Some Problems the Elderly Have for Sleep

A doctor writes the article I am using for this blog and she chooses to label it, ”5 Top Causes of Sleep Problems in Seniors.” I am certain that Dr. Leslie Kernisan understands this topic far better than I do, but I do feel she left much out of the discussion on sleep apnea.

There are several warnings that should be issued. First, even though mortality is mentioned, there should be a clear warning about obstructive sleep apnea causing death and/or heart attacks. Even central sleep apnea can cause serious health problems.

I have had sleep apnea since 1999 and have had treatment since 2001. I use a CPAP mask every night. I have progressed from the original CPAP to a machine known as a Bi-PAP machine, which is much quieter and more efficient. I am not like many people that have problems and either won't wear the mask or only use it part of the night. Two friends have moved to an oral device and say they like the device better than the mask. Two other friends like using the mask and are using their machine every night, like I do.

Doctors use a language seldom used by patients. Sleep apnea is no different. They use sleep-related breathing disorders (SRBD) and it is sometimes referred to as sleep-disordered breathing (SDB). The SDB is an umbrella term covering a spectrum of problems related to how people breathe while asleep.

Sleep apnea (as most patients know it) is a common condition, which is important to have diagnosed since it has been associated with many other health problems, especially in adults of middle age. In sleep apnea, a person has frequent pauses in their breathing during sleep. The most common form is obstructive sleep apnea (OSA), in which the breathing pauses are due to obstructions in the breathing passages. OSA is often associated with snoring. A less common form is central sleep apnea, in which the breathing pauses are related to changes in the brain.

The likelihood of having sleep-disordered breathing disorders goes up with age. It’s also more common in men, and in people who are overweight. In one study of 827 healthy older adults aged 68, 53% were found to have signs of SRBD, with 37% meeting criteria for significant sleep apnea. Interestingly, most participants did not complain of excess sleepiness.

Studies have found that untreated OSA is associated with poor health outcomes including increased mortality, stroke, coronary artery disease, and heart failure. However, studies also suggest that these associations are strongest in people aged 40-70, and weaker in older adults. For older adults with symptomatic OSA, treatment can reduce daytime sleepiness and improve quality of life.

Helpguide.org’s page on sleep apnea has a useful 7-item questionnaire, to help you determine how likely it is that symptoms are sleep apnea. It also has a discussion on sleep apnea. You can also ask the doctor about further evaluation if you’ve noticed a lot of daytime sleepiness. To be diagnosed, you’ll need to pursue polysomnography (objective sleep testing) either in a sleep lab or with a home sleep testing kit.

Whether or not you pursue an official diagnosis for SRBD, avoiding alcohol (and probably other sedatives) is likely to help.

Other problems listed by Dr. Kernisan in addition to the above:

#1. Sleep problems due to an underlying medical problem.

#3. Restless leg syndrome (RLS).

#4. Periodic Limb Movements of Sleep (PLMS).

#5. Insomnia.

In my research, I found an article in Newswise that covers the problems with oral devices for obstructive sleep apnea. You may read about it here. It does discuss a French study with this opening statement: In patients with severe obstructive sleep apnea (OSA), oral appliances that treat the condition by moving the lower jaw forward appear to improve sleep but not reduce key risk factors for developing heart and other cardiovascular disease, according to new research published online, ahead of print in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

How Sleep Apnea Hurts Your Health

Snoring can make for a bad night’s sleep, for you and your bed mate. But if it happens because you have obstructive sleep apnea (OSA), it is a sign of a bigger problem.

The condition raises your risk for other health issues like high blood pressure and diabetes. It can even make you more dangerous on the road. But when you treat sleep apnea, you can ease or even cure some of these issues.

Here are seven health problems you might face if you have OSA:

#1. High blood pressure.

#2. Heart disease.

#3. Type 2 diabetes.

#4. Weight gain.

#5. Adult asthma.

#6. Acid reflux.

#7. Car accidents.

High blood pressure. If you already have it, sleep apnea can make it worse. When you wake up often during the night, your body is stressed. That makes your hormone systems go into overdrive, which boosts your blood pressure levels. Also, the level of oxygen in your blood drops when you can’t breathe well, which may add to the problem. Treatment can make a difference, though. Some people with high BP who get help for sleep apnea will see their blood pressure improve. Their doctors may be able to cut back on their BP medications. But you shouldn’t stop or change your dose without talking to your doctor first.

Heart disease. People with OSA are more likely to have heart attacks. The causes may be low oxygen or the stress of waking up often. Strokes and atrial fibrillation -- a fast, fluttering heartbeat -- are also linked with the condition. Sleep apnea disrupts how your body takes in oxygen, which makes it hard for your brain to control how blood flows in your arteries and the brain itself.

Type 2 diabetes. Sleep apnea is common among people with this condition -- 80% or more of them may have OSA. Obesity raises a person’s risk for both disorders. Although studies haven’t shown a cause-and-effect link between sleep apnea and type 2 diabetes, not getting enough shut-eye can keep your body from using insulin properly, which leads to diabetes.

Weight gain. Extra pounds raise your chances of getting sleep apnea, and the condition also makes it harder to slim down. When you’re overweight, you can have fatty deposits in your neck that block breathing at night. On the flip side, sleep apnea can make your body release more of the hormone ghrelin, which makes you crave carbs and sweets. And when you're tired all the time, you might not be able to turn the food you eat into energy as efficiently, which can lead to weight gain. The good news? Treatment for OSA can make you feel better, with more energy for exercise and other activities. This can help you lose weight, which can help your sleep apnea.

Adult asthma. Science hasn’t proven a link to OSA, but people who get sleep apnea treatment may find they have fewer asthma attacks.

Acid reflux. There’s no proof that sleep apnea causes this kind of heartburn, but many people say it’s a problem. Treating it seems to improve apnea symptoms for some people, sleep doctors say.

Car accidents. When you feel groggy, you raise your risk of falling asleep at the wheel. People with sleep apnea are up to five times more likely than normal sleepers to have traffic accidents.

