The Gelb Center of NYC and White Plains, New York provides time-tested best in class treatment of sleep disorders. Patients from around the world with sleep disorders, including sleep apnea, seek out Dr. Michael Gelb’s top-rated treatments for their particular sleep disorder. The Gelb Center’s team of doctors offer a comprehensive inpatient diagnostic and treatment service for patients with primary sleep disorders including; obstructive sleep apnea, hypopnea, upper air way resistance syndrome, periodic limb movement disorders, Bruxism, parasomnias and more.
- Dr. Michael Gelb is the co-inventor of the NORAD, or Nocturnal Oral Airway Dilator for Sleep Apnea and the Airway Centric ™ medical device.
The sleep specialist Michael Gelb, DDS, MS has earned the prestigious award of Top Doc New York® multiple years in a row and is a NYC top rated, best in class sleep specialist / sleep disorder specialist doctor on Vitals, HealthGrades, MakeMeHeal, Google+, RateMDs, and other doctor’s services rating websites. Dr. Gelb has been featured as a TMJ and Sleep Apnea / Sleep Disorders authority in The New York Times, The Chicago Tribune, Fox News, Fox Business News, CBS, CNN, Women’s Day, The Doctors, ABC News, CBS News, and other national and international newspaper and networks.
- For patients with sleep disorders, including sleep apnea, The Gelb Center now offers two affordable, patient friendly, at-home sleep test systems, which aid in patient screening, clinical assessment, and treatment to restore peace and quiet to your bedroom.
Snoring, obstructive sleep apnea, clenching, sleep bruxism, and excessive daytime fatigue and poor concentration and memory loss are the most common complaints from our sleep disorder patients. Snoring is the sound that is made when there is an obstruction as the air tries to move across the soft palate. Treatment for snoring ranges from improving nasal breathing through allergy treatment, sprays or surgery. Losing weight and sleeping on one’s side can be helpful for some people, while oral appliances are also effective for many snorers.
Many of our TMJ and pain patients also sleep poorly and suffer from breathing related sleep disorders as well as sleep fragmentation. Several of our female TMJ patients sleep with loud snorers which can also fragment sleep. Some snorers do not seem to be disturbed by the noise they make as they try to catch their breath, but, in fact, if you were to measure the quality of their sleep, you would find they suffer from wakefulness. Such sleep is generally not restful (neither for the snorer or the snorer’s partner) and if untreated, can lead to significant medical problems. This condition causes fragmented sleep, in essence because the snoring person doesn’t have a chance to recover.
Signs and symptoms of fragmented sleep: Excessive daytime sleepiness, waking up gasping for air, depression, high blood pressure, morning headache, poor memory, neck size over 17, poor sleep quality, loud snoring, and waking up tired.
Sleep Disorder Treatments: There are several treatment options that our NYC and White Plains, NYC sleep specialist doctors may prescribe for your sleep disorder. Some sleep disorders treatments may include:
- Continuous Positive Airway Pressure (CPAP) Machine: For those patients suffering from sleep apnea, a CPAP machine is often used as a treatment option. With the CPAP Machine, users will experience a continuous level of positive airway pressure while they sleep.
- Polysomnogram (PSG) or Sleep Study: Many patients come to The Gelb Center with a copy of their PSG and a diagnosis of sleep apnea. The American Academy of Sleep Medicine (AASM) recommends oral appliances as a primary treatment for mild and moderate sleep apnea. The PSG measures how many obstructive breathing events occur each hour as well as oxygen desaturation levels throughout the night. The percent of the night in Stage 1, 2, 3, 4 NREM as well as REM is measured. Patients who snore and obstruct while laying on their back do better with oral appliance therapy. Lack of stage 3 and 4 NREM can lead to fatigue and widespread muscle pain. Restorative sleep is when repair and regeneration occur and a human growth hormone is released.
