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Koala Center for Sleep Disorders – Biltmore

Beth Hamann, DDS & Shari Aftahi, DMD

602-357-7539

602-957-3830

Hours:
          Mon. – 9:00am-6:00pm
          Tues. – 8:00am-5:00pm
          Wed. – 8:00am-5:00pm
          Thur. – 7:00am-4:00pm

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4235 N. 32nd St., Suite A, Phoenix, AZ 85018

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Meet the Doctors

Dr. Beth Hamann Web

Beth Hamann, DDS

Licensed General Dentist

Dr. Beth Hamann has enjoyed practicing general dentistry for nearly 30 years. In the past several years, her continuing education has centered on the area of dental sleep medicine, as she is passionate about helping people with sleep disorders.  Dr. Hamann is trained to provide a comfortable treatment option for patients who suffer from Obstructive Sleep Apnea, snoring and Temporomandibular Joint Disorder (TMD).  Her goal is to help you sleep better so that you will experience a greater quality of life.

Professional Affiliations

  • American Academy of Dental Sleep Medicine
  • Diplomate of the American Sleep and Breathing Academy
  • American Association of Women Dentists
  • American Academy of Cosmetic Dentistry
  • Arizona Dental Association
  • Central Arizona Dental Society
  • Academy of General Dentistry
  • American Dental Association
  • California Dental Association

Dr. Shari Aftahi - Web

Shari Aftahi, DMD

Licensed General Dentist

Dr. Shari Aftahi received her degree in Dental Medicine from the University of Pittsburgh in 1995. She further pursued her advance training and completed her residency at the Veteran’s Hospital in Pittsburgh, Pennsylvania.

Dr. Aftahi has been practicing dentistry in Arizona for the past 20 years. She has also acted as an adjunct faculty at the AT Still School of Dentistry. Her interest in helping patients with Sleep Disorders has led to take extensive training in the area of Sleep Apnea and Oral Appliance Therapy.

Her professional association with Dr Rod Willey, the founder of the Koala Center for Sleep Disorders, has given her a comprehensive knowledge of the use of Oral Appliance Therapy as an innovative and non invasive method to treat obstructive sleep apnea. Dr. Aftahi has now dedicated her practice to the treatment of Sleep Disorders to improve the quality of life of her patients.

Dr. Aftahi is a member of the American Academy of Dental Sleep Medicine, the American Sleep and Breathing Academy and the American Academy of Sleep Medicine.

Professional Affiliations

  • American Academy of Dental Sleep Medicine
  • American Association of Sleep Medicine
  • American Sleep & Breathing Academy

Dr. Beth Hamann & Dr. Shari Aftahi are licensed general dentists.

Snoring Partial BlockageSnoring occurs when the soft tissue structures of the upper airway collapse onto themselves and vibrate against each other as we attempt to move air through them. This produces the sound we know as snoring. Large tonsils, a long soft palate, a large tongue, the uvula, and excess fat deposits in the throat all contribute to airway narrowing and snoring. Usually, the more narrow the airway space, the louder or more habitual the snoring.  Snoring is the sound of partially obstructed breathing during sleep. While snoring can be harmless, it can also be the sign of a more serious medical condition known as Obstructive Sleep Apnea (OSA).When Obstructive Sleep Apnea occurs, the tongue and soft palate collapse onto the back of the throat and completely block the airway, which restricts the flow of oxygen. The condition known as Upper Airway Resistance Syndrome (UARS), is midway between primary snoring and true obstructive sleep apnea. People with UARS suffer many of the symptoms of OSA but require special sleep testing techniques.

Sleep Apnea Total BlockageOSA is characterized by complete airway obstruction.  It is often found, but not limited to, older, overweight men and affects significant percentages of women and children as well. If someone in your family has OSA, you will be more likely to have it also.  The serious and life-threatening problems start when sleepers begin experiencing apneas, where breathing stops, and hypopneas, where breathing is shallow due to an obstruction.  Breathing is usually blocked in the back of the throat because:

  • The tongue and muscles relax during sleep.
  • The lower jaw falls back toward the throat.
  • The airway becomes blocked.