All the health problems linked to the condition can sound scary, but there are lots of ways to treat it. Your doctor may recommend a machine called CPAP, short for continuous positive airway pressure. The machine, with a mask attached by a hose, can help you breathe better at night and get the rest you need. It can take some getting used to, but people who use it when they sleep feel better and are healthier.

I can vouch for the above as I have sleep apnea and have been using various

models of the CPAP machine since 2001. From the list near the top, I have never had problems with number 5 and 7.

Diabetes and Sleep Apnea - P2

After Max and I worked with three recent new members, Tim called and asked us to meet with him. When we arrived, there were the two that had been asking us questions before and five other members. Tim told us we had the floor for any questions they wanted to ask. Questions we received and Tim asked that they take turns.

I said that I should start with the experiences that I have been through as all seven would be 65 years of age in a few years. I said that Max and I had each been to separate doctors and thus our experiences are different. Both of us needed to use a sleep study lab for the first time we changed equipment under Medicare. I went to Mason City and Max went to New Hampton.

I said that even my first sleep study was a sleep study lab. A sleep study lab means that you will arrive about 7:00 PM and then you will be fitted with a harness of wires attached to sensors on your head, neck, and chest plus a few on your lower legs. Then you are expected to sleep while cameras watch you. Yes, you have covers over you. I actually had two sleep study labs for Wellmark. The first determines that you actually have sleep apnea and the second to determine the pressure settings. When I had the one for Medicare, I was set up like the first sleep lab and when I had satisfied the first requirement, I was changed over to the second part of being on a CPAP machine.

Max stated that his first was a home sleep study that determined he had sleep apnea and the second was a sleep study lab to determine what pressures would be best. Max then stated that the Medicare was the same as what I experienced, just at a different place.

Everyone wanted to know why the two times and Max said that the first is to determine the degree of sleep apnea and that you have sleep apnea. The second sleep study is to determine the upper and lower pressure settings as now most CPAP machines do operate in a range and this is important for you to get the best sleep.

Max stated that his lower pressure is set on 12 and the upper pressure is 18. When asked I said my lower is set at 10 and the upper is set at 15. My average during sleep is 12.4 and I have lows at 10.3 and upper at 14.8. Max said his average is about 14.4 with lows at 12.8 and upper level is at 17.

Several more questions followed asking if we had a favorite doctor. Max and I both agreed we liked our doctors, but I stated that this should be up to each of them. I said that three others could answer that question after they finished their in home tests. I said home tests are becoming more acceptable and are being used more than the sleep study labs.

I stated that my sleep doctor is from India, and for several years showed his heritage by ignoring women until he encountered my first wife. When she asked a question and when he did not answer, she got up in his face and asked him why he could not answer her question. She told him that in the U.S. women are considered equal to men and just because I was the one being treated, she felt her question was important and if she was to help me, she should receive an answer. I said since then he has always answered questions from my second wife and not hesitated.

Max said his doctor is from Tennessee and talks more to my wife than he does with me. She, like Bob's wife, does not like the noise from the CPAP machines and complained about the first two machines, but the last one is quiet. Also, some of the earlier CPAP machines had masks that expelled a lot of air and you had no control over where it was aimed, which makes the position you sleep in miserable for a spouse. The newer masks are somewhat better, but still can blow air on your spouse if you sleep in the wrong position. Max said this means that you will be the one adjusting to be kind to your spouse.

We talked for another hour and answered many questions, but everyone seems ready to be tested and asked for the phone numbers of our doctors. We said we would be available to answer future questions and would ask the other three if they would be willing to answer questions once they had their CPAP machines.

Max said he would send out an email showing some of the machines available and they needed to be aware that their insurance might only cover one or two machines. As is was all had the same insurance that Max and I had and so they would have at least four different CPAP machines available.

Diabetes and Sleep Apnea P1

This article from WebMD has several of our newer members asking questions that are serious. Two of the women are overweight and three of the men are well overweight. We do make an issue of this, but accept them as they are. When this showed up in their email on January 5, three of them were talking to Max and me about what they should be concerned about. Max and I both have obstructive sleep apnea and use a type of CPAP machine when we sleep.

All three were stating they were tired during the day and did not feel like they were getting enough sleep. Two said that even if they tried to get nine hours of sleep, they still felt sleepy during the day. All three said they often were fighting to stay awake during the day and have been warned about sleeping on the job.

Max said they probably had sleep apnea and needed to be tested and then follow what the doctor recommended. Max knew the local doctor that could help them and gave them the name and phone number. The next day they all had appointments and by Friday, they were scheduled for in home sleep studies.

Now they were asking more questions about how the studies were done and what the studies would show. Both Max and I said they should wait until they received the sleep study kits and instructions. I said I had never had a home sleep study and had always been in a sleep study lab and been hooked up to many sensors and had been observed while I slept. They asked how many times I had this. I said the insurance I had before age 65 required a sleep study and when I turned 65, Medicare also required a sleep study lab. They do not accept that I had sleep apnea and that is why they require it.

I said that sleep apnea involves pauses in breathing during sleep. The periods of stopped breathing are called apneas, which are caused by an obstruction of the upper airway. Apneas may be interrupted by a brief arousal that does not awaken you completely -- you often do not even realize that your sleep was disturbed. Yet, if your sleep is measured in a sleep laboratory, technicians would record changes in the brain waves that are characteristic of awakening. In other words, you have been awakened out of REM sleep by the apnea and now must relax enough to reenter REM sleep.

Sleep apnea results in low oxygen levels in the blood because the blockages prevent air from getting to the lungs. The low oxygen levels also affect brain and heart function. Up to two-thirds of the people who have sleep apnea are overweight. Researchers have found a possible link between sleep apnea and the development of diabetes and insulin resistance (the inability of the body to use insulin).

Peripheral neuropathy, or damage to the nerves in the feet and legs, is another cause of sleep disruption. This nerve damage can cause a loss of feeling in the feet or symptoms such as tingling, numbness, burning, and pain.

