NightLase Presentation Waled2014

NightLase Procedure
-Laser Snoring and Sleep Apnea

Reduction Treatment
Case presentations with 28 months Experience

Jaana Sippus DDS
Waled Congress 01-02 May 2014, Aachen
NightLase Laser Snoring and Sleep Apnea
Reduction Treatment
28 months experience
Dr.Jaana Sippus, Waled Congress 01-02 May 2014, Aachen

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Introduction
Method
Results
Conclusion

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 Introduction
Snoring is described in Wikipedia as the vibration of respiratory

structures and the resulting sound, due to obstructed air movement
during breathing while sleeping. It has been stated that 75% of snoring
people also have sleep apnea, where breathing is disrupted for short
periods. This increases the risk of developing coronary heart diseases.
It also leads to problems in partnerships ending often to divorce.

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Screenshot of a PSG system showing a central apnea. Wikipedia

Dr.Jaana Sippus, Waled Congress 01-02, May 2014, Aachen
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There are three forms of sleep apnea:
Central (CSA),
Obstructive (OSA), and
Complex or mixed sleep apnea
(i.e.. A combination of central and obstructive) constituting 0,4%, 84% and 15% of
cases)
Morgenthaler TI, Kagramanov V, Hanak V, Decker PA (September 2006).

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What is an Obstructive Sleep

Apnea (OSA)?
 In Greek “apnea” translates to “without breath” and
is characterized by repetitive episodes of blocked or
restricted breaths sometimes hundreds of times
during a single night and affects millions of
Americans.
 Obstructive sleep apnea (OSA) is caused by changes
in the position of the tongue during sleep that result
in the closure of the soft tissues at the rear of the
throat.
ImTheraMed™ Dr.Jaana Sippus, Waled Congress 01-02, May 2014, Aachen
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What is an Obstructive Sleep Apnea (OSA)?
ImTheraMed™ Dr.Jaana Sippus,Waled Congress 01-02 May 2014, Aachen

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The severity of sleep apnea is determined by dividing the number of episodes of

apneas and hypopneas lasting ten seconds or more by the number of hours of
sleep. The resulting number is called the Apnea-Hypopnea Index, or AHI.
AHI# Condition
Below 5 No OSA
5-15 OSA
15-30 Moderate OSA
Over 30 Severe OSA

ImTheraMed™ Dr.Jaana Sippus, Waled Congress 01-02, May 2014, Aachen
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Symptoms related to Obstructive Sleep Apnea

By American Association of Oral and Maxillofacial Surgeons (AAOMS)
 Snoring with pauses in breathing (apnea)

 Excessive daytime drowsiness
 Gasping or choking during sleep
 Restless sleep
 Problem with mental function
 Poor judgment/can't focus
 Memory loss
 Quick to anger
 High blood pressure
 Nighttime chest pain
 Depression
 Problem with excess weight
 Large neck (>17" around in men, >16" around in women)
 Airway crowding
 Morning headaches
 Reduced libido
 Frequent trips to the bathroom at night

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It's estimated that approximately 30% to 50% of the US

population snore.
Approximately 1/3 have Sleep Apnea,
yet only 5% have been diagnosed and treated.

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How Serious?
Yes, OSA is potentially life threatening.
• 50% of adults with hypertension & heart
disease also suffer from OSA.
• 77% of male and 64% of female stroke
patients have OSA.
• OSA may be responsible for 30,000
cardiovascular deaths per year.
• OSA patients are 7 times more likely than
non- OSA patients to be involved in car
accidents.
• Many marriages become strained due to
severe snoring.
Wikipedia

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Image Jugoslav Jovanović, DDS,

From Wikipedia, the free encyclopedia LAHA Expert clinical lecturer
 Snoring is the vibration of

respiratory structures and
the resulting sound, due to
obstructed air movement
during breathing while
sleeping. In some cases the
sound may be soft, but in
other cases, it can be
rather loud and quite
unpleasant ( Up to 85 dB).
 Generally speaking, the

structures involved are the
uvula and soft palate.

