What Pro2 is Up2

This blog post was written by Joanna Murray.

It amazes me how things can change with the blink of an eye when it comes to COPD. There were times when my mom could almost do summersaults and dance across the room, and then there were times when she was down for the count and couldn't move. Any effort to move was just too much for her. Her breathing would become labored and her lung function decreased and became difficult to control.

I remember times when Mom would come over to my house and help me clean. She was amazing! I had more energy than she did, but she would always out-do me every time. She didn't want her illness to get her down. No matter what, when I needed her, she was there with bells on.

Now that it's been almost seven months since Mom's death, I can really sit back and take a hard look at her illness. My mom became a daily part of my life. I did a lot for her and vice versa. Even if she was having trouble breathing- if it came down to her spending time with her grandkids or staying home, she would choose her grandkids.

Seasonal COPD was the hardest for her and our family. When the seasons changed, she would get asthma that would eventually turn into bronchitis, and then she would end up with pneumonia. She would be hospitalized sometimes four to six times a year. Anyone that has COPD or is a caregiver can understand this.

When taking care of Mom, some of the things that I noticed during seasonal changes were that she had more of an issue with her lung capabilities with both the outdoor climates as well as the temperature of the house. A fall or rise in either one of these could drastically change her need for oxygen. During the cold weather, she was more at risk of getting infections. During the summer months, she would get so over-heated that breathing would be difficult. When she moved in with me the last month of her life, I had central air conditioning. But for her, that was not enough and my husband had to install a portable air conditioner in the window to help keep her room cool.

I noticed over the years that there were certain things that Mom incorporated in her life to help her get through. One thing was she took a daily multivitamin and Vitamin D. She also would have a yearly flu shot. I realize now there were more things my mom could have done in her daily routine to help maintain her oxygen levels. I miss her dearly but am grateful she enjoyed her life.



Turner, Katelyn. (2011, May 13). The Changing Seasons and COPD. [Web log post]. Retrieved September 24, 2013, from http://blog.copdfoundation.org/the-changing-seasons-and-copd.

What is NY State of Health?

Under the Affordable Care Act, a Health Benefit Exchange will be operating in every state starting in 2014. States have the option to set up an Exchange themselves or to allow the federal government to set up an Exchange in their state. New York has chosen to set up its own Exchange, named the NY State of Health.

NY State of Health lets you shop for, compare, and buy a health plan online, in person, or over the phone. Individuals and families with incomes below certain levels ($45,960 for individuals and $94,200 for a family of four) may be eligible for financial assistance in the form of federal tax credits only available through NY State of Health. Federal tax credits limit the amount a person pays for insurance each month. Monthly payments will be far below the cost of buying insurance today.

Why does New York need a Health Plan Marketplace? Nearly 2.7 million New Yorkers under age 65 do not have a health plan. That is approximately 16% of people in NY.

Who can use the Marketplace? NY State of Health can be used by individuals, families, and small businesses with 50 or fewer employees.

Who can I call for help? You can reach NY State of Health Customer Service by calling 1-855-355-5777 (toll free).

Important Dates: October 1, 2013: exchange begins accepting insurance coverage applications. January 1, 2014: exchange coverage becomes effective.

To learn more, please visit the official NY State of Health website: http://www.nystateofhealth.ny.gov/.

We realize PAP therapy can be a difficult adjustment. Our team of Respiratory Therapists is here to assist you through that transition. Give yourself time to become accustomed to the therapy!

In order to succeed, it's essential to apply the therapy every night. If you experience any of the following problems, please follow the suggestions listed. If your problems persist, don't hesitate to call our office for assistance at 716-667-9600.

Dry/Bloody Nose or Runny/Congested Nose
This may signal inadequate humidity. Nasal congestion or a runny nose can be the body's attempt to compensate for the dryness by flushing fluid to the area. Slowly increase your humidity level.

[Please note: a very small percentage of people react to high heat levels which could create more congestion. The range is available to allow you to adjust to your most comfortable setting. If you try the higher heat settings with no success, try the lower settings.]

Dry Mouth
First, try increasing the heat level on your humidifier. You may be breathing through your mouth or leaking a small amount of air through your mouth. If you're wearing a nasal mask, consider changing to a full face mask. If you're already on a full face mask, an oral lubricant (e.g. Biotene or Oasis, which may be purchased at your local drug store) may help.

Fatigue
If you're using your therapy nightly for a minimum of four hours a night, you'll usually notice a decrease in your feeling of fatigue. You may notice this as soon as the first night you start using your new therapy. But it may take as long as a month, depending on the duration and severity of your OSA.