Now the three were very anxious and wondered if the sleep study was worth the effort. Max answered with an emphatic – YES and I said it is such a great feeling to not feel tired during the day. If there is a link to diabetes, since they already had diabetes, this should not affect their decision and using a CPAP machine should help with insulin resistance and possibly weight loss.

Max and I both stated that we had neuropathy and sleep apneas before we were diagnosed with diabetes and felt that we were better able to manage our diabetes by using the CPAP machine. We told them that the lack of sleep did make diabetes more difficult to manage. They wanted to talk more after the sleep study and after meeting with their doctor. Max and I agreed and said we could go with them to pick out the CPAP accessories.

Sleep Apnea – Gout Flares, Tied

I have sleep apnea and use a type of CPAP machine when I sleep. I apparently am doing all the right things, as I have never had any problems with gout. However, this study says that sleep apnea may increase the risk of developing gout and experiencing flare-ups.

I know from friends that the pain can be intense and make walking very difficult. Gout causes swelling of a joint, normally in the big toe. Gout is caused by the accumulation of uric acid crystals in joints and tissue. Sleep apnea causes periods of oxygen deprivation during the night when people stop breathing, and this triggers the overproduction of uric acid in the blood stream. The study team states that little in known about the relationship between the two conditions.

The study, in Arthritis and Rheumatology, states that in 2007-2008, almost six percent of men and two percent of women in the U.S. Experienced gout, according to the Centers for Disease Control and Prevention. Sleep apnea, which is more common and if untreated can increase the risk of high blood pressure, heart attack, stroke, and heart failure.

Lead author, Yuqing Zhang of Boston University Clinical Epidemiology Research and Training Unit says obesity plays a role in both sleep apnea and gout. He continued that sleep apnea still increased the risk of gout even when weight was taken into account.

The researchers in the United Kingdom used data on almost 10,000 people newly diagnosed with sleep apnea and compared them to more than 40,000 people of similar sex, age, and body composition, but without sleep apnea. In a one-year period, there were 270 cases of gout with 76 in the sleep apnea group and 194 in the larger comparison group. Gout was diagnosed at an average age of 60. Gout was almost twice as common in the sleep apnea group as in the comparison group, according to the analysis.

Obesity increases the risk for sleep apnea, but some thin people have sleep apnea, too, and even in these people, the risk of gout was increased by 80 percent.

The next step is to test whether treating sleep apnea also reduces the risk for gout. Some studies show that if you get treatment, your uric acid may go down. Sleep apnea can be treated with lifestyle changes, such as losing weight, wearing mouthpieces, breathing devices at night, or with surgery.

“It takes years for uric acid crystals to accumulate in the joints and lead to an eventual gout flare, so sleep apnea may not “cause” the gout, but may create a more ideal environment for a flare up, said Dr. Robert Thomas Keenan of Duke University School of Medicine in Durham, North Carolina, who was not part of the new study.”

“Gout is the most common inflammatory arthritis in the western world,” he told Reuters Health by email. “Sleep apnea and gout risks can be reduced in many people by losing weight if they are overweight, eating healthy and indulging in alcohol and red meats in moderation,” he said.

Sleep Apnea May Cause Blood Pressure Increase

I am finding some consistency in articles about sleep apnea and how it affects other diseases or conditions the patient may have. A new meta-analysis conducted by an international team of sleep and respiratory researchers suggests that untreated sleep apnea may be a major factor in causing medications to be less effective in reducing hypertension (high blood pressure) in some people.

In reading the entire article, there are several things mentioned that makes this meta-analysis more valuable. These include:

1. Using continuous positive airway pressure (CPAP) therapy may be a key to helping people with hard to treat hypertension.
2. Most people with resistant hypertension also have obstructive sleep apnea (OSA).
3. OSA and resistant hypertension is a deadly combination that exponentially increases the risk of death or disability from a stroke or heart attack.
4. The study indicated that the patients with resistant hypertension and the very highest blood pressure experienced the greatest reduction in blood pressure after using CPAP therapy
5. This response suggests that untreated sleep apnea may be why these people haven’t seen improvement in their blood pressure despite the concurrent use of three or four medications.

Ulysses Magalang, MD, the study’s principal investigator and director of the Sleep Disorders Center at The Ohio State University Wexner Medical Center and co-author Christopher Valentine, MD, a nephrologist at Ohio State’s Wexner Medical Center both say that these findings suggest that physicians may need to be more aggressive with screening for sleep apnea and ensuring CPAP therapy compliance in patients with resistant hypertension.

Dr. Valentine did say, “That there is evidence about the benefits of CPAP in people with hypertension and OSA, but ours is the first analysis to systematically review CPAP use in people with difficult to treat hypertension and apnea.” He continued, “The results are clinically relevant because the effects that we found are significantly higher than what’s been previously observed in a more general hypertensive population. CPAP use could offer this subset of patients a new chance to reach a healthier blood pressure goal, or even to reduce their medication burden.”

Drs. Magalang and Valentine say that their findings also support the idea that resistant hypertension and OSA represent an “extreme phenotype” of those who have OSA, but never develop hypertension. The researchers further suggest that resistant hypertension in those with sleep apnea may be caused by a less common gene variant that nonetheless has significant impact.

It’s a hypothesis that will likely be put to the test over the next decade. The researchers who collaborated on the paper all belong to the Sleep Apnea Genetics International Consortium (SAGIC), a partnership of scientists from five continents who are building the first-ever international biomedical database to uncover the genetic causes of sleep apnea. By collecting biological material from thousands of patients with sleep disorders, the group hopes to amass enough data to start identifying underlying genetic causes of different conditions.

“We’re only just now beginning to appreciate the link between sleep apnea and disease,” said Magalang. “We hope that one day we will find common genes shared between people who have uncontrollable blood pressure and sleep apnea, and that will open up a whole new world of interventions and treatment strategies.”

