor treatment success.
