The leading cause of death in the hospital is infection usually caused by staff, patients, and visitors not washing their hands. Respiratory supplies were changed every forty-eight hours to help prevent respiratory infections. When I got into home
health I recognized that patients were not changing their CPAP supplies. I discovered that a lot of patients did not know that most insurance companies would pay for these new supplies. They were very thankful; some of them had never received a new CPAP mask or supplies. Thus the Supply Program was born! My hope in this article is that you will find out how to recognize symptoms associated with Sleep Apnea, learn some new terms, and discover the proper treatment to help you
sleep better.

Sleep Apnea Diagnosis

Sleep Apnea can be best defined as someone who stops breathing while sleeping. According to the American Sleep Apnea Association this affects more than twelve  million Americans alone! There are three types of Sleep Apnea: Central,
Mixed, and Obstructive Sleep Apnea (OSA). The most common form of Sleep Apnea is OSA, which is caused by an obstruction or collapse of the airway. For example, the tongue, palate, orepiglottis can obstruct the airway. Central Sleep Apnea is
caused when the brain fails to tell the muscles to breathe. Mixed Sleep Apnea is a mixture of both Central and Obstructive Sleep Apnea. Untreated Sleep Apnea can cause Congestive Heart Failure, Diabetes, High Blood Pressure, Headaches, Weight
Gain, and Motor Vehicle Accidents. Since most people are not familiar with the symptoms of Sleep Apnea it is most often overlooked and undiagnosed.

Testing for Sleep Apnea with the Edgeworth Sleep Test

A Sleep Test is the most common tool used to diagnose Sleep Apnea. During the sleep  test usually half the night will be spent diagnosing whether the patient does have Sleep Apnea. The second portion of the test will be spent using CPAP
equipment to document any improvement and measure its effectiveness. The most common test for symptoms is the Epworth Sleepiness Scale. This is not a diagnosis but simply a guideline to indicateto your physician that you may have Sleep
Apnea and may require a sleep study. If you suspect that you or a loved one may suffer from Sleep Apnea try answering the following questions:

How likely are you to doze off or fall asleep in the situations described below, in contrast to feeling just tired?
This refers to your usual way of life in recent times. Even if you haven’t done some of these things recently try to work out how they would have affected you. Use the following scale to choose the most appropriate number for each situation:

0 = would never doze
1 = Slight chance of dozing
2 = Moderate chance of dozing
3 = High chance of dozing

Situation Chance of dozing

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 the traffic

Total

_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________

_____________

Score:

0-10 NORMAL RANGE
10-12 BORDERLINE
12-24 ABNORMAL

Treatment With CPAP Equipment

CPAP (Continuous Positive Airway Pressure) is the most common treatment for patients who have been diagnosed for Sleep Apnea. The amount of pressure being delivered with a CPAP machine is usually determined by your sleep study
and varies for each person. This equipment is only available through an order written by your physician. The biggest problem associated with CPAP is the patient’s inability to tolerate air pressure, the type of cpap mask used, or poor cpap mask fitting. Over a period of time many patients do get used to the pressure from CPAP with practice. I
have found that an excellent way to alleviate the discomfort especially during this learning phase is to use the “ramp” feature. The patient can use this feature anytime they are having difficulty tolerating the pressure from CPAP. The
“ramp” feature reduces the pressure dramatically and within 30-45 minutes the pressure slowly builds up until optimal pressure has been reached again. The patient will usually fall asleep during this period and not notice the increased air
pressure.

BiLevel or BiPAP (Bilevel Positive Airway Pressure) is designed for patients who have a high pressure prescribed or who have trouble tolerating the pressure associated with CPAP. BiPap has two pressures. Inspiratory (inhalation) and
Expiratory (exhalation) The Expiratory pressure is dramatically reduced so the patient can tolerate BiPAP. Although this equipment is much more expensive than CPAP most insurance companies will pay for it with the proper documentation.