Diabetes and Sleep Apnea

I have written more than the one below on sleep apnea, but this is mainly concerning sleep apnea and management of blood glucose.

http://bobsdiabetes.blogspot.com/2014/04/sleep-apnea-makes-diabetes-harder-to.html

The sad part is many people with sleep apnea do not realize that they are at risk for diabetes and a slightly a smaller percentage of those with diabetes are at risk for sleep apnea. Even then, people will not listen when they have one condition and you warn them about the risk for the other.

Sleep apnea and understanding that it affects blood glucose management negatively is important. I am fortunate that I have no problems using my sleep apnea equipment, as I obtain the sleep I need and sleep apnea is not a factor in the management of my blood glucose levels. I have a few acquaintances and a few more friends that ignore their sleep apnea and laugh at me when I bring the following into the discussion.

Some of the reasons people refuse to use their sleep apnea equipment include:

1. Vanity – they don't feel sexy or manly wearing the mask
2. Some feel wearing the mask is claustrophobic
3. Some do not like the lines that the mask straps cause in their skin because they have the straps too tight
4. Many complain about the noise the machine makes
5. Many have a problem with the air leaks around the mask because they aren't properly fitted or having a mask that fits properly
6. Many people do not understand that not getting the sleep they need will contribute to the development of diabetes or make diabetes more difficult to manage.

Severe obstructive sleep apnea (OSA) may increase a person's risk of developing diabetes by 30% or greater. This is according to an article published online June 6, 2014 in the American Journal of Respiratory and Critical Care Medicine.

Of the 8678, patients who underwent the sleep study, 1017 (11.7%) developed diabetes during a median of 67 months of follow-up, which translates to a cumulative incidence of 9.1% at 5 years. Incidence came to 7.5% for patients with mild OSA, 9.9% for moderate OSA, and 14.9% for severe OSA. Limitations of the study include missing data on some potential confounders, such as race and family history of diabetes and the inability to categorize diabetes as type 1 or type 2.

Another author wrote, a man over age 65 with type 2 diabetes has a 67 percent chance of having sleep apnea; for older women, the chance is almost 50 percent. Besides making it difficult to get a good night’s sleep, sleep apnea increases stress on the body, causing blood sugar levels to rise. So it is especially important for people with type 2 diabetes to recognize sleep apnea and have it treated.

People with type 2 diabetes are often obese and insulin resistant, and have large amounts of visceral fat, fat deep inside the body that is covering and surrounding their organs. What causes sleep apnea isn’t entirely known, but there appears to be a connection between insulin resistance, obesity, especially with visceral fat and a big waistline, and sleep apnea. This makes obese people with visceral fat and type 2 diabetes more likely also to have sleep apnea.

The most common symptom of obstructive sleep apnea is loud, persistent snoring, which may include pauses followed by gasping or choking. (Keep in mind that not all snorers have sleep apnea.) Other symptoms include:

• Chronic fatigue (for example, you may fall asleep while driving or during inactive times throughout the day)
• Problems concentrating (inability to complete simple tasks)
• Mood swings (happy one minute and unhappy the next)
• Difficulty controlling blood pressure and blood sugar levels

Still Learning about Sleep Apnea

I thought I had learned a lot about sleep apnea, but the lessons keep coming. I am now on my third CPAP machine and I am happy that I still ask questions. It seems that sometimes I ask too many questions as I am still searching for the right combination of machine, mask, and supplies to give me a great night's sleep. A question I asked recently has resulted in more problems as I believe an incorrect adjustment was made instead of the one I asked for.

I have had to change from a nasal mask to a full-face mask because of problems of breathing through my mouth. This will require some getting used to for me. Another problem that will require adapting is from a machine with an easy fill humidifier to one that cannot be filled beyond a certain level. Overfill slightly and then the air hose from the machine to the mask needs to be removed and the water drained out of the air hose. Then, while the machine is off, the humidifier needs to be drained to the right level. Fun, fun, and more fun for me.

I am happy that this CPAP machine runs more quietly than the previous machines, but I do miss the large capacity water container of my first CPAP for humidity. The last two have had small containers that only last for a day.

I have received questions from other readers and friends that wonder how I can tolerate wearing a mask of any type and sleep. I can only say that with the rest I am receiving by wearing the mask and using my CPAP, I would not want to sleep without it. I can remember how tired and sleepy I was before the CPAP machine that as long as I need it, I will use it.

A friend of Allen and me, who also has diabetes, refuses to wear a mask because he is so claustrophobic. He has even refused to use an oral device. He will not shut the bathroom door when he is using it and refuses to have a curtain for his shower. To play a joke on him one day, as he was getting his coat out of the closet, Allen pushed him in and shut the door. Allen will not do that again as he now has removed the door and refuses to put it back. Other closet doors are now missing in his home. Allen recently said he had been shown the results of the last sleep study by our friend and the apneas were almost normal. Our friend is happy about this as he has lost weight and had also refused surgery and another treatment.

While my CPAP machine is a true BiPAP or as others call it, an AutoPAP, I do like it as it is set with two settings, one for the lowest pressure, and one for the highest pressure. Then the machine self adjusts as I sleep to keep me breathing and not having apneas. I used a different source for my machine than previously because I felt I was not obtaining reliable service or even caring service. The number of problems just kept multiplying.

Sleep Apnea in the US Threatens Public Health

New studies highlight the destructive nature of obstructive sleep apnea and benefits of CPAP therapy. Public health and safety are threatened by the increasing prevalence of obstructive sleep apnea, which now afflicts at least 25 million adults in the U.S., according to the National Healthy Sleep AwarenessProject. Several new studies highlight the destructive nature of obstructive sleep apnea, a chronic disease that increases the risk of high blood pressure, heart disease, Type 2 diabetes, stroke, and depression.

Public safety is only given a mention, but needs more emphasis as it is unknown how many accidents are caused by people being drowsy or asleep while driving. I have even seen drivers asleep at the when at stoplights. Sometimes other drivers sit and honk at them, but most just drive around them.

Data published previously in the American Journal of Epidemiology shows that the prevalence rates of obstructive sleep apnea have increased substantially during the last two decades, most likely because of the obesity epidemic. The latest estimates predict that 26 percent of adults between the ages of 30 and 70 years have sleep apnea.

