July 30, 2014

More on Sleep Apnea Home Testing

I would strongly urge you to have a talk with your insurance carrier before using any sleep apnea home test.

This is the only way to know what they will reimburse and to know if they want you to have a lab sleep study or if they will allow a home sleep apnea test.

I do not think my search has discovered all the home sleep test equipment or suppliers, but these are what I have found.

#5 - http://www.novasom.com/   This was covered in the previous blog.

I feel that all are FDA approved, but only numbers 2, 3, and 4 made mention of this on their website. I am not familiar with any of them since the two studies I had, were in a sleep study lab and I was hooked up to wires everywhere.

I personally prefer the lab sleep study, but I am aware of a few people that have use a home test sleep study kit. None of those I talked to could remember the name of the kit, but did say they were satisfied and were using a CPAP machine. Two of the individuals did comment that they had to have their machines adjusted twice after using them because the pressure was too low and they were still not feeling rested after using them for two or more weeks.

They all make claims that make me wonder. All are not very specific about how they handle testing or who owns the equipment. Some tell you that lab sleep studies cost as high as $2,600 when many sources say only $1,300. I know this varies by region and often by hospital. Home test kits seem to vary from $100 to $600 if they are telling the truth.

This is just another reason to talk to your insurance carrier before doing anything.

July 29, 2014

Sleep Apnea Home Testing

There are some changes taking place in sleep apnea testing. More people are being tested at home rather than being tested in sleep study labs. This is sensible from a cost standpoint and a reality in setting. Many people have strong objections to having wires attached to their head and other places. Then to sleep with an infrared camera watching them is often more than some people will tolerate. Other procedures vary between sleep labs.

Lots of people are reluctant to let a stranger watch them sleep,” said Dr. Michael Coppola, a former president of the American Sleep Apnea Association who is now the chief medical officer at NovaSom. NovaSom is the manufacturer of a home sleep-test kit that promises to streamline the process. In this blog, this will be the only one discussed. Other brands will be in a future blog, as I am not recommending any one home testing method. Read this blog in the NY Times about this home test.

Strict warnings come with home testing. Using the home sleep apnea test is not recommended for those with heart failure, emphysema, seizures, and a few other health conditions. The home test does not record brain waves as a hospital lab does. A home test can be fooled, but it is useful for many people who exhibit the warning signs of sleep apnea.

Severe apnea can be lethal. By starving the brain of oxygen all night quadruples the risk of stroke. This is the reason to be tested. If you have sleep apnea, you will often be given three alternatives. The first is lose weight, the second is have airway surgery, and the third is sleep with a CPAP (continuous positive airway pressure) machine.

Thank goodness, most sleep doctors do not recommend surgery. For most people surgery seldom solves the problem. If the surgery does not solve the problem, you cannot go back and repair or replace what was removed, plus surgery can be sore and irritating for several months. For some people losing weight will take care of the sleep apnea problem. Most people need to use the CPAP machine. If you use the CPAP and do lose the weight later, then you may be able to stop using the CPAP machine. I would urge talking with the sleep doctor before just stopping.

The NovaSom home testing kit requires three consecutive nights. The device arrives by mail and is returned by mail. You will wire it up yourself. A belt goes around your chest, a finger is poked into a blood-oxygen sensor, and a breath sensor is hooked over the ears and taped beneath the nose. Then each is plugged into a box about the size if a computer modem that is strapped to an arm.

Each morning, the device is plugged in to recharge it and while recharging the night's data is sent to NovaSom. After the three nights and a few days you will receive a call from a doctor as NovaSom, at which time you will be given the results of the test.

Sleep apnea is measured on the apnea/hypopnea index, or how many time per hour a person stops or nearly stops breathing for at least 10 seconds. The guidelines state that below five times per hour is minimal, five to 15 is mild, 15 to 30 is moderate, and more than 30 is severe.