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Etiology
 Being overweight
 Pregnancy
 Nasal congestion
 Deformities of the nose or nasal septum
 Swelling of the muscular part of the roof of the
mouth
 Swallen adenoids and tonsilis
 Use of sleeping pills, antihistamines or alcohol
 Polyps and cysts
 Malignant tumor

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Self-treatment options for sleep apnea:

 The Importance of weight loss
 Sleep on your side
 Nasal strips
 Treat nasal congestion or obstruction
 Avoid alcohol, sleeping pills, and sedatives
 Avoid heavy meals
 Quit smoking
Wikipedia Dr.Jaana Sippus, Waled Congress 01-02, May 2014, Aachen
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Treatments Options:
 Oral appliances
 Continuos positive airway
pressure –CPAP
 Palatal implants
 Uvulopalatopharyngoplasty –
UPPP
 Laser assisted uvulopalatoplasty
– LAUP
 Radiofrequency tissue ablation
 Alternative medicine
(Wikipedia)
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 Introduction
 Method
 Results
 Conclusion

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 Laser Treatment Option: NightLase

● Non ablative Er:YAG tightening of uvula, soft palate and
surrounding tissues.
● No anesthesia – no needles
● No pre or post-op pain
● Three 15 minute sessions over 2 months
● Immediate results from the 1st day (in average 50%
reduction)
by Jugoslav Jovanović, DDS, LAHA Expert clinical lecturer
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Treatment Method (1)

 Pretreatment of the patient
 No anesthesia or pre-medication is needed
 Post treatment
 Patients can restart their routine life immediately
 No special therapy or care after the laser treatment is needed
 Exclusion Criteria
 -Epilepsy (?)
- -Pregnancy
 -Patients having therapies with photosensitive drugs
 -Blood disease (Leucopenia, Leukemia, Anemia)
 -Malign tumor
 -TMJ disorders
Jugoslav Jovanović, DDS, LAHA Expert clinical lecturer

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 A fractionated laser beam is used at minimally
invasive settings:
- The laser beam is fired at soft intraoral tissue
with repetition rate of 10 Hz
- The laser beam is manually delivered across
the target, either vertically or horizontally
(depending on the region)
- 7-8 passes are performed across each region
(with 50% overlap)
- The treated tissue is thermally processed and
consequently, it shrinks

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Fotona LightWalker was used (Dualis XS, Fidelis Er III, AT Fidelis)
Fractional handpiece with following settings:
 Energy 560 mJ – 750 mJ at 7 mm spot
(Fluence = 1,46 J/cm2 - 1,95 J/cm2)
 Frequence = 10 Hz
Pulse duration = LP
 Overlap: 50%
 Passes: 7-8 per area
(plus 4 additional passes to finish the session)
 Sessions: At day 1, 15 and 45
 Dr.Jaana Sippus, Waled Congress 01-02, May 2014, Aachen

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 Treatment Method (4)
Parameter settings used for Light
Basic passes
Finalizing passes
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Treatment method (5)

Patient Classification
Mallampati classification
Class 1: Full visibility of tonsils, uvula and soft palate

Class 2: Visibility of hard and soft palate, upper portion of tonsils and uvula
Class 3: Soft and hard palate and base of the uvula are visible
Class 4: Only Hard Palate visible

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 Interview (Complete the Questionnaires, describe the procedure
and post-treatment period, establish possible contra indications,
establish treatment schedule 1-15-45 days)
 (Polysomnograph – if possible)
 Photo of oropharynix (definition of Malampati type)
 Protection of the patient and the stuff (laser goggles)
 Irradiation with Er:YAG laser
 Photo of oropharynix
 (Polysomnograph – if possible)
 Post treatment recommendation

