The Challenge of Proper CPAP Mask Choice 07/28/2011
It is always a challenge when we have met a person for the first time and we ask a few questions and than we have to help them choose a mask that will work for him or her. This is a very interactive experience that can take a short period of time, or what usually happens is that it takes quite a bit of time making the decision. There are basically five ways to make this experience easier and more successful
Add Comment Oral Appliances for Sleep Apnea 07/17/2011
More people are being diagnosed with obstructive sleep apnea every day. With this increase it is important to develop new ways of treating this disorder. PAP, positive airway pressure, devices are considered the gold standard of treating sleep apnea. The problem is that there are patients who are unable to tolerate this therapy. One of the options for people who are unable to tolerate PAP is an oral appliance or dental device. These devices work best for those who have mild to moderate sleep apnea. Mild sleep apnea is defined as 5-15 respiratory events per hour. Moderate sleep apnea is defined as 15-30 respiratory events an hour. Anyone who has more than 30 respiratory events per hour is considered to have severe sleep apnea and although they can use an oral appliance it is not as successful in treating this disorder. There are two different types of oral appliances, mandibular advancement devices and tongue retention devices. The MRA devices work by advancing the mandible or lower jaw forward 6-11mm to help open the back of the airway. TRA devices work by pulling the tongue forward and that helps to keep the airway open. MRA devices are generally fitted and adjusted by a dentist. Ideally you should go to a dentist that specializes in sleep dentistry. You can get a list of registered dentists at http://www.aadsm.org/FindaDentist.aspx. These dentists are board certified in this specialty and have the ability to fit you with the correct device and to do any follow up testing you may need. The dentist will take an impression of your teeth and create an oral appliance that will fit you and cause the least amount of side effects while opening your airway sufficiently to correct your sleep apnea. The TRA devices are also fitted by a dentist however there are several styles that are available to buy directly and to then self-fit by the boil and bite method. These particular devices work best for patients who have an oversized tongue. Some of the side effects of these devices are drooling, your teeth shifting, tooth pain and sometimes jaw pain. According to current research it does not appear that the devices contribute to TMJ. Patient with severe sleep apnea may consider using an oral appliance in conjunction with the CPAP because you might be able to decrease the pressure of the PAP device. The ability to have a choice of therapy for obstructive sleep apnea is a great advance for people. Not everyone can tolerate CPAP or BIPAP but they still need to have some treatment for their sleep disorder. Dr Steven Park is a surgeon in New York who specializes in helping those with sleep apnea and other sleep disorders find surgical solutions to their issues. He has written a fantastic book Sleep, Interrupted . He has made sleep his specialty and gives monthly free webinars to answer patient's questions, educate about the newest research in sleep and to interview the top people in the field. His next webinar is Tuesday 7/12/2011 at 8pm. If you are interested you can sign up at http://doctorstevenpark.com/ask-dr-park-teleseminar Shaquille O’Neal recently let the world know he has sleep apnea. He shared his experience of testing and treating it with the world on You Tube. A month later he is announcing his retirement from professional sports. Is it possible that the long term effects of sleep apnea have caused him to feel he has come to the end of his career sooner than he could have? Did his poor sleep from traveling and changing time zones add to the problems he was already having? Sleep is important to everyone but for an athlete it is an essential part of training. Getting slow wave sleep is where the body releases its growth hormone and heals itself. This deep sleep occurs during the first third of the night. If, like Shaq, you stop breathing 20-39 times an hour it becomes impossible for the body to reach this portion of sleep. Add to the inability the stress of his oxygen dropping throughout the night so he is unable to give enough oxygen to his muscles and you do not get fed. Finally add the stress all this lack of sleep on the body as a whole will keep his body from healing properly. Shaq also lived a life that kept him from having good sleep hygiene. Traveling and the constant change of time would cause issues with his ability to go to sleep and wake up. The body works best when it has a routine and with constant changes not only of time but also the light that stimulates the brain to help regulate the body rhythm can make the brains ability to shut down difficult. If Shaq had actually treated his sleep apnea earlier it might have helped improve his health significantly. As this stress works on the body it contributes to high blood pressure, diabetes, heart disease, stroke, and current research has even linked it to certain types of cancer. The body needs rest to recover and it needs rest to reboot our brain and help with our short term memory. When we do not get this solid rest we pay a price with out health. Although Shaq has played professional ball for 19 years he may have been able to go that 20th season if he had just rested a little better. What lessons can we learn from this in our own lives? We should listen to our bodies. Snoring and fatigue are not normal. They are signs that should be listened to and discussed with your doctor. If you live alone and do not know if you snore but have other health issues such as high blood pressure or diabetes that are not improving even on medication you might want to ask your doctor about sleep apnea. You might also think that sleep apnea is just for those who are overweight, this is not the case. You can be any size or shape and have sleep apnea. It is more about how your airway is built then how much fat you carry on your body. Overall sleep is important to your health and if you get a good night sleep each night you will find that your health and your energy levels should improve. Your First Week on CPAP 04/14/2011