One word of caution, the people promoting home test results may use statements to give you a false sense of security. While it is true that your own home is a more natural setting, claims that the home sleep apnea test kit is more accurate is very questionable. They also claim that lab monitoring creates false sleep scenarios.

From the two sleep studies I have had done, the hospital was the best even though I was watched the entire night. The other lab as not as comfortable, but it still proved I suffered from sleep apnea.

July 28, 2014

The Dangers of Sleep Apnea

Patients with OSA (obstructive sleep apnea) are at significantly higher risk for developing hypertension, diabetes, heart disease, obesity, and sudden death. If this does not get your attention, then nothing will. Personally, I have lost friends that had sleep apnea and would not do anything about it. Some had CPAP machines, but vanity ruled and they did not like the lines on their face from the mask straps, so would not wear the masks.

This video from 'youtube' should make you interested. If your wife, husband or someone you care about is too proud to do something about it, have them watch this video. If they snore, sound like they are gulping for air, wake up with headaches, has trouble staying awake during the day, has bad short term memory, or get confused doing more than one thing at a time, they may have sleep apnea.

After my experiences with sleep apnea before being prescribed a CPAP, I know I was better off after using it for a few days. Most men and many women think they can tough it out and won't do a sleep study. The men think it is not manly to use a CPAP machine while sleeping and many women do not like the lines the straps can leave and vanity takes over for both sexes.

If you need a CPAP and don't want to use it for yourself, at least use it for the ones you love. You might be surprised how restful you are after using it. Also, think of NFL star Reggie White. He decided he didn't need a CPAP machine and he died because of it.

I was having a lot of trouble staying awake when driving and when I had to stop and walk around the car to wake up, my wife always asked if I was getting enough sleep. Fortunately that day we were both seeing the same doctor and my wife mentioned my snoring and what she said was, it was as if I was gasping for air. He said you may have sleep apnea. He went on to examine my wife, and if you guess I went to sleep you would be right. When they woke me up, the doctor said you definitely have sleep apnea and I have scheduled you for a sleep study this evening since the sleep lab has an opening.

When I got to the sleep lab, I was very nervous and it took me a long time to go to sleep. Of course, in the morning they would not tell me anything except the time of my appointment to see the doctor. The next week, I was there for the appointment and was shown lots of graphs and then some statistics which showed that I had 116 apneas per hour for the four plus hours I did sleep, if you could call it that. The graphs showed the length of the apneas with the longest being almost 100 seconds. I don't remember the shortest other than there were a lot of them.

It was not surprising that was why I was tired and sleepy so much of the time. This was back in 2001 and when I took the prescription to the medical supply store, I was carefully fitted for a mask and shown how to use it. I was not shown how to reset the pressure or any other settings on the CPAP machine, as I would be required to bring it in for that. This was done once at about 5 years.

Once I was on Medicare, they required a sleep study and since then, I have received supplies and other replaceable parts covered by Medicare and my supplemental insurance.

July 27, 2014

Information for CPAP Users - Mask Liners

This blog is about an accessory piece of sleep apnea supplies. This is mask liners, which will help in the use of most masks, nasal and full face. The purpose is to provide a soft cloth cushion between the silicone and your skin. RemZzzs™ is an accessory to your mask, made from a special blend of naturally absorbent fibers that are designed to help absorb facial oil and moisture. Both the facial oil and moisture will help deteriorate the silicone in the mask.

In addition, when we sweat, a mask’s silicone cushion tends to lose its seal. This increased moisture usually results in a loss of air pressure, setting off an entire chain of events that can end with scenarios like burping and squealing noises from air leaks, constantly re-adjusting your mask, red marks, and skin irritation, never really getting a good nights’ rest, or eventually just throwing your mask on the floor! This is not the purpose or proper use of the mask.