In conclusion, there are many types of equipment and supplies to treat Sleep Apnea. Selecting the right equipment to handle your personal pressure settings along with a comfortable mask and the right filters and cushions can be quite
confusing. Therefore, it is important that you select a company that can not only provide you with quality CPAP machines and CPAP supplies but also with personal service customized for your particular needs. The very best durable medical
equipment companies are awarded the Gold Seal of Approval by the Joint Commission so that is also something to look for when selecting a company. Lastly, select a company that specializes in Sleep Apnea equipment and service for your best
chance at achieving your goal to sleep better now!

About The Author:

Lloyd Mote is a licensed Respiratory Therapist with over twenty years of experience. He is also the Chief Executive
Officer and founder of Americare Respiratory Services, Inc., which has been awarded the Gold Seal of Approval from the Joint Commission.

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The Differences Between the CPAP and the BiPAP

The CPAP machine is designed to increase the pressure when you inhale to keep the airways in the nose, throat and mouth from closing while you are sleeping. This has been a great help to many people who suffer from sleep apnea and may stop breathing several times a night.

On the other hand, the BiPAP machine may help as well. Using the same setup as a CPAP with tubing, masks and a machine, the BiPAP uses a different setting. The CPAP uses one pressure and the BiPAP uses two. These two pressures are called inhalation pressure (IPAP) and the exhalation pressure (EPAP).

Where the CPAP works as the person using it inhales, the BiPAP provides more breathing assistance. They have been prescribed for patients who have congestive heart failure and other serious diseases affecting the heart and lungs. People with nerve and muscle problems may also benefit from the BiPAP machine rather than the CPAP machine.

The BiPAP is preset with two settings. The pressure when inhaling and exhaling is monitored. When the person sleeping does not breathe for a certain mount of time, the BiPAP increases pressure and forces them to take a breath. There are higher level CPAP machines that do this as well. These machines need a BPM (breathes per minute) setting that is targeted to your particular breathing needs.

Both machines are designed to make sure the users breathe a set number of times per minute. One of the main benefits of the BiPAP machine is the pressure is decreased as the person breathes out. This keeps them from having to work as hard at breathing and the person is able to have a more restful sleep.

The BiPAP machine is not large or noisy. They are designed to make the least amount of noise possible so you can sleep. The inclusion of a humidifier may be included with the BiPAP making it a higher end machine than the CPAP.

The main difference between these two machines will be the needs of the patient. The one that will help each individual with the specific breathing problems they have will be based on doctor’s examinations and recommendations. A sleep test will be conducted to allow the doctor to see exactly what settings are needed on the type of machine required.

The CPAP machine will be used for mild sleep apnea. Make no mistake, this can be a dangerous condition. It just depends on the levels of sleep apnea to govern the needed machine. Both machines are quite beneficial and are crucial to keeping sleepers breathing when they have problems.

In conclusion, remember, the sleep apnea machines are not designed to be used as ventilators. They do not breathe for you. They merely make sure you take the number of breaths per minute that your doctor believes is right for you. After doing tests to determine what the correct number may be, the doctor will advise you as to which machine he thinks you need.

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There are three types of sleep apnea are central sleep apnea, obstructive sleep apnea and complex sleep apnea (the combination of the two types). Central sleep apnea is caused by the imbalance of brain respiratory control center, while obstructive sleep apnea is caused by the obstruction of airway by decreased muscle tone or increased soft tissue around the airway (e.g. obesity or aging). Obstructive sleep apnea makes up about 84% of sleep apnea cases; the complex sleep apnea makes up about 15% and the central sleep apnea makes up 0.4%. [1]

The symptoms of obstructive sleep apnea commonly include loud snoring, restless sleep, and sleepiness during the daytime. The treatment of this type of sleep apnea is usually the use of breathing treatments, such as Continuous Positive Airway Pressure (CPAP). Other habits that contribute to symptoms of sleep apnea is smoking, drinking alcohol, or losing large amounts of weight.

