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.
CPAP stands for continuous positive airway pressure.It is the most common therapy used for the treatment of OSA.It is one continuous pressure that supports the airway.This pressure was determined during the second sleep study, called the titration study.On some occasions the titration is able to be done on the same night as the diagnostic study.During the titration the technician will slowly increase the pressure until the breathing issues, snoring and airway resistance is eliminated or reduced to within normal levels.In order for the insurance company to pay for the machine you must have at least 5 respiratory events an hour with some type of co-morbitity such as hypertension, or excessive daytime sleepiness.Once the respiratory events increases to 15 events or higher a co-morbidity is no longer needed.
Bilevel or BIPAP therapy is similar to CPAP however, instead of one continuous pressure there are two pressures.The lower pressure is the EPAP or expiratory pressure is increased to eliminate obstructions.The higher pressure called IPAP or inspiratory pressure is adjusted to eliminate snoring, upper airway resistance and partial closing of the airway.This therapy is also used to help people who can not tolerate CPAP therapy.Patients who can not tolerate the pressure they need or who need high pressures this can allow the use of a more comfortable lower pressure.The change in pressure also assists some people to feel more comfortable or natural.In order for insurance to pay for this therapy the technician or the doctor must document that CPAP was used unsuccessfully and that Bilevel therapy is the best alternative.
APAP or AutoPAP is a self titrating therapy that is used for people who may need higher pressures part of the night such as when they are in REM, the stage of sleep where they dream or when they sleep on their back.This allows the pressure to remain low until the higher pressure is needed.This therapy is also used when the patient does not wish to come back for the second sleep study.Many insurance companies do not wish to pay for Autopap because it is more expensive and it is not set to specific settings.
ASV, AutoSV, or BIPAP ST all of these are similar.They have an inspiratory pressure and an expiratory pressure the difference is they have a rate as well.This particular therapy was designed for people with central apnea.Central apnea is when the brain does not tell the body to breathe.The Bilevel therapy allows the machine to give a breath and the back up rate allows the machine to give the breaths when it does not sense a breath after a certain period of time.These machines are only ordered when there are more central apneas then obstructive apnea.Insurances pay differently for this therapy since it needs closer follow up by the doctor and the durable medical equipment company that sets it up.
Oxygen can be ordered for some patients.It can be added to the therapies described above or be given alone.Oxygen is prescribed when the level of oxygen in the blood is lower then 89% for a minimum of 5 minutes without an associated respiratory event.This means that there is not an obstructive apnea or hypopnea causing the decrease in oxygen.
Therapy for breathing disorders can be complicated.It is best to talk to your doctor and your technicians.The more information you have about the therapy and the options available the more likely that you will be successful.It is also important to understand your insurance policy’s durable medical equipment reimbursement as this can have a high initial cost.If you work with your team you should have a successful experience and start to feel better rested and healthier in no time.
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Technology has come a long was and studying sleep is no exception.We are now able to perform sleep studies in the home as well as the sleep lab.This is a great thing because it allows more people to be tested for sleep disorders then every before.The drawback is that there are limitations to what can be done in the home versus the lab.
In home sleep studies are generally modified unsupervised sleep studies.This means that the equipment is delivered to the patient and then they are responsible for applying it and taking it off.In some areas a technician will come out in the evening to apply the equipment and you will wear it the rest of the night, then you may have to take it off or the technician will come back in the morning and remove it.Generally these types of studies are limited in nature and only monitors certain parameters, oxygen level, heart rate, breathing, and whether you are awake or sleep and position.Because the study is limited it is designed strictly to diagnoses sleep apnea.Other conditions a person may have will not be diagnosed, such a periodic limb movement disorder and teeth grinding.This type of testing is also not good for patient with significant health issues such as congestive heart failure or COPD.
In lab testing has several differences.The first one is there is a technician there with you if any problems should arise.If one of the wires become dislodged it can be fixed right away.You do not need to have another study performed.The technician is also there to answer questions should you have any during the nights.The most important role of the technician, however, is that they can intervene if there is a significant health issue during the night.They can also do a special type of study called a split night, or combination study, which allows you to be diagnosed and treated for your sleep apnea on the same night.This way if you have severe sleep apnea you can be treated right away instead of waiting.You also are able to be evaluated for other conditions you may not know you had.
Treating sleep apnea after the home sleep study can occur in two different ways as well.You can be brought into the sleep lab for a titration study.During this test the technician finds a mask that works for you, educates you about CPAP and how it works and then finds the right pressure to eliminate most of the apneas and snoring.This test also allows the doctor to look for the other disorders such as periodic limb movements.
