Is a Caffeine Tax a better idea than the Sugar Tax?

Is a Caffeine Tax a better idea than the Sugar Tax?

Are high caffeine drinks the symptom or cause, of our short sleeping, overtired population?

While sipping a new thing to me, a Caramel Machiato (bit too sweet for me), and enjoying the ‘Cafe Culture’, I looked around me and a thought occurred to me.

“Is perhaps the next way for Governments desperate to prop up failing economies a caffeine tax?”

Would a new indirect tax be such a surprise?

We have tax on alcohol, tax on cigarettes, tax on fuel and soon a tax on sugar.

Why not start taxing caffeine?

My thoughts continued like this:

We have a ban on advertising alcohol and cigarettes that is justified by health economic arguments. I suggest a health economic argument could be made for the impact of caffeine on sleep, which we know if fragmented impacts leptin and ghrelin*, which in layman’s terms means we getting fatter.

The International Diabetes Federation suggest that there may be a relationship between obstructive sleep apnoea and type 2 diabetes** and we have obesity and cardiovascular epidemics. This all adds up to a considerable cost to the State…

Could we then perhaps conclude that full fat milk, high caffeine coffees and also perhaps sugar loaded, high caffeine ‘energy drinks’ contribute to Society’s obesity problems and are not so much a symptom of our short sleeping society but actually the cause?

I don’t consider it too improbable, that in time, we may see a tax per mg of caffeine in coffee and ‘energy drinks’….

Remember, you read it here first! 🙂

Related posts

Dental Appliances for Sleep Apnoea | Snorer.com

Dental appliances for sleep apnoea are an appealing option. But how do you know if they will work without buying one? This post explores how predictor or titration dental appliances for sleep apnoea came to be and the vital role they may play building trust between medical and dental sleep professionals.

http://www.ncbi.nlm.nih.gov/pubmed/17212793 new-window

** IDF statement: http://www.idf.org/sleep-apnoea-and-type-2-diabetes new-window

Created by Adrian Zacher new-window| Page last updated 9 May 2016

TURN OVER! You’re Snoring… Heard that before? Too many times…

TURN OVER! You’re Snoring… Heard that before? Too many times…

Rated 5/5 based on 10 customer reviews

If you or your partner snore, then the words:

TURN OVER! – You’re Snoring… 

May be all too familiar!

Of course, the premise here is that the snorer (me!) will stop snoring in a different position (off their back most probably) and the offended, sleep disrupted partner, can then try to go back to sleep…

Most people have heard of ways to help ‘train’ the snorer to get off their back (known as ‘Positional therapy’) including perhaps a tight fitting T-shirt with a tennis ball sewn into the back of it.

The idea being to make it uncomfortable to sleep this way (known as ‘supine’).

I’m a sleep-industry insider (learn more about me: Adrian Zacher) ↗ with a quarter of century of sleep medicine experience. Adrian Zacher MBA

Author, Dental Sleep Medicine Instructor and Sleep Apnoea Evangelist

Getting more serious

These approaches then develop slightly to include foam tubing or pillows attached to the offending snorer’s back.

All these methods can help, but any change in sleep position throughout the night and over the course of time isn’t documented, and perhaps its not a lifelong solution:

So who knows what’s happening?

Certainly, the snorer’s partner may appreciate some noise reduction, but when they themselves are asleep – what’s going on?

Enter the new high-tech solutions and some more jargon (or when you know this device ‘buzz’ words) to explain:

  • Vibrotactile feedback: Essentially this means that when the device detects that the snorer is on their back it vibrates, just enough to encourage the snorer to turn over. You may know this, perhaps on your mobile/cellphone, as ‘Haptic feedback’.
  • Supine dependency: This is when the snorer either only snores when sleeping on their back, or that sleep apnoea is worsened when sleeping this way.

There are currently two competitors in this space and I was lucky enough to have the chance to try the NightShift device.

Point to note here: 

I don’t get paid for my thoughts and ramblings or get some other kickback.

Before I continue, its important to note that the NightShift device is a prescription medical device and that snoring may be a symptom of obstructive sleep apnoea (OSA).

If you are concerned about OSA you should consult your Doctor.

Now we have that out of the way, lets take a look at this thing:

Here’s a shot, I grabbed from the company leaflet:

NightShift device
Here it is on my hand (to give you some idea of scale).
NightShift on my hand for scale

My personal experience

I was impressed with the packaging and pleased to see how small the device was.

Hmmm….

The strap around the neck looks like it will throttle me – BUT – actually it contains two magnets to separate and release, right under my Adams apple. So if my wife gets annoyed with me… it separates.

The straps are actually quite comfortable, it just feels a bit strange the first few nights.

Note: The strap has loops (the manufacturer calls them retention bands) to slip the excess through. I mistakenly thought that mine had these loops missing, but they were at the end of the straps, over the magnets…

See the picture below (yes, its a bit small and hard to make out [its the ‘lump’ at the end] but it will become clearer in context below):

Neckstrap of NightShift device
You have to slide the loops along the strap, to limit the amount it can move.
See picture below:
slide the loops along

After getting the straps right, I turned it on…

Mistake!

Charge it first by plugging it into your computer with the micro USB lead that it comes with.

The next thing to do (which again I didn’t do the first night) is to head over to the manufacturer’s website (with the Nightshift device plugged in to your computer) and correct the time and date: www.nightshifttherapy.com

You need to have a current version of Java running on your PC for this to work. Get Java

So, did it work for me? Did I turn over?

Yes.

Put it this way, I use it every night.

I also use an oral appliance ‘mouthpiece’ and together the Nightshift controls my snoring and I feel better rested in the morning.

However, the first few nights of using it, I actually felt worse on waking as the device was making me turn over to sleep on my side. (At least it wasn’t my wife screaming at me “Turn over! You’re snoring….”)

This is to be expected I guess.

Now after a few weeks of using it, it must be changing my behaviour.

When I had it charged it lasted in excess of 3 nights. Its neat how when you turn it on, it vibrates to indicate how many nights of use it can provide.

I also like the delay in starting the vibrations for 15 minutes, so you can get to sleep before it starts working.

Did I turn over?