A typical sequence of OSA occurs when a person stops snoring and is silent for seconds, or minutes.  The body’s oxygen level drops and the blood pressure rises.  The heart is forced to beat faster, causing the pulse rate to increase.  The brain may cause the arms, legs or whole body to jerk in an attempt to wake the sleeper so breathing will resume.  The silence may end with a loud snort, cough or gasp.  This causes the sleeper to wake briefly and begin breathing.  Once asleep again, the muscles relax and the airway becomes blocked, cutting off the airway again.  This cycle can occur hundreds of times per night.  Obstructive Sleep Apnea is the most common form of sleep apnea.  It ranges in severity from mild to moderate, to severe.  Other forms of sleep apnea include Central and Mixed Sleep Apnea.

  • Excessive daytime sleepiness
  • Morning Headaches / Migraines
  • Snoring
  • Weight Gain
  • Short Term Memory Problems
  • Acid Reflux
  • High Blood Pressure
  • Depression
  • Severe Anxiety
  • ADD & ADHD Symptoms
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  • Choking/Gasping sensation that wakes you up
  • Insomnia / Inability to sleep through the night
  • Diabetes
  • Sore Throat / Dry Mouth
  • Slow Metablism/ Inability to lose weight
  • Poor job performance or problems in school
  • Mouth Breathing /Difficult Nose Breathing
  • Restless and tossing and turning during sleep
  • Impotence and/or Decreased Sex Drive
  • Mood Swings / Temperamental Behavior

If you’re experiencing frequent headaches, back and neck pain, dull aching facial pain, or popping in your jaw you are not alone. Approximately 35 million people in the United States suffer from TMJ problems. While both men and women experience TMJ disorders, the majority of those seeking treatment are women in their 20’s and 30’s. Many believe stress or a busy lifestyle is to blame but do not realize that these symptoms are often related to their jaw muscles and their jaw joint known as the temporomandibular joint or TMJ. Your bite can be a factor in many types of pain or functional problems because of the inter-relationship of the overall muscle and skeletal system.

TMJ Diagram

TMD is a condition involving the temporomandibular joint, bone and cartilage resembling a ball-and-socket that sits right above your ear canal on either side of your head. When the joint slips out of position, pain can result, and TMD is characterized by clicking or popping of the jaw when you open or close your mouth, persistent headaches, and sometimes chronic pain. We have many patients who come to us complaining of headaches, jaw and facial pain as well as pain in the ears, never realizing that their pain was caused by a misalignment in their jaw.  Some people, however, report no pain, but still have problems using their jaws.

The cause of TMD is not clear, but dentists believe that symptoms arise from problems with the muscles of the jaw or with the parts of the joint itself.

Macrotrauma to the jaw, temporomandibular joint, or muscles of the head and neck such as from a heavy blow or whiplash are common causes of TMD. Other possible microtraumas include:

  • Grinding or clenching the teeth, which puts a lot of pressure on the TMJ
  • Tooth loss, misalignment of teeth
  • Dislocation of the soft cushion or disc between the ball and socket
  • Presence of osteoarthritis or rheumatoid arthritis in the TMJ
  • Stress, which can cause a person to tighten facial and jaw muscles or clench the teeth
  • Chewing gum excessively or biting your nails can inflame your temporomandibular joint and may cause TMD.

TMJ Diagram Signs & Symptoms

  • Headaches
  • Jaw Joint Pain
  • Jaw Joint Noise or Clicking
  • Limited Mouth Opening
  • Ear Congestion
  • Dizziness
  • Ringing in Ears
  • Difficulty Swallowing
  • Loose Teeth
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  • Clenching or Grinding
  • Facial Pain
  • Sensitive Teeth
  • Chewing Difficulties
  • Neck Pain
  • Postural Problems
  • Tingling in Fingertips
  • Hot & Cold Teeth Sensitivity
  • Nervousness or Insomnia

Diagnosing Sleep Apnea

Since OSA is a serious medical condition, it must be diagnosed by a physician. Once a diagnosis of sleep apnea is made, the severity of the dysfunction can be classified and treatment options will be given.

