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Provent- A New Sleep Apnea Treatment

Provent- CPAP Therapy alternative for OSA patientsApproved by the Food and Drug Administration in 2008, Provent has spread mostly by word of mouth. But it has caught on fast. Its manufacturer, Ventus Medical, says it has shipped one million of the devices in the past 12 months, up from a half million total in the two years prior. Doctors say it has given them a new weapon in the battle against sleep apnea, and many patients who struggled with CPAP call it a godsend.

Bob Bleck, who owns a computer networking firm in Ohio, struggled with poor sleep and chronic fatigue for decades. But it was only a year and a half ago that he finally went to a sleep clinic, prodded by his wife, who worried about his heavy snoring.

The diagnosis was severe sleep apnea. Tests showed that in a typical night, Mr. Bleck, 47, awoke or stopped breathing 42 times an hour.

“After I started using it, I noticed a difference right away,” he said. “My symptoms subsided dramatically.”

Provent works like a traditional CPAP machine but is only a fraction of the size. When people with apnea fall asleep, their throat muscles collapse, constricting the airway and causing the body to fight for air. CPAP machines use mild air pressure to keep the airway from constricting.

Provent does too, but in a different way. The device contains two pinhole-size valves, one over each nostril. The valves let air in easily — most people breathe through their nostrils while asleep — but there is resistance as the user exhales. That resistance creates a backpressure in the airways, dilating the muscles that would otherwise collapse in the middle of the night. In the morning, the patch is removed; a new one is used every night.

Last year, in a large study of 250 apnea sufferers published in the medical journal Sleep and subsidized by Ventus, researchers found that those who used Provent devices over a three-month period saw their apnea episodes fall sharply, compared with people who were given a sham, or placebo, device. A follow-up study tracked people over the course of a year and had similar results.

Unlike CPAP, Provent is not covered by Medicare and most major insurers, though some doctors say they expect that will change in the near future. In the meantime, a 30-day supply of the patches costs $65 to $80.

For now, CPAP will continue to be the gold standard, and certainly the first option for patients with severe apnea. But for the roughly 50 percent of patients in whom CPAP fails, Provent may be a reliable alternative.

[Excerpts taken from Well: The New York Times Health/Science Blog. To Treat Sleep Apnea Without the Mask by Anahad O'Connor. Click here to read the entire story.]
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Source: O'Connor, Anahad. (April 9, 2012). To Treat Sleep Apnea Without the Mask. Well: The New York Times Health/Science Blog. Retrieved October 16, 2012 from http://well.blogs.nytimes.com/2012/04/09/treating-sleep-apnea-without-the-mask/

Benefits of Acupuncture for COPD Patients

AcupuncturePeople suffering from COPD (chronic obstructive pulmonary disease) may not normally look to acupuncture to help ease their symptoms. But a study published this past June by the Archives of Internal Medicine may cause COPD patients to think otherwise.

This study, conducted over the course of almost three years, divided patients into two groups: those who received actual acupuncture, and those who received placebo (fake) acupuncture. Both groups received their treatments once a week over the course of twelve weeks and in the same body locations.

After the twelve-week treatment sessions were complete, patients underwent a 6-minute walk test. They were then rated according to a modified 10-point Borg scale which measures breathlessness from 0 to 10 where 0 equals "breathing very well" and 10 equals "severely breathless."

Patients who had received real acupuncture scored markedly better on the Borg scale versus the placebo group. They also showed better exercise tolerance overall, showing that acupuncture can be a useful therapy for those suffering from COPD.

Those that are interested can read the full study here.
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Common Terms Used in Sleep Medicine

Patients ask us on a daily basis to explain some of the terms they hear when going for a sleep study or read when they receive their sleep study results. We thought it would be helpful to compile a list of some of most commonly used terms.

Actigraph: A biomedical instrument for the measurement of body movement.

