It is a long day and sometimes you just need to just shut down and take time to reset your brain.  A nap can be a great thing if done right.  It allows you to consolidate your memories so you can have fresh perspective. 
As children, we are encouraged to take a nap so we can refresh ourselves and have energy and the ability to keep control during the second half of the day.  Sometimes as adults, we should remember how that we felt after that nap. 
There are certain things we do have to consider when we do nap.  A nap should only last about 20-40 minutes.  We do not want to reach REM sleep because then you will feel more tired and sluggish.  Make sure you set an alarm so that you will make when you want to wake. 
You need to make sure you are comfortable.  The light should be low to help you relax.  You also might want to have soft music or white noise to help you to focus and to drown out background noise.  Find a position that is comfortable for you for this short nap.
Aromatherapy may also be helpful because sent scan help your brain to focus and allow our minds to wander.  Scent is the sense attached to memory.  Use a scent attached to good memories then it will help to relax and drift.
Once the nap is over it is good to get up and move around and to get some sunlight to help you to wake and get alert and oriented.  Then enjoy the rest of the day.

You received your CPAP, shown how to use it, chose your mask and brought it home.  You put it on and stare at the ceiling.  What to do?  You know you need it and that if you do not wear it there are health consequences.  You also know that the insurance company is going to monitor your use before they will pay.

So this is how I start the people I have worked with.  I ask them t o wear it in the late afternoon, early evening for 20-30 minutes while watching tv. The next day add 5 minutes.  And keep going until you can wear it for 2 hours.  Then move it to the bedroom.  (If you happen to fall asleep with it then you know you are ready to wear it all night).  

I will add some relaxation techniques I use in future post.  '
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Many people do not realize how sleep deprived they are.  Do you believe that the minute your head hits the pillow you fall asleep is normal?  Do you believe that you should want to take a nap during your lunch break or as soon as you get home from work?  Do you get frustrated or anger easily?  All of these are signs that you are sleep deprived. 
It is even more difficult to determine sleep deprivation in children.  Many children act differently than adults when they are chronically tired.  The problem is that sleep deprivation and sleep apnea symptoms in children look a great deal like ADHD.  Children will become agitated and have difficulty concentrating.  They become very active during the day instead of tired. 
Sleep apnea also looks different.  They will snore or breathe with their mouth open.  They may have some disruptions during their sleep but not always.  They may toss and turn a lot.  However, many times sleep deprivation is caused because as parents we do not send our children to bed early enough.  They may also be woken up too early.  Children need longer sleep times and if you keep them up too late, they miss important periods of sleep that allows them to produce growth hormone as well as consolidate their memories. 
In adults, sleep deprivation shows up as memory issues both long term and short term because your brain does not get to process the memories.  It also can prevent the brain from the time it needs to clean out waste.  This may affect memory as well as contribute to morning headaches.
You may experience other symptoms like fatigue and sleepiness, headaches and snacking.  I am aware that snacking sounds like a weird symptom, however, when our brain is tired many times we misinterpret the signal as being hungry and we make poor decisions that will cause us to snack.
Everyone has his or her own symptoms. This is not an exhaustive list of symptoms but it does give you a place to start considering what in your life is caused from sleep and is it worth your health to give up the 1 to 2 hours a night sleep? 

This is the question I hear all the time.  What one thing I can change?  Usually the answer I give is not what people want to hear and will not do. 

If you truly want to sleep better tonight you need to shut down the electronics.  Not just right before you go to bed but at least 40 minutes before bed time.  This includes the phone, tablet and the television.  

In order for our brain to make Melatonin we need exposure to darkness. 

That does not mean turning on a filter to a phone or tablet.  It means we need to turn down the lights and read a book or do another relaxing activity.  Do some stretching or deep breathing exercises to help wind down.

I would also suggest that you put the cell phone on the opposite side of the room face down.  I would also use the do not disturb feature.  This will not block calls from people on your favorite list but it will block the sound of texts, IMs and spam calls.  The benefit to having the alarm go off across the room is that you have to get up to turn it off which will help you to start the day.  

No one needs the television on to sleep.  Television prevents you from sleeping and in fact will wake you up during the night.  Advertisers take advantage of the fact that sleep deprivation reduces inhibition to sell you products.  The flashing lights at 3am are designed to wake you up.  It is not just about sound but it is about light. 

If you truly want to get a good night sleep and fall asleep easily  then take the time to prepare for bed and embrace the dark. 

Do you know what the best way to put your new baby to bed.  There is a great deal of advice out there and more than a few schools of thought.  The most important issues is to keep your baby safe when they sleep.

The bed should be comfortable and a safe protective place.  This is one area you should never skimp on price.  A firm supportive mattress is essential.  Remember you newborn can not really move positions if they accidentally turns his or her face into the mattress.  That is why it needs to be firm and not conform to the shape of the child. 