The an auto-titrating CPAP. This machine is set to allow a range in pressure that adjusts as you have events during the night.The technician will fit you for a mask and then leave the machine for you to use.The drawback is that there is no one there during that first night to assist you if there is an issue.The other issue is that unless you call your doctor or the company that delivered the machine they may not be able to correct any problems that happen until they download the information in the CPAP memory.
Overall home sleep studies do have a place in the diagnosis and treatment of sleep apnea.They are very good for diagnosing the straight forward sleep apnea patient.If, however, there is any issues that need to be addressed right away or if a person needs some assistance this may not be the best choice.A full sleep study allows for the possibility for quicker treatment and intervention.There is also the ability to diagnose other conditions that might go unnoticed in the home setting.That and the personal care involved in testing help to create a successful long term care situation.other option for treatment is to have a homecare company deliver
More people and their physicians are looking at sleep habits and problems that might be contributing to problems such as hypertension, difficult to control diabetes and congestive heart failure.They are also looking beyond medications to take care of issues like chronic fatigue.Snoring is looked at as something more significant then an annoyance.To find out the source of the problem a sleep study has been scheduled.Unfortunately not much is explained before the study and it is hard to figure out what is expected by talking to friends and family.There are a few tips to make the experience more pleasant and get a good night sleep
Take a tour of lab.If the doctor owns the lab you can probably take the tour the day the appointment is scheduled.However, if you are going to an independent or hospital based lab then taking the time to visit the facility to will give you and idea of what to expect and if you feel you can not sleep in that facility it gives you a chance to call another center or discuss other options with your physician
Make sure your sleep clothes are comfortable.Many facilities keep the rooms cool to prevent sweating.If you know that you will be cold bring socks and warmer clothes.If you tend to be hot during the night shorts and a t-shirt may be all you need.
Bring your pillow or blanket.Bring something with you that will make you feel like you are sleeping at home.Many people prefer their own pillow or blanket.Other may bring their child’s teddy bear or an object that belongs to their spouse.
Read all the paperwork and instructions carefully.Different facilities have different requirements for preparation.Some basics will be to have your hair washed with no products in it, no lotion on your face and legs, and to avoid caffeine the day of the study. Make sure all paperwork is filled out and a list of all medications you are on is attached. Some labs will want you off or on certain medications.
Talk to your doctor if you feel you can not fall asleep.Some labs will prescribe a sleep aid for you to take if you try to fall asleep and are unable to.If you know you have anxiety issues or you have a history of first night effect, the inability to fall asleep in a strange bed the first night, having some medication as a back up might prevent you from having to come back for a second study.This is also useful if you need a titration study.Adjusting to CPAP can take some times.If you have a sleep aide or anti anxiety medication it might make the adjustment to the CPAP go a little more smoothly.
Having a sleep study can be very stressful if you do not prepare for it.But these steps will help to make you more comfortable and allow your sleep through the night.The closer your sleep is to sleep at home the more likely the lab will be able to find a problem you might be having.
Your wife or husband tell you they need to go to bed before you or they will never sleep. You know if you are going on a trip you can not share a room with anyone else because they will complain. Do you know when a snore is something you need help for or just annoying?
The fact is that no matter what a snore is not normal. If you snore there is something in your anatomy that says you need to have it evaluated. It may be just that you have a large uvula that vibrates when you breath at night. It could also mean you have sleep apnea, a condition where you stop breathing or breathing is partially obstructed and your oxygen levels in your blood drop.
If you have plain snoring this can be treated with several medical treatments including medications, surgery, or an oral appliance. You might also benefit from positional therapy. This is where you avoid sleeping on your back. You can use a special pillow or other device. My personal favorite is to take a t-shirt sew or glue a pocket down the center of the back of the shirt and place 3 tennis balls into the pocket then close it. Every time the person rolls onto their back they become uncomfortable and roll to their side.
If you are not sure if you might have sleep apnea take the Sleep Quiz. If you have a score of 9 or greater then it is time to speak with your physician. Sleep apnea is important to treat because sleep apnea can contribute to many health issues including depression, high blood pressure and diabetes.
If your child is a snorer you should take the time to talk to his or her pediatrician. Sleep disorders can very easily be disguised as irritability, short attention span and can lead to other health problems. It can be caused by enlarged tonsils and adenoids. It can also be caused by a small airway. The current research is discussion new medication treatments to help children.
No matter who in the family is snoring it is something that is not normal. It is something that should be evaluated by a professional. If they can sleep quieter then everyone will get a better night sleep.
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