Obstructive sleep apnea is destroying the health of millions of Americans, and the problem has only gotten worse over the last two decades. The effective treatment of sleep apnea is one of the keys to success as our nation attempts to reduce health care spending and improve chronic disease management.

Findings from new studies emphasize the negative effects of sleep apnea on brain and heart health. These health risks can be reduced through the effective treatment of sleep apnea with continuous positive airway pressure (CPAP) therapy.

1. “A neuroimaging study in the September issue of the journal Sleep found that participants with severe, untreated sleep apnea had a significant reduction in white matter fiber integrity in multiple brain areas, which was accompanied by impairments to cognition, mood, and daytime alertness. One year of CPAP therapy led to an almost complete reversal of this brain damage.
2. A study published online ahead of print Sept. 21 in the journal NeuroImage found functional and anatomical changes in brainstem regions of people with sleep apnea.
3. A study in the October issue of Anesthesiology shows that diagnosing sleep apnea and prescribing CPAP therapy prior to surgery significantly reduced postoperative cardiovascular complications - specifically cardiac arrest and shock - by more than half.
4. A study published online ahead of print Sept. 19 in the Journal of Hypertension found a favorable reduction of blood pressure with CPAP treatment in patients with resistant hypertension and sleep apnea.
5. A Brazilian population study published online ahead of print Sept. 23 found that nocturnal cardiac arrhythmias occurred in 92 percent of patients with severe sleep apnea, compared with 53 percent of people without sleep apnea. The prevalence of rhythm disturbance also increased with sleep apnea severity. “

Common warning signs for sleep apnea include snoring and choking, gasping, or silent breathing pauses during sleep. The American Academy of Sleep Medicine, Centers for Disease Control and Prevention, Sleep Research Society, and other partners in the National Healthy Sleep Awareness Project urge anyone with signs or symptoms of sleep apnea to visit this website to pledge to "Stop the Snore" and talk to a doctor about sleep apnea.

If you suspect you have sleep apnea, follow the directions above and see a doctor specializing in sleep problems. I use a CPAP machine daily and find that I have not had more problems with sleep and am generally rested when I awake in the morning.

CPAP Effective for Older People

Continuous positive airway pressure (CPAP) is effective at treating sleep apnea in older people, a new study has found. I can believe this as most older people have conquered most of their fears and vanity of wearing the equipment and realize the importance of sleep to their health.

Previous studies have established the benefits of CPAP in middle-aged people with OSA (obstructive sleep apnea), but until now there has been no research on whether the treatment is useful and cost-effective for older patients. The new research found that CPAP reduces how sleepy patients feel in the daytime and reduces healthcare costs. The researchers say CPAP should be offered routinely to older patients with OSA, and more should be done to raise awareness of the condition.

Now if the United States would accept the research. The study was published in Lancet Respiratory Medicine. It involved 278 patients aged 65 or over at 14 NHS centers in the UK. It was led by researchers at Imperial College London and the Royal Infirmary of Edinburgh in collaboration with the Medical Research Council Clinical Trials Unit at UCL, and the Universities of Oxford and York. It was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme.

Sleep apnea can be hugely damaging to patients' quality of life and increase their risk of road accidents, heart disease and other conditions. Lots of older people might benefit from this treatment. Many patients feel rejuvenated after using CPAP because they're able to sleep much better and it may even improve their brain function. Patients with sleep apnea sometimes stop breathing for 30 seconds or longer at night before they wake up and start breathing again. In these pauses, their blood oxygen levels fall.

The low oxygen levels at night might accelerate cognitive decline in old people, and studies have found that sleep apnea causes changes in the grey matter in the brain. They're currently researching whether treatment can prevent or reverse those changes.

Family Support May Be Beneficial For CPAP Users

Family support for CPAP use may help in using the equipment. I know that does not matter for me because without my CPAP equipment use, I would be overtired and difficult to be around. Other people depend on family support for doing anything that their doctor may prescribe or recommend. I have seen this first hand and when I ask friends why they won't take a medication or use their CPAP machine, I normally receive this answer – 'my spouse makes fun of using it' or 'my family thinks it is funny and make a comedy out my using it.”

I now have a widow of a friend that is regretting the fun she made of her husband using a CPAP machine and full-face mask. Last week he did not wake up after suffering an apnea and even CPR could not revive him. She is a nurse and should have known better than making fun of his CPAP and its use. The autopsy revealed that he had died from a heart attack. On several occasions, I had warned him that this could happen and that he needed to use the equipment every night. I had even introduced him to the mask liners which had stopped the air leaks and noises from the mask when the seal was broken.

Yes, he was about 40 pounds overweight and had been in a sleep lab for his diagnosis, but his wife was not sympathetic and constantly made fun of the equipment and his use of it. I attended his funeral, but avoided his wife, but afterward she wanted to talk to me. I told her there was nothing to talk about and I was there for him. I left without saying anything.

This study by the American Academy of Sleep Medicine, is very clear in stating that people with obstructive sleep apnea (OSA) who are single or have unsupportive family relationships may be less likely to adhere to continuous positive airway pressure therapy.

Results show that individuals who were married or living with a partner had better CPAP adherence after the first three months of treatment than individuals who were single. Higher ratings of family relationship quality also were associated with better adherence. Results of the study were adjusted for potential confounding factors including age, gender, and body mass index.

If you are a CPAP user, a spouse of a CPAP user, or a family member of a CPAP user, do them a favor and give them your support, please. Read the article in the link above and help them use the CPAP equipment; they just might live longer and be around when you need them.

“The American Academy of Sleep Medicine reports that obstructive sleep apnea is a common sleep illness affecting up to seven percent of men and five percent of women. It involves repetitive episodes of complete or partial upper airway obstruction occurring during sleep despite an ongoing effort to breathe. The most effective treatment option for OSA is CPAP therapy, which helps to keep the airway open by providing a stream of air through a mask that is worn during sleep.”

