Tuesday, August 26, 2014

Impotence and Sleep Apnea

Thus far, I've written quite a bit on the subject of obstructive sleep apnea (OSA). I've described many sequelae resulting from OSA. Some of these include diabetes, hypertension, obesity and many others. There are so many medical problems that are directly attributable to OSA and are therefore impossible to list them all here. Please read my other blogs regarding this topic to get a more thorough perspective on the subject.

This week I will discuss the link between OSA and impotence or erectile dysfunction (ED). Men that suffer from sleep apnea are twice as likely to experience ED. There are many potential reasons. We will focus our discussion on two major reasons. 

  • Vasculature to the penis
  • Hormonal regulation
Vasculature to the penis

Blood oxygen levels should be as close to 100% as possible. We start to worry when a person starts to drop into the low 90's. Amazingly, I've seen some of my patients drop into the 60's! They are dying every single night!

Sleep apnea decreases blood oxygenation levels. We have known for years that chronic low blood oxygenation levels adversely affects the vasculature of many organ systems such as the heart, lungs, kidneys, liver and brain. 

In the case of ED, the vasculature of the penis is greatly diminished. In order to have an erection, blood must flow to the penis. After many years of vascular damage from diabetes, hypertension and/or high cholesterol, the effects are quite predictable. By the way, I have written about these links (with sleep apnea) as well. There are many complicated interconnections with these disease processes.

Hormonal Regulation

Testosterone, estrogen and many other hormones are best regulated when we get into the deeper levels of sleep. A person that suffers from sleep apnea has difficulty getting to the deeper levels of sleep.

In order to have an erection, sex hormones must be finely regulated. We believe that when a person sleeps, at least 20% of the night should be at the REM (rapid eye movement) level. Just the other day, one of my patients was only there for approximately 1.7% of the night! That was the lowest I've seen with my patients. I was amazed.

Another consideration in the lack of testosterone is a decreased sex drive. No sex drive……no sex.


Fortunately, when sleep apnea is treated, a high percentage of men have their ED resolved. In fact, many couples report a significant increase in the frequency and quality of sex.

Women, pay attention……even though this blog was about men, women that suffer from sleep apnea also suffer from sexual dysfunction.

It is important to know that if you or a loved one has experienced ED, it certainly is a problem. But, please be aware that this may be the least of your worries since it may only be a warning sign for many more serious and potentially lethal medical conditions.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit www.advanced-smiles.com

Sunday, August 17, 2014

Gender Differences in Oral Health

Is there a difference between men and women regarding their oral health? There have been numerous studies in many different countries that were aimed at figuring out the differences.

Here are ten findings from various studies:

  • Women are more likely than men to brush at least twice a day.
  • Women use fluoride toothpaste more than men.
  • Women have a higher dental IQ.
  • Women are more likely to floss.
  • Women value their teeth more.
  • Women visit a dentist more frequently.
  • Women are much less likely to lose a tooth from trauma.
  • Women are far more likely to be embarrassed by an unattractive smile.
  • Women are more likely to notice missing teeth in other people.
  • Men are more likely to try to fix a minor dental problem themselves.

These are just statistical findings. You will of course see many men with superb dental health and many women with poor oral health.

Ladies, get the men/boys in your lives to significantly improve their oral health. They may not do it on their own.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit www.advanced-smiles.com

Thursday, August 7, 2014

Dry Mouth (Xerostomia)

Xerostomia (dry mouth) is a condition where the salivary glands do not produce adequate amounts of saliva. The problems can range from mild temporary discomfort to significant and permanent health issues.

This condition affects approximately 10% of the population. Women, the elderly and people that take certain medications make up the majority.

The Effects of xerostomia:
  • Tooth Decay
  • Difficulty eating and digesting properly
  • Difficulty with speech
  • Sores and ulcers
Some of these are obvious. I'll elaborate on just a couple to keep this blog a short quick read.

Tooth decay is a common issue when there is diminished salivary output for a couple of reasons. First, the saliva helps dilute and wash the foods away from the surfaces of the teeth. It is also beneficial in neutralizing the acidity of many foods. One other benefit of saliva is it's antibacterial properties. It helps keep oral bacteria in check.

Difficulty with speech can become a challenge. When the mouth is dry we have difficulty making "S", "T", "F" and "V" sounds. Try it the next time you have a dry mouth.

  • Certain medications
  • Certain diseases 
  • Radiation and Surgery
  • Dehydration
  • Smoking
  • Mouth Breathing
Again, most of these are obvious. I'll elaborate on a few things.

Medications are the most common cause for a dry mouth. There are too many medications to list. Here are a few: medications for blood pressure, asthma, diarrhea, nausea, obesity, acne, Parkinson's disease, antidepressants, antihistamines, antiepileptics, decongestants, diuretics, and non-steroidal anti-inflammatory drugs. All of these can decrease salivary production.

Diseases like Sjogrens, Systemic Lupus Erythematosis, diabetes, mumps and cystic fibrosis are just some that can cause xerostomia.

Radiation to the head and neck is often administered in an effort to kill cancer cells in the region. Unfortunately, the cells lining the salivary glands are also destroyed.

It is easy to see how dehydration can occur from a lack of fluid intake. What may not be as obvious is that dehydration can also occur from diarrhea, burns, vomiting, fevers, excessive sweating and blood loss.


It all depends on what the true cause is. Some causes are easy to address whereas others are impossible. There are some over-the-counter salivary substitutes that may prove helpful. Speak to your physician or dentist to see what is best for you.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit www.advanced-smiles.com