Have a look at the graph below and I will attempt to explain what they mean. 

This ‘3 day graph’ shows that my attempts to sleep ‘supine’ (on my back) have decreased considerably. I have deliberately spaced the nights chosen to give some idea of change.

The most recent data is the first graph. This shows improvement!

Look at the red line. This is when I was sleeping on my back and just following the line you can see I turned over like a good boy.

Now look at the second and third graphs and you will see I am sleeping less on my back, than I originally was.

It works!

There is the capability to record and display up to 12 months data, which I anticipate when I have been using it for some time, will prove valuable as there will be more data to work with.

Its interesting to see that it records how much I was snoring too… (click the image below to make it a bit bigger)

3 day detailed report

How to use the NightShift device

Here’s a user instruction video placed on YouTube by the manufacturer.

I make no representations as to how useful or valid it is.

Conclusion

I think this is a fascinating area with real potential to manage sleep-related breathing disorders.

According to the manufacturer’s research 83% of participants had a 50% reduction in AHI (apnoea hypopnea index), 90% had > 35% reduction in AHI. The mean reduction across all participants was 69% and the median reduction was 79%.1

Combining an oral appliance with positional therapy appears to manage snoring and for those with supine dependent, mild to moderate obstructive sleep apnoea – reduce the incidence of apnoeaic episodes.

Its not clear to me, but I would imagine that it would also reduce the length of the apnoeaic episode too.

The take-away message seems to be:

‘Turn over and you will sleep better yourself 

Finally, a question occurred to me when thinking about this post and discussing my experience with the supplier:

  • Is the device really ‘training’ me to turn over?
  • What would happen if I stopped using it after a period of training?
  • Would I ‘forget’ and resume supine sleep?

The inventor Dan Levendowski was kind enough to let me know that yes it was training me – but continual use is advisable.

It just remains for me to add my thanks to Advanced Brain Monitoring and GDS Medtech for letting me try this product and review it.

Night Shift is CE marked and gained FDA clearance on the 3rd June 2014.

Here are some more high quality posts about snoring and sleep apnoea products, cures and aids:

Reference and Related

The NightShift research paper, “Capability of a neck worn device to measure sleep/wake, airway position, and differentiate benign snoring from obstructive sleep apnea“, published in the Springer Journal in Feb 2015 http://link.springer.com/article/10.1007%2Fs10877-014-9569-3 new-window

Related:

NightShift crowdfunding page: https://www.indiegogo.com/project/preview/29da0980 new-window (now closed – Nov 2018)

Found this useful? Please take a moment and write a review:

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1 - 5 out of 5, where 5/5 is the best and 1/5 is the worst


Created by Adrian Zacher new-window Last updated 18th Oct 2018

Dental Devices for Snoring: 9 Crazy Claims Sleep-expert Reviewed (2019)

Dental Devices for Snoring: 9 Crazy Claims Sleep-expert Reviewed (2019)

Rated 5/5 based on 10 customer reviews

Wow!

Over-the-counter (OTC) dental devices for snoring sound so great! 

So, I’m going to show you everything you need to know about their claims.

Researched over 4 years, this comprehensive review, also looks at the regulatory framework governing the device manufacturers.

Do they stop snoring? Are they easy to self-fit? 

Let’s find out…

I’m a sleep-industry insider (learn more about me: Adrian Zacher) with a quarter of century of dental sleep medicine experience. Adrian Zacher MBA

Author and Sleep Apnoea Evangelist, Snorer.com

Claim 1 – OTC dental devices stop your snoring

After all, that’s what you buy them for…

Verdict: Do OTC dental devices stop your snoring?

Sadly, these gadgets do not always stop snoring. But don’t take my word for it, the BBC, when covering a ‘Which?’ report1 (the UK’s consumer champion) noted, that claims made for their success were an ‘exaggeration’.

Indeed, the BBC report had a callout box stating, “Many snoring products simply don’t live up to their claims”.

in other words… “they don’t work”.

Hmm… It seems lots of OTC dental devices are sold, and the Which? report is a bit old (2001), so could the Beeb and Which? have looked at the wrong devices?

Let’s continue…

Many snoring products simply don’t live up to their claims

Emma Copeland,
Health Which?

stop OTC devices don't work

Claim 2
Does what the expensive ones do

You might think:

I will try this (OTC device) and if it works, then I’ll get a custom one”?

Which on the face of it, seems reasonable…

Verdict – Are they the same as the expensive ones?
Clinical research2 has shown that OTC dental devices bear little resemblance to custom-made ones.

But it’s harmless right?

No.

If you fail with an OTC dental device for snoring, you may also think a custom-made anti-snoring device won’t work, which is known as a ‘false negative’.

This ‘false negative’ delays people getting valid help. Which for the snorer with undiagnosed sleep apnoea, who has tried and failed with an OTC dental device for snoring, is a potentially life-and-death issue.

They may kill themselves (and others) should they fall asleep in unsuitable circumstances

Did you know?

Diagnosed (and untreated) sleep apnoea sufferers are up to 15 times more likely to have road traffic accidents3. They may injure or kill themselves (and others) should they fall asleep driving or performing a similar vigilance critical activity.

I recently created these posts (and updated some older ones):

OTC beaten up

Claim 3 – OTC dental devices for snoring are cheap

Over-the-Counter, dental devices for snoring range in cost from approx. £50 – £200 GBP. But remember you’re bypassing medical assessment and diagnosis, and then bypassing the dentist.

DIY appears to save money, but….

 

What are the risks of bypassing Dentists?

Verdict - Are OTC dental devices for snoring actually 'cheap'?
Moving past the medical risks of self-diagnosis for a moment…. which we’ll come to in Claim 5.

Dentists are experts in mouths, teeth and jaw-joints. Bypass them and self-fit your OTC dental devices for snoring and you’re asking for trouble.

Always a pleasure, having failed at DIY, to then ask an expert to clear up after you…

What does the sleep-trained dentist do?
From a dental perspective, if you use an OTC dental device for your snoring you’re ‘going it alone’. The sleep-trained dentist would monitor your teeth for what is known as ‘uncontrolled orthodontic tooth movement’. Which means your teeth tilting in various undesired ways. This could result in a change to how the teeth in your upper and lower jaws bite together (creating what is known as a malocclusion).

