August 2, 2014

Sleep Apnea Treatments

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 apnea include:
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:
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

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 = .

Oral appliances. 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. 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.

August 1, 2014

Sleep Apnea, Appointment Preparation

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 doctor directly.

Hopefully some of these tips from the Mayo Clinic will be helpful.
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 life changes.
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 your doctor.”

Again this can be important for sleep apnea. I again turn the the Mayo Clinic:

What's the most likely cause of my symptoms?
Are there other possible causes for my symptoms?
What kinds of tests do I need?
Do these tests require any special preparation?
Is my condition likely temporary or long lasting?
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 recommend?”

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 providing information.
#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 symptoms?
#5 Does anything worsen your symptoms, such as sleep position or alcohol consumption?
#6 Are you aware if you stop breathing during sleep?
#7 Is there anything that has helped your symptoms?

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.

July 31, 2014

Making Sense of Lab or Home Sleep Apnea Testing

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 include:
#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 testing.

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 disorders.

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 proper assessment.

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 -   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.