Sleep Apnea May Be Tied to Diabetes

Prior to this study, most studies included few patients and were too short in length. Now we have a larger study and a suggested link between sleep apnea and diabetes.  Unfortunately, the study had some critical limitations. The limitations included lack of family history of diabetes, the race of the participants, and the possible misclassification of some subjects due to the limitations of the administrative health data used.

This is a severe fault of the study and that is the reason I only used the words 'may be tied' in the title. I don't care that they used the word “tied” in their title with claims of a link between obstructive sleep apnea and diabetes. Yes, there are some similarities between the two and being overweight is very common. As to one causing the other, this is still unproven. I will continue so that you can make up your own mind.

Lead author, Tetyana Kendzerska, MD, PhD, of the University of Toronto says, "Our study, with a larger sample size and a median follow-up of 67 months was able to address some of the limitations of earlier studies on the connection between OSA and diabetes. We found that among patients with OSA, the initial severity of the disease predicted the subsequent risk for incident diabetes."

The study included 8,678 adults with suspected OSA without diabetes at baseline who underwent a diagnostic sleep study between 1994 and 2010 and were followed through May 2011 using provincial health administrative data to examine the occurrence of diabetes. The apnea-hypopnea index (AHI) was used to assess sleep apnea severity. The AHI indicates severity based on the number of apneas per hour of sleep. Patients were classified as not having OSA (AHI < 5), or having mild (AHI 5-14.9), moderate (AHI 15-30) or severe (AHI>30) OSA.

During the follow-up, 1017 (11.7%) patients developed diabetes. In analyses, adjusting for known risk factors for diabetes, including age, sex, body mass index, neck circumference, smoking, income status and comorbidities at baseline, patients with an AHI>30 had a 30% higher risk of developing diabetes than those with an AHI <5 .="" 23="" a="" developing="" diabetes.="" had="" increased="" mild="" moderate="" of="" or="" osa="" p="" patients="" risk="" with="">

"After adjusting for other potential causes, we were able to demonstrate a significant association between OSA severity and the risk of developing diabetes, said Dr. Kendzerska. Our findings that prolonged oxygen desaturation, shorter sleep time, and higher heart rate were associated with diabetes are consistent with the pathophysiological mechanisms thought to underlie the relationship between OSA and diabetes."

Sleep Apnea, Alternative Medicine and Other Info

There is not an abundance of information about alternative medicine and sleep apnea. I have seen some on acupuncture and sleep apnea, but most is very short and limited like this by the Mayo Clinic. There is also dental (oral) appliances for sleep apnea which I wrote about in September 2010.

Oral appliances are available and some dentists have been through the sleep specialist training to qualify to fit oral appliances for sleep apnea. If you are a person that sleeps on you stomach and tosses and turns a lot in your sleep, these may not be for you and they can do damage to your teeth. This information was received from a dentist that fits oral appliances for sleep apnea. More dentists now are qualified to handle mild to severe obstructive sleep apnea. I have written about oral appliances here. The national group for oral appliance part of dentistry is here.

Most of the discussion to this point has been about patients with sleep apnea that have been overweight. However, people with normal weight can develop sleep apnea as they age. So if you happen to be in this group, be careful as well. Also if you were an overweight person with sleep apnea and have lost weight, this does not mean that you have cured your sleep apnea problem. A friend of mine stopped using his CPAP when his weight was at his normal or ideal weight. Two months later, he complained about being so tired he could not stay awake.

After several days of discussion, he said it was six years since he received his CPAP machine and Medicare would maybe consider another sleep study and definitely a new machine. After talking to his sleep doctor, it was determined this would be best. After the sleep lab, it was determined that he still had sleep apnea and averaged about 50 apneas during the lab. Now he is waiting for the new APAP machine. He told me that in most of his reading they have said losing weight normally took care of the sleep apnea problems. He now knows better.

Two of the organizations for sleep apnea are:

http://www.sleepapnea.org/support/here-to-help/all-about-a.w.a.k.e.html

http://sleepfoundation.org/sleep-disorders-problems/sleep-apnea

http://www.ninds.nih.gov/disorders/sleep_apnea/org_sleep_apnea.htm

This one also lists the previous two organizations.

I have written about surgery for sleep apnea and from my reading would discourage considering this. Two blogs are here:

http://bobsdiabetes.blogspot.com/2011/02/obstructive-sleep-apnea-surgery.html

http://bobsdiabetes.blogspot.com/2010/10/sleep-apnea-surgery-options.html

Some other blogs that may be of interest are:

http://bobsdiabetes.blogspot.com/2013/04/sleep-apnea-are-you-prepared-patient.html

http://bobsdiabetes.blogspot.com/2012/03/avoiding-cpap-problems.html

http://bobsdiabetes.blogspot.com/2012/02/children-with-osa-benefit-from-cpap.html

This article from CardioSource is very informative and contains some straight forward information about CPAP use and the effects on lipids, hypertension, and diabetes.

Even with firm evidence that lack of sleep has a proven effect of making diabetes more difficult to manage, CPAP has mixed results on improving insulin resistance.

This concludes this series on sleep apnea.  I have come across more information and will have a few blogs in the near future.  

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 = http://www.directhomemedical.com/30-DAY-PROVENT-therapy-sleep-apnea-treatment.html#.U9bW6bH8DFE .

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. 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.

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.

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.

Sleep Apnea Makes Diabetes Harder to Manage

This study conducted in Europe supposedly, is not news to me because I have sleep apnea. It just confirms what I am already aware of and can't get one person I know to wear his CPAP mask. He has type 2 diabetes and it is poorly managed. He now refuses to tell me his A1c results because he knows that I will tell him that his sleep apnea is making his diabetes more difficult to manage.

I am not sure why he will not use his CPAP, but I know he is constantly overtired. Recently, he lost his job because of falling asleep at work and this endangered other workers. This of course has made him more upset and I have been very careful about what I say to him. However, I still ask him why he will not use his CPAP. I have informed him that he would be able to manage his diabetes more effectively.