That same sleep-trained dentist would also monitor your gums (periodontal condition) and jaw-joints. They wouldn’t prescribe a custom-made, dental device until they were sure it wasn’t going to harm you.

And, if they felt it necessary they would take X-rays to ensure your roots could withstand the lateral loads the device creates – and they carry professional indemnity insurance should anything go wrong…

While perspective is needed when considering tooth movement and breathing, a dentist and a custom-made, prescribed anti-snoring device can limit and control things.

OTC dental devices for snoring ultimately cost you more money and cause you pain
MONEY – perhaps much more than you would spend on a prescription alternative to correct jaw pain, dental and periodontal issues (assuming you don’t lose your teeth or any existing crown & bridge work aka ‘caps’).

PAIN both short-term and perhaps permanent, chronic pain:

SHORT-TERM PAIN if you’re lucky, short-term pain from overloading individual teeth (typically the upper front incisors). This is short-term if you stop wearing the device, resume snoring, ‘put it down to experience’

PERMANENT (CHRONIC) JAW PAIN from an imposed incorrect ‘bite’ (when you close your teeth together). Jaw pain is known as temporo-mandibular joint dysfunction (TMD). It may be caused by devices that don’t close together evenly (known as a ‘premature posterior contact’) or devices that force your jaw to move beyond its limits.

Risky Business
Having tried to wear the OTC device a few nights and found yourself dribbling profusely when it’s in your mouth, experiencing tooth ache and jaw-ache in the morning…. you might now think to return it for a refund.

Nope. You’re unlikely to be successful with any claim on the promoted ‘Money-back guarantee’, because the device is now ‘used’. Gotcha!

Permanent pain and occlusal change

So, OTC anti-snoring devices have other costs, even if financially they at first appear ‘cheap’. They may cause you permanent, chronic pain and occlusal change (which means how your teeth ‘bite’ together).

In 2014, an eminent British dental expert, Dr R.J. Wassell, published in the British Dental Journal4 about ‘Over-the-Counter’ devices (he focused on devices for people who grind their teeth – ‘bruxists’). This is relevant, because he notes OTC devices sold online (and he includes those for snoring and sleep apnoea) are purchased by individuals as a possible alternative to manage their condition, without the need for a dental or medical consultation.

He notes safety information on many internet sites was “notable for its paucity” or was totally lacking.  He points out that manufacturers are not obliged to provide safety information online, but it must be provided with the product and observes that the MAUDE adverse events database5, maintained by the FDA, “showed a number of potentially serious adverse events associated with these splints including choking hazards, tissue damage and occlusal changes”.

Dr Wassell advised the GDC about the OTC device market in 2014. What are we to conclude from their apparent inaction, some 4 years on?

Claim 4 – Easy to self-fit

If you go around professional assessment, ‘treat’ yourself with an OTC gadget and amazingly no longer snore (which is unlikely) you might assume you’re fine.

Are you?

Verdict - Are you OK and are they easy to self-fit?
You should be screened for sleep apnoea before using any dental device for snoring (see Claim 5) and we looked at why going the DIY route (cutting out the dentist) is a bit dumb in Claim 3. However, for the sake of argument, let’s explore this ‘Easy to Self-Fit’ claim.

IF you read the instructions, you’ll learn you must heat up each part and – while its hot – ‘squidge’ (for want of a better word) the device onto your teeth.

Repeat this for the other jaw.

OK, not so bad you might think. But it gets worse…

For some devices, you must do both jaws AT THE SAME TIME and ensure both parts correctly line up. Or it won’t work and you can’t get your money back. Oh don’t forget to make sure it clicks comfortably into place or…

It won’t work.

If the pieces don’t line up – it won’t work – you will have to heat it up again, reform the material and try again. Assuming of course, that the material can withstand another heat cycle…

Try now to claim on the ‘Money-Back Guarantee’. Hah! Good luck with that!

But of course, this is exactly what the OTC dental device for snoring manufacturer wants. They’ve had your money after all – and there’s no comeback on them, if you give up. Regardless of whether it doesn’t work or causes you problems.

All the above assumes you fit the device – i.e. the shape of your mouth and the alignment of your jaws suit the device. Which is totally backwards, it would be like the shops only selling underpants in one or two sizes…

Ouch.

Anti-snoring devices, exist at the point where medicine and dentistry meet

Both are essential

pants

Claim 5 – Quick Fix – No need to wait

Anti-snoring devices, exist at the point where medicine and dentistry meet.

I’ve highlighted the importance of the dental role.

But is a medical assessment essential?

Verdict - Is it a 'quick fix'?
Medical assessment (screening for sleep apnoea at a minimum) for your breathing is a no-brainer. Subsequent dental assessment (should anti-snoring devices be the proposed option), is necessary because the anti-snoring device used to help you breathe, is in your mouth.

Cutting out either professional is, shall we say, ‘foolish’? Bypassing assessment and/or prescription (going the DIY route), is risky because the snorer may have undiagnosed, and therefore untreated, sleep apnoea/apnea.

Claim 6 – Adjustable in protrusion

(How much they push your chin forwards)

Some, but not all, OTC anti-snoring devices are adjustable in protrusion. In either relatively large steps or for more money, with a screw-thread at the front of the mouth, like a ‘volume control knob’!

volume control knob
Verdict - Are OTC dental devices adjustable in protrusion?

The increment technology (approx. 2mm steps) is inherently flawed, because assuming everything else is good…, the difference between an effective position and a painful, impossible to tolerate one, may be much less e.g. 0.5mm.

Outcome: It won’t work

Problems with the volume control
As for the ‘volume control knob’ type, you fit the device in one position and as you adjust it (most likely forwards, because you’re still snoring and think more advancement is required), the ‘biting’ relationship changes. Which changes the alignment of the upper and lower parts of the device, most likely making it hard or even impossible to close your mouth and put your teeth together evenly.

