Welcome to Forum 360.

I’m Mark Welfey, your host.

Thank you for joining us for our global outlook with a local view.

How are you sleeping these days?

If you feel a little restless or wake up tired, it may not be the stresses of the world outside, but in fact, something inside of you.

Perhaps a condition called sleep apnea, a sleep disorder when your body is deprived of oxygen it needs due to airways closing, among other things.

Nearly 80% of people who have sleep apnea are unaware of it, according to statistics.

Today, we will talk to an expert who will bring us some new fresh air into the sleeping disorder of sleep apnea.

And my guest is Dr.

Ben Utterback, a dental expert and diplomat of the American Board of Dental Sleep Medicine.

Welcome, Dr.

Utterback.

- Thank you very much for having me, Mark.

- So you’re from Canton, Ohio and tell me a little bit about how you came to become a sleep disorder expert and expert on sleep apnea.

- So I'm originally from Northeast Ohio.

I grew up in North Canton, went to Hoover High School.

I then went on to my undergrad training at Mount Union and then dental school at Ohio State.

I was a general dentist for probably about 17 years practicing with my father and a few other dentists.

And, I guess it's a fortunate, unfortunate circumstance on how I got involved with dental sleep medicine.

They practice with a a dentist for almost my entire career.

Dr.

John (unknown), great dentist, great friend.

And, unfortunately, his wife passed away in her sleep in 2017.

And she was 55 at the time.

And afterwards, John and I talked, and he was pretty certain she possibly had obstructive sleep apnea.

He and I then became more involved, wondering what we could do with our own patients to screen them, to maybe be a person who could look at a patient and say, hey, you should talk to your physician about getting tested.

And so he and I started doing some smaller courses on the weekends, just to kind of gain more knowledge about how dentists can involve themselves and, you know, be part of that screening process for patients.

Well, then I looked at John one day, I said, John, I think I'm going to go the whole distance on this.

I think I want to go back, do a two year training through the American Academy of Dental Sleep Medicine, and then take the board exam after the two years to be a true diplomat with the American Board of Dental Sleep Medicine.

So I completed that in 2018 and 19, the years I did that.

And then from that point on, I started becoming a lot more involved in treating patients, building relationships with doctors in Northeast Ohio.

And then at the end of 2024, I sold my dental practice and formed a new practice, only treating patients with sleep issues such as obstructive sleep apnea and snoring issues.

- So sleep apnea.

Tell us, what is it and how do you know if you have it?

- Okay.

So there are, there are essentially two different forms of sleep apnea.

We have the most common one, obstructive sleep apnea, which is most commonly where the tongue relaxes at night while you sleep and it obstructs the airway, which causes a total stoppage or partially, partial obstruction of air getting down to your lungs while you sleep.

That's the most common form.

The second form that a lot of times patients could be diagnosed with, although it's a much smaller percentage, is central sleep apnea.

That is when your brain essentially forgets to send signals to the muscles near the lungs to, you know, promote the breathing, how people breathe at night then, so.

We don't see that one as much with what I do.

I only treat patients that have obstructive sleep apnea.

- The apnea, the central apnea, does that develop over time?

- It can— - Where the brain just stops delivering the impulses as you say?

- Usually you're going to see that in older adults.

A lot of times it's going to be patients that have had a history of having a cardiovascular event.

Sometimes patients that have had opioid dependency, those are going to be patients that are going to be more prone to developing central sleep apnea.

Occasionally, patients that have been on CPAp can also be induced to have central sleep apnea because essentially, their brain, I hate to use the word, gets lazy, but with the CPAp controlling the airway, sometimes the brain just kind of forgets to send the signals to breathe, so.

It can be a treatment emergent sleep apnea, central sleep apnea is what they call it.

- So sleep apnea according to the stats and the reports I read is on the rise.

Do you see that?

And why do you think that is?

- So the main reason, and when I talk to groups, physicians, dental groups, so when I do lecturing, we know that there is a big proponent of— What is the word I'm looking for?

There’s one sector of society that developed sleep apnea is due to weight.

So we know obesity is on the rise in our country.

I show slides that will show, you know, how our country has progressed with obesity over just even 25 years.

I think currently only one state, Colorado, I believe, is the only state that is still considered a normal weight state compared to the rest of the other 49 states.

So as obesity rises, we know that we build up fat in our necks, which shrinks down that airway.

So we know that obesity and sleep apnea are directly correlated and that's a lot of the reason why we now know that about 1 in 5 adults has obstructive sleep apnea.

Most of them are underdiagnosed though, are not diagnosed.

- So is it possible that people have sleep apnea and now there's a greater awareness of it?

So, the number of cases are on the rise, not because the number of cases is higher, it's just there's a greater awareness and people are discovering it.