Everyone has questions and issues as they learn about their new bedtime friend, their CPAP machine. This first week will really set the tone for your success with your machine. During this time it is essential for you’re to ask questions and get the help you may need so that you sleep better at night. These 5 steps will help you have a great first week on your CPAP and will help you move on to a successful future of restful sleep 1. Learn what the results of your sleep study were. You really need to understand why you need the CPAP. Learn what your test says. What was your Apnea/Hypopnea index, the number of times you stopped breathing and breathed so shallow your oxygen levels dropped? Knowing how bad your sleep apnea is will allow you to understand that this machine will help you to feel better and live healthier, Did you have other issues such a limb movements and teeth grinding, also known as Bruxism? If you have other issues your doctor may not want to deal with them until after he has dealt with the sleep apnea. Know that these conditions may still cause you to wake up during the night and might have to be pursued at a later time. What pressure did they use to correct the breathing issues and what pressure did all snoring go away? If you understand why the pressure was set at a certain level you might better understand why the machine feels the way it does. 2. If you are having a mask problem, deal with it as soon as possible. Most insurance companies will replace a mask during the first 30 days. If you do not give the company enough notice you may run out of time and have to pay for a new mask. This is especially true if you develop a pressure mark of any type. These usually occur on the bridge of the nose. They mean one of two things, either you have the headgear too tight or that your skin cannot tolerate the pressure of the mask. There are many masks on the market so if the first one gives you problems there is likely a second style of mask that will work better for you. 3. If you cannot sleep with the machine the first night, do not fret. Many people have this problem. The sensation of CPAP blowing air in your nose and mouth may take a little getting used to. Try using it while sitting in the living room watching television. This will give your mind something to concentrate on, a comfortable place for you to learn to adjust to the air and will make it less threatening then lying in a dark room with nothing to do but stare at the ceiling. Once you have done that for a few hours then bring it back to the bedroom and try using it at night again. The second time you should feel more comfortable and be more successful falling asleep with your CPAP. 4. Find the right humidity for you. Humidification can help reduce stuffy nose, sinus issues and dry mouth but you have to find the balance between fixing drying problems and getting too much water in your mask and tubing during the night. Just remember that a dry nose and mouth is much more uncomfortable then a little condensation on your nose. 5. Talk to someone if you cannot solve a problem. Three days after you get your new machine the company that set you up should call you to see how you are doing. Do not hesitate to talk to them. Tell them the truth. They may have a solution to your problem. If they do not have a solution, talk to your doctor. Sometimes they are able to give you a prescription to help deal with an issue. If you need to be reinstructed about something to do with the machine. The company that set you up will be happy to come out and reinstruct you. That is what they are paid for. But they do not know what you need if you do not tell them. Ask the question you never know what solutions will pop up. Once you have had your first week of sleep on your CPAP machine you will find that you will start to feel less tired during the day. You might even find that some of your health issues that brought you to the sleep lab in the first place may be improving. It might take a little work but in the end the time you spend learning to use your CPAP will be well worth it. Support Is the Key to CPAP Success 12/16/2010
If you are just starting out as a new CPAP user you will find that a little support goes a long way. Family support is important but it is support from other users that will truly allow you to find what will work for you. The problem is that most physician’s offices and DME companies do not tell you where to find support. But if you look online and in your community there are some great support groups. Local Support Groups The American Sleep Association is an excellent resource for finding local support groups. They are the association that started the A.W.A.K.E. groups. They have even started on online meeting for truck drivers since they have unique issues such as repeated testing and traveling with their machine. Their website sleepapnea.org also has up to date research, and an online forum to have questions answered. If there is not a support group near you then they will help you start one up. Online Support Groups Talkaboutsleep.com was started by a sleep apnea patient who felt she needed more support. The site has a chat room, message board and strong basic information about sleep disorders. The most interesting part of the site is the reviews of equipment and the comparisons of the masks. Once a quarter they will trial two similar masks from different manufacturers. They send samples to members to trial and then review. This gives people the opportunity to hear what actual patients think of new masks when they come out. They also have an excellent store to buy masks and accessories for your machine. Sleepguide.com is a message board for sleep patients. There are patients and health care professionals who frequent the site and answer each others questions. You will find many opinions from different sources. Physician Sites DrStevenPark.com is a great resource. He has monthly webinar that answers pre-submitted questions on CPAP and sleep disorders. His site has interviews with other healthcare professionals and medical articles. He also has a book for sale called Sleep Interrupted. About.com has a page on sleep disorders that is written by Dr. Brandon Peters. He has a weekly newsletter that covers basic topics such as what is sleep apnea and new treatment options. Everything he has written is archived on the website so you are able to look up specific topics or disorders. This site covers many sleep disorders including Restless Leg Syndrome, REM Behavior Disorder ad Sleep Talking to name a few. Seeking Help is the Key If you are starting out with CPAP these sites and groups will help you to understand you are not alone. It will also help you to overcome problems that might arise while you get used to the new therapy. The more educated you are about your disorder and the more support you seek the more successful you will be.  