That is also the reason you should not have soft toys, pillow or fluffy blankets in their crib.  We want to make sure they never have issue with something covering their nose.  
 
The best position is on their back.  this allows their head to be in the best position to breath.  

If you do want your baby to sleep in your room a bassinet would be an excellent choice.  Co-sleeping with a baby is not the safest choice for your little one.  Adult beds are too soft, the blankets are too big and when we are asleep and snuggling our babies we could accidentally hurt our babies. 

We always want what is best for our babies and sleep is essential for their brain development.  We just need to make sure that we protect them from possible injury or crib death.  
 

When we celebrate the New Year, we set goals, resolutions or ideas about what we want to accomplish in the coming year.  However, keeping these plans is difficult.  Especially if we are not sure how to keep ourselves motivated.  So this year as well as using SMART goal setting I thought about what helped me to stay motivated. 

While I was listening to a podcast the question was posed; “what keeps you motivated?  Are you motivated by rewards or by challenges?”  This is an excellent question.  If I want to achieve my goals, I need to know what will help me to stay on track.  I can write SMART goals because I have been doing it for years.  However, achieving my goals is another thing.  This made me realize I was missing the one thing that I always seem to lack.  A motivational tool. 

I realized that I am not motivated by rewards. This may have something to do with my feeling of unworthiness (that is a topic for another blog.) I do like a good challenge.  In fact, that what got me to jogging the first time was the goal of finishing the Disney Princess 5k.  I love a good challenge.  I just need to find the right one that keeps my interest.  The challenge need to motivate me, be interesting to achieve.  That is what motivates me. 
Not everyone wants to step up to a challenge.  Some people work better with small steps, small rewards. Then when you reach, the ultimate goal there is a bigger reward.  It needs to be something that would excite you.  A vacation, a day at the spa, or something else that you would enjoy that is big.   
When focusing on sleep and learning to use you CPAP this can be difficult as it is not necessarily something you want to use. However, the focus of the goals should be on your health.  The need to use the PAP device and to find improvement in your health. 

New users may find it difficult and will need to set those short term and long term goals using rewards or challenges.  You may need to start with wearing your PAP for 30 minutes and build up to 60 minutes.  That is worth a reward.  Of the challenge of watching an hour of television before taking off the mask.  This is a great way to get used to it and push forward to wearing your PAP all night.
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Sometimes it takes time to get used to it.  You just need to learn your motivation and then move forward with your use. 

​With this year’s changes in healthcare many people who think that what their physician has ordered or what they want should be paid for by their insurance.  They also may believe that since they pay for insurance there should be no cost for the study.  Both of these are not true. 
Who Truly Makes the Decisions
If you have insurance they will review any order and decide whether it is justified by doing a prior authorization.  At that time the authorization is done they can do several things,

• Say yes you need this study and we will authorize it, however that does not guarantee payment
• No we will not pay for the prescribed procedure but we will pay for a different procedure and they could require a different provider.
• They could outright deny the procedure. 

If the study is denied the option for the ordering doctor to do a peer to peer review can change this decision.  A phone call by you most likely will not change this decision but they can give you an explanation of the denial.
Let’s Talk Money
Understanding the difference between premiums, copays and deductibles can be confusing; but each of these are different aspects of the insurance. 

• Your premium is the amount you pay each month to the insurance company for your coverage.  If you fall 30days behind you start your grace period. This means that the insurance company will give you a chance to catch up on your premiums. 
• A copayment or coinsurance is the percentage of the insurance company’s contracted fee for service you are required to pay.  Usually they are anywhere from 10% to 50%.
• A deductible is the amount of money you must pay before your insurance company will pay for a service.  There may be services such as a doctor’s office visit or mammogram that do not apply toward your deductible. 

If you need to have a sleep study and you know you have a large deductible and you are only checking for sleep apnea you may benefit from having a home sleep test.  If you are looking at other disorders than a full night in lab sleep study is more beneficial. 
You doctor knows what is best for you but remember you get to have some input into your care.  

Snoring can be a sign of a sleep disorder but there are many people who just snores.  For those who do not have sleep apnea, a disruption or reduction in breathing during the night, snoring can be because of the shape of the soft palate or due to other issues that cause vibrations during sleep.   The problem is that snoring has been found to contribute to health issues for both the person who experiences it as well as those who living with the snorer.  Sleep deprivation and the physical act of snoring has profound effects on sleep. 
Snoring has been found to contribute to plaques on the Carotid arteries and also has been known to loosen those plaques which can lead to a stroke. 
So what do you do to treat snoring if you do not have sleep apnea?

