We talk about living healthier, exercising and eating whole foods. We still do not take sleep and a sleep routine seriously. We are still looking for the instant pill or the idea that will say that less sleep is better. What the studies say is that poor sleep contributes to health issues across the board.
· The studies that lead to contribution to colon, prostate and breast cancer all involve both sleep deprivation and sleep disorders that prevent sound sleep. These to conditions can be helped with therapy and possible treatment of a sleep disorder.
· Studies have shown that children have difficulty learning and learning proper behavior due to poor sleep, lack of sleep and snoring. We really do need to teach our children and teens that sleep is as important to health and good grades as studying.
· Studies have proved that we still only help 20% of those with sleep disorders. However that does not include the family that was affected by the disorder. If husband or wife cannot sleep because of loud snoring, leg movements or acting out dreams than you have more than one person affected and we need to consider all who are affected as patients. Sometimes the treatment may be time and space.
· Weight and sleep are interconnected. This is the vicious cycle the higher your weight the worse sleep disorder breathing will be, the worse the sleep disorder breathing the more difficult the body has at maintaining weight.
With all those issues you would think insurance companies and doctors would be asking more sleep questions and explaining proper sleep. The issue is they are not educated in the importance of proper sleep. In fact if you look at a medical student’s time you will see they do not live what they preach. This is a time where you need to take control. You need to go to your doctor with written questions, maybe a three to four day diary with symptoms.
Explain your desire to not just take a pill but to truly fix the problem and you may get some strong feedback. Doctors like to know a straight ahead question they can fix and that would be a sleep disorder.
The change has to start with an informed patient or at the very least a patient with relevant questions. This way we are able to work with the insurance company. Our goal ultimately is to get a good night sleep with the least amount of medication. I believe we can achieve that if we work as a team.
One of the first issues I hear when a person comes into a sleep lab to be introduced to a CPAP is that they have claustrophobia; that you cannot stand to have anything on your face. There is always an excuse for not tolerating therapy. Most of the reason has to do with feeling out of control. There are so many ways that can create a successful experience.
Let’s start with the mask. It is probably the most important piece of equipment you will use and the easiest to change. If you are unable to use the mask during the night of your study tell your tech, however, what usually happens is that they use the mask for 1-3 days at home and find that it is not the best mask for them. It may move too much causing leaks, it might cause your skin to mark or breakdown, it might make your eyes dry; all these issues can be handles with a change of mask. It is also common for people who are claustrophobic to be much more successful with a full face mask due to the ability to breathe through both the nose and mouth which will make anyone more comfortable. Your insurance will pay for replacement mask during the first thirty days of the therapy. After the first thirty days a new mask must be ordered. At many centers they will allow you to trial or borrow masks to find one that will work for you.
Knowing how to perform relaxation techniques will allow you to be successful when you are trying to fall asleep the first few days. It can also help on days where your stress level is high. The two techniques I have found that help are progressive relaxation. This is easy to learn and allows you to focus on relaxing as well as helping you to focus your thinking.
1. Start at your feet and tighten them as tight as you can, hold for the count of ten and then allow them to relax and go limp
2. Progressively move up the body focusing on one muscle group at a time.
3. To reach the top of your head should be having spent about 10 minutes on deep breathing and your muscles may be relaxed. This centered concentration helps increase oxygen levels and allows the mind to camp down preparing it for bed.
Diaphragmatic breathing is another exercise that will allow you to relax and breathe deeply with a technique that takes focus. Lie flat on your back with your hand on your stomach just below your ribs. As you take a slow deep breath in push your hand out; when you exhale draw in your abdominal muscles so you are pulling your hand in. I usually like to hold the breath 3-5 second between peak inhalation and exhalation. Having to concentrate allows the mind to calm and it increases the oxygen level from doing nice slow inhalations.
If relaxation techniques do not work for you medication or working with a councilor that practices Cognitive Behavioral Therapy. Your physical can help you to find assistance that will work for you. It is not unusual for someone to need a little extra support, this is long term therapy and sometimes it takes a little time to become compliant with it.
Some accessories can help you with some of the small issues. Chin Up strips can help a mouth breather minimize the leak. A Gecko will help with sores on the nose and leaks into the eyes. A heated hose might help with mouth drying.
Overall working with a patient technologist or physician is the best way to be successful when using PAP. The more you communicate about your issues the sooner a solution to help you be successful on your machine, and sleeping a healthy sleep.