Now, you’re in trouble, whichever way you go:

  • If you persist with the device (because you feel emotionally blackmailed by your partner) and ignore the pain, you risk creating permanent dental and jaw-joint issues. See Claim 3 above.
  • If you stop wearing the device, you’re in ‘hot water’ with your partner, because you’ve ‘quit’ trying to stop snoring…

Oh, and forget the ‘Money-Back Guarantee’ – you’ve used the device. Did you read the small-print? No, thought not.

stop snoring

Claim 7 –
Fits most people’s teeth and jaws

I covered ‘Easy – Self-Fit’ (Claim 4) above, and arguably, yes, the overall shape of OTC dental devices for snoring approximates people’s teeth and jaws BUT,

and here’s the thing:

Verdict - Do OTC dental devices for snoring fit most people’s teeth and jaws?
 

  1. 1OTC dental devices for snoring are inherently bulky (to make them ‘one-size-fits-all’ so they cannot be discrete and comfortable). Which means you may attractively dribble while it’s in your mouth. If it isn’t comfy you won’t wear it, and of course if you don’t wear it – it won’t work.
  2. 2You might struggle connecting the two parts, once in place in your mouth (upper and lower jaw). If you struggle with it – you’re unlikely to wear it – if you don’t wear it – it won’t work.
  3. 3It might not stay in place on your teeth. Your dentist will call this ‘poor retention’. If it doesn’t fit properly then (you guessed it) – it won’t work.

Above, are three more reasons why it’s pointless, struggling in the bathroom mirror with boiling water, squidging bits of hot plastic into your mouth.

Incidentally, custom-made, prescription devices would be remade or professionally adjusted if they exhibited these problems.

You guessed it…  

It won’t work

Where everything gets lost with which Regulator is responsible

I also contacted the Charities Commission because one business, seemed ‘confused’ about its commercial status, variously claiming to be a ‘not-for-profit’ organisation or a Charity.

The result of all the above?

The status quo: Encouraging snorers to DIY their diagnosis, ‘treatment’ and follow-up. Which is wrong on so many levels. 

Regrettably, unlike snorers, the above regulatory organisations are (so far) silent…

As for claiming ‘FDA Cleared’ [FDA means Food and Drug Administration and they control the US market for medical devices]…. my advice is to read what it is cleared for.

OTC devices have been FDA cleared for snoring – not for sleep apnoea/apnea. This means the manufacturers can market them.

But, I must repeat, in the US (just like the rest of the world), there is:

NO WAY to differentiate between snoring and sleep apnoea/apnea symptoms without an overnight sleep study.

Seriously though, after reading this, do you think DIY is sensible? There’s more about the US system in Claim 9 below.

silent
Do You Recall This Materials Scandal?
Relying on a manufacturer’s assertion the product or materials used are safe (which is what you do with an EU Class 1 device, US Class 2 device) leaves you potentially at risk, should the manufacturer not be entirely honest. I’m not saying they’re all dishonest but…

Do you remember this?

French firm, Poly Implant Prothese (PIP) manufactured breast implants using industrial grade silicone not medical device grade7,8. And this was for an implanted medical device (EU Class 3) that should have been tightly regulated. Not something seen as ‘low-risk’ e.g. an OTC anti-snoring device….

Having a professional at least look at the product before you rely upon it to help you breathe while you’re defenceless (asleep) might be considered a good idea!

Surely consulting an expert is no-brainer…?

CE mark

Claim 9 –
OTC dental devices for snoring are: Low-Risk

A bunch of boring but essential rules exist for US and European medical devices. In medical device language, they control how devices are ‘placed on the market’.

Verdict - Are OTC dental devices for snoring 'Low-Risk'?
In the process of researching this, I found some US pre-market notifications (FDA 510k’s) for OTC dental devices for snoring and observed that the FDA review boards for some were ‘dental’ (were any medical professionals involved?).

In Europe, the medical device ‘Class’ is defined by the manufacturer, when they register with the ‘Competent Authority’. If they choose, they may opt for ‘Low-Risk’ (Class I) without any checks on this decision – no external assessment. They may then put the CE mark on their packaging.

OSA trivialised
This trivialises undiagnosed sleep apnoea / apnea

Sadly, EU regulators appear impotent, despite my notification (and notifications by others and also some reputable professional organisations). They fail to protect the Public (yes, I did say that). They continue to allow unscrupulous businesses to sell dental devices for snoring directly to the Public, because the manufacturers have declared the product a ‘low-risk’ Class 1 device.

In May 2017, I happened to visit a leading brand, High Street pharmacy. Amongst the snore-relief products (which irritates me enough) I found an OTC dental devices for snoring that claimed to treat SLEEP APNOEA / APNEA… [lost for words].

——————–

In the US, the FDA does assess whether medical devices are safe and categorised correctly, before they’re sold. The FDA took legal action against one manufacturer9 – yet the device is still available. The FDA did make the manufacturer stop claiming their product treats sleep apnoea/apnea. Consequently, the manufacturer calls it a ‘Snore Relief Device’…

A quote below from an OTC anti-snoring device website Disclaimer (brand name removed), where they proclaim the device is for sale in Europe without a doctor’s prescription and the materials are safe [accessed 22 Oct 2016]:

OTC dental device for snoring Disclaimer - what does this tell you?
Seriously, when you see disclaimers and legal notices like the below on a page – what does it tell you?!

OTC disclaimer

“The XXXXX mouthpiece is designed to cure snoring but the United States, FDA will not allow us to make the claim that our mouthpiece is a cure for sleep apnea, which is a medical condition. Should you suffer from this complaint then you should consult your doctor. While we do not claim to cure sleep apnea, many people have found relief from it as an additional benefit of eliminating snoring with the XXXXX mouthpiece.

Though the FDA won’t allow us to sell the XXXXXX anti-snoring mouthpiece without a doctor or dentist prescription, it is approved for sale in Europe under the European Union Seal of Approval without a doctor’s prescription.

We have deliberately decided to not pursue FDA approval for our product because of the associated costs that we would have to pass on to you, our customer. It has always been our intent to provide a low-cost snoring relief solution. Rest assured, 100% of our product is sourced and made in the USA with non-toxic, latex and BPA-free materials.

