Welcome! This is written primarily for people with Type 2 Diabetes. Some information covers all types of diabetes. Always keep a positive attitude is my motto.
I am a person with diabetes type 2 and write about my experiences and research. Please discuss medical problems with your doctor. Please do not click on the advertisers that have attached to certain words in this section. They are not authorized and are robbing me by doing so.
For mild and some moderate cases of
sleep apnea, doctors may recommend only lifestyle changes, such as
losing weight or quitting smoking if applicable. Another suggestion
may be be using supports to help you sleep in your side. If these
suggestions don't improve your signs and symptoms then you may be
required to use the equipment for moderate to severe sleep apnea. As
a last resort, you will be assessed for different types of surgery.
Treatments for moderate to severe sleep
Continuous positive airway
pressure (CPAP). If you have moderate to severe sleep apnea,
you may benefit from a machine that delivers air pressure through a
mask placed over your nose while you sleep. With CPAP (SEE-pap), the
air pressure is somewhat greater than that of the surrounding air,
and is just enough to keep your upper airway passages open,
preventing apnea and snoring.
Although CPAP is the most common and
reliable method of treating sleep apnea, some people find it
cumbersome or uncomfortable. Many people give up on CPAP, but with
some practice, most people learn to adjust the tension of the straps
to obtain a comfortable and secure fit. You may need to try more
than one type of mask to find one that's comfortable. Some people
benefit from also using a humidifier along with their CPAP system.
Also see my blog here for an accessory that will help prevent air
leaks and allow for slightly less strap tension.
Don't just stop using the CPAP machine
if you experience problems. Check with your doctor to see what
modifications can be made to make you more comfortable.
Additionally, contact your doctor if you are still snoring despite
treatment or begin snoring again. If your weight changes, the
pressure settings may need to be adjusted.
There are other equipment options.
Adjustable airway pressure
devices. If CPAP continues to be a problem for you, you may
be able to use a different type of airway pressure device that
automatically adjusts the pressure while you're sleeping. For
example, units that supply bilevel positive airway pressure (BPAP
BiPAP) are available. These provide more pressure when you inhale
and less when you exhale.
The other types of positive airway
pressure machines are:
Expiratory positive airway
pressure (EPAP). This is the most recent treatment approved
by the Food and Drug Administration (FDA). These small, single-use
devices are placed over each nostril before you go to sleep. The
device is a valve that allows air to move freely in, but when you
exhale, air must go through small holes in the valve. This increases
pressure in the airway and keeps it open. The device helped reduce
snoring and daytime sleepiness when compared to a sham device And,
it may be an option for some who can't tolerate CPAP. Read this for
further explanation =
Another option is wearing an oral appliance designed to keep your
throat open. CPAP is more reliably effective than oral appliances,
but oral appliances may be easier to use. Some are designed to open
your throat by bringing your jaw forward, which can sometimes relieve
snoring and mild obstructive sleep apnea.
A number of devices are available from
your dentist. You may need to try different devices before finding
one that works for you. Once you find the right fit, you'll still
need to follow up with your dentist at least every six months during
the first year and then at least once a year after that to ensure
that the fit is still good and to reassess your signs and symptoms.
One option not found in any of the
medical articles is this device. Now
that you have digested all of this, consider if you want a mask and
check out this site. https://www.nomask.com/index.cfm
This needs to be considered by some people. Not everything works for
every person. There could be medical reasons making this more
important than the masks.
This will vary some by who is the sleep
doctor. My appointments have varied in length from 15 minutes to
more than 30 minutes depending on what was to be covered.
Preparation is important. Some people will need to see their regular
doctor for a referral while others will be directed to the sleep
“Be aware of any
pre-appointment restrictions. At the time you make
the appointment, be sure to ask if there's anything you need to do in
advance, such as modify your diet or keep a sleep diary.
Write down any symptoms
you're experiencing, including any that may seem
unrelated to the reason for which you scheduled the appointment.
Write down key personal
information, including any major stresses or recent
Make a list of all
medications,vitamins or supplements
that you're taking.
Ask a family member or
friend along, if possible. Someone who accompanies
you may remember information that you missed or forgot. And, because
your bed partner may be more aware of your symptoms than you are, it
may help to have him or her along.
Write down questions to ask
Again this can be important for sleep
apnea. I again turn the the Mayo Clinic:
“What's the most likely cause of
Are there other possible causes for
What kinds of tests do I need?
Do these tests require any special
Is my condition likely temporary or
What treatments are available?
What are the alternatives to the
primary approach that you're suggesting?
Which treatment do you think would
be best for me?