I do tell him that with sleep apnea, he could die in his sleep when he can't recover from an apnea. He just laughs at me and all I can do is shake my head. I finally had a talk with his doctor and urged him to consider an intervention. His doctor would not say anything because of HIPAA and I just said I was informing him of a problem with this patient.

The study is not really useful as it was done with non-diabetic people. I could not confirm this, but I could not find that it had random controls as part of it. At least it was not U.S. taxpayer money wasted on a useless study.

I doubt that sleep doctors will consider this warrants attention and screening for diabetes as the lead author tries to point out.

Since I have type 2 diabetes and sleep apnea, I can confirm how important it is to use my CPAP equipment – actually a BiPAP machine. I use my equipment every night and my sleep apnea is a non-factor in the management of my diabetes as a result.

Some of the reasons people refuse to use their sleep apnea equipment include:

1. Vanity – they don't feel sexy or manly wearing the mask
2. Some feel wearing the mask is claustrophobic
3. Some do not like the lines that the mask straps cause in their skin because they have the straps too tight
4. Many complain about the noise the machine makes
5. Many have a problem with the air leaks around the mask because they aren't properly fitted or having a mask that fits properly

I have several blogs about these problems, but feel that number 3 and 5 above can be solved if people would consider nasal mask liners as discussed in my blog here. Noise can be a problem for some, but the noise has been decreased in recent years, especially in the newer machines, and should not be the problem of older CPAP machines.

Another factor is having the mask properly fitted by a sleep specialist. Many people do not do this and blame the manufacturer for their bad decision or they just won't ask the right questions.

If you have sleep apnea and type 2 diabetes, please do yourself a favor and use your equipment as you will feel better and manage you diabetes more easily.

Sleep Apnea - Are You a Prepared Patient?

What do you know about your sleep apnea? Do you know your equipment? Do you know what your options are – for equipment, equipment replacement, parts replacement, and other supplies? I am sorry to report that many people do not and some do not care. Others hate the equipment and still others let vanity rule. There are some things about my equipment that I do not like, but I still use the equipment as I feel better using it and know what will happen if I don't.

You will have to excuse me for a little ranting, but I have a friend that only wears his mask for short periods each night and then takes it off. Why does he do this? I don't know as I have helped him adjust the snugness and even had him order the nasal mask liners from this source, but still he would not wear it throughout the night. With the nasal mask liners, he was able to loosen the tension on the mask straps even more. Finally, I started kidding him that it was vanity that caused him to remove the mask. He questioned why I would say this. I said that he was so self-conscious about the lines the straps could cause that he did not want them when he woke in the morning.

He finally admitted that this bothered him and I won't go into some of the things I said to him, but if we were good friends, he would have told me to get lost and never see him again. We did settle on a weekend and I worked with his significant other (SO) to adjust the straps and he did give it an honest try. Even his SO said that he did not have lines an hour after he awoke. Then the following weekend to prove this, I took away his nasal mask liners and had him tighten the straps to prevent air leaks. It took almost three hours for the mask lines to go away. He was finally convinced and now he wears his mask all night.

Yes, there are many choices that are available to people with obstructive sleep apnea. One choice that you do not have is walking into a medical supply store and choosing a piece of equipment, a mask, and other supplies, paying for them, and walking out with them. You must have a prescription, obtain equipment that your insurance will cover, and have counseling by your sleep doctor or a sleep therapist. Even if you can afford to pay for the equipment, the law does not allow them to sell you the equipment without a prescription.

Equipment choice may be more flexible as the doctor can influence the choice and sometimes force the insurance to cover equipment they do not want to, but this still may be a point of contention. So be careful when writers claim that you can make the choice.

This article makes a lot of sense and does cover many of the facts that need to be covered. I do appreciate the fact that she mentions mild, moderate, and severe sleep apnea. I even needed to laugh at her analysis leading up to her question – are you a dead man walking. Yes, sleep apnea of any type can cause you to die if not properly managed.

The sleep study is the first step that needs to be accomplished. This will determine your apnea hypopnea index (AHI). This is then used for the type of machine the doctor may recommend, the pressure setting(s), and the type of sleep apnea you are diagnosed as having. The next piece of vital information is your oxygen level according the author and in checking with my sleep doctor, it is not a measure they do other than as part of the sleep lab at the beginning and end of the lab experience. This is something some sleep labs did not measure until recently. High blood pressure in connection with low oxygen levels puts us at risk for a heart attack or stroke.

In summary, to become a prepared patient, your objectives should be:

1. Take responsibility and lead your healthcare team.
2. Know your AHI and oxygen levels.
3. Understand the anatomical features that cause your OSA .
4. Know your equipment choices, machine pressure and take responsibility to learn patient controlled comfort and adjustment features.
5. Report all problems and challenges to your healthcare team as quickly as possible for resolution.
6. Maintain due diligence by scheduling routine follow up visits with your sleep doctor.

I would add that you need to forget about vanity and do some testing to see how long the lines from the straps actually last before giving up. This is when number 5 above should be used and discussed with your sleep team.

I admit I don't remember the exact number for my AHI, but in both sleep studies, it was over 100 apneas per hour. I have attended several of the maintenance sessions and not had any problems. They have called me in several times to download the data from the disk, but after doing it once or twice, the insurance company quit complaining and asking for more. My sleep doctor knows that I use my machine and asks how I keep it so clean. I say that I use only distilled water and clean the filter monthly or more often if needed. I use a clean cloth to wipe the outside of the machine.

My wife complains that I don't clean the nasal mask often enough, but with the nasal mask liners, they do a pretty good job of keeping it clean, so I don't need to clean it that often. Apparently, I take better care of my equipment than most do. The sleep specialist is always surprised that I don't need replacement parts at the frequency of many people. I am now happy that I do take care of my equipment as Medicare is monitoring how often people need to replace equipment parts and has set some limits.  For most supplies, it used to be quarterly, but now much of it is biannually, except for some parts.

Why Do CDEs Not Have Sleep Apnea Training?