I have been working with patients for well over 15 years and during this time therapy has changed greatly. The problem is that the issues I hear are the same ones I heard when I first worked with patients setting up PAPs in homes in the 1990s. The facts are that the therapy has changed and the issues are not nearly as serious as they once were.
Many people talk about how unsexy the therapy is. I think snoring, tossing and turning and being on multiple medications for health issues is much more unattractive. Many of the new masks on the markets are smaller and less intrusive. The Fisher Paykel nasal mask and the RESMED pillows and nasal mask are much smaller with less head gears. These are easier to put on and because less equipment touches the face they are more comfortable to wear.
Many say the machines are too loud. This is no longer true. There are many different machines on the market and the newer ones are much quieter. In fact many of the people cannot tell if the machine is on. This is especially true with the correct mask.
There are some who complain that they dry out when they wear their mask. This was very true when I first set up therapy when I was first doing set ups. Now not only do they have heated humidification that is almost always ordered with the machine. The heated wire hoses helps to prevent water buildup in the hose as well. This new technology helps to make sure those issues, such as nasal congestion, nasal and mouth drying and sinus swelling is kept to a minimum. If you continue to have such problems there are products that can help or you should consider going to a full face mask.
I am a mouth breather and cannot find a good mask. While full face masks can be a little more difficult to get used to there are other options as well. Chin-up strips to help keep your mouth from opening during the night and the Fit Life mask from Respironics may be a better option because it does not sit on the bridge of your nose but does cover your whole face. You can also use products like nasal saline spray or Oramoist to help add moisture to your airway.
The biggest complaint is the pressure. No one expects you to get used to the therapy overnight. There are people that will help you with desensitization to therapy. There are also several new ways that can help you. C-Flex, Sense Awake or ERP are all ways that the machine helps to relieve the pressure. If that does not work than there are other options for the doctor to take. But you need to give it a try getting used to the therapy first. Most people will in 2-4 weeks.
CPAP therapy is one of the best ways to treat sleep apnea. There are few reasons to not try the therapy. The most important thing is to keep communicating with the doctor or the home medical equipment company. They cannot help you if they do not know you are having problems.
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
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.
The new Respironics TrueBlue mask
One of the biggest issues people have with CPAP is that if they sleep in any position other than on their back the mask slips, slides, leaks or honks. The goal is for you to be able to use your CPAP every night and for you to get a restful night sleep. The solution comes in several little changes and maybe one big change.
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.
CPAP therapy is considered the gold standard for treating sleep apnea. It is a machine that uses a mask of some type to deliver a specific pressure of air to help keep the airway open. The problem with CPAP therapy is that it does take getting used to in order to be successful in using it nightly. There are some very specific reasons that people fail to be able to adjust to it and there a definitely ways to overcome these obstacles to be successful and feel better.
If you wear a CPAP you might notice that this time of year you have more side effects. The cold dry weather and the increased time indoors can cause many side effects such a drying of the mouth and nose, congestion, sinus infections, and illness. It is important that if you are using your CPAP that you are comfortable all year so you have to consider the time of the year and make the changes you need.
The first problem is the dry air that occurs during the winter. This is true even if you have a humidifier in the house. Your humidifier is the best defense for this. Most humidifiers on CPAP machines have settings of 1 to 5 and are usually set to 1 or 2. The reason for the low setting is due to water accumulating in the tubing and mask. This problem can be reduced by making a sleeve for your tube. A nice piece of flannel and some seam glue is all you need. You want to turn it up high enough to make your airway comfortable.
One of the side effects of an overly dried airway is congestion. This is one of the easiest ways to tell if you need to increase the humidifier setting. If you are experiencing congestion you might also want to use a nasal saline spray before going to bed and then again when you wake up to help rehydrate your airway.
The other issue that really causes problems during the winter is colds and flu. Illnesses makes wearing your CPAP challenging. This is where owning two masks can come in handy. It helps to have a full face mask if you usually wear a nasal mask or nasal pillows. It is essential that you keep your mask, tubing and humidifier clean. Warm damp places are a great place for viruses and bacteria to grow. The best way to keep your equipment clean is to wash it with soap and water and then you can disinfect it with one part white vinegar and 3 parts water. Just soak them for 20 minutes then rinse very well so your equipment does not smell like salad dressing then allow your equipment to air dry.
If you try some of these ideas and they do not help you then go back to your doctor, sleep lab or DME company and ask for some help. Everyone wants you to succeed with your CPAP and they will be happy to help.