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Sleep Apnea- Test Yourself

Closed Airway Obstructive Sleep ApneaIf you think you or someone you know may suffer from obstructive sleep apnea (OSA) or another sleep breathing disorder, there are several simple tests you can take. Be sure to always discuss your concerns with your health care provider.

One of the best tests may be a complaint by your bed partner that you snore loudly or stop breathing repeatedly while you're asleep. Findings recently presented at CHEST 2012 (the annual meeting of the American College of Chest Physicians) showed that being elbowed or poked by a bed partner while sleeping was a good indicator of having OSA.

Three tests that you can take right now are the American Sleep Apnea Association's Snore Score, the Epworth Sleepiness Scale, and the Berlin Sleep Questionnaire.

If you have any questions regarding your results, please contact your physician or one of our Respiratory Therapists at 716.667.9600. CPAP can change your life!
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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/

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.

Children & Snoring

Child SmilingOn August 27, 2012 the American Academy of Pediatrics issued new recommendations for primary care practitioners regarding the diagnosis and management of obstructive sleep apnea syndrome (OSAS) in children and adolescents.

The new recommendations include the following:
- All children and adolescents should be screened for snoring
- A sleep study should be performed if the child or adolescent snores and presents symptoms or signs of OSAS
- If the child has enlarged tonsils, the first line of treatment is to have them removed
- If tonsils cannot be removed or are ineffective in treatment, then CPAP should be attempted
- Weight loss is also recommended for children and adolescents who are overweight or obese

If your child snores, it's important to discuss his or her condition with your child's primary care practitioner. Click here to read the full list of recommendations released.

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The CPAP Challenge

Woman Smiling CPAP (continuous positive airway pressure) can be a very difficult therapy to adjust to. But, with the right attitude and the help of a good support group, it can be made into an easier transition.

It's important for the patient to understand why the CPAP is needed and what health benefits are gained from correcting obstructive sleep apnea (OSA). At Pro2, a Respiratory Therapist reviews the sleep study with each patient to reiterate the findings made during the testing and to show the corrective outcome with continued use of the therapy.

Next comes the application of the mask and the subsequent pressure to follow. Talking with the patient and explaining the feelings he will have of resistance on exhalation is very important. Letting him know that the mask has an exhalation port and feeling the air escape from that mask helps him to realize he is able to exhale completely. Most patients are then able to relax within the first minute of therapy.

Each CPAP is also equipped with a ramp feature which allows the patient to press a button and initially reduce the pressure. The ramp pressure will slowly increase to the prescribed pressure all while giving the patient time to fall asleep and not even notice the gradual change. If at any time during the night the patient wakes up, we encourage the use of this comfort feature.

The use of the heated humidifier is then reviewed. A dry, bloody nose or sinus pain may signal inadequate humidity is being provided. Nasal congestion or a runny nose can be the body's attempt to compensate for dryness by flushing fluid to the area. Waking during the night after a few hours and removing the mask can also be due to congestion starting to develop. A gradual increase in humidity can eliminate these symptoms. CPAP units have various humidity ranges and the patient is encouraged to adjust his setting to find his own comfort level. During colder months, a high setting will usually create condensation in the tubing and we advise patients to place the CPAP unit on the floor so that any water can drain back into the chamber.

One of the biggest challenges with CPAP is obtaining a good mask seal for a patient who has a high pressure. We stock many masks and the patient is given the opportunity to try as many as he likes in order to find the best mask for him. With every mask, he has 30 days to exchange it for a different option.

Some people are unable to tolerate CPAP and after a strong attempt by the patient, our Respiratory Therapists may suggest AutoBIPAP, which automatically adjusts the inspiratory and expiratory pressures to the patient’s needs. When the patient is awake and not obstructing, the pressure will be minimal, but while sleeping and obstructing, it will deliver a higher pressures required to open the airway. AutoBIPAP will only be covered by insurance companies if the client fails at the use of CPAP.

Most important in the CPAP process is encouraging our patients to call us with any issues. Our follow-up care plan consists of frequent calls by our Respiratory Therapists to monitor patient progress and we encourage patients to call us if any problems arise.
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