You wake up with the nagging pain, difficulty concentrating and wishing you could just go back to bed and pull the covers over your head. If this happens on a regular basis there may be more going on then a hatred of mornings. Sleep disorders and sleep deprivation can have a serous effect on your waking hours. One of the symptoms of sleep apnea is a morning headache. It is an effect of several things happing during the night. Sleep apnea causes multiple arousals during the night which keeps you from getting a restful sleep as well as going into the deeper slow wave sleep which where your body heals itself. Each time someone with sleep apnea stops breathing it causes an increase in pressure in the chest that can effect the entire body and lead to high blood pressure. Your oxygen levels also fall depriving your body and brain of oxygen. This can definitely lead to that morning headache. Sleep deprivation can also lead to that foggy feeling when you get up in the morning. This could be due to routinely getting poor sleep. If you change your bedtime frequently your body can become confused and cause disrupted sleep or insomnia. Your pets can be another disturbance. Pets tend to move around during the night and they wake you during the night. But the worst culprit of a restful sleep is light and sleep; this can come from the TV, computer or outside. You can not sleep restfully with light and sound disturbing you. Lack of continuous sleep on a regular basis will bring on difficulty with short term memory, concentration and morning headaches. One of the best ways to look at what you might be doing that could be contributing to your morning headache is to keep a sleep diary for two weeks. It should have the time you went to bed, the time you woke up, how many times you think you woke during the day, what medications your took before bed, how much caffeine you consumed during the day and any unusual activities or exercising you may have done that day like shoveling snow, going to the gym or staying in bed because you were ill. Since we are looking for reasons you have a morning headache you should document what mornings you woke up with one. If you do not find a correlation between any type of behavior and the morning headache you should bring your sleep diary with you when you go to your doctor to discuss treatment for those morning headaches. Just remember that a morning headache more then 2 times a week for more then a couple of weeks are not normal and you should not suffer with the problem. Traveling with your CPAP or BIPAP 06/09/2010
With the increase in the ability to diagnose and treat obstructive sleep apnea a new group of issues have come into play for many people. It is time to take the family vacation or on a business trip and you wonder do you have to bring this machine with you? If you do what do you need to know to make traveling with it easier? The first question of whether or not you need to bring it with you is relatively easy to answer. CPAP and BIPAP do not cure sleep apnea they treat it. Just like medication, you should not stop using it without a doctor’s order. As soon as you stop using it your symptoms will reappear. Keep in mind that the fatigue which may have brought you to the sleep lab may not come back quickly because you are no as sleep deprived as you were before you were treated. However, the issues of low oxygen levels and the fact that you stop breathing and your snoring will come back when you do not use your therapy. If you are sharing a room, this can be quite troublesome for yourself or your room mates. When packing up your PAP machine there are a couple of things to keep in mind. The first is that it is important that you empty the humidifier. Many people forget this step and upon arriving at their destination they find a waterlogged machine. If the humidifier is separate from the machine you should still take it with you. Nasal congestion can be a problem when you travel and the humidifier will help to limit issues you might have with congestion and drying of the mouth and nose. When you are flying it is essential that your machine be a carry on. The change in pressure in the baggage compartment is not healthy for your machine. With most airlines, because it is medical equipment, it will not count as your one carry on luggage. You should have no problem making it through security because they are quite familiar with CPAP machines. Just take it out of the carry on case like you would a computer. In some airlines if you are taking a long flight and you are traveling first class or business class there may be electrical plugs that you can plug your machine in and wear if you plan on sleeping. If you are traveling to a high altitude some of the older CPAP machines have an adjustment that you can set to deal with the change in pressure. Other machines have internal sensors that will make this adjustment for you. Camping with your machine may be one of the most interesting issues that you may to deal with. If the campground has electricity then this is not an issue. If you are going to be somewhere a little more rural and you camp on a regular basis you might want to look at a machine that has a back up battery pack for it. It is always important to enjoy yourself when you are taking a vacation. If you do not sleep well then you may miss out on the enjoyment of your trip. With a small amount of planning using you CPAP will allow you and your family or friends to be well rested for the next day’s activities. How to Choose your Idea CPAP 05/08/2010
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.  You have been diagnosed with obstructive sleep apnea or OSA and then they hit you with a bunch of words you have never heard before. They start talking about machines and mask and humidity. You are told this is long term therapy. What they do not explain is what the machine does, what types of therapy are you eligible for and what will be the best type of therapy for you.
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