 This week I will be helping identify and talk about some of the interesting sleep disorders. The most common one is snoring. What the most recent studies have found is that snoring even if it is not associated with sleep apnea may be indication of health issues.
In children sleep apnea may not be present but snoring may be a sign that your child may need to be treated. Snoring alone can disrupt sleep, limit the amount of sleep your child may be getting or may just prevent your child from getting into the deeper sleeps needed to grow and to heal. If your child has symptoms of ADD or ADHD it may be due to that sleep disruption. If you find that your child is snoring evaluation by their doctor is the best way to get to the bottom of the problem. Some dentists are also looking at sleep apnea, as they can visualize issues with their upper airway. The physician may have the child evaluated by an ENT or have them do a sleep study to evaluate the extent of the snoring and to see if their breathing is being affected. In adults snoring is not just associated to obstructive sleep apnea. Snoring itself has been associated with high blood pressure and diabetes. They have also associated it with dementia and memory loss. Some people may only snore when they reach certain stages of sleep causing the disruptions to happen at approximately the same time each night. Usually during REM sleep, where we dream, are muscles are the most relaxed and this can bring on snoring and sleep apnea. Also it may be worse when someone is sleeping on their back because the tongue relaxes and moves to the back of the throat. If you have snoring and you have been tested for sleep apnea with a mild or negative result than you may still want to treat it. An oral appliance made by a dentist who specializes in sleep would be your best option. Because different oral appliances work for different people I would make sure that the person you are working with knows how to create more than 1 appliance. You may also want to attempt to use positional therapy so you do not sleep on your back. You can use a wedge pillow which will allow you to sleep with your head elevated. The more productive way however is the tennis ball method, where you create a pocket on the back of a t-shirt, place a couple of tennis balls in them and sleep in it for about a month. This will help encourage you to stay off your back when you sleep. Snoring, no matter how we look at it, is not a fun for the person who has it or the person who has to listen to it. You should do what you can to deal with it to keep yourself and your family as healthy and well rested as possible.
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I feel that part of my job as a healthcare writer is to cover issues that will affect you life. Your choice of insurance is a big choice you are making during this time of year. I was talking to someone who was saying how few of the people at her workplace choose to have health insurance, especially for their children. This is a huge issue that affects a person’s budget as well as their health.
Most people believe that insurance is essential. I do not necessarily believe that. I believe HSAs, health savings accounts, are a great way to plan for the future that may be option. I also think that people do not take advantage of the states children’s health care programs that provide low cost HMOs, health maintenance organization programs, in Florida it is called Healthy Kids. These coverages are designed to take care of emergencies but provide minimal coverage for wellness care. You can negotiate cash prices for visits or testing you may need. For someone who does not have a chronic problem this could be a compromise between cost and coverage. If you have a chronic problem this may not be the solution. Sleep apnea may be the one chronic problem that this rule does not pertain to. I will say this for several reasons. Sleep studies are usually done once every three to five years. If you are a cash paying patient you might be able to negotiate a lower price for the test. Since the company does not have to wait for payment they might lower the price. The one exception is that they cannot charge less than the reimbursement that Medicare due to the laws surrounding Medicare. So it might benefit you to know the Medicare reimbursement. When you need PAP equipment or supplies I will be honest you can get them a lot cheaper than the insurance company’s negotiated price. When pricing masks research the online sites and the sites that do drop shipping of supplies, this little bit of research could save you a significant amount of money. They also tend to buy in bulk and have fewer employees so they have less overhead. They then share the savings with those purchasing the equipment. As to whether sleep apnea will end up costing you more as a pre-existing condition or less because you are treating a health issues actually varies from insurance company to insurance company. If you have been diagnosed with sleep apnea and you choose not to treat it than you will be treated as having a pre-existing condition and they could not cover other issues such as high blood pressure or diabetes as they are associated with the sleep apnea. However if you are using your PAP than many of the insurance companies may ask for proof of use and will treat you as if you do not have a pre-existing condition. You will have to shop around and ask questions about that particular plan’s policy. When it comes to our children many of them do have sleep apnea and it can look like many things such as ADD, fatigue, hyperactivity, anger and learning disabilities. If we looked at their sleep and have a sleep study they are usually treated initially with a tonsillectomy and if still needed PAP therapy or an oral appliance. It is important that we need to help our children to be able to achieve their best and taking care of sleep problems is worth the cost of insurance. If you can not afford your children’s coverage you need to ask your state what programs they have to help you cover them. It is worth it in the end and will help them to behave better and be more successful in school When you are looking at insurance you must take many things into consideration including the cost to you and the ability to balance your budget while paying the premiums. But when choosing not to have coverage or you are choosing minimal coverage you must consider the effects it will have on chronic issues and your ability to pay for care. 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. We turn more and more to medications to solve our health problems. Although they usually can correct symptoms they do not necessarily correct the problem that is causing the problem. Many problems can be made worse by sleep deprivation and some may look like one health issue and actually be an sign of a sleep problem.
Is it depression or a sleep issue? Many people who have a sleep issues have the same symptoms of depression. If you are tired all the time this could be due to sleep apnea or sleep deprivation as much as depression. If you wake in the morning with a headache or feeling like your thinking is blurry this is a common sign for sleep apnea. You probably spent the night with your oxygen levels going up and down, this keeps the brain from getting the oxygen and blood it needs throughout the night. Your memory needs rest to work. Many people whether you are a student getting ready for a test or a person who thinks that if they work just a few more hours they will get ahead are actually causing issues with their memory. When we sleep we go into certain stages of sleep. We start the beginning of the night going into slow wave sleep, this allows our body to heal and grow by releasing several hormones including human growth hormone. Later in the night we go through cycles of sleep and REM sleep. REM sleep is where we dream and is also where we take information and move it from short term memory to long term memory. If you disrupt this cycle you may miss the refreshment of your body and your mind. High Blood Pressure, Diabetes and other conditions aggravated by Sleep Apnea Try holding your breath. You will feel your heart start to pound and feel pressure building in your chest. Now imagine doing that all night long. Some people may only do this during certain positions or during certain stages of sleep. Other people do this all night long and get worse as the night goes on. The heart is stressed and has to work harder every time you hold your breath. Each time you are unable to breathe you cause stress. This stress releases cortisol which causes you to stress. This contributes to increases in your blood pressure and blood sugar. Keep a diary see if your sleep is affecting your health. We really do not think about how much or how well we sleep. Keeping a sleep diary will help you to determine if your sleep habits or your sleep quality is contributing to your problems. You should keep it for at least two weeks. During this time you should document the time you go to bed, how long you think it took you to go to sleep, the time you wake up and how long until you get out of bed. You should also document any time you get out of bed during the night and for how long. I would also keep track of how much caffeine you had consumed during the day, if you took a nap and for how long and any unusual exertive activities you may have done. In the end it is as much up to you as it is up to your doctor to figure out what is causing your health problems. There are times when you can find that the solutions to your problem may not need a medication as much as it is small changes in your lifestyle or maybe be evaluated for a sleep disorder. 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. 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. 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. 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. |
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