- Nose Remedies: Air is warmed, filtered and humidified by the nose before it descends in to the lungs. Blockage can occur from enlarged turbinates, nasal polyps or a deviated septum. An ENT doctor or allergist should be consulted if nasal congestion persists. In allergy season or during a cold, snoring worsens because the nose is congested. Rhinometry and Cone Beam CT (CBCT) are helpful diagnostically to determine the cause of nasal congestion.
- Oral Appliances: The Gelb Center has been using and developing oral appliances for sleep medicine for over 27 years. Oral appliances work by maintaining a forward position of the tongue and soft palate as well as widening the lateral pharyngeal walls. It accomplishes this feat mechanically as well as by stimulating the oropharyngeal muscles. Oral appliances are titrated to an optimal position to alleviate fatigue and snoring and to reduce apneas and hypopneas. Follow up home sleep studies are routinely used to ensure effectiveness of treatment. Oral appliances may include: Norad™ appliance, Full Breath Solution™ , or Respire™
- Bruxism Treatments: Bruxism refers to clenching and grinding of the teeth. The Gelb Center offers advanced treatment of bruxism in NYC and White Plains, New York. Bruxism is a stereotyped movement disorder which occurs during sleep. It is typically accompanied by grinding of the teeth and clenching of the jaw. It can therefore overload the TMJ as a repetitive strain injury and exacerbate muscle pain as well. The treatment of sleep bruxism continues to evolve. At The Gelb Center we use 3 approaches:
- Oral appliances
- Botox Injections
- Risk Factors For Sleep Bruxism: The number one risk factor for sleep bruxism is obstructive sleep apnea. Sleep bruxism is common in the general population and represents the third most frequent parasomnia. It has numerous consequences, which are not limited to dental or muscular problems. Among the associated risk factors, patients with anxiety and sleep disordered breathing have a higher number of risk factors for sleep bruxism, and an educational effort to raise awareness of dentists and physicians about this pathology is necessary. We realize that sleep bruxism is a central nervous system phenomena. Certain SSRI medications actually worsen bruxism.
Options for Sleep Apnea Patients at our NYC and White Plains, New York offices:
- A continuous positive airway pressure (CPAP) machine may be prescribed for the treatment of sleep apnea at home. The CPAP machine, by delivering a stream of compressed air through a hose to a device such as a nasal pillow, nose mask or full-face mask, splints the airway (keeping it open under air pressure) so that unobstructed breathing becomes possible. These result in a reduction or prevention of waking episodes called apneas and hypopneas. CPAP is generally prescribed for severe apneics with an AHI greater than 30.
- For those who suffer from mild to moderate apnea there are other options. Oral appliance therapy is a first line or primary treatment for mild to moderate apnea. This is where The Gelb Center is considered a Center of Excellence.
- ENT evaluation may be helpful in diagnosing obstruction to allow better outcomes in all types of apnea and snoring.
- Orthognathic jaw surgery is an option in more extreme situations where the jaws are more retruded.
At The Gelb Center our modern technology allow our Sleep Specialists / Sleep Doctors to visualizes the nose, sinuses, jaw bone, TMJ, tongue and palate in 3 dimensions:
- CBCT: (Cone Beam Ct) allows 3 dimensional visualization of the airway, and ENT analysis of the nose and sinuses.
- Pharyngometry and Rhinometry: Acoustic eccovision allows volumetric measurement of the tissue in the nose and throat which can block the airway. With this technology, ideal jaw positioning can be achieved.
- EndoPat 2000: This Itamar Medical device allows the doctors at The Gelb Center to measure endothelial dysfunction which is the most dangerous risk factor for cardiovascular disease. ED can be corrected with CPAP and oral appliance treatment.
- Home Sleep Studies: At The Gelb Center, home sleep studies are used to monitor the effectiveness of our various oral appliances. These studies measure apneas and hypopneas per hour of sleep as well as oxygen saturation levels throughout the night. Some units even measure the amount of deep and REM sleep. We can titrate the oral appliances with multi-night home studies. Examples of home sleep monitors include: the ARES, Watch Pat 200, Braebon, Embletta, and Nox T3.
