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Want Optimal Health?
Get a Good Night's Sleep

“The truth is,” observes Dr. Charles Ferzli of the TMJ & Sleep Therapy Centre in Cary, “there is no path to optimal health that doesn’t involve what we might call ‘a good night’s sleep’.”

Dr. Ferzli, with some of the diagnostic
tools used in patients’ sleep and
breathing evaluations.

There’s a reason that we spend a third of our lives sleeping, he points out. “Because sleep—in all its stages —is essential for all aspects of our health, providing the foundation for healing, growth, and cognitive processing.

“When we don’t sleep, we don’t learn, we have trouble remembering things, and we don’t heal. We have more inflammation, we feel more pain, we’re more tired and irritable. We have more anxiety, and suffer more from depression.

“Most importantly,” adds Dr. Ferzli, “it’s during sleep that the body heals. This is when human beings secrete the hormones that allow children to grow and that allow the body rest, regenerate, and heal itself.”

What Is a “Good Night’s Sleep”?

“A ‘good night’s sleep’,” says Dr. Ferzli, “starts with quantity. We need enough hours for our brain to regenerate and heal—to flush out toxins and make room for new memories and new cognitive skills. For adults, ‘enough’ means six to eight hours; children require more. This is not trivial; insufficient sleep increases the risk of hypertension, obesity, diabetes, mental health issues, even on-the-job accidents. In youngsters, inadequate sleep is linked to attention disorders and learning problems.”

“Sleep quality is related to four stages of a healthy sleep cycle,” explains Dr. Ferzli. “Each stage has a unique role in maintaining cognitive health and performing physical repair. Stage one is the transition from wakefulness to sleep; in stage two, the body slows down. Deep healing sleep occurs in stage three; and, the fourth stage—the dream stage—furthers the process of memory consolidation, and readies one for learning.

“These four stages are repeated four or five times a night; disruptions in the cycle impair the quality of sleep.”

Obstacles to a Good Night’s Sleep

What interferes with a healthy sleep cycle? “So many, many things,” responds Dr. Ferzli, with a smile. “High blood pressure, acid reflux, heart problems, even diabetes can all interrelate with sleep issues. Breathing issues—such as obstruc-tive sleep apnea or upper airway resistance—are major disruptors. Diet, allergies, jaw pain, mouth breathing, even medications—are all connected to sleep problems. Among the environmental factors that contribute to a poor sleep cycle, are too much light (especially from TV and cell phones), room temperature, and shift work. What’s important to understand is that these factors are all connected.”

A Master Student of Dental and Sleep Health

Dr. Ferzli’s expertise in the field of dental sleep medicine reflects both his passion for learning and his professional evolution. “Someone once told me everything a dentist reads is obsolete within two years,” he says, “so learning is a continuing process—and what I love about this profession.”

That commitment to learning led him to explore virtually every branch of dentistry. “But it was my study of craniofacial pain that really hooked me,” he says. “And that ultimately led me to the field of dental sleep medicine—because I soon learned that sleep and craniofacial pain are intimately connected.”

This understanding prompted him to earn Diplomate status with the Academy of Craniofacial Pain, board certification from the American Board of Craniofacial Dental Sleep Medicine, and a second Diplomate status with the American Academy of Dental Sleep Medicine. And it led him to focus his practice on the important interconnection of dental and sleep issues.

“I was a dentist for a long time before I took courses in sleep medicine,” says Dr. Ferzli. “And it wasn’t until then that I really understood how all parts are related and how all systems need to fit properly together; how adjust-ing someone’s bite can affect their posture or relieve back pain; how treating an allergy can improve one’s sleep. The connections are amazing—and no one talked about that in dental school! I love dentistry because there’s always something new to learn.”

Diet and Sleep

Among all the lifestyle factors that affect the quality of sleep, notes Dr. Ferzli, perhaps the most significant is diet. “In terms of sleep disruption,” he says “the biggest culprit is sugar—refined carbo-hydrates. Alcohol, which contains a lot of carbohydrates and can contain a lot of sugar, is also significant problem. For example, taking in alcohol past, say, 2:00 or 3:00 PM, is likely to affect your sleep cycle. So that evening glass of wine may contribute to a poor night’s sleep.”

Stimulants such as nicotine also interfere with healthy sleep cycles, as do food sensitivities and allergies. Acid reflux brought on by spicy or oily foods can be exacerbated when lying down; and foods that cause inflammation can hinder breathing as the airway swells. Low levels of minerals and vitamins, such as iron and Vitamin D, also cause sleep problems.

Regaining a
Good Night’s Sleep

Millions of Americans, notes Dr. Ferzli, suffer a variety of sleep disorders; the most common one—insomnia—affecting about 70 percent of the population. Millions more suffer other conditions that affect breathing and prevent deep, restful sleep.

“In my sleep therapy practice,” says Dr. Ferzli, “I help people with sleep-related breathing problems. So there are many different types of sleep conditions—such as narcolepsy—that I do not treat, and would refer to a sleep physician.

“But, as we’ve discussed, sleep-related breathing problems are not isolated; they are inextricably connected to other issues, such as jaw pain, stress, allergies, diet, structural and dental problems—the list is long. Treating these problems begins with a thorough understanding of each patient’s sleep issues—and which factors contribute to their problem.

“Our starting place is a detailed questionnaire and interview, which helps us understand how the sleep cycle is disrupted and what other issues are involved. Questions about snoring and daytime fatigue, for example, reveal a great deal. We also want to know about allergies, medications, pain issues, and more.

“Our primary goal is to determine if the patient has any airflow disturbances, such as obstructive sleep apnea or upper airway resistance. And our first treatment priority is to optimize their breathing.

“There are a number of ways to do this,” he explains. “We may use an appliance to prevent airway collapse, or to prevent clenching and grinding. A dislocated jaw joint may need to be fixed; exercises might help to improve the jaw’s range of motion. We use specialized appliances in many instances; but other tools are equally important, since so many factors contribute to sleep and breathing issues.

“We deal a lot in our practice with upper airway resistance (UARS) problems where the airway does not collapse, but becomes narrower,” notes Dr. Ferzli. “Unfortunately, this is a problem that is too often untreated. Many of our patients have had sleep studies that determined that they don’t have sleep apnea, and therefore they aren’t treated for sleep-related breathing issues. But they do have a serious problem, because they are not getting sufficient oxygen while they sleep. We treat those patients with oral appliances to keep the airway open and prevent waking up throughout the night.”