Feeling Air Starved
You may be adjusting to the feeling of pressure resistance on exhalation; give yourself time to adjust. After a period of time, if this feeling continues, contact our Respiratory Therapy Department for assistance.

Gastric Distention
You're probably swallowing air. Limit yourself to using only one pillow while you sleep. If this doesn't correct the problem, contact us.

Mouth Breathing
If you've just started therapy, give yourself a little time to see if your body will adjust. Sometimes people will begin to breathe through their nose to avoid the high air flow caused when opening their mouth.

Popping or Gurgling Noise
Your tubing probably has water inside it. Condensation develops when the warm, moist air inside meets the cool tubing in a cool room. You have a couple options: (1) lower your machine to allow the water to drain back into the humidifier, or (2) call our office to purchase a hose wrap or heated tubing system.

Red Marks on your Face
The marks could be from dry skin irritation from the mask material. Try using the CPAP Moisture Therapy cream we carry.

Too much pressure can cause sores on the face. Please refer to your mask fitting guide for the correct application of your mask. Be sure to use the minimal amount of tightening needed to obtain a good seal.

A mark at the bridge of the nose may go away after a short period of time if you loosen the headgear and apply a cushioned band-aid to the area. You may also try our Sleep Comfort Care Pad, which will help protect this area of your nose.

Snoring
If you continue to snore while on your therapy, please contact us.

Unable to Fall Asleep
Use for an hour each night, slowly working up to a full night's use by applying the therapy more and more every night. After one week, if you see no improvement, please contact our Respiratory Therapy Department.

Waking Up after 1-2 Hours with the Need to Remove
You may not be receiving enough humidity and your body may be trying to compensate by pushing fluid to your nose, which can create inflammation or congestion. Increase your heater temperature to increase your humidity.

If these suggestions don't alleviate your problem, please contact our Respiratory Therapy Department at 716-667-9600 option 8.

The Epworth Sleepiness Scale is widely used in the field of sleep medicine as a subjective measure of a patient's sleepiness. The test is a list of eight situations in which you rate your tendency to become sleepy on a scale of 0 (no chance of dozing) to 3 (high chance of dozing).

When you finish the test, add up the values to your responses. Your total score is based on a scale of 0 to 24. The scale estimates whether you are experiencing excessive sleepiness that possibly requires medical attention.

How Sleepy Are You?
How likely are you to doze off or fall asleep in the following situations? You should rate your chances of dozing off, not just feeling tired. Even if you have not done some of these things recently, try to determine how they would have affected you. For each situation, decide whether or not you would have:

No chance of dozing = 0
Slight chance of dozing = 1
Moderate chance of dozing = 2
High chance of dozing = 3

Write down the number corresponding to your choice after each situation and then total your score below.

Sitting and reading
Watching TV
Sitting inactive in a public place (e.g. a theatre or a meeting)
As a passenger in a car for an hour without a break
Lying down to rest in the afternoon when circumstances permit
Sitting and talking to someone
Sitting quietly after a lunch without alcohol
In a car, while stopped for a few minutes in traffic

Total Score =

Interpretation:
0-7: It is unlikely that you are abnormally sleepy
8-9: You have an average amount of daytime sleepiness
10-15: You may be excessively sleepy depending on the situation. You may want to consider seeking medical attention.
16-24: You are excessively sleepy and should consider seeking medical attention.



Source: Johns MW. A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale. Sleep 1991; 14(6):540-5

Until recently, traveling with CPAP meant dedicating an entire bag to your machine, humidifier, mask, and accessories.

But advancements in the technology have made traveling with CPAP much easier.

For frequent travelers or campers, there is Transcend. Transcend is the smallest, lightest, most portable CPAP on the market. It weighs less than one pound and fits in the palm of your hand. Utilizing a waterless humidification system called a heat moisture exchange (HME), the unit recycles moisture from the air you breathe out into the air that you breathe in.

Click here for more information on Transcend, including the fact sheet and pricing guide.

A second option for those who don't want the hassle of packing a machine at all is Provent. It utilizes your own breathing to treat your obstructive sleep apnea.

The device itself is completely disposable. You wear a new pair each night, then discard when you wake up in the morning. They're placed just inside the nostrils and a hypoallergenic adhesive keeps them secure. When you inhale, flow is normal. During exhalation, the device directs flow through small holes which increase airway pressure (similar to what a CPAP device does).

Click here for more information on Provent Therapy.

If you have any questions about these, or any other devices, don't hesitate to contact us at 716-667-9600.