Due to the drop of oxygen level and increase of carbon dioxide level during sleep, hypoxia and hypercapnia are usually the results of central sleep apnea. Consequently, hypoxia and hypercapnia have effects on human body and could result in more serious health issues, angina, arrhythmias, heart attacks or at worst sudden death. [2]

Diagnostic tests of sleep apnea include home oximetry or polysomnograph readings in a sleep clinic. Oximeters that measures blood oxygen levels are a necessary device to measure normal stats in a person’s body while their asleep. According to the results of a study published in the Jan. 15 issue of the American Journal of Respiratory & Critical Care Medicine.

“The practical purpose of diagnostic assessment in most cases of obstructive sleep apnea is to predict which patients have symptoms that will improve on treatment. Portable monitors record primarily oxygen saturation, can be used at home without supervision, and are cheaper [than polysomnography].”

OctiveTech oximeters offer a flexible and affordable way for sleep apnea sufferers and their doctors to monitor their blood saturation during sleep. We especially recommend the handhelds that alarm at a certain low blood oxygen concentration.

References:
[1] Mayo Clinic Discovers New Type Of Sleep Apnea, ScienceDaily, 2006
[2] Sleep apnea, Wikipedia

Disclaimer:
The information on this website aims to provide customers with relevant knowledge regarding our products. Under no circumstances should the information be used for therapeutic purposes. Customers must consult their doctors for the correct use of these information and products. ClinicalGuard.com is not responsible for any losses or accidents caused by the use of information on this website.

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This scary list of adverse health outcomes demonstrates the significance of diagnosing sleep apnea in a timely manner, in order to initiate treatment t. This last comment is actually the point — fortunately, sleep apnea is a treatable condition. And you might be surprised that there are different options for treatment. With the right guidance from qualified experts, successful treatment is readily attainable.

First of all, we must dispel any myths, which prevent many people affected with sleep apnea from seeking the appropriate medical attention. The biggest myth is that only overweight or obese people get OSA. That is simply not true. In fact, many people who are considered to be at their ideal body weight, based on BMI (Body-Mass Index), are in fact diagnosed with OSA or Upper Airway Resistance Syndrome (UARS). UARS is a form of sleep-related breathing disorder in which a person has frequent arousals from sleep due to respiratory airway collapse or obstruction. Often, the events are not as obvious as seen in OSA, and in many cases, a person affected by UARS may not even snore. However, people with UARS may complain of unrefreshing sleep, frequent nocturnal awakenings, or excessive daytime sleepiness or fatigue. UARS, like OSA, is a treatable medical condition.

So how does one get sleep apnea?

Well, most people who have sleep apnea are predisposed very early in life. It is actually the size and shape of the jaw and upper airway that determines whether a person will develop OSA. A narrow jaw and upper airway (i.e., oral cavity and throat) results in less space for air to flow during breathing. When a person sleeps, the soft tissues and muscles of the upper airway relax and collapse, leading to increased airflow resistance and airway obstruction. The airway obstruction is what causes OSA.

OSA is simply a repetitive, cyclical pattern in which a person stops breathing or nearly stops breathing for periods of longer than 10 seconds each time. The following is a description of what happens during an episode. As a person sleeps, the upper airway and jaw relax, resulting in collapse of the upper airway (i.e., the back of the throat). The lower jaw often relaxes and drops back a few millimeters when we sleep. Since the tongue base is attached to the lower jaw, the tongue will also drop back a few millimeters further during sleep. This combination of events leads to a very narrow passageway for air to flow through the back of the throat during sleep. Occasionally, the upper airway is so collapsed that little or no air can pass. These episodes are called apneas (complete obstruction with no air movement) or hypopneas (partial obstruction with minimal air movement). When an apnea or hypopnea occurs, it lasts for a period of 10 seconds or more. In some cases, the episodes can last for over a minute! During this time, the blood oxygen saturation starts to drop, because no fresh air or oxygen is being delivered to the lungs. As the blood oxygen saturation drops, the body goes into a fight-or-flight response, resulting in increased heart rate and elevation of blood pressure. In essence, the heart is beating faster in an attempt to bring in more fresh blood and oxygen from the lungs. This sequence of events continues until, ultimately, a person has an arousal from sleep, resulting in a change in body position, a deep breath or gasp, or a brief awakening from sleep for 2-3 seconds (which most people don’t recall). This cycle of events may then repeat itself several times per hour or even hundreds of times per night, depending on the severity of the case. These cyclical arousals not only disrupt and fragment one’s sleep by resulting in a very shallow and unrefreshing sleep, but they also cause repetitive stress on the cardiovascular system with the elevations in heart rate and blood pressure. This repetitive stress causes the heart to work harder. Night after night, this chronic extra stress on the heart is what many scientists believe leads to the long-term adverse cardiovascular events (such as heart attacks, strokes and cardiac arrhythmias) and the impairment of blood pressure and blood sugar control.