In using the nasal mask liner, I have found that I have been able to slightly loosen the straps and still have a firm fit with few air leaks even when tossing and turning during my sleep. I have done several experiments to see what can be done to get more use from the CPAP nasal mask liners. The manufacturer strongly recommends using a new liner each night. I have found that if I am careful, turn the liner over, and carefully lay it out, I can use it for two nights. I have tried using it for three and four nights, but then there are problems of the air leaks happening again. The facial oils have filled the pores of the liner and it looses its effectiveness.

Washing the liners in my wife's delicates bag in the laundry does not work. The liner basically disintegrates, as it does not have a sewn edge holding it together. So I took eight of the used liners and soaked them for about four to five hours in a mild laundry soap. I did squeeze them to force the facial oils out two or three times. After rinsing them carefully two or three times to remove the laundry soap, I carefully laid them out on a sweater rack and laid a couple of paper towels over the top using a couple of large bamboo spoons to anchor the paper towels and let them dry. The reason for this is because the liners do curl over and make them more difficult to use and putting them in place when putting your mask on.

I have washed the mask liners up to ten times, but after the fifth washing, they only were effective for one use. After the sixth washing, the air leaks increased. Your results may vary. I have used paper towels under and over the liners with other anchors and that worked as well. Even laying this on the washing machine lid worked.  I also suggest leaving them flat between the paper towels until ready to use.

Yes, this is extra work, but until Medicare started paying for them, this helped me defray my costs. Most insurance now covers them with a co-pay.

July 26, 2014

Information for CPAP Users

I admit that I love my sleep apnea machine. It is a BiPAP and this means that two settings are input into the machine. The first is the lowest reading allowed and the second is the maximum reading allowed. Then the machine adjusts automatically between the two and provides the correct pressure. The minimum on mine is 10 and the maximum is 15. The average on the last printout obtained over 18 months ago was 12.5, with rare excursions to 10 and 15 and the majority of readings between 11 and 13.5. The data recorded includes sleeping time on a daily basis and averages.

There are different types of CPAP (continuous positive airway pressure) machines. Most insurance companies have a strict schedule of what they will cover and what they will replace and when. Do not try to get fancy, as they will not as a rule, allow exceptions to policy. Do talk to your insurance company and ask for the schedule.

Also, Federal law requires that sellers of sleep apnea equipment have a valid prescription on file before they ship or supply you with your machine or appliance. Yet there are many suppliers that are bypassing this having their own specialists ask some questions and prescribing internally. Not the wisest choice as then you will not know what pressure settings to use. Plus insurance may not reimburse you. Many of the internet advertising companies do not accept insurance or Medicare.

Because of the above, I would urge you to talk to your insurance company and find out what machines they will reimburse and cover. They may even be able to suggest the suppliers they prefer to use. I used a local supplier and Medicare reimburses the same supplier.

Speaking of Medicare, they will require another sleep study to determine your eligibility for equipment and supplies. I was required to have a sleep study in a facility separate from the hospital and I admit I was not happy with the schedule. Once the study was complete, Medicare received the results and authorized the equipment they would cover. I had three choices and no more. My supplier only carried two of the authorized machines.

The different types of machines are:

CPAP – Continuous Positive Airway Pressure

APAP – Auto Adjust Positive Airway Pressure

BiPAP – Bi-level Positive Airway Pressure

VPAP – Variable Positive Airway Pressure

Auto-titrating Continuous Positive Airway Pressure (To determine the concentration of (a solution) by titration or perform the operation of titration.) In this case, by pressure is titrated. This is the most complicated of the machines and possibly one I would be cautious about having.

After having an auto-titrating machine during the sleep study lab, I would still urge caution, but would not hesitate to consider having one. The one used for me was very quiet.

Then in addition to the above types, a determination needs to be made if you need a humidifier. This is where full disclosure to the prescribing doctor is very important. If you have allergies, sinus infections, regular colds or cold like flare-ups, sleep with mouth open and have many dry mouth mornings – discuss this information with your doctor to get the right machine and mask for you.