And so there's no more people that need to be treated.

- That is correct.

And I think it's, you know, I think people now realize that, it's a simple test to diagnose you.

You know, you can't just say, well, my spouse snores or they gasp at night or they're tired during the day.

Does that automatically mean you have sleep apnea?

No.

You need to have a formal test that is read by a dental sleep medicine specialist.

And I think with the improvement of home sleep tests, in addition to the in lab tests, which we still know are the gold standard of all testing, the awareness and the availability of this testing process has made it easier, and it allows more people to get tested and diagnosed.

- Okay, so if you think you have sleep apnea and you seek out a medical professional, their first course of action will be to schedule either an in sleep study or they send you some type of device that that you hook up on your... your face or your nose, and then send that back for reading?

- That's exactly right.

Okay.

- Yeah.

So, your primary care is— And that's how I just worked with the State Dental Board last year on revising how the State Dental Board views dentists and our involvement with this and our position with the State Dental Board now is, we want the patients to get the diagnosis from their physician before they come to somebody like me to be treated.

So, yes, you go to the physician.

The physician orders the test, whether they want it to be in lab or at home that has to be read by a specialist in dental— In sleep medicine, I'm sorry.

And then they get the diagnosis back, and then the physician then decides what type of treatment it's going to be best for that patient.

- So if a person wakes up in the morning with a headache, consistently, or is there some other symptom that can trigger the individual to say, hey, I might have sleep apnea versus hey, I woke up with a headache because, you know, I didn't drink enough water last night or... How would someone help self-diagnosed, at least to get themselves on the rails to some true diagnosis from a medical professional?

- So even online, somebody who's just kind of wondering if they or their spouse might have obstructive sleep apnea, there is a simple question here, it's called the Epworth Scale, and it asks a few quick questions.

And, you know, the patient kind of scores how likely they are to have each one of those symptoms or how likely they are to fall asleep as a passenger in a car during a car ride.

And that, there's a scoring table and that's one way that, you know, a lot of times that's used in physicians offices, for the specials that I work with, it's always used to get an idea of how tiredness, how tired this patient is.

But it's just one of many ways to really kind of dive deep into it, to know whether or not that patient may or may not have sleep apnea.

- So if I hear, say either my partner or my brother or someone snoring at night, should I be worried or should I say that's the first step toward sleep apnea?

Or can you be a completely, you know, good snorer and still get good sleep and have... not be obstructed with having problems getting air to your, you know, to your system?

- That's a great question because it can work both ways.

Sometimes we see people who snore and they do not have sleep apnea.

But oftentimes there's also patients who don't snore much who have sleep apnea.

One difference between men and women that we know, women tend not to snore nearly as loud as men.

Women sometimes get underdiagnosed, because they're more likely to talk about having fatigue, morning headaches, depression, anxiety.

Whereas with men with sleep apnea, we know it's more of the loud snoring, the gasping, the choking in their sleep, things like that.

So that's also a reason why we have to be careful on making sure that both men and women are being, you know, referred even though their symptoms might be completely different, though.

- Yeah.

Interesting.

Okay.

Treatments.

I know you're a specialist in, in several of the different types of treatment for sleep apnea, but can you, can you take through, some of the treatments that are, that are widely known and available?

- Okay.

So the most common, and I still consider it the gold standard is the CPAp, or BiPAP, either way, it’s pressurized air.

And what that's doing is, you know, the patient wears it either on their full face, almost like a firefighter wood or just in their nose.

And what that's doing is it's pushing air throughout the night and keeping that airway open behind the tongue.

So it's forcing the space to stay open so that the patient can breathe totally fine throughout the night.

That's considered the gold standard.

If I have a patient that comes to my office and says, hey, I'm looking into switching over to a dental sleep appliance, and they're severe sleep apnea.

And I say, how often do you wear your CPAp machine?

They say, oh, I wear it every night, and I wear it eight hours a night.

Well, I'm going to tell them you're not, we're going to keep you there because we know with what I do with a dental appliance, we know it works really well for mild and moderate cases.

So a lot of times we have to know the severity.

So CPAp obviously is the gold standard.

But we know that the compliance on a CPAp machine is not always the greatest.

For mild cases, the newest studies say that it's probably under 40% of patients actually are wearing it after one year.

So they need to be treated with something.

So that opens up the avenue to a dental appliance, which is what I do.

For a dental appliance, we bring them in and we do a complex exam, and then we do digital scanning of their teeth.

We don't use those old goopy molds that you and I might have had as a kid with our braces.

And we make digital models.

I then work with a lab.

I work with one lab tech at that lab, and we design the case to the patient.

We don't take the patient and say, let's hope that you fit into this appliance.

Everything is very, very specialized.

The third option that we see some patients look into is inspire surgery.

