Better Sleep Coach; Your Help to Better Health through Better Sleep

Sleep problems during hot weather are very common and the fatigue that accompanies it makes sleep more important then ever.  However, if you can not make yourself comfortable then you will not get the rest you need to have the energy you want during the day.  So here are a few tips that might help you to feel great during the day and sleep well at night.

• Remember to drink your water during the day.  It is very easy to get dehydrated and when you are dehydrated you are more likely to have a headache or body aches when you are getting ready for bed.  If you do not like water keep in mind that you want to limit your intake of caffeine as it can act like a diuretic and dehydrate you even further.  Herbal tea can be very refreshing and light especially mixed with a little honey to sweeten it, and don’t forget that lemon or lime aid are also fun choices for the summer.
• Get up earlier so you can take advantage of the cool mornings.  We do not like to work or exercise when we are too hot.  So take advantage of the cooler morning weather to get your exercise done
• Change your sheets to cotton rather then satin or non absorbent material.  This will be more comfortable if you sweat.   You might also want to consider what your pillow is made from.  Foam rubber pillows can be very hot.
• Uncover your feet.  If your feet are hot you tend to feel hotter.  If you sleep with a sheet over you and you uncover your feet you are more likely to feel cooler during the night.
• Open the window and the bedroom door to create a breeze.  If you do not have an air conditioner you want to take advantage of the cooler night weather and any breeze so creating a way to have a cross draft during the night might be helpful.  The exception to this is if you live in a loud area because the noise will keep you awake.
• An inexpensive fan can help you by moving the air.  Even if the air is not cooler if it is moving you will feel more comfortable during the night.  Fans are an inexpensive way to keep the air moving.  Just keep in mind that they should be placed out of reach of children.
• An ice pack on the back of you knees or a cool damp cloth on the back of your neck are great ways to cool your body.  If you choose to use an ice pack remember to wrap it in a towel as the ice can be very uncomfortable or irritate your skin.  An extra tip if you are woman who suffers hot flashes the cloth on your neck will help with that as well.
• Take a cool shower before bed.  A cool shower helps you to feel better.  If you are feeling less sweaty and sticky before you fall asleep you are likely to stay asleep longer
• Keep to your normal bed time.  Staying up later will confuse your body and its circadian rhythm.  It is important that we keep a normal schedule and routine so we have the best chance of getting a good night sleep.

 The summer can create some challenges when it comes to sleeping.  It is important if we want to take advantage of all the great weather that we take the time we need to get the sleep our body wants.

You have been diagnosed wit sleep apnea for the most part you are dependent on your doctor, lab technicians, the equipment company and your insurance for which machine you will have the ability to get.  But if you know what machines are on the market and what they offer you can choose a machine that will help you while keeping your needs in mind

The first think you need to consider is cost.  What really is the issue is not so much the cost of the machine, because they all run about the same price, but what you are willing to pay for and what you are willing to accept if you have insurance.  Insurance companies have different ways of paying for durable medical equipment.  Some treat as a regular part of insurance.  So if you have a deductible of $500 and then they pay 80% for care once that deductible is reached then you know what your expense will be.  This is not all insurances.  You may have an insurance hat has a durable medical equipment rider.  In this case it will have its own deductible that you will have to meet and then it will pay a percentage after it is met.  The third type of program is an HMO program.  Usually they have a specific copay of $50-$100.  They also require the use of a specific durable medical equipment company and will limit what equipment can be used including machines, masks and if you get a home visit or if you receive the machine from a UPS box.    If you are paying cash then you will have the most say over what type of machine you will receive.  However if you have a big deductible and know it you might get a better deal paying cash and submitting the claim yourself then you would using your insurance.

Once you have determines what you are willing to spend and what your insurance will cover then next decision is to figure out what is the most important aspects of the machine for you.  If you travel a lot it might be the size of the machine.  If you like to camp it might be that you want a back up battery.  If you know you have a great deal of problems with nasal congestion in might be a machine with the best humidification system.   Whatever issues you face it is important to know them up front so when you are working with the therapist who is setting up you new machine they know what is important to you.