It just so happens that the XXXXXX mouthpiece also works very well as a “sports” mouthpiece. That is why we have decided to only sell the very same “anti-snoring” mouthpiece in the United States as a XXXXXX brand “sports mouthpiece”.

Scandalous
Stating: “Should you suffer from this complaint [sleep apnoea/apnea] then you should consult your doctor”, is scandalous. It is impossible to differentiate between snoring and sleep apnoea (unless you’re a sleep-trained expert!) If it was easy, we wouldn’t need Doctors or sleep units….

Arguing the toss, by saying manufacturers comply with the rules, just means the rules are wrong, inadequate or in reality unpoliced. Regardless of which side of ‘the pond’ you are, unscrupulous manufacturers are swerving the existing rules and lack of action by the regulators to sell (in my view) incorrectly categorised products (that should be prescription items), directly to the naïve Public. Buyer beware!

To add insult to injury…. In the UK, dental devices for snoring (both OTC and custom-made) are classified by HMRC as ‘luxury items’10.  Which means they’re standard rated (currently 20% VAT).

What an indictment!

It just goes to show, how poorly sleep-related breathing disorders, of which snoring is one, are understood.

In this way, they’re:

  1. 1Avoiding the cost (and the commercial risk of failure) of a ‘Notified Body’ assessment
  2. 2Gaining access to the whole EU market without external verification of that decision
The correct way to approach a snoring or drowsiness problem:
  1. Professional screening for sleep apnoea using a recognised protocol
  2. Diagnosis if sleep apnoea is suspected
  3. Prescription of the appropriate therapy/treatment

If the proposed treatment is an anti-snoring device, you then have a dental examination prior to being prescribed an appropriate custom-made one.

Although not yet widely adopted, the UK refines this process further by permitting sleep-trained dentists to screen for sleep apnoea6, and in defined circumstances, provide a custom anti-snoring device, without a prior medical diagnosis. Sleep-trained dentist are ideally placed to help simple or ‘benign’ snorers.

This pragmatic solution short-circuits the costly, time-consuming and pointless referral to hospital, of anti-social snorers without sleepiness symptoms or other comorbidities (other related health problems).

The expensive-to-the-system (ask yourself who’s profiting?) alternative, which at the time of writing is current practice in the US and Europe is:

  • For every snorer to be assessed by their GP (Primary Care Practitioner) and then if sleep apnoea/apnea is suspected, referred for further investigation to a sleep centre. This ‘paper assessment’ is time-consuming and requires knowledge that your GP/PCP may not possess.
  • Only for the individual (who after consuming secondary care resources) doesn’t merit treatment with Positive Airway Pressure (PAP) therapy, to then be lost to the system, when they’re ‘advised’ to obtain an anti-snoring device (no formal referral being made due to a silo mentality – see my post about Guidelines for the medical profession).

And they’ve cost the system how many thousands of pounds/euros/dollars? Perhaps in some US States things aren’t so bleak, so perhaps I’m being cynical. But this IS the overall picture.

We’ve been over the medical and dental consequences of buying OTC anti-snoring device, but to summarise:

  • Is BREATHING important to you? Assuming staying alive is important, why would you trust this device to keep your airway open, when you’re ASLEEP?
  • How much would you pay for a pair of glasses (spectacles)?
  • Quite a lot, I imagine because you consider it essential to see. Why then do you think your teeth, gums and jaw-joint are any less important?
  • Do you like to eat without chronic long-term pain in your jaw joint(s)? and to retain your smile?

Illustration of how OTC dental devices for snoring delay Diagnosis and Treatment

Encouraging self-diagnosis and self-treatment to profit from sales of an OTC dental devices for snoring, is irresponsible, harmful to the individual’s health, costly and perhaps dangerous to society.

The step-by-step illustration below is meant to illustrate what typically happens. While fictitious and dramatised, it is based on typical disease progression.11 

 

  1. 1“Johnny Snorer” self-diagnoses his snoring and buys an OTC dental device for snoring online. Miraculously his snoring is silenced, but his undiagnosed sleep apnoea remains untreatedhe remains drowsy during the day, yet doesn’t snore at night.
  2. 2“Johnny” has a near-miss on the motorway because he ‘nodded off’ for a moment. This time, he’s fortunate not to have an accident. He brushes it off and later forgets all about it.
  3. 3“Johnny” is prescribed high blood pressure medication. He falls asleep on the settee immediately after dinner – every night. He never sees the end of the movie. His wife leaves the bedroom after he goes to sleep because his snoring is so bad.
  4. 4He wakes up with a headache every morning, feels hungry all the time, and struggles with his weight. His wife cannot broach the subject of his snoring, because it just ends up in blazing row.
  5. 5“Johnny” has lost interest in sex. His relationship is in crisis, he’s irritable and not much fun to be around. His weight gain is seemingly out of control.
  6. 6“Johnny” is diagnosed with type II diabetes. His GP sends him for dietary advice.
  7. 7His family thinks he “Drives like he’s Drunk” and are very worried about him.
  8. 8His work performance is woeful, and when he has an accident at work through inattention, his employer issues a formal warning and refers him to Occupational Health. His GP refers him for a sleep study.
  9. 9His obstructive sleep apnoea syndrome is diagnosed, some years after he began using an OTC dental device for his snoring.
  10. 10 He begins PAP therapy and rediscovers his love of life. His erectile dysfunction resolves itself and he begins to take exercise. He feels “ten years younger”. He fights to hold on to his job, his home and his family.
  11. 11 Sadly, irreversible damage has been done, to his heart, blood vessels and metabolism. He’s lucky not to have had a stroke.

Conclusion

Time and Money

Everyone likes to save money, but OTC dental devices for snoring are a false-economy, and in my view incorrectly categorised medical devices, that delay sleep apnoea diagnosis and effective treatment.

The personal and socio-economic cost of quite possibly years of mismanaged, undiagnosed sleep apnoea, through the inappropriate sale and use of OTC dental devices for snoring, far exceeds the cost of consulting trained professionals.

Effective, life-transformational, sleep apnoea therapy is NHS funded (it’s ‘free’ in the UK) because it makes economic sense for the NHS to pay for it12.  Businesses that sell OTC dental devices for snoring have flourished in a vacuum because, until now, there has been no viable alternative. Snorers searched online and were easy ‘prey’.