What that is, is hypoglossal nerve stimulation.

And it's actually a true surgery where the patient has a, essentially almost like a battery pacemaker, if you want to call it in their upper chest.

And then it leads to wires that kind of control the tongue.

So every time the patient takes a breath, those wire impulses the electronic impulses are then making the tongue push forward to get it out of the back of the throat.

Obviously, inspire surgery, it's a newer process.

It works very well for some patients.

The patient needs to be more on the high moderate to severe side, and they have to meet certain criteria of having a BMI under a certain amount.

And also where the actual collapse in the airway is.

But those are the three main ways that patients typically go with treatment choices.

If you're just joining us, thank you very much for listening and for watching.

We're talking about sleep apnea and sleep disorders.

And I'm here with Dr.

Ben Utterback, who is a... a sleep disorder expert, dental expert and diplomate at the American Board of Dental Sleep Medicine.

I want to go back to something you touched on earlier, which is the mouth impressions.

When I first started looking at this story... And the interview that we have here today, you know, my perception was that the— What I saw on TV from ten years ago regarding CPAp machines was still the reality today, which is loud, covering your mouth.

Your partner is, you know, nudging you, you know, you're banished and ostracized.

But when I started talking and reading and realized that these machines are really quiet.

They're small, they're portable.

And, so I would imagine a lot of technology has gone into them and developed them to be where they are today so it's not such an onerous device to have with you.

Do you share that view?

- I do.

Like I said, I'm still a big proponent of CPAp machines in general.

I do see that a lot of patients now, you know, because of traveling and if they're going out of the country and trying to find distilled water for their CPAp machine or going on a cruise that a lot of more people are still looking for even more convenience.

And that's where, you know, the dental device does come into play, because they're literally taking a small little case, goes in their backpack for traveling, for people that do camping, or are prone to having their power go out.

You know, obviously the CPAp does not work as well.

I had somebody recently who does these long backpack expeditions through Canada, and he had a portable CPAp machine that actually had a battery built into it.

But he told me that it only lasts like 7 or 8 days.

And he said he's gone for 2 to 3 weeks at a time.

So those are the type of patients where they're really looking for convenience and not depending on, you know, electricity as much.

Even, you know, the Amish population, we've seen an uptick in the number of patients coming to the office and looking to possibly switch over to having a dental device because it does not rely on electronic involvement at all.

- You mentioned three different forms of treatment.

And you touched on surgery, but insofar as the... the special treatment with the stimulation.

But is there a surgical option at all in the throat?

Shave down the tongue?

I don't know, but you get where I'm going.

- Yes.

- Is there some option there that can end all these so-called treatments of machines and dental pieces and apparatuses?

- There is.

And 25 years ago, it was extremely popular.

It was called the UPPP, and that stands for uvulopalatopharyngoplasty.

Okay.

And what that is is a major surgery done by an ear, nose and throat specialist.

And essentially they go into the patient's throat.

They trim out any tonsils.

They kind of re contour the soft palate.

You know, they’re kind of broadening by doing tissue removal and kind of shaving down things like you said, it's a very in-depth surgery.

Patients that have had it done, and it, unfortunately, the tissue does grow back.

You know, just in my experience with dealing with patients that have had that done years ago, and then they kind of redeveloped the sleep apnea or the symptoms again, it's not used nearly as much in today's world just because the recovery is very, very tough.

It's probably a good 3 or 4 week recovery after the surgery.

And we know it's about 50, 60% effective for about the first 2 to 3 years.

And then as the tissue starts growing back then they start kind of having all the symptoms back.

So in today's world I don't see that happen very much.

Ironically with children, which, you know, the percentage of children that develop obstructive sleep apnea is only about 2 to 3% of kids.

But that is the first line of defense for kids that do have obstructive sleep apnea is to remove the tonsils and possibly adenoids right away.

They know that is a very effective for children.

- Are there new treatments on the horizon for sleep apnea?

- So the biggest one that we have seen, and it's very known to all of our population, is the introduction of weight loss drugs such as Zepbound.

Last... let's see, it was October, I believe, of 2024, Zepbound was actually approved to treat obstructive sleep apnea.

And because of what we talked about earlier, with the idea of the weight component, we know that if patients do lose a significant amount of weight, there is a chance that their sleep apnea could, could is the keyword, be resolved completely.

Do we see that all the time?

No.

And a lot of times it's because we know that anatomy also plays a role in this.

So, anatomy meaning narrow jaw, tongue that sits higher in the mouth than it should, maybe a very narrow, soft palate, teeth that are tipped into each other, reducing that tongue space.

But the drugs are going to be a big thing to follow.

A lot of times we've seen patients who may not have been a candidate for inspire surgery or the dental appliance because they were so severe when they were originally diagnosed.