The other issue is something that many patients are not aware of but is vital to getting insurance to pay for the machine.  Many insurances including Medicare require documented compliance of the use of the equipment.  This is usually done one of three ways.  A person comes to your house reads the hours of use on the machine.  The second way is that the machine has a card that you either plug into your computer and download and send to the DME company or your physician.  The third, and newest way, is that your machine will have a modem that will allow the DME company and your physician to follow you use remotely.  The remote compliance also allows changes to your machine without someone having to come to your house.  

Now that you know about what factors are involved with choosing a machine let discuss what some of the machines on the market have to offer.  

As far as size on the average the newer machines weight between 2.5 and 3 pounds and are quite small.  They have built in humidification systems, although some are better then others.  The newest machines are also more aesthetically pleasing.  Resmed's new machine the S9 has a sleep look and resembles a book shape sitting on the night stand.  Most of the other machines are either shaped as a cube or shaped like and alarm clock.  They all have a hose and a mask to attach the machine to the patient. If however you plan to travel the Everest has the ability for you to purchase a rechargable battery that fits over the bottom of the machine.  This allows for a stacked cube shape that is still faily light weight.

The cost can be a big consideration for a person especially if they have a high deductible or no insurance.  Some of the basic machines like the Everest, the Tango and some of the older models do not have as many of the newer comfort measures but they do allow for good basic therapy at an affordable price.  For those with no insurance and limited income many of the DME companies work with the manufacturers to get discounts of no cost machines based on income. 

If you have trouble with drying during the night then one of the machines with a heated wire tubing system such as the Resmed S9 or the Fisher Paykel machines will pprobably be your best choice.  Fisher Paykel is the leader in this technology having initially created it to help with ventilation of neonatal patients who were being ventilated. 

If you wish  for the newest, quietest machines with the most comfortable software so that the machines allows the pressure to work with you both the Respironics  PR series and the Resmed S series of machines have been upgrades to be the quietest on the market.  They have also created software for their machines that will work to make these machines more like natural breathing then breathing on a machine.  Both of these machines also have th eability to have a modem added for closer following of compliance and for changing of pressures without having to go visit the patient's house. 

When choosing a CPAP machine you should always listen to you physician but with a little education you might be able to avoid some of the problems that many new patients have.  Decide for yourself what issues are most important to be met and then discuss your options with a professional.  Look at these machines and try them out at your local DME company before you make a final decision. 

  CPAP therapy is the “gold standard” for treating obstructive sleep apnea, also called OSA.  For some of the people who use CPAP it is very difficult to use every night.  There are many reasons for this, but the biggest is a lack of education.  With this in mind there are five things that you can try that may help you being more successful with your CPAP.

 

1. You can start using it little by little.  For the first couple of days try wearing you CPAP while watching the evening news.  Make sure you are in a comfortable position such as sitting in your recliner.  The reason for this is because it is less intimidating then lying in a dark room telling yourself you must fall asleep with this strange machine attached to you.  Once you have been able to sit for 30 minutes increase it to an hour.  Usually if you can use the machine for an hour you can move to the bed and all asleep with it. 
2. Clean the mask properly.  Many people are not taught how to properly clean their mask.  Using the improper technique can lead to your skin breaking down, red marks on your face or a rash where the mask and headgear sit on your face.  You should wash the part of the mask that sits on your face every day with a gentle soap like ivory, rinse it very well then air dry it.  Your headgear, hose, humidifier chamber and the full mask is washed once a week.  Again you should use a gentle soap, rinse well and then disinfect it.  Many companies sell a product you can use or you can use the old fashion method.  Use 1 part white distilled vinegar and three parts water, soak for 20 minutes, rinse well then air dry.  Just make sure you rinse the equipment well enough or you will smell the vinegar all week.
3. Humidification is essential to reduce swelling and congestion in the nose.  Many people do not use or underuse their humidifier because of rain out or water in the tubing.  If you create a sleeve for the tube using flannel and some fabric glue you can help to reduce the rain out. 
4. Leaking masks do not help anyone sleep better.  Many people will put their mask on before turning on the machine.  They then tighten the mask down too tight.  This actually increases the leak rather then decreases it.  Most of the new masks are designed to create an air seal against the skin.  If the CPAP is not on this pocket does not inflate.  If you over tighten the mask it will crush this pocket keeping it from keeping it from sealing properly. 
5. Ask for help.  You have a team that is supporting you.  Take advantage of that team especially if you are having problems.  Talk to your DME provider, your sleep lab or your sleep specialist.  They are there to help you be successful.  If you need a new mask or have questions they are there for you.  They can get you a new mask if you need one.  They may also be able to look at other therapy for you including BILEVEL therapy or oral appliances.  Find support websites and local support groups.  These will allow you to talk to someone who is outside your care group and will also allow you to find other patients who may be able to share what they did to overcome your problem. 