The Real Problem

Is how these things are supplied

Verdict: What to do if you snore?

So what do you do if you snore?

Your GP is there to help, but you must realise that the NHS will NOT fix your snoring.

GPs must determine if your snoring is a symptom of sleep apnoea that needs a hospital referral for further investigation by sleep study. Their problem is that they’re ‘time-poor’.

The solution is to get someone else to screen you!

In the UK, a sleep-trained dentist can screen you for obstructive sleep apnoea and in defined circumstances provide a custom-made, anti-snoring device without a prior medical assessment.

We train dentists online to screen for OSA, and we are creating a signposting tool.

Grab our GP Guidelines for snoring and sleep apnoea, and take them with you.

PostScript

I am reliably informed, (name withheld) that should a medical professional, suggest to a snoring patient that they use an Over-the-counter dental device for snoring (self-fit), their professional indemnity insurer would consider them having acted outside their area of professional expertise.

They would then be personally liable for the dental consequences.

Clearly, the correct thing to do, is to refer to appropriate expertise: a sleep-trained dentist. I blogged about the need for Guidelines for the Medical Profession when it comes to oral appliance therapy, in 2012!

Here are two useful resources, if you’re struggling with a snoring problem:

More about Snorer.me Signposting
Snorer.me signposting utilises the British Society of Dental Sleep Medicine (BSDSM) pre-treatment screening protocol, as published in the British Dental Journal (2009) by Prof. Stradling and Dr Dookun BDS.

This forms part of the ARTP (Association for Respiratory Technology and Physiology (UK)) Standards of Care for MRDs (mandibular repositioning Devices) 13.

The relevant extract from the Standards of Care Document:

Both Dental Protection (UK) Ltd and the Dental Defence Union would indemnify individual members to treat simple, uncomplicated snoring with an MRD following a pre-treatment screening protocol, without the involvement of a medical practitioner, subject to proof of appropriate, formal training. Such cover would be considered on an individual member basis, and application should be made to the relevant underwriting department.

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References

References

  1. Snoring cures success ‘exaggerated’ http://news.bbc.co.uk/2/hi/health/1701735.stm [accessed 16th Oct 2016]
  2. Vanderveken OM, Devolder A,  Marklund M, et al, 2008. Comparison of a custom-made and a thermoplastic oral appliance for the treatment of mild sleep apnea. Am J Respir Crit Care Med; 178: 197–202. Available here:  http://www.atsjournals.org/doi/abs/10.1164/rccm.200701-114OC#.V9ukcFT_rio[accessed 12 April 2017]
  3. Horstmann, S. et al, 2000, Sleep related accidents in sleep apnea patients. Sleep 1;23(3):383-9.https://www.ncbi.nlm.nih.gov/pubmed/10811382
  4. Wassell, R. J. et al 2014. Over-the-counter (OTC) bruxism splints available on the Internet. British Dental Journal 216. E24. Available here: http://www.nature.com/bdj/journal/v216/n11/full/sj.bdj.2014.452.html [accessed 9th April 2017]
  5. FDA maintained MAUDE database of adverse events: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/Search.cfm
  6. Stradling, J. and Dookun, R. 2009, Snoring and the role of the GDP: British Society of Dental Sleep Medicine (BSDSM) pre-treatment screening protocol, British Dental Journal, 206, 307 – 312. Available here: http://www.nature.com/bdj/journal/v206/n6/abs/sj.bdj.2009.214.html [accessed 12 April 2017]
  7. Breast implant register for UK in the wake of the PIP scandal. https://www.theguardian.com/world/2013/dec/29/breast-implant-register-established-pip-scandal [accessed 17th October 2016]
  8. Wikipedia link https://en.wikipedia.org/wiki/Poly_Implant_Proth%C3%A8se#Scandal [accessed 9th April 2017]
  9. The legal fight between the FDA and an OTC anti-snoring device manufacturer: https://www.meddeviceonline.com/doc/legal-brief-anti-snoring-mouthpiece-manufactu-0001 [accessed 8th August 2017]
  10. HMRC VAT Notice 701/57: health professionals and pharmaceutical products https://www.gov.uk/government/publications/vat-notice-70157-health-professionals-and-pharmaceutical-products/vat-notice-70157-health-professionals-and-pharmaceutical-products [accessed 27 Oct 2016]
  11. Punjabi NM. The Epidemiology of Adult Obstructive Sleep Apnea. Proceedings of the American Thoracic Society. 2008;5(2):136-143. doi:10.1513/pats.200709-155MG.
  12. Weatherly, H. et al. 2009. An economic analysis of continuous positive airway pressure for the treatment of obstructive sleep apnea-hypopnea syndrome, International Journal of Technology Assessment in Health Care. Available here: https://www.cambridge.org/core/journals/international-journal-of-technology-assessment-in-health-care/article/an-economic-analysis-of-continuous-positive-airway-pressure-for-the-treatment-of-obstructive-sleep-apneahypopnea-syndrome/2124FA6645420641F224C1A1C75113F1# [accessed 9th April 2017]
  13. ARTP standards of care v.4 http://www.artp.org.uk/en/sleep/sleep-standards/sleep-documents.cfm/sleep-standards-iods [accessed 15th June 2017]

© eeZed Ltd / snorer.me 2018. All rights reserved.
Images © artenot/www.shutterstock.com
Created by Adrian Zacher | Page last updated 14th Nov 2018

CE mark Snorer.me signposting is CE marked, clinical decision support software, software as a medical device. 

manufacturer Manufacturer is Snorer.com Ltd. 94 High Street, Sutton Courtenay, Abingdon, Oxfordshire, OX14 4AX, UK. 

Could Snoozing KILL YOU? Why ignore the Warning Signs?

Could Snoozing KILL YOU? Why ignore the Warning Signs?

Snoozing…

This morning when I woke up, I lay there thinking about snoozing. Not thinking I wanted to snooze, but about snoozing per se. My wife was practicing the art of snoozing (repeatedly – but that’s another story).