Next is the type of mask which will be best for you. Types are nasal masks, full-face masks, nasal pillow masks, and other headgear and chinstraps. The biggest problem is getting the correct one for you. Whoever is setting up the order should cover this and you should verify that you are getting the correct size of mask. Masks are normally small, medium, and large. There is not a standard and a medium in one type of mask may require a large in a different mask. They should also discuss with you whether you have seasonal or chronic allergies, whether you have a deviated septum, do you awaken with a dry mouth, do you need heated humidification, and they should measure your nasal bridge – average, tall, wide, narrow, or flat.

I cannot emphasize how important the two paragraphs above are. This is how you obtain the right equipment and the equipment that fits you and your needs. The next blog will cover an important accessory.

July 25, 2014

Some Signs You Need More Fat in Your Diet

I can only say that since childhood, I have seemed to know when I needed extra fat in my diet. My mother always wondered when I asked for fatty foods, but I always received them. Even as I have aged, there have been times that I craved foods with lots of fat. Currently I have needed to purchase my own foods for this, as my wife still believes in low fat. I have had her read articles that have proven that Ancel Keys was wrong, but she won't budge.

So when I want extra fat, I have to purchase them for myself and prepare them myself when she is working. The one time I wanted a piece of meat with lots of fat, she took it away from me and trimmed the fat off. Talk about a tasteless, dry meal! Fortunately, she was scheduled to work the next day. What a tasty meal!

Therefore, when I read Mark's Daily Apple blog, it did catch my attention. He named it 9 Signs You Need to Eat More Fat.

#1. You have dry skin.
Dry skin can indicate a lot of things, such as allergic reactions, imbalanced gut microbiota, topical exposure to abrasive chemicals. It often means that you simply need more fat in your diet. How so do we obtain the needed fat? Sebum is the body’s natural moisturizer, and we produce it in-house using the fatty acids that are available. Some of the fats come from our own body stores, while others have to come from the diet. Increasing fat intake, then, is a painless, simple way to potentially improve your skin’s moisture levels.

#2. You’re low-carb and feeling “off.”
Fat has bad connotations for some people. A person reduces carb intake to lose weight without realizing that they need to increase their consumption of fat to make up for some of the missing energy. They begin losing weight, but the exhaustion, lack of energy, and headaches make it hard to stick to the plan. Since fat is still bad for many people (though that’s changing), what happens all too often is a person will reduce carbs and keep their fat intake way too low. If they’re burning lots of body fat in the process, that can certainly help with energy needs, but most people will also need to increase the fat they eat.

#3. Your physical performance is below par.
People are quick to suggest upping carb intake when physical performance suffers. Depending on the nature of the performance, it may help in certain cases. But another macronutrient also plays a big role in physical performance - fat, specifically saturated fat. We use saturated fat as precursors to steroid hormones like testosterone. Without enough saturated fat in the diet, we can’t make enough testosterone. Without enough testosterone, we can’t build muscle, recover from our workouts, or enjoy that healthy feeling.

#4. Your joints ache.
Achy joints can mean different things to different people. You could have poor mobility, improper movement mechanics, and tight surrounding musculature and fascia. You could have arthritis. You could have suffered an acute injury that’s just now making itself known. Whatever the cause, reducing inflammation through dietary means can really help dull the pain and even improve the underlying issue. If you have a sore knee or a creaky hip, eat more fatty fish or increase your fish oil intake for a few days. The omega-3s are anti-inflammatory and have even been shown to improve symptoms in patients with rheumatoid arthritis. If animal models of osteoarthritis hold true for humans, omega-3 intake can even enhance wound and joint repair following joint injury.

#5. You have low HDL.
Getting regular exercise, moderate alcohol consumption, and weight loss all increase HDL. Health professionals are quick to mention those as viable options. However, eating more fat, particularly saturated and monounsaturated fats, can also increase your HDL. This isn’t very surprising, actually, as both exercise and weight loss involves the oxidation of stored body fat, which is similar to eating a bunch of animal fat. Maybe that’s one reason why losing body fat is so good for us and results in so many improvements to health markers. It inadvertently places us on a high-animal fat diet (regardless of the diet used to achieve the fat loss). Some fats are better than others at increasing HDL. Saturated fats like the ones in coconut oil increase HDL, while the PUFAs found in soybean oil tend to lower it.

