Better Sleep Coaching

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. 

  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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  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. 

  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

 

1. 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
2. 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.
3. 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. 
4. 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. 
5. 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. 

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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.

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.

Sleep may not seem productive because we believe we are not doing something we define as productive.  Unfortunately, this belief causes many people to put sleep at the bottom of their priority list.  Te long term effects of sleep deprivation will keep you from having a quality of life you have always wanted.  Sleep.  If you want to have energy and clear thought then you really need to consider your length and quality of sleep.

Sleeping is a personal need.  For most adults between 7 and 8 hours is the average amount needed.  This is an average and there are people who need a little more or a little less.  of course when we are children and even teenagers we need more sleep.  When we get older we may need less sleep, but contrary to popular opinion older people do need between 6 and 8 hours of sleep. 

Sleep time allows two important processes to happen.  It allows us to process our thoughts and move them from short term to long term memory, and it allows our body to heal itself.  These two processes are so important  especially as we grow older. 

How do we achieve a good night sleep.  You need to put it on your to do list.  If you make sleep a priority, set that absolute bedtime, make sure you are creating a routine to help, it will help to make life more energetic.  Creating the best sleep environment will help to get the most of this time of day. 

At the end of the day it is important for you to take advantage of this 7 hours a day of good healthy sleep to allow you to really enjoy the rest of the day.  Y