I have other health conditions. How
can I best manage these conditions together?
Should I see a specialist?
Is there a generic alternative to
the medicine or product you're prescribing me?
Are there any brochures or other
printed material that I can take home with me?
What websites on sleep apnea do you
Don't hesitate to ask additional
questions during your appointment.
Next, here are some questions your
doctor may ask you: This is when a spouse may be able to assist in
#1 When did you first notice symptoms?
#2 Are the symptoms consistent?
#3 How severe are the symptoms?
#4 How does your partner describe you
#5 Does anything worsen your symptoms,
such as sleep position or alcohol consumption?
#6 Are you aware if you stop breathing
#7 Is there anything that has helped
Between now and your appointment, the
following are things that you can do to help. Sleep on your side if
possible since most forms of sleep apnea are milder then. Avoid
alcohol close to bedtime and reduce the amount of alcohol consumed as
this tends to cause obstructive and complex sleep apneas to worsen.
If necessary, confer with your doctor to stop prescription sleep aids
and stop all over the counter sedative medications, as they also
worsen sleep apnea.
Lastly, if you have trouble with
wanting to fall asleep while driving, forget driving and ask someone
to drive for you. Even is you live alone, consider having a friend
do your driving if possible.
Home sleep apnea tests don't always
detect cases of sleep apnea and most don't detect other sleep
disorders. Yet because they are inexpensive, many insurance carriers
are not allowing the sleep study labs, except as a last resort. The
Mayo Clinic does say the following: “Your doctor may make an
evaluation based on your signs and symptoms or may refer you to a
sleep disorder center. There, a sleep specialist can help you decide
on your need for further evaluation. Such an evaluation often
involves overnight monitoring of your breathing and other body
functions during sleep.”
Tests to detect sleep apnea may
#1 - Nocturnal polysomnography.
During this test, you're hooked up to equipment that monitors your
heart, lung and brain activity, breathing patterns, arm and leg
movements, and blood oxygen levels while you sleep.
#2 - Home sleep tests. In some
cases, your doctor may provide you with simplified tests to be used
at home to diagnose sleep apnea. These tests usually involve
measuring your heart rate, blood oxygen level, airflow and breathing
patterns. If you have sleep apnea, the test results will show drops
in your oxygen level during apneas and subsequent rises with
awakenings. If the results are abnormal, your doctor may be able to
prescribe a therapy without further testing.
Portable monitoring devices don't
detect all cases of sleep apnea, so your doctor may still recommend
polysomnography even if your initial results are normal.
A USA Today story on the other hand
promotes home sleep study tests. While they do present both sides,
have no doubt that home testing is favored.
This is the attitude of many insurance
carriers. "You get to sleep in your
own bed with your own pillow," said Dr. Laddie Tackett, medical
director for Anthem Blue Cross and Blue Shield in Kentucky. "It
makes testing more accessible. It makes it more affordable. It
makes it more convenient." But many doctors are
skeptical. They say in-home tests -- which make up a small
percentage of overall sleep tests -- aren't as thorough as lab
The amount of data from a home study is
significantly less than what is obtained from a lab sleep study. I
can confirm that walking around with untreated sleep apnea is no fun
and can be very wearing on your body. It took me about three weeks
to feel fully rested and another month to feel like my body had
healed from the wear sleep apnea had caused.
The home study equipment varies, but
should include something that measures air flow, an instrument that
measures the effort people make during respiration, and a finger
device that measures blood oxygen saturation. The air flow sensor is
placed under your nose, the respiration effort belt goes around your
chest, and the oxygen saturation clip in put over your finger
(generally next to the thumb).
Tackett says the home study equipment
is relatively easy to use and most patients usually do well in the
home setting. There is much discussion still taking place about
where home testing fits into the overall sleep disorder setting.
The lab sleep study equipment is
extensive. It includes about 25 sensors for the head, legs, and
other body areas, two belts to monitor breathing and respiratory
effort, and snoring microphones. The equipment measures breathing,
air flow, respiratory effort, heart rate, oxygen levels, brain waves,
snoring, and leg movements. It can detect about 80 types of sleep
Many doctors believe that it is a
misconception that patients always sleep better at home and I would
agree. Just knowing that your sleep study is being monitored with
equipment that can determine if it is just sleep apnea or has other
sleep disorders involved can make sleeping in a lab quite comforting.
Some patients will require lab tests
before a CPAP machine is prescribed to determine is there are other
sleep disorders present. Both the home and lab may have advantages
and disadvantages and this is why a sleep specialist should do a
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.
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
“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.
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
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.
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.