After asking several certified diabetes educators (CDEs) whether they have training for sleep apnea, I have to ask why they are so secretive about their training. Even my CDE relative would only answer that her practice has sent them to some training. Of five others I asked this question of, only one would say that she has some training because the practice she worked for sent her to a couple of classes.

Why are CDEs so secretive about their training? It would seem to be something they should be proud to discuss for people to understand why they display the acronym behind their names; and limit the profession by making it difficult for people to gain access to the title. Registered nurses, physician assistants, doctors, and pharmacists are not that secretive and will generally answer questions about their continuing education and even their education.

This begs another question, is the training so poor that they do not want to acknowledge what they do know and that they take classes and webinars solely to be able to check the boxes for recertification? Are they getting anything from these classes or webinars that is useful? I have tried on more than one occasion to ask questions of CDEs, but I seldom get a straight answer. Is this part of their training not to answer questions about their training? Or, is it that they are ashamed of their continuing education.

Those that are willing to talk divert the questions to their core training. Nurses will talk about their education; pharmacists will talk about their education; but try to get information about the CDE training is like talking to the proverbial brick wall. Even my relative will not answer certain questions although she will for some after she is sure I will not use her response in a blog. I asked her if I am asking the wrong questions, and she did say I was asking the right questions and that I was being polite in the way I asked most questions.

She did comment that sometimes my writing was a little blunt, but occasionally she could understand the reason behind it and the need for showing my frustration. I did tell her to read this blog, as I am very frustrated that the current AADE head is apparently alone in her ivory tower and those that answer to her are painting a picture that is not representative of what is going on in the trenches.

It is difficult to make changes when you are not given the truth or a true picture of what is happening at the lower levels. The blog I wrote back on October 6, 2011 is still as applicable today, if not more important. In the last paragraph, I made mention of a few thousand CDEs that needed our support, but in what has happened recently, maybe I should change that to a few hundreds.

Now do not misunderstand, I do not see the need for CDEs to be experts in sleep medicine. They should learn to ask the right questions about sleep and recognize the symptoms of sleep apnea. Then they should recommend to the doctor that he/she investigate further and possibly refer the patient to a sleep specialist. Because many of the people with type 2 diabetes (above 40 percent for combined men and women) have sleep apnea, this should be necessary in CDE training.

Since I am not able to say with any certainty that they have training about sleep apnea or are required to have training, this is the reason for wording the title the way I did.

Now that I have had my say, I will turn this around and say I was pleasantly surprised when I sent an email to the AACE education division. I received a prompt reply with a lot of information to research and get my head around. I was supplied with information about a sleep apnea resource for CDEs. Since I do not have a copy of the book, I will copy the description from the AADE site.

“Many resources address major complications of diabetes, such as heart disease, stroke, blindness, and kidney disease. Managing Diabetes: Complications and Comorbidities focuses on the number of conditions and comorbidities that affect an individual's activities of daily living. Help your patients learn to recognize the early signs of changes that can lead to these conditions so together you can work to prevent or delay their onset.”

“Learn and Earn

Free continuing education (CE) for nurses, dietitians, and pharmacists included with book purchase. When you purchase the book, the post-test will be uploaded to your online learning portal. You have two opportunities to pass the post-test and receive 4.5 CEs. One post-test is allowed per book purchase.”

“Your Price: $ 24.95, Member Price: $ 19.95” This was published in January 2012 by the AADE, therefore do not look for this in your bookstore or favorite online bookseller.

I will take the word from the person corresponding with me that the topic of sleep apnea is included since the topic is not included in the description.  The site has been totally revamped and the URL that I had is not longer valid. I am just happy I have as much information as I did get.

Avoiding CPAP Problems

It is interesting to read articles on approximately the same topic. One is by a doctor for other doctors and the second by hospital staff for the general public. I suspect that the hospital staff involved nurses, but it is clear to me which one is more meaningful. I think you will see this as well.

The one written by a doctor was for Medscape and the second appeared on the Mayo Clinic website. You just have to love the doctor for his use of adherence and non-adherence. These words are a show of disdain about patients and when put with the statement of “the primary goal is to promote 100 percent adherence to CPAP”, I must confess I could not even consider this doctor for my sleep apnea.

The doctor did acknowledge several problems that people encounter, but always countered with what medically could be done to alleviate the problem, even if it meant medications. His attitude showing through his writing is one of the patient must be made to comply.

The Mayo Clinic article starts with this “CPAP is an important treatment for obstructive sleep apnea, but it's not without its frustrations.” The article lists ten very real problems and suggests ways to lessen each problem.

1. The wrong size or style CPAP mask

2. Trouble getting used to wearing the CPAP device

3. Difficulty tolerating forced air

4. Dry, stuffy nose

5. Feeling claustrophobic

6. Leaky mask, skin irritation or pressure sores

7. Difficulty falling asleep

8. Dry mouth

9. Unintentionally removing the CPAP device during the night

10. Annoyed by the noise

Both articles do come up short as they are all promoting plastic masks and do not allow for people that are allergic to plastics. There are a number of aids that are available to help with the allergies and air leaks. Neither article supported other professions like sleep therapists or even sleep doctors. Both also do not recognize that there are dentists that have taken the required education to deal with sleep apnea. The dentists do use oral appliances which regular doctors cannot.

Yes, I realize that the two professions are different, but a doctor or dentist specializing in sleep apnea should realize that the other exists and acknowledge them.

To get away from plastic allergies, consider the sleepweaver cloth mask. I will give you a sales site as the two times I have tried the regular web site, I am kicked out by one or the other of my virus checkers alerting me of a Trojan virus. So unless you trust your virus checkers – you have been warned. They may have solved the problem, but as of two days ago – no.  as of June 29, it is good.

I have never used this for sleep apnea, but I have an acquaintance that says he would not use anything else. The web site is here for no mask. For those having problems with air leaks, I know this site should interest you. I use these nasal maskliners and it does prevent air leaks.

Some of the national sleep apnea organizations can be seen here, here, and here.