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Regions to be treated
1 and 3:
anterior pillar extending to the
outer face up to the retromolar
region and posterior third of
the cheek
2 and 4 :
soft palate and uvula with
lower part of hard palate
5 and 6 :
posterior pillars and tonsils
7 and 8 :
lateral and bottom of the
tongue
l
Jugoslav Jovanović, DDS, LAHA Expert clinical ecturer
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Example of patient with

Mallampati class 2

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Mallampati class 3

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Mallampati class 4

NightLase Laser Snoring and Sleep Apnea Reduction
Treatment
Procedure showing
Area 2 treatment

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Procedure showing Snoreplasty treatment

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Post treatment recommendations
 Loose weight
 Avoid consumption of heavy meals two hours before
bedtime
 Avoid consumption of alcohol,coffein
 Avoid sedatives and relaxants
 Exercise breathing through the nose
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Introduction
Method
Results
Conclusion

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 Patient no1 before

NightLase treatment

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Patient no1 before NightLase Patient no1 after 1.NightLase

treatment treatment

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Patient no1 before NightLase Patient no1 after 2.Nightlase

treatment treatment

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Patient no1 before NightLase Patient no1 after 3.NightLase

treatment treatment

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 Patient no1 after 3

NightLase treatments

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Patient 2 before NightLase Patient 2 after 1. NightLase

Treatment Treatment

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Patient no2 before NightLase Patient no2 after 2. NightLase

treatment treatment

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Patient no2 before NightLase Patient no2 after 3 NightLase

treatments treatments

Patient no2 after NightLase
treatment

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Patient 3 Before NightLase Patient 3 After 3 NightLase

Treatment Treatments

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Patient no4 before NightLase Patient no 4 after 3 NightLase

treatment treatments

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Results collected by patient questionnaire
Patient Session Snoring Dry mouth Sore Throat Awakening Lack of sleep Pain of Tx
101 Tx3 3/10 0/10 2/10 0/10 0/10 0/10
102 Tx3 2/10 0/10 0/10 0/10 0/10 0/10
103 Tx3 2/10 1/10 2/10 0/10 0/10 0/10
104 Tx3 (-4)/10 0/10 0/10 0/10 0/10 0/10
105 Tx3 0/10 0/10 0/10 0/10 0/10 0/10
106 Tx3 1/10 0/10 0/10 0/10 0/10 0/10
107 Tx3 3/10 0/10 2/10 0/10 0/10 0/10
108 Tx3 3/10 0/10 0/10 0/10 0/10 0/10
109 Tx3 2/10 0/10 2/10 0/10 0/10 0/10
110 Tx2 1/10 0/10 1/10 0/10 0/10 0/10

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 Results 12
Total score before
10 patients
(4 M, 6 F ) 10
Average age: 49 8
(30-63) 6
Total score before
 Mallampati types: 4
2
I:0
II : 0 0
III : 1 101 102 103 104 105 106 107 108 109 110
IV : 9

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Total score after treatments
 Results 12
10 patients
10
(4 M, 6 F )
8 Before
Average age: 49 Tx1

6 Tx2
(30-63)
Tx3
4
 Mallampati types:
2
I:0 0
101 102 103 104 105 106 107 108 109 110
II : 0
III : 1
IV : 9

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 Results:
After the third treatment 120
patients were reporting 100
better than 85% 80
improvement. Average 60
improvement after one 40
treatment session was 51% 20
and after the second 0
session 61%.

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Durability of results:
 All patients reported the effect of NightLase

treatment to stay stable over post-op period of at
least one year.
 Five patients could leave CPAP-mask after the first
treatment.
 All patients reported snoring reduction but most
satisfactory was the improvement in sleep apnea.

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Satisfaction of NightLase therapy
All ( 100% )patients would

recommend NightLase
therapy to their friends
and relatives.

