It is the beginning of the summer season and we will all change our daily routines. One of the biggest issues will be our sleep and our children’s sleep. The weather changes and the sunlight changes which leads to new sleep habits. If we are not careful especially with our children that can causes us issues three months from now when they return to school.
So why all this change. That is simple since our day to day routine changes and become more relaxed our sleep routines also become more relaxed. This includes how much sunlight we get, how much napping we do and how strict we are about our bedtime. Our brain is like a computer in that it enjoys the routines we have that tells it when to boot up and when to turn off. When we change our exposure to light, our exercise, our bedtime or any of our other routine activities it will become confused and not want to shut down. In the case of our children this can become the fight for going to bed. Since they no longer have to be at school at 7am we figure it is fine to let them go to sleep when they are tired.
When school starts up again in August or September the fight to get them to bed on time will be that much bigger if we do not keep their routines intact during the summer. This does not mean there are no exceptions, just that it should be more normal than not.
If you have ever been to an amusement park you will know what I am talking about. You see a child in a stroller at 3 in the afternoon and he is whining and fidgety and cranky. That is because he is usually napping around 3 in the afternoon but his or her parents do not want to deprive him of the experience. In the end everyone loses. If the parents took the child to the room to nap instead they may have missed two hours in the park but they would have a child who has been refreshed mind and body and is now ready to enjoy the evening.
The temperature and long exposure to light also has an effect on our bodies that can lead to insomnia. To help with this it is essential that we stay hydrated. That is why you feel so fatigued when you spend the day out in the sun. Our body needs water to operate effectively. It is also important that we get that good morning sunlight that tells our brain it is time to wake up and that we have light blocking shades in our bedrooms at night so we have the darkness we need to produce Melatonin.
If you feel that a change in your routine is needed that is great. With summer’s relaxed routine it is a great time to add or try new things for your sleep routine. You can try exercising in the early evening to see how it affects your sleep, meditation or yoga as part of your sleep routine or changing your bedtime or wake time to determine if a change will lead to better sleep. I have found that if I change my alarm clock from 6am to 6:15 I wake more refreshed because I have ended my REM sleep by 6:15. Summer gives me that time to play with these adjustment.
Take the time to enjoy yourself this summer but remember that you still need a sleep routine if you want to enjoy your day.
Whether you have an HMO or a PPO most tests and procedures and even equipment will require an authorization from your health insurance. Generally people think this is just some paperwork that needs to be done, however there is significantly more to this procedure than meets the eye.
The insurance company will ask for the doctor’s notes about why you need the procedure, your medical history and any supporting documents. If there is not a certain diagnosis or a specific medical history than the order will be reviewed by a medical review board, a group of people made up by nurses who have been trained by the insurance company. If certain criteria are not met the order will be denied and a different procedure may be ordered.
If the doctor does not agree with the insurance they can ask for a peer to peer review where your doctor can talk to an insurance company physician. Your doctor must make the case of why you need this procedure and another one cannot be done. The insurance company can still deny the procedure.
When you come to the sleep lab and we are telling you that you have to have a home sleep test it is usually after we have gone through every avenue available. We want to follow your doctor’s order but we understand that there is a balance.
Sleep labs now employee one or more people to handle the need of getting authorizations. They also make sure that paperwork that is necessary for the study and the possible therapy are obtained.
Now think about the effort needed to get a PAP device. You go to the doctor and get an order. Someone must work with the insurance company to get the order for the initial sleep study or Home Test. We must explain the decision and why the doctor’s order was changed. We do the study then send the results to the doctor. We go through the same thing for the follow up study or the therapy.
Insurance companies have a lot of power on the care of a person. Most people are unaware of this change in the decision making process. The bottom line is your health care is decided based on cost; not based on the best outcome.
It hit the news that that ASV should not be used for certain patients due to the poor outcomes of a study that was being done. The question is what is ASV and why is it prescribed for some sleep disorders? It starts with the fact that this is not a common mode of therapy.
It is specifically used for those who have central apnea or complex sleep apnea. Central apnea is when the brain does not tell you to breathe. This is usually due to other health issues such as brain injury, hormone imbalances such as diabetic ketoacidosis, or neuromuscular disorders. Complex sleep apnea is a combination of obstructive apnea and central apnea. The central part of it has to due to the changes in brain chemistry that occurs when a person has obstructive sleep apnea.
Cardiac problems will also contribute to central apnea. A study that was recently being conducted by Resmed found that people who had central apnea and heart failure where there hart only puts out less than 45% of the expected amount of blood could have negative results from the use of ASV. This is a very small percent of people who are currently using this mode of therapy.
ASV is basically Bilevel therapy with a respiratory rate. The computer internally look at each breathe and decides how much pressure is needed. The technician who titrated you found the expiratory support needed to keep your airway open. The machine decides how much pressure you need during inspiration to take a normal breath. It also decides when it needs to give you a breath because you have not taken one quick enough. Ultimately the fact is that it will help you to breathe when yoru body forgets to breathe.
It is essential that if you have questions about your therapy that you talk to your ordering doctor.
There are so many people who come into the sleep lab with preconceived notions. I really believe that there are still not enough information out there from the techs and the successful patients that is positive. You can find many technicians and technologists who will post complaints about their night. The patients tell horror stories, I believe mostly from the lack of education provided to them or because they just do not understand the importance of the test.
The truth is that the test is not the most comfortable in that you do have to wear wires but that the test is not painful or difficult. It is easier if the patient can come in early and be set up. They can then unwind while getting used to the equipment. If they arrive at 7:30-8:00pm and they are set up and do not go to sleep until 10:00pm they have had enough time to learn how to get comfortable with the wires.
The second part is that the technician is explain the importance of the different monitors while the patient is set up. Knowledge is power and it is also comfort. If the patient understands that they cannot get tangled in the wires, that they cannot be electrocuted and that ultimately a good test will allow for a good diagnosis they will be more compliant.
Lastly you need to understand how the patient learns. I know that if I have an engineer I need to go into the science of the technology. I explain the Piezo crystal in the snore mic or the RIP technology so they can relate to it. If I have a teacher I tend to talk more about the biology and how good sleep improves grades and memory, If I have a young person I can go over some of the benefits that they will see such as the increased energy and I will also go over sleep hygiene so they have a take home.
As we move forward fighting the insurance companies for the importance of in lab studies for the appropriate person we need to stop scaring away the patients who need to be here. We have great technicians and we all have bad nights but we really need to look at how we are representing ourselves to the community at large.