Welcome to Sleep Well Northwest

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Sleeping Woman by RelaxingMusic http://www.flickr.com/photos/83905817@N08/7676645672/Our mission at Sleep Well Northwest is to get you on your way to a better night’s sleep. We constantly strive to exceed the expectations of our patients by delivering dental sleep medicine treatments at the highest degree of quality and comfort possible. Dr. Marinkovich’s clinic is the only accredited dental sleep clinic by the American Academy of Dental Sleep Medicine in the Area. Dr. Marinkovich, certified by the American Academy of Dental Sleep Medicine, always stays abreast of the latest techniques and materials, utilizing only proven effective techniques with a track record for success.

Obstructive Sleep apnea is a sleep disorder characterized by abnormal pauses in breathing or instances of abnormally low breathing during sleep. An individual iwth sleep apnea is rarely aware of having difficulty breathing, even upon awakening. Sleep Apnea is recognized as a problem by others witnessing the individual during episodes or is suspected because of its effects on the body. Symptoms may be present for years (or even decades) without identification, during which time the sufferer may become conditioned to the daytime sleepiness and fatigue associated with significant levels of sleep disturbance.

Dr. Marinkovich

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Dr. Steve Marinkovich
 graduated from the University of Washington Dental School and continues his dental and dental sleep medicine education every year. He keeps up with all of the latest treatments in dentistry and DSM to better serve his patients. He presently serves part time on the clinical faculty at the University of Washington School of Dentistry in Restorative Dentistry, and is credentialed by the Certification Board of the American Academy of Dental Sleep Medicine. There are not many dentists with this distinction.

Steve is also one of the very few dentists in the area that has been honored with the prestigious fellowship in both the American and International Colleges of Dentists. Membership to these organizations are gained through nomination by one’s peers, based on professional integrity, caliber of treatment, and outstanding service to the community and the profession.

In the past, for six years, Dr. M was a member of the Washington State Board of Dental Examiners, (the folks who test dentists and issue licenses to practice in this state), including serving as the board’s president. Acting as a Consultant to two different insurance companies and an investigator for the State of Washington, with regard to fairness in health care issues, along with activity in dental organizations, have been valuable learning experiences to add to his diverse expertise.

Steve adores all forms of sports, most notably golf, fly fishing, and tries to stay fit with exercise. He and his wife enjoy travel and going to the movies. Be sure to ask about our annual Academy Award contest. Our patients love it!

Sleep Apnea Solutions

Oral Appliance Therapy was first endorsed as effective management of obstructive sleep apnea by the American Academy of Sleep Medicine in 1995. In 2005, the Standards of Practice Committee of the AASM updated the practice parameters for the use of oral appliances as appropriate first line therapy for snoring and mild to moderate Obstructive Sleep Apnea. Occasionally, Dr. Marinkovich will prescribe a different appliance when he decides the care warrants that decision.

Most patients with narrowed airways will have increases in the volume of the airway and decreased resistance to airflow when the mandible is advanced. This is the fundamental principle of airway management, utilized in cardio-pulmonary resuscitation (CPR), where the tongue is moved from the airway by head and mandibular posture.

The base of the tongue is moved farther from the airway tissues to a position where contact and obstructions are less likely or unable to occur. Increased airway volume causes a slower rate of flow, which increases air pressure (Bernoulli’s Principle), and increased tone is imparted to the tongue by the stretching of the masseter muscles. This keeps the tongue from blocking the airway.

Dr. Marinkovich is versed in using several different appliances and will select the best appliance for each individual case. These are the two appliances he uses most.

The Herbst Appliance is a mandibular repositioner that has been used for many years for orthodontic and TMJ therapy, but has now been modified for treatment of Sleep Disordered Breathing.

This appliance allows the patient to move laterally and vertically without disengaging the appliance. Also if the initial position does not relieve symptoms, this appliance can be adjusted to move the mandible farther forward quite easily. This appliance is typically fabricated of hard acrylic and is quite durable.

The SomnoDent Appliance has a patented fin-coupling mechanism on the lower arch to ensure that your jaw remains in the correct position whether you sleep with your mouth openor closed. Like the Herbst Appliance you can open vertically to speak or get a drink of water. Patients report the Somno Dent Appliance is very comfortable.

The appliance is typically made of hard acrylic but a softer lining material is available when appropriate. This appliance is very durable. Like the Herbst Appliance the Somnodent is custom fin to each patient’s mouth.

The Tap III Elite is a custom-made two piece appliance. The top appliance has a hock which engages an internal mechanism on the lower appliance. A tool can be used to adjust the position of the hock which in turn is used to move the mandible farther forward if needed.

 

OTHER TREATMENT OPTIONS

Continuous Positive Airway Pressure (CPAP) (At your Physician’s office)

Airway collapsibility is reduced by the application of increased air pressure which “splints” the airway open. This therapy is termed the “gold standard” by sleep physicians but unfortunately many patients simply cannot tolerate the form of treatment.

Surgery as Primary or Adjunctive Therapy (At your Surgeon’s office)

Surgery can be used to remove or reposition redundant tissue to reduce the noise of snoring and the potential for obstructions. Resulting airway volume increases may increase air pressure. Radio-frequency ablation (“Somnoplasy”) of the soft palate may reduce the volume of tissue while preserving its anatomy.

Surgery is invasive and irreversible. The proper case selection and work up are essential to decrease your risks, and to increase your chances of improvement. Surgical interventions now also include implants to stiffen the soft palate, permanent advancements of the upper and lower jaws, stomach alteration surgeries to reduce weight in the very obese, and even tracheostomies to bypass the obstructions during sleep. All of these procedures have significant risks, and understanding those risks as they apply in individual cases is necessary for proper informed consent. It is recommended that patients request documentation from peer reviewed medical journals describing outcomes for any of the surgical procedures that are contemplated.

Postion Therapy

For some patients, avoiding sleeping on the back (supine position) will either correct the problem or help reduce the airway collapsibility. When supine position avoidance is hybridized with other therapies such as the use of the TAP Appliance, the overall outcome is often enhanced.

Our home monitoring system will accurately determine the patients’ habitual body positions during sleep, and when analyzed against the airway collapsibility data, the potential usefulness of this additional therapy can be easily determined.

Sleep Hygiene/Weight Loss

All patients, regardless of diagnosis, or severity of sleep disordered breathing should follow basic principles of good sleep hygiene.

  • Most Adults require 7-9 hours of sleep per night
  • Optimize sleeping conditions
  • Quality bed
  • Optimal temperatures
  • Minimize allergens
  • Avoid stimulants and alcohol within 3 hrs of bedtime
  • Don’t eat or drink in excess before bed
  • Keep a regular sleep-wake schedule
  • Develop relaxing bedtime rituals
  • Reserve only appropriate activities for the bedroom
  • Don’t read in bed
  • Don’t watch TV in bed
  • Don’t eat in bed

Exercise and weight loss is an essential part of all patients’ treatment plan. You may be referred to a weight loss / nutrition program if you are at all overweight.