Sleep Studies

A sleep study gives the best picture of how you breathe when you sleep. It provides information regarding apneas (when breathing stops) and hypopneas (when breathing is shallow due to an obstruction) as well as pulse, blood pressure and other physiological processes such as REM sleep, EEG and leg or arm jerking. Depending on your circumstances, the doctor will recommend either a PSG or a HST.

Polysomnogram (PSG)

A PSG is a sleep study that is done in a sleep lab overnight and monitored by a trained sleep lab technician. The patient is hooked up with wires via sticky electrodes to the apparatus that will monitor their sleep channels. The physician associated with the sleep lab will examine the results and interpret the data collected.

Home Sleep Test (HST)

Home Sleep TestAn ambulatory sleep study, or HST, is a convenient monitoring system that the patient can use in the comfort of his own bed. The HST is a small, portable unit that utilizes wireless technology. The data recorded during sleep is then downloaded to a computer the next day. This data is analyzed by a board certified sleep physician.

Home Sleep Test (HST) Instructional Video

 Cone Beam Volumetric Tomography (CBVT)

Dental CatscanLike a Medical Cat Scan, but emitting dramatically less radiation, the Cone Beam is a powerhouse of technology used to view and analyze airway passages, tissues, structure and anomalies from the neck up. A board certified oral and maxillofacial radiologist performs the CBVT read and provides an exhaustive report of all findings. IIDSM uses this information to provide optimal treatment for patients as well as shares the findings with the patient’s physician to partner in patient care.

Good sleep hygiene, weight loss, and exercise are some helpful OSA treatments a patient can practice on their own. However, medical and dental treatments include Oral Appliance Therapy, Continuous Positive Airway Pressure and surgery.

Oral Appliance Therapy

Herbst 3Oral appliances are worn during sleep to treat snoring and Obstructive Sleep Apnea. These devices are similar to orthodontic retainers or sports mouth guards. Oral Appliance Therapy involves the selection, design, fitting and use, and professional titration of a custom designed oral sleep appliance that is worn during sleep. The job of the oral appliance is to prevent the obstruction which occurs when the lower jaw, tongue and tissues in the back of the throat become relaxed during sleep and collapse into the narrow airway space.

Oral Appliances are indicated for use in patients with:

  • Mild to moderate OSA who prefer then to CPAP (Continuous Positive Airway Pressure)
  • Severe OSA who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP

Oral appliances may be used alone or in combination with other means of treating OSA. These means include general health, weight management, surgery, or CPAP. Oral appliances work in several ways:

  • Repositioning the lower jaw, tongue, soft palate and uvula
  • Stabilizing the lower jaw and tongue
  • Increasing the muscle tone of the tongue

Oral Appliances should be fitted by qualified dental personnel who are trained and experienced in sleep apnea and the overall care of oral health, the temporomandibular joint, dental occlusion and associated structures.  We will work with your physician as part of the medical team in your diagnosis, treatment, and on-going care.  Initiation of oral appliance therapy can take from several weeks to several months to complete. Once maximum medical improvement is reached, a follow up sleep study with the oral appliance is place is done to determine medical efficacy.  The doctor will continue to monitor patient adherence, evaluate device deterioration or maladjustment, and to evaluate the health of the oral structures and integrity of the bite every six months the first year, and then yearly thereafter.

Advantages of Oral Appliance Therapy

  • Most people acclimate quickly to wearing Oral Appliances
  • Patients who cannot tolerate or refuse to use CPAP now have a non-surgical alternative
  • Oral Appliances are small, convenient and easy to carry when traveling and require no electricity
  • Bed partner approved, discreet and quiet
  • Easy to clean, low maintenance
  • Denture friendly

Follow Up Care

On-going care, including short- and long-term follow-up is an essential step in the treatment of snoring and Obstructive Sleep Apnea with Oral Appliance Therapy. Follow-up care serves to assess the treatment of your sleep disorder, the condition of your appliance, your physical response to your appliance, and to ensure that it is comfortable and effective.