 

CPAP therapy is designed to help you live a healthier life.  It is long term care for the person who is using it and for the person who sleeps with him or her.  It reduces snoring, apnea, and airway resistance.  It does take some getting used to but in the end the energy and better health you experience from using your CPAP on a regular basis will be worth it. 

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  An article was released about teens and the effects of caffeine and technology is having an effect of teens and their sleep.  I know I live this issue daily.  I have a teen son and a daughter who is just in her 20s.  The problem is that we have not created a culture that supports teens and their needs.

 

This article was timely as this week my son took his yearly standardized tests.  He has to get up at 6am to get ready for school so he can arrive just before 7am.  He will then sit in the testing room he is assigned to and will take a test that will determine his future.  Of course what they are not thinking about as these students enter the school is that more then half of the students walk on campus with an energy drink, diet soda or Starbucks in their hand.  They are all yawning, dragging their feet and look like they could use two more hours of sleep.  When they normally attend class at least 3-4 of the students will want to put their head down during at the very least 1 period.  These are not fresh, excited students.  These are sleep deprived people that our culture is trying to get to fit into a cheapest easiest way to give them an education.  We have not created an education that is designed for them to become successful educated individuals that can perform at their optimum. 

 

Add to this early more education some new parts to our culture.  Their diets include processed food, chemical substances, and stimulants like caffeine.  They are exposed to light 24 hours a day and their brains are stimulated from the time they wake up until the time they go to bed.  They are in the computer, playing video games or watching television.  They have 2-3 hours of homework they need to do when they come home.  They also have outside activities.  Things like my son’s Boy Scout meeting will last from 7-10:30 at night.  We have not set them up for optimal sleep we have set them up to be sleep deprived. 

 

It is difficult to tell a 5’10” boy that it is bed time at 9 or 10 pm.  The world has not stopped or even slowed down by then.  He still has homework he wants to tweak, friends to chat with or challenge on a game, or just wants to watch a show he knows everyone will be talking about at school the next day.  He gets tired around 11-12pm and is sound asleep no later then 1am.  On the weekend he sleeps until 11am and sometimes a little longer.  His friends are the same way. 


I believe that we have to look at what our children need, how to create a healthy environment for them and then nurture that.  Is sending our children to school at 7am really in their best interest?  One of the local school districts changed the time for the high school children from 7 to 9.  Next year they are changing it back because it interferes with after school work and activities.  Did they even bother to look at the student’s attendance, grades or test results?  They did not. 

 

So what is the result of sleep deprivation with our teens?  It is multifold, sleep deprivation can increase the incidence of depression, increase the symptoms of ADD, increase the chances of obesity.  It interferes with learning and storing information into long term memory. 

 

Now we need to explain to our teens why a sleep routine, turning off all electronics and going to bed early I so important.  We need to overcome peer pressure so that our children understand that this is the norm.  We need to be examples for them.  We need a very strong sleep routine that includes turning off the computer and the television.  We need to make time for the family to sit and eat together and read together.  These changes will help them during the tough teen years.  We need to help them reach their true potential.