#6. You’re never satisfied after meals.
Low-fat diets are notorious for making their followers extremely hungry, whereas low-carb, high-fat diets are well known for curbing out-of-control appetites. Most people attribute that to the higher protein content of low-carb diets. Both reduce appetite, to be sure. Plus, fatty cuts of meat, not just the lean meat, provides saturated and monounsaturated fats (along with protein). Saturated fats appear to confer the most satiety via the satiety hormone PPY, whereas monounsaturated fats from olive oil have favorable effects on another satiety hormone, GLP-1.

#7. You’re trying to love vegetables.
Edible vegetation is essential for optimal health. Maybe not ten cups a day of leafy greens or anything, but some really does help round out the diet and provide vital nutrients that are otherwise tough to get elsewhere. The problem for many people is the “edible” part of that equation. Plain vegetables simply don’t taste very good, at least until you develop a palate that can appreciate them. Here’s where fat comes in. Fat transforms vegetables into delicious meal additions. Steamed broccoli is tolerable plain. Toss it with some grass-fed butter, salt, and black pepper and it becomes irresistible. Toddlers, with their instinctual distrust of vegetation, develop a taste for even the dreaded Brussels sprout more quickly when paired with fat. Vegetables are loaded with vitamins, minerals, antioxidants, and fermentable fiber. They’re some of the healthiest things a person can consume, but you do have to actually eat them.

#8. Your mental edge seems dulled.
Part of the transition into lower-carb eating involves a period of mental dullness for many people. You’re eating fewer carbs, which means less glucose is available for your brain, and your metabolic system hasn’t quite caught up to begin burning fat and ketones efficiently for energy. But what if this persists? A number of studies show that eating specific fatty acids – medium chain triglycerides, whether found in refined MCT oil or in coconut oil – can improve cognitive function by increasing ketone availability. Interestingly, access to ketones (whether through ketosis or medium chain triglycerides) doesn’t impair the brain’s ability to utilize glucose. When the brain’s access to ketones increases, so does its uptake of glucose. Oh, and krill oil, which contains omega-3 fats in phospholipid form, may also improve cognitive function.

#9. You’re going out drinking.
If you plan on drinking more than a serving or two of alcohol, increasing your intake of certain fatty acids and decreasing your intake of others before can protect your liver from injury, reduce the toxicity, and diminish the resulting hangover. Saturated fats appear the most hepatoprotective, with the fats in dark chocolate and coconut/MCT oil being especially helpful. Linoleic acid/omega-6 is the most dangerous when drinking alcohol. You’ll get the best results by eating more SFA and less linoleic acid several days prior and up to drinking, since it takes a few days to shift the composition of your liver fat.

July 24, 2014

Researchers Say Pre-diabetes Label Unnecessary

Researchers from University College London and the Mayo Clinic have raised a few valid concerns, if, they had done their research properly. Too often, other factors drive research and not the true nature of research. In this case, financial considerations seem to be front and center and studies were hand picked to fit the researcher's agenda.

While people may not agree with me, this article should be read and people making their own determinations. At least the World Health Organization (WHO) has stated that the use of 'pre-diabetes' is discouraged to avoid any stigma associated with the word diabetes and the fact that many people do not progress to diabetes as the term implies. Bold is my emphasis.

I do agree that the term pre-diabetes is a poor term and causes most people that do not understand diabetes to ignore what they could do to prevent the full onset of type 2 diabetes. The following statement bothers me and is what raised red flags for me. “The authors (of the study) showed that treatments to reduce blood sugar only delayed the onset of type 2 diabetes by a few years, and found no evidence of long-term health benefits.”