Continuous Positive Airway Pressure (CPAP)

CPAP NO CPAP

Continuous Positive Airway Pressure (CPAP) is pressurized air generated from a bedside machine. The air is delivered through a tube, connected to a mask, covering the nose. The force of the pressurized air splints the airway open. The CPAP opens the airway like air into a balloon; when air is blown into the balloon, it opens and gets wider. This is exactly how CPAP clears the airway.

Surgical Procedures

In addition to Oral Appliance Therapy, dentists who are oral and maxillofacial surgeons may consider a variety of methods to evaluate, diagnose and treat upper airway obstruction. These dental specialists treat upper airway obstructive disorders by utilizing both minimally invasive procedures as well as more complex surgery, including jaw advancement. Additionally, an ENT specialist may evaluate you for other types of surgery, mainly the removal of the excess tissues in the throat. It may be necessary to remove tonsils and adenoids (especially in children), the uvula, or even parts of the soft palate and the throat.

TMD ApplianceDiagnosis and treatment for TMD, utilizes advanced technologies such as Cone Beam Volumetric Tomography, K-7 Electromyography and TENS (Transcutaneous Electrical Neural Stimulation). With TENS, electrodes are applied to the patient’s jaw, neck and shoulder areas.   TENS sends a painless electrical current that increases blood flow to the joint, relieves stiffness, improves mobility, and acts as a drug-free pain reliever.

 

Step One:

By using TENS, the doctor is able to confuse the muscle memory and find the optimum true rest position for the jaw.   A custom made appliance called a neuromuscular orthotic is created to promote healing and maintain the new, corrected bite position.

Step Two:

Permanent stabilization may be necessary and can be determined after Step One.  Options may include wearing a long term orthotic, providing orthodontic treatment, placing crowns or veneers on the affected teeth, or creating a neuromuscular denture.  With the techniques and technologies of neuromuscular dentistry, we can help you achieve a healthier bite, more comfortable muscles and jaw joints, and a beautiful smile.

What’s Your Sleep Score?

Do you snore? Tired all the time? You may have sleep apnea. Take the Epworth Sleepiness Scale to learn your sleep score.

Take Test Now!

Advantages of Oral Appliances

      • Covered by most medical insurances & Medicare
      • Comfortable alternative to CPAP
      • Small, convenient, and easy to travel with
      • Prevents snoring – Bed partner approved!
      • Approved by the American Academy of Sleep Medicine and FDA

What Patients are Saying

The oral appliance is comfortable, easy to handle, and a “life changer”. What a blessing. Thank-you!
Connie, Actual Patient
I love the convenience when traveling. I’m from Kenya, and the village where my family lives doesn’t have electricity. Now I don’t have to worry about a power outlet for a CPAP machine!
Janet, Actual Patient
Immediately after I got the oral appliance my snoring stopped. Now my wife and I are both getting quality sleep and are much happier and healthier!
Tom, Actual Patient
I am so excited to finally be feeling energetic and happy again! I have my life back. The appliance has truly changed my life.
Lisa, Actual Patient
I never dreamed I would sleep so well the first night. I have better health, more resilience, energy, and I think I play better golf. My wife is happy too. The oral appliance is just fantastic!
Don, Actual Patient
My snoring was so bad even our pet parrot would mimic the sound. I couldn’t wear the CPAP so this was a great alternative. My wife is so happy because I now have energy to do the things we love!
Sam, Actual Patient
The appliance is lightweight, easy to manage, and easy to clean. I couldn’t be happier. I have energy, don’t have to wear the CPAP, and my blood pressure has come down since wearing the appliance.
Marcia, Actual Patient

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