ENT/Sleep Studies: One of the fastest-growing areas for CBCT scanning technology is among ENT physicians and surgeons. CBCT has, in an important sense, become the standard of care for this branch of medicine. Because they provide accuracy far superior to conventional cephalograms, CBCT scans are now used not only for diagnostic imaging for such conditions as ZMC fractures and other cranio-facial trauma, they’re also used in intra-operative applications. One of the growing areas of application for this technology is CBCT-based surgical navigation. Now maxillo-facial surgeons can process the same 3D images they’ve utilized for diagnosis through software programs that can be used to guide them during surgery.
CBCT imaging also enables dentists and ENT physicians to uncover other problems, such as air passage abnormalities, that are instrumental in causing such conditions as sleep apnea. As with many dental specialties, CBCT cephalometric imaging is changing the paradigm for ENT physicians and maxillo-facial surgeons.
NewTom NNT analysis software and Anatomage enables The Gelb Center NYC and White Plains sleep specialists to realize the greatest benefit from three-dimensional CBCT images. It allows the dentist to perform initial diagnoses and subsequently to superimpose images for assessing growth, treatment changes, and the stability of treatment. The software supports the identification of such things as root inclination, positioning of impacted and supernumerary teeth, resorption, hyperplastic growth, and tooth structure anomalies.
NewTom Implant Planning Software (NIP) enables The Gelb Center to utilize CBCT images to create detailed plans for performing implant surgery on your own personal computer. It provides accurate assessment of the thickness and morphology of bone at implant anchorage sites, as well as supporting unequaled quality panoramic, axial, and cross-sectional images.
You can simulate the implant position on 3D models, identify the mandibular canal, draw panoramics and cross sections of the bone model, show the 3D bone model and calculate the bone density. Using NewTom Implant Planning the Dentist can plan the prothesis implant operation in a safer, more efficent and faster way.
At The Gelb Center of NYC and White Plains, New York, a thorough evaluation is performed by our NYC Sleep Specialist doctors. The anatomical structures which can contribute to sleep disorders and/or sleep apnea including the:
- Soft Palate
- Upper jaw
- Lower jaw
- Deviated Septum
- Nasal polyps
- Clenching muscles
Orthodontic Treatments: Because NewTom CBCT scan images eliminate the linear projective transformation errors, including distortion and magnification, that plague 2D imaging, they’ve become the method of choice for orthodontic diagnosis and treatment planning. In fact, so effective are CBCT images at reconstructing with great accuracy the maxillo-facial structure of orthodontic patients that they have virtually eliminated the need for several steps in the conventional orthodontic treatment process.
Once the image data has been captured, it can be used to create three-dimensional “virtual models” that enable The Gelb Center to visualize electronically without having to take impressions and wax bites. This saves time for the dental professional and eliminates the need for the unpleasant and often messy practice of creating plaster models.
In addition, it is now possible for The Gelb Center’s sleep doctors to locate impacted molars and cuspids and to measure the dimensions of the alveolar bone with great accuracy. And the technology makes it possible to assess with a high degree of confidence the amount of resorption of adjacent teeth that has occurred and to precisely determine the potential for orthodontic tooth movement.
CBCT imaging means more accurate and economical record-keeping for the Patient. The typical orthodontic post-treatment process used to mean double-pouring the model from which the patient’s retainer was made and preserving it as a final study model, taking lateral head and panoramic x-rays, and photographing the patient. With CBCT, these steps are unnecessary. All that’s required is to take a final cone beam scan and take photographs. This represents important time, space, and money savings for the Patient.
If you currently experiencing Sleep Apnea or a Sleep Disorder please feel contact the best in class, top rated Sleep Apnea / Sleep Disorder specialist, Dr. Michael Gelb’s NYC or White Plains, New York office today.
The Gelb Center of NYC
635 Madison Avenue, 19th Floor
New York, NY 10022
P: (212) 752-1662
The Gelb Center of White Plains
12 Old Mamaroneck Road, Suite 1C
White Plains, NY 10605
P: (914) 686-4528