With the total absence of education by the medical profession and researchers world wide, it is small wonder that people that develop type 2 diabetes are not aware that full onset of diabetes could be delayed or prevented. These same doctors even laugh about how they will have patients to treat until they retire because people will progress to diabetes and then to the complications. This is a typical reaction by doctors that do not understand diabetes.

"Pre-diabetes is an artificial category with virtually zero clinical relevance," says lead author John S Yudkin, Emeritus Professor of Medicine at UCL. "There is no proven benefit of giving diabetes treatment drugs to people in this category before they develop diabetes, particularly since many of them would not go on to develop diabetes anyway. Sensibly, the WHO and NICE and the International Diabetes Federation do not recognize pre-diabetes at present but I am concerned about the rising influence of the term.”

While I doubt this study will do anything to cause action by the American Diabetes Association (ADA), we can hope that the ADA will make the readings above 99 mg/dl,
part of the diabetes spectrum. There can be serious complications developing in this area called pre-diabetes. These complications vary by individual and with most doctors ignoring pre-diabetes and declaring that nothing happens, more people will continue to develop complications.

July 23, 2014

More Diabetes Management Tips Part 2

This is a continuation of the previous blog with five tips.

#6. Fight Everyday Stress With Activity. Living with diabetes can make you sad or unhappy at times. Stress not only affects your mood, but it can raise your blood glucose levels. Stress may cause you to make poor food choices and drink more alcohol. An easy way to feel better from everyday stress is to become active. Being active raises the levels of chemicals in your brain that make you feel good. If you don't want to exercise in a gym, join a sports team or take dance lessons to keep moving. Swimming is also another way to stay active.

#7. Exercise in Short Sessions, If Needed. Finding the time to exercise may be hard for some people. It can also be hard to keep going if you're not used to exercising for 30 minutes straight. The good news is you can spread your 30 minutes throughout the day. Three 10-minute walks are as good as 30 minutes at once. So don't hold out to exercise when you have a lot of time. Moderate physical activity (both strength building and cardio) will help you control your blood glucose, lower your blood pressure and cholesterol, and reduce stress.

#8. Try Strength Workouts If You Are Able. All types of exercise can benefit people with diabetes. But training with weights or other resistance equipment may help you prevent muscle loss (lost muscle often leads to more fat). Several studies suggest strength training. Lifting weights, for example, improves your reaction to insulin and your glucose tolerance. Of course, regular strength training can also improve your muscle mass and help you lose weight, too.

#9. Check Your Feet Every Night. Use a hand mirror or ask someone to help you look for cuts, swelling, or color changes on your feet. Don't forget to look between your toes, too. If you see unhealed cuts or broken skin, call your doctor right away. Make foot care part of your daily routine. Wash and moisturize your feet and trim your toenails as needed. Talk to your doctor about treating corns or calluses. Have your doctor examine your feet during every appointment.

#10. Choose a Date to Quit Smoking. If you smoke, picking a date to quit gives you the chance to prepare for it. You may need help beating the mental and physical parts of nicotine addiction. Stop-smoking programs, support groups, and wellness centers can offer professional help. Whether you quit cold turkey or use other treatments to help you quit, having time to prepare for it may improve your chances of success. Choose what works for you and quit as soon as possible.

#11. Drink Alcohol Only With Food. Your doctor may say it's OK for you to have an occasional drink. Drink alcohol only when you can eat something along with it, because alcohol can cause low blood sugar. Also have some water handy in case you get thirsty. Even so, mixed drinks can raise your blood sugar if you use juice or a regular soda as your mixer. Women should drink no more than one alcoholic drink per day, and men no more than two a day. Or I would suggest stop alcohol consumption completely.

I have said this before, but it is worth repeating. Keep a positive attitude. This will serve you well.

If you have other things that help you manage diabetes, make use of them and don't forget them. Every person varies in their management and abilities to manage diabetes, but this should not deter you from managing your diabetes to the best of your abilities and seeking help from others, if needed. Your doctor may be one of these persons as well as your pharmacist.