I was thinking it’s not a great idea. How to communicate this to her and help her? By pure coincidence I found an article about why snoozing isn’t good for you etc1. For the sake of marital harmony I opted NOT to forward the link to her…

My own inaction made me think about how people may recognise others’ need for help but for one reason or another do not act.

Need a snooze?

Is it a fear of confrontation?

A desire for harmony, or plain old cowardice, or is it that it’s just too much trouble and it doesn’t really matter anyway?

Perhaps my inaction is more relevant to sleep apnoea and snoring than it is to snoozing. Specifically, obstructive sleep apnoea syndrome (OSAS) which you may recognise as recurrent ‘drowsiness’ or excessive daytime sleepiness, in circumstances when ordinarily the stimulus of the individual’s environment should keep them alert i.e. driving, flying, operating machinery etc.

Call it what you will, perhaps “Snoozing when Driving“(!) but I’m thinking that most of us know someone, perhaps even live with someone, who snores or who has become more drowsy and grumpy over time.

 

  • Perhaps they fall asleep on the couch straight after dinner?
  • Perhaps they can’t drive for more than an hour without a stop for a sleep or strong coffee/energy drink?
  • They snore like hell and over time have become more, sleepy, irritable and grumpy?

Yet we don’t reach out to help them – and I’m wondering why?

Some possible excuses you may have used?

  • Overcoming the ‘Status Quo’ – change is unsettling?
  • Elephant in the room – as in, been there before and met with an argument?
  • Recognising the problem for what it is – they don’t see it as their problem?
  • Pride, ego and a fear of showing weakness?
  • Shame?
  • Irrational fear of fate?

What’s in it for ME?

Perhaps you think that there’s nothing but an argument to be gained from confronting the drowsy / sleepy person – once bitten, twice shy, perhaps?

Here are some solid reasons for action:

  • Staying alive! What if they were driving the family car with YOU on board (or the kids) and they fall asleep …. no more you and how many other people get killed at the same time?
  • Money you don’t pay in tax. Chronic disease care consumes a huge amount of NHS funds and it is set to rise enormously. 
What's in it for me?

Still need a reason?

If you know the snorer/drowsy person, perhaps they think of you as a friend or partner?

Does any of the above excuse your inaction?

A challenging question perhaps or one you’ve never really asked yourself.

Prevention, individual responsibility and self-awareness are perhaps components of a longer-term solution; a change in culture to one where we take responsibility for our own health and wellbeing, instead of taking them for granted and looking for ‘cures’ after things have gone wrong.

What can you do RIGHT NOW about “Johnny Snorer” on the couch?

That snorer across the room on the couch or snoring in the spare room needs your help and by helping them (the health benefits for them are significant) you help yourself.

Assuming you give a damn about living and not dying in a sleep related accident… it changes the question from: 

What do I need to do?

to:

What challenges await me?

And do you ‘hear the sound of sleep apnoea’? Silence between snores? Yes? Read this. ↗

You need a Plan

Plans take a little effort and some ‘homework’.

We have a dedicated page for Partner’s who are kept awake that will help you start.

Including how to discuss snoring with your partner constructively… and how to record the noise / videoing the sleepy episodes.

STOP – Don’t just kick of an argument now! 

Conclusion

Lately, I’ve been giving some thought to how to encourage people to think about their health. So far, I’ve only come up with possible reasons mentioned in the above list, with no real answers as to what to do about it.  

Ideas anyone?

Created by Adrian Zacher. Last updated 29th Oct 2018

Related posts

Dental Appliances for Sleep Apnoea | Snorer.com

Dental appliances for sleep apnoea are an appealing option. But how do you know if they will work without buying one? This post explores how predictor or titration dental appliances for sleep apnoea came to be and the vital role they may play building trust between medical and dental sleep professionals.

Reference

1. Huffington Post Why Hitting The Snooze Button Will Screw Up Your Entire Day

Sleep well. If you or a loved one has problems with sleeping (or not sleeping), please DO consult a Doctor with experience of sleep medicine. I strongly support providing current, accurate medical information so that individuals are better able to make informed decisions about their health care. If you think you have a sleep disorder please seek appropriate medical advice.

I HATE Instant Snoring ‘Cures’ – they Do More Harm than Good [2019]

I HATE Instant Snoring ‘Cures’ – they Do More Harm than Good [2019]

Rated 5/5 based on 10 customer reviews

It starts off like this:

Imagine, you have a snoring problem and like so many people, you search online for a ‘cure’, a quick fix – and in no time at all there it is:

Your instant snoring cure!

Sold to you with all sorts of promises, guarantees and ‘testimonials’ – etc. etc.

What could possibly go wrong? 

I HATE instant snoring ‘cures’ because they do more harm than good.

What annoys me about supposed instant ‘snoring cures’, aids, strips and goodness knows what gadgets, is that unscrupulous businesses are simply exploiting desperate snorers (and their families and partners) for profit, without giving a damn about the punter; the harm their ‘cures’ do and the delay the cause, in obtaining actual help.

Such businesses encourage the desperate to part with their cash by asking daft questions, such as:

‘Work out what kind of snorer you are’

Read self-diagnose to then sell them a supposed instant ‘snoring cure’ to ‘treat’ snoring.

The merit (or otherwise) of the supposed ‘cure’ is one thing, but:

The individual is unable to distinguish between anti-social, nuisance snoring and obstructive sleep apnoea

It is a SCAM and a dangerous one at that. Funnily enough they will have just the cure you need in stock!

That’s a surprise isn’t it…

Here’s an analogy

If you cannot see properly – do you guess what lenses you need and fit your own glasses?

No of course you don’t.

You get assessed, diagnosed and provided with the right ones.

Key points are:

1  Assessment
2  Diagnosis
3  Prescription treatment

In that order – by a Professional.

Snoring is no different.

It’s not a joke: In fact it could be very serious indeed.

So, if you’re thinking about a ‘cure’ then you should see a sleep-trained DENTIST. 

Read on…

Let’s break your argument down

You’re the expert right?

Its your snoring after all – and your mouth, teeth and gums too. What would a Dentist know about teeth and gums?

Yes exactly:

A lot.

But Snoring? What do Dentists know about that?