Fortunately, as stated before, sleep apnea is a treatable condition. Further, effective treatment of OSA results in reductions in daytime blood pressure. Effective treatment not only reduces the risk of cardiac arrhythmias such as atrial fibrillation, but it can also reduce the risk of recurrent episodes of arrhythmias. The incidence of stroke and death is also significantly less in people treated for OSA. As compared to those who remain untreated for OSA, people who are treated have lower levels of blood glucose. Studies have highlighted how closely linked OSA and diabetes are. Therefore, people with OSA and diabetes who undergo treatment for OSA have much better control of their diabetes. Finally, treatment of OSA improves sleep quality and duration, associated with deeper and more refreshing sleep. This improvement in sleep carries on into the daytime, resulting in reduced daytime sleepiness and increased energy levels.

In fact, there is more than one form of treatment available. The American Academy of Sleep Medicine recognizes three forms of treatment that have been demonstrated to be effective for sleep apnea. The first of these options is known as CPAP, or Continuous Positive Airway Pressure. CPAP is still the gold standard of treatment for OSA, because it is a very safe and effective form of treatment. It is also generally successful for all degrees of OSA severity, including mild, moderate, severe, and very severe. CPAP is a device weighing less than 10 pounds that sits on your nightstand and filters the air in your room. Once it filters the room air, it blows it out at a higher, fixed pressure through a tube that connects to a mask. The mask, which can come in a multitude of varieties, either sits on your nose, under your nose, or over both your nose and mouth. The device is used during sleep to keep the upper airway stented open, using the higher, fixed air pressure delivered from the machine, through the tube, to your mask. It is not a ventilator, so it does not force you to breathe (although there are some models which do have this feature for very unique cases). However, it does make it easier to breathe, by keeping the upper airway open and preventing its collapse during sleep.

It does take time to get adjusted to using CPAP. Most people become adjusted to CPAP within 2-3 weeks. The real issue is getting used to sleeping with a mask on your nose, or under your nose. Once you get used to this new habit, then treatment with CPAP becomes easy. Generally, most people become comfortable using CPAP within one month, and at that point, they are able to sleep with CPAP for 4 or more hours per night. Research studies have shown that using CPAP for at least 4 hours per night results in associated health benefit. Therefore, it is important to sleep with CPAP for at least 4 hours per night, once the initial adjustment period is over. Further, the more time spent using CPAP during sleep, the more beneficial it is for your health. There are over 1 million people across the United States successfully using CPAP on a regular and continual basis, and if you ask one of them how well they sleep, they will likely tell you how CPAP has dramatically improved their sleep and changed their life for the better.

For people who do not succeed with CPAP or for those who prefer a different option, surgery can be an effective form of treatment. Generally, there is about a 50-70% chance of successful cure of sleep apnea with surgical intervention. This number takes into account all cases, including mild, moderate, severe, and very severe degrees. This statistic also accounts for the varied skills of surgeons who perform these types of procedures. In most cases, surgery usually improves the impairment in sleep-related breathing disorders, and generally, there is a reduction in the severity of OSA after surgery. It is important to discuss your individual situation with the ENT surgeon who will be performing the surgery. The risks and benefits of surgery should be examined prior to moving forward with surgery. Some risks associated with this type of surgery are bleeding, infection, and the risks commonly associated with general anesthesia. Further, it is vital to make certain that the ENT surgeon you choose has a breadth of experience in the type of procedure you plan to undergo. Not all ENT surgeons receive specialized training in sleep apnea surgery, so it is important to make sure that you find someone with extensive training and experience in this area for better results.