Apnea: Cessation of airflow at the nostrils and mouth lasting at least ten seconds. There are three types of apnea- obstructive, central, and mixed. Obstructive apnea is secondary to upper airway obstruction; central apnea is associated with a cessation of all respiratory effort; and mixed apnea has both central and obstructive components.

Apnea-hypopnea Index (AHI): The number of apneic episodes (obstructive, central, and mixed) plus hypopneas per hour of sleep as determined by all-night polysomnography.

Autotitration Device: A device that increases and decreases pressure in response to specific events, such as snore, flow limitation, apneas, and leak.

Bi-level Device: A device that provides two levels of positive pressure, one for inspiration (breathing in) and one for expiration (breathing out). Beneficial for some CPAP patients who are unable to tolerate high fixed pressures and for patients who present with hypoventilation.

Body Mass Index (BMI): Evaluates weight independent of height and may be correlated with mortality and other health-related factors. It is not a direct measure of body fatness and varies with body composition in relation to gender, age, and ethnicity. BMI= weight divided by height squared.

Central Sleep Apnea (CSA): Respiratory event that is characterized by no air flow for at least ten seconds during which no respiratory effort is evident.

Continuous Positive Airway Pressure (CPAP): A device that delivers continuous positive pressure to a patient's airway through an interface. The positive pressure acts as an air splint to keep the upper airway patent during sleep.

Electroencephalogram (EEG): A recording of the electrical activity of the brain by means of electrodes placed on the surface of the head. Together with EMG and EOG, EEG is one of the three basic variables used to score sleep stages and arousals.

Excessive Daytime Sleepiness (EDS): Subjective report of difficulty in maintaining the alert awake state, usually accompanied by a rapid entrance into sleep when the individual is sedentary; daytime tiredness or fatigue.

Hypersomnia: Excessively deep or prolonged major sleep period. May be associated with difficulty in awakening or sleep drunkenness.

Hypopnea: An episode of shallow breathing (airflow reduced by at least 50%) during sleep lasting ten seconds or longer, usually associated with an arousal or an oxygen desaturation.

Mixed Apnea: Respiratory event characterized by no air flow for at least ten seconds with both a central and obstructive component. The central component precedes the obstructive component.

Multiple Sleep Latency Test (MSLT): A series of measurements of the interval from "lights out" to sleep onset that is utilized in the assessment of excessive sleepiness. Subjects are allowed a fixed number of opportunities to fall asleep during their customary awake period. Excessive sleepiness is characterized by short sleep latencies. Long latencies are helpful in distinguishing physical tiredness or fatigue from true sleepiness.

Obstructive Sleep Apnea (OSA): Respiratory event characterized by no air flow for at least ten seconds with continuous respiratory effort.

Periodic Leg Movement (PLM): A rapid, partial flexion of the foot at the ankle, extension of the big toe, and a partial flexion of the knee and hip that occurs during sleep. The movements occur with a periodicity of 20-60 seconds in a stereotypical pattern lasting 0.5-5.0 seconds in duration and are a characteristic feature of the periodic limb movement disorder.

Polysomnogram (PSG): The continuous and simultaneous recording of physiological variables during sleep (i.e. EEG, EOG, EMG, EKG, airflow, respiratory movements, lower limb movements, and other electrophysiological variables).

Respiratory Disturbance Index (RDI): The number of respiratory events (apneas, hypopneas, and RERAS) per hour of total sleep time which cause an arousal or an oxygen desaturation as determined by all-night polysomnography.

Sleep-disordered Breathing (SDB): Describes a number of breathing disorders which occur during sleep, such as OSA, CSA, Cheyne-Stokes respiration, nocturnal hypoventilation.

Upper Airway Resistance Syndrome (UARS): Presence of repetitive arousals following periods of increased respiratory effort; are undetected by thermal sensors (i.e. thermistors or thermocouples) but can be identified by a nasal pressure transducer signal.


Source: Glossary of Terms Used in Sleep Disorders Medicine, Resmed.