Then they go on these drugs for six months, a year or whatever, and because they lose will say 40 or 50 pounds, now they get a new sleep study and the sleep study shows that their severity is no longer in the severe range.

Now they're down to a mild range, which makes it a lot more predictable for me to treat them or for them to be a candidate, possibly, you know, for a surgery or something like that if their BMI is now lower, too.

- So the drugs are essentially weight loss drugs.

- They are weight— - That is the treatment?

- It can impact the apnea.

- I've also seen... article stories where, if you sleep in a certain way, your head on the side or tilt to the side, that can either reduce the events per night, or on occasion I, when I'm on my desk, I kind of lean over and just put my head down where I'm looking down, and that seems to give me better breathing.

Is there, is that true, or is it just an old wives’ tale?

- No, you're exactly right.

So every time I treat a patient, I'm always asking the referring physician for their sleep study.

And that's one of the first things I'll look at is, is there a positional component with this patient or not?

Just like you said, patients that sleep on their back for the most part, we'll say, I'm going to say at least 90% are worse when they're on their back compared to their side and that's because gravity takes over.

And if they're on their back, guess where that tongue is going?

It's falling right to the back of their throat.

So sometimes I'll talk to patients, especially the patients that are more in the high, moderate, low, severe range that are asking me to treat them.

I'll talk to them about getting a positional pillow.

They make all kinds of different pillows and adjuncts that you can use to sleep while also using an oral appliance.

I also talk to patients about, you know, using nasal dilators and occasionally mouth tape as well, because we know nasal breathing is much more efficient than mouth breathing.

And a lot of times patients come to me with complaints of dry mouth, things like that.

And that tells me that they're breathing too much through their mouth.

And if they're able to breathe through the nose, why wouldn't we encourage more nasal breathing?

So, yes, positional components, adjuncts to aid in nasal breathing, those are all things that we all use in addition to the oral appliance.

- Sure.

I think that when you fall asleep on your side, you assume that you stay on your side the whole night.

But I think the reality is, you don't know that and you actually turn and maybe lay on your back, and then you get an instance or an event, and then you wake up and you say, oh, this is a good but really in the night you've been been moving into an all other types of activities that have not been necessarily helpful to, to counteract sleep apnea.

- That is a common eye opener in my office when I go over the sleep study with the patient at the consult and I said, well, you're on your back for 3.5 hours of the night.

And they're like, no, I went to sleep on my left side and woke up on my left side.

Yeah, but these are tracking you as you're sleeping all night on whether you're on your back or on your side or on your stomach.

So, sometimes a little bit of, you know, education on what's happening throughout the night also will help a patient gain better quality sleep, too, if we can know these things at the onset.

- Well, can you put, like, foam bricks on either side so that you can't turn?

You know, turn?

Does that work?

Or... - For some people that works well, a simple wedge pillow that you can get off of an online Amazon or something like that.

Even, I've had patients who have taken fanny packs and they take the fanny pack, move it around to their back, put a baseball or a lacrosse ball in there and that keeps them from going on their back, too.

So there's lots of ideas that I talked to patients about before we even start treatment, if we know that that is a, a big issue in terms of their own sleep, it's not for everybody.

Not every case is the same, but for the people that show, they're ten times worse when they're on their back.

Those are the patients we really want to try to focus, to keep them off their back, to make my, my therapy more predictable for them and more successful.

- Sure.

You know, in the last 30 seconds we have, could you... could you take us ten years into the future and tell us where you think sleep disorders and maybe sleep apnea will be?

- I'm hoping that it becomes widely more, where patients are more tested, where it almost becomes like, you know, you go in, you get your cholesterol tested.

I want it to be something where it's on the forefront of all diseases.

We know that it's the second leading disease behind hypertension in the United States.

So I'm hoping there's more awareness and it almost becomes, even if you don't have symptoms, that you are tested just to rule it out.

- Yeah.

So you don't ever see a cure for it?

It will always be a treatment.

- It's probably always going to be a treatment.

Yep, yep.

I do.

It's hiding, perhaps sleeping in pure sight.

Sleep apnea is a treatable condition that affects nearly 1 billion people worldwide.

If we can recognize the symptoms of sleep apnea in ourselves and in others, we may be able to wake up to improved health and a better quality of life.

I'd like to thank my guest, Dr.

Ben Utterback, sleep disorder expert and dentist from the Dental Sleep Solutions of Ohio for the visit today and ask each of you to keep your eyes, ears and mind open until next time on Forum 360.

Forum 360 is brought to you by John S. and James L. Knight Foundation, the Akron Community Foundation, Hudson Community Television, the Rubber City Radio Group, Shaw Jewish Community Center of Akron, Blue Green, Electric Impulse Communications, and Forum 360 supporters.