• The first thing is to not sleep on your back.  There are several techniques and products out there that can help.
  • The least expensive is the tee shirt and tennis balls.  You take a piece of cloth and make a sleeve on the back of a tee shirt using seam glue.  This will cause discomfort and the person will roll to the side.  It is not attractive but it has been used for many years successfully.
  • If you want something that looks more professional then there are products on the market to help you not sleep on your back such as the sleep bump.
• You can elevate the head of the bed.  This will also help with gastric reflux.  The easiest way to do this is to purchase a wedge pillow.  They can be ordered online or gotten at Walmart or Bed Bath and Beyond.  This will elevate the head to 45 degrees which would be optimal and should not cause issues with a person’s back.  It also helps pregnant women who are experiencing breathing issues. 
• You can purchase on oral mouth guard either from your dentist or from your local drug store.  The drawback is that it may not work or it could cause issues such as TMJ or headaches.
• There are special pillow that will help to extend your neck further back.  Again there are drawbacks including a stiff neck or a headache. 
• A white noise machine or room fan may help if the snoring is mild. 
• There are a couple of chin straps on the market that may help with snoring.  They are designed to help bring your jaw forward which increases the size of the airways and could reduce snoring in some people

What does not work to help reduce snoring?

• Any oral spray that says it will fix snoring.  Most of these are just vegetable oil of some sort and although they may lubricate the airway in the beginning of the night they do not do anything that help to open the airway.
• Nasal strips or dilators.  These were designed to open up the nasal passages.  Although it may help someone who has an issue with a moving air through the nose it is not designed to fix snoring. 
• Anything at all that says it works all the time.  People snore because of different issues with the build of their airway.  Therefore that is no one right fix for anyone. 

Keep in mind that sedatives and drinking do increase snoring.  Muscle relaxants have also been known to increase snoring.  They are also known to contribute to sleep apnea so keep in mind how these affect your body.
The last issue to help is for those who live with a snorer.  I am sorry to say that other than ear plugs, hick will help drown out the noise the only way to help is to treat the reason for the snoring. If it is affecting the person’s sleep then insurance will cover some of the procedures used to help reduce snoring.  

We hear tons of articles about balance and happiness and being purpose driven or being successful but with each of these things we see that the suggestions tend to be out of balance or unrealistic.  What if instead of using these catch all’s we look at what is important to our health and make those priorities.  In particular healthy sleep.  If you really want to achieve any goal you need to have your brain working at optimal levels which will not happen unless you allow yourself to get healthy sleep.  In order to get healthy sleep you must make that one of your priorities. 
The question then is what is healthy sleep?

• Your brain requires a certain amount of time in each stage of sleep.  In the first half of the night you go into slow wave sleep which is the deep restful sleep your body needs to health and rejuvenate itself.  If you go to bed too late you miss that important part of sleep. 
• Every hour and half to two hours you go into REM sleep or rapid eye movements sleep.  This is also known as active sleep and is a very light layer of sleep.  It is where your brain processes your experiences and emotions and stores them.  It is also the part of sleep where you release certain hormones that help you to sleep.  One of the issues with REM sleep is that you release a hormone that relaxes your muscles and keeps you from acting out your dreams.  If you have a sleep disorder such as snoring or sleep apneas this stage of sleep can become interrupted. 
• As the night goes on your REM sleep sessions last longer so if you wake to an alarm and you find that you are having difficulty waking it may be that you are waking during a REM session and you might benefit by changing your alarm by 15 minutes in order to miss this problem.
• When you are not in slow wave sleep or REM sleep you are in non REM sleep.  If you have pain issues this can be very disrupted and may cause your brain waves not to slow down properly.  Proper pain management is important so you can go into all stages of sleep.
• Medications will affect your sleep significantly.  It is not just sleep medications that will disrupt your sleep.  Heart medication, blood pressure medications, antidepressants, pain medication and respiratory medications can all affect your sleep staging and your ability to go into slow wave sleep and REM sleep.  If you are finding your sleep is disrupted talk to your doctor or pharmacist about the effects of your current medication on your sleep. 
• Alcohol may help you fall asleep faster but as it leaves your system it will disrupt your sleep significantly during the important long REM cycles causing your sleep to not be as restorative as it can be.  Alcohol is not the friend of sleep. 

Which brings us back to the fact that sleep is important for your brain to function optimally.  When you are sleep deprived because of short sleep times or disrupted sleep times your frontal lobe does not function optimally.  This is the part of the brain where you make judgement decisions.  Think of your brain without proper sleep as the brain of a 16 year old who has to make some important life decisions.  Because the brain is not fully engaged in these decisions you tend to be more impulsive and head for the decision that may not be in your best interest.   Instead you want to be fully engaged alert and be able to take both long and short term goals into the consideration.  A well-rested brain will let your do that.  In the end it will help you to be the well balanced and successful person you choose to be.