So what exactly do they do for surgery? Well, the most common surgical procedure for sleep apnea is called uvulopalatopharyngoplasty (UPPP). It basically means removing the uvula that hangs in the back of the throat, along with any excess tissue around the soft palate. At the same time, any residual adenoid or tonsil tissue will be resected, to increase the size of the airway to improve air flow. This type of surgery is quite painful due to the sensitive nerve fibers in that area, so recovery time is usually about 1 week after surgery. Your doctor will provide you with medications for pain during this time. You should then repeat a sleep study 2-3 months after surgery to reassess for any persistent, residual sleep apnea. If the UPPP is not completely successful, then a second phase of surgery may help to resolve the problem. The most common second phase of surgery is called genioglossal advancement (GA) with or without hyoid suspension. This surgery involves making a small window in the bone at the front of the lower jaw, to pull it forward a few millimeters. By fixing this part of the lower jaw forward, it also brings the tongue base forward a few millimeters, thus opening up space in the back of the throat. This procedure can be performed with or without a hyoid suspension, which is a surgery to done to bring the hyoid bone in the throat forward, thereby increasing the space in the upper airway.

Again, these surgical interventions can help to successfully treat OSA, especially in mild to moderate cases. For very severe cases, other more involved surgeries may be the only way to a surgical cure. For individuals who are extremely obese with OSA, gastric bypass surgery or lap-band gastric surgery may be the only realistic surgical option. This type of surgery is considered a major surgery and careful planning and discussion with both your sleep disorders doctor and the surgeon is necessary.

A third option for treating sleep apnea is oral appliance therapy, also known as mandibular advancement splint. These oral appliances look very similar to retainers. They work by holding the lower jaw in a slightly forward position during sleep. This helps to increase the space for air flow in the upper airway, thereby reducing the frequency of respiratory events during sleep. It is important to be aware that oral appliances are only approved to treat snoring and cases of mild-to-moderate sleep apnea. They have not been shown to be successful in treating severe cases of OSA, due to the limitations on forward movement of the lower jaw.

The oral appliances are custom-made by dental labs. Generally, to get an oral appliance made for yourself, you will have to visit a dentist who is familiar with the use of these devices for the treatment of snoring or sleep apnea. You can talk to your sleep disorders doctor to find a dentist with this specialized training in your area.

Oral appliances can sometimes cause dental pain, TMJ pain, or jaw discomfort. These issues can usually be resolved with further adjustments of the device by your dentist. Often 2-3 regular follow-up visits with the dentist can help to prevent problems from developing. However, there are some cases in which an individual is unable to adjust to this form of treatment. Another issue with oral appliance therapy is that health insurance companies, historically, have not covered the cost for this type of treatment. Further, dental insurance has never provided coverage for oral appliance therapy. Nevertheless, with the growing medical evidence for oral appliance therapy, some health insurance companies are beginning to recognize this as a viable medical treatment alternative. Just as with surgery, a follow-up sleep study should be performed 2-3 months after starting treatment with an oral appliance, to ensure adequate treatment of snoring and sleep apnea.

Hopefully this review of obstructive sleep apnea, the significant cardiovascular consequences, and the treatment options will bring more awareness and understanding to this very important health issue. OSA is a treatable condition. Untreated sleep apnea is associated with an increased risk for hypertension (or high blood pressure), heart attacks, strokes, heart failure, cardiac arrhythmias, and diabetes. People with hypertension and untreated sleep apnea are more likely to have higher blood pressures. People with diabetes and untreated sleep apnea are more likely to have higher blood glucose levels. If you or someone you know may have sleep apnea, please consult a sleep disorders specialist with formal training in sleep medicine. The American Academy of Sleep Medicine (www.aasmnet.org/) and the American Board of Sleep Medicine (www.absm.org/) are helpful resources for finding a board-certified sleep disorders doctor near you.

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