Instant snoring cures are most commonly things you wear in your mouth. Some Dentists (see below) choose to develop a special interest in snoring or more correctly ‘sleep-related breathing disorders’ (SRBD) and they should be your first call when you’re thinking of a snoring cure.

Think about it 

You’re going to wear this thing in your mouth while you are ASLEEP and depend upon it to keep your throat open, so you can breathe and sleep at the same time (and pray it doesn’t break and you end up inhaling or swallowing it…)

Dunno about you but I like breathing… and not having bits of broken gadget in my lungs…

That’s apart from the impact your instant snoring cure WILL have on your teeth, your gums and jaw-joints…

Click for: Dentists with a special interest in sleep

The lesson here is to see someone who knows what they are doing (and hasn’t just been on a manufacturer’s half-day course)

Both snoring and sleep apnoea / apnea deserve proper assessment, diagnosis and treatment. Not muffling with a ‘quick fix’ cure or gadget.

You might have seen some blurb for instant snoring gumshields online, at the Pharmacy, Dentist, Doctors or perhaps read about them here and there.

They are all over the internet.

You might have even read our Free NHS England’s Information Standard accredited Guide about
“How to choose a ‘mouthpiece'” and perhaps thought: – 

“Yeah that’s obviously a sales pitch as its co-written by a Dentist… and Dentists just want to make money right – so they’re going to say that Dentist fitted mouthpieces are better!”

 

Well, you’d be wrong:

We don’t sell anti-snoring gadgets, potions, cures, sprays or aids…..!

How to prescribe oral appliances for snoring and sleep apnoea / apnea

What’s your beef with instant stop snoring ‘cures?’

I particularly hate instant snoring cures worn in your mouth, as the balance of side-effects versus benefits, is generally not in your favour:

All anti-snoring mouthpieces have side-effects

This is true for both instant and professional fit/custom-made ones fitted by a dentist.

It is simply a risk/benefit analysis.

This means you may well suffer some irreversible harm – or – if you get lucky just waste your money

Let’s clear this up now:

Anti-snoring mouthpieces may also be described as splints, gumshields, mandibular repositioning devices, oral devices and appliances. Or combinations of these terms. You may see: MRD, MAS, MAD…

But this is not a post comparing the merits of Over-the-Counter versus Custom-Made Mandibular Advancement Devices.
This is.

You should be screened for sleep apnoea before using ANY ‘cure’

Assuming you are not keen on being exploited by the unscrupulous ‘quick fix’ gang selling ‘cures’ and snake oil, or are into hurting yourself… and you want to stop snoring – you should be screened for obstructive sleep apnoea symptoms first.

Snoring may be warning sign of Obstructive Sleep Apnoea/Apnea (OSA).

Your first port of call is your GP or primary care physician. Grab a copy of GP Guidelines and take them with you.

Exceptionally, in the UK, you can also consult a sleep-trained Dentist. They can also screen you for OSA symptoms and recognise when you need further investigation and when it is safe to proceed with a custom, adjustable anti-snoring mouthpiece.

If you want to find an anti-snoring mouthpiece that works consult a sleep-trained dentist.

You have choices there too.

You need knowledge and criteria for choice (which is what Snorer.com is all about):

How you can tell if the sleep-trained dentist knows their stuff?

Some simple questions to ask:

  • Are they a member of a professional dental sleep organisation?
  • Ask them what training they have in sleep
  • Are they insured to provide anti-snoring mouthpieces?
  • Do they offer a range of custom-made anti-snoring mouthpieces?
  • Ask to see example mouthpieces (they should have at least 2 or 3 different designs)
  • Do they work with a local hospital sleep/ENT department?

The responsible sleep-trained Dentist doesn’t just ‘fit’ you with an anti-snoring mouthpiece and wave goodbye.

They are going to make sure that your snoring isn’t a sign of obstructive sleep apnoea (OSA)

And if they are concerned refer you for specialist investigation. The Dentist will assess you including examination of your teeth, gums and jaw joint, to ensure that they are healthy and are able to withstand the loads the anti-snoring mouthpiece will place upon them.

And to establish the situation now before you start using the mouthpiece (so change may be monitored) they will take x-rays of your teeth (or if fairly recent x-rays exist – request sight of them from your regular dentist).

They will establish that your nasal airway is satisfactory, they will assess the size of your tongue, soft palate and oral tissues. The list goes on and on. They will also keep what is known as ‘master casts’ (records of the position of your teeth). Oh and their training is recognised by their professional indemnity insurer.

They do this to ensure they don’t make a problem while trying to ‘cure’ your snoring

The ideal anti-snoring mouthpiece doesn’t exist

The ideal anti-snoring mouthpiece yet exist – but fear not. Getting close to perfect for you is something that the expert sleep-trained Dentist can help you with (it depends upon many things eg: how many teeth you have and where, whether you grind your teeth [bruxism] and how much you can protrude [push your jaw forwards] amongst other things).

The feature set below should help you have a more informed conversation:

  1. Cheap (or very durable and can be modified if you lose a tooth)
  2. Has good retention
  3. Is adjustable
  4. Isn’t bulky
  5. Comfort (as in you can use it)
  6. Has minimal side effects
  7. Is easy to keep clean

Point 1

Cheap – Click here to learn more

Point 2

Retention – Click here to learn more

Point 3

Adjustable – Click here to learn more

Point 4

Bulky – Click here to learn more

Point 5

Comfort – Click here to learn more

Point 6

Side Effects – Click here to learn more

Summary

Today, you have to be alert for scams online, in the Post, on the telephone, pretty much everywhere. (I even received a scam phone call while typing this).

Please use your head.

If it looks too good to be true – then don’t fall for it. Snoring may well be nothing more than a nuisance, but it could be obstructive sleep apnoea.

Self ‘diagnosing’ and ‘treating’ yourself with gimmicks and instant ‘cures’ is NOT a cost saving, it may well do you harm and mask a real problem that needs investigating and treating properly, regardless of whether it’s ‘just’ snoring or sleep apnoea.

Oh, and NO I am not a dentist.

Keep doing your homework by reading our impartial (we don’t sell them) comparison and review posts in Related section below:

Created by Adrian Zacher. Page last updated 8th Nov 2018.

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