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Introduction
Method
Results
Conclusion

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Conclusions
NightLase is:
- Safe and efficient therapy for significant
improvement in snoring and sleep apnea
- Minimally invasive treatment; no need for special
preparation neither requires any post-op therapy
- No anesthesia is needed – well tolerated by patients
- Quick and easy treatment
- “Walk-in walk-out” treatment; no need for steril operational field
- High satisfaction among patients
- Long lasting effects – so far at least one year - 28months
Dr.Jaana Sippus Waled Congress 01-02 May 2014
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Thank You for your attention !
Dr. Jaana Sippus 2014 e-mail:

jaana.sippus@netikka.fi

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NightLase Procedure

-Laser Snoring and Sleep Apnea

Case presentations with 28 months Experience

Dr.Jaana Sippus, Waled Congress 01-02 May 2014, Aachen

Dr.Jaana Sippus, Waled Congress 01-02 May 2014, Aachen

Snoring is described in Wikipedia as the vibration of respiratory

Dr.Jaana Sippus, Waled Congress 01-02 May 2014, Aachen

Screenshot of a PSG system showing a central apnea. Wikipedia

There are three forms of sleep apnea:

Dr.Jaana Sippus, Waled Congress 01-02, May 2014, Aachen

What is an Obstructive Sleep

What is an Obstructive Sleep Apnea (OSA)?

ImTheraMed™ Dr.Jaana Sippus,Waled Congress 01-02 May 2014, Aachen

The severity of sleep apnea is determined by dividing the number of episodes of

15-30 Moderate OSA

Over 30 Severe OSA

Symptoms related to Obstructive Sleep Apnea

 Snoring with pauses in breathing (apnea)

Dr.Jaana Sippus, Waled Congress 01-02, May 2014, Aachen

It's estimated that approximately 30% to 50% of the US

Dr.Jaana Sippus, Waled Congress 01-02, May 2014, Aachen

Dr.Jaana Sippus, Waled Congress 01-02, May 2014, Aachen

Image Jugoslav Jovanović, DDS,

 Snoring is the vibration of

 Generally speaking, the

Dr.Jaana Sippus, Waled Congress 01-02, May 2014, Aachen

Dr.Jaana Sippus, Waled Congress 01-02, May 2014, Aachen

Self-treatment options for sleep apnea:

Dr.Jaana Sippus, Waled Congress 01-02, May 2014, Aachen

 Laser Treatment Option: NightLase

Treatment Method (1)

Jugoslav Jovanović, DDS, LAHA Expert clinical lecturer

Treatment Method (2)

Dr.Jaana Sippus, Waled Congress 01-02, May 2014, Aachen

Treatment Method (3)

 Sessions: At day 1, 15 and 45

 Dr.Jaana Sippus, Waled Congress 01-02, May 2014, Aachen

 Treatment Method (4)

Parameter settings used for Light

Treatment method (5)

Class 1: Full visibility of tonsils, uvula and soft palate

Dr.Jaana Sippus, Waled Congress 01-02, May 2014, Aachen

Treatment method (6)

Jugoslav Jovanović, DDS, LAHA Expert clinical lecturer

Treatment method (7)

Treatment Method (8)

Example of patient with

Dr.Jaana Sippus, Waled Congress 01-02, May 2014, Aachen

Treatment Method (9)

Example of patient with

Dr.Jaana Sippus, Waled Congress 01-02, May 2014, Aachen

Treatment Method (10)

Example of patient with

Dr.Jaana Sippus, Waled Congress 01-02, May 2014, Aachen

Treatment Method (11)

Dr.Jaana Sippus, Waled Congress 01-02, May 2014, Aachen

Treatment Method (12)

Procedure showing Snoreplasty treatment

Dr.Jaana Sippus, Waled Congress 01-02, May 2014, Aachen

Post treatment recommendations

Dr.Jaana Sippus, Waled Congress 01-02, May 2014, Aachen

 Patient no1 before

Dr.Jaana Sippus, Waled Congress 01-02, May 2014, Aachen

Patient no1 before NightLase Patient no1 after 1.NightLase