Insomnia, Snoring, Sleep Apnea

The world and life of a sleep tech

Archive for March, 2009

Be Your Best Healthcare Advocate Part 2

Posted by amykr on March 29, 2009

You gathered new information. You have questions about a many different issues. Now you want answers. Where do you find the answers to your questions? What resources do you have to get the answers about your health in particular?

Your doctor is you’re first thought, but you have only one visit a year for a physical so you want to take advantage of the time you have. This is where you take a list. The list should be in order of importance. This way if you do not get to all your questions the most important ones are answered. If you have specific questions about something make sure you have any supporting issues with you. With my patients I suggest a two week sleep diary and a sleep questionnaire such as an Epworth or FOSQ. They can then see why you have questions or concerns. This will save time to cover other issues.

If there is a long period of time until your next doctor’s visit you have two options. Do not hesitate to ask questions on the nurse’s line. You do not know if your question might be a reason to come in for a visit. If you do not feel comfortable with leaving a message or you need an immediate answer almost every hospital and many insurance plans have a nurse’s line. These lines are to answer questions about medical issues. They are manned by an RN or a specialist such as a dietician or respiratory therapist to answer questions about their specific field. They can also give you referrals to specialists or a primary care doctor in your area.

There are several sites online who can give you access to medical professionals immediately to get advice. Liveperson.com is one site where the professionals will charge you by the minute or the issue. They supply you with biographies and you are able to see who is online. Justanswer.com allows you to ask questions and use certain topics. They have experts who will answer your questions but you do not get to choose the person. These two are just examples of many organizations online that can give you immediate advice.

Thee walk in clinic is great resource for something that needs a doctor’s visit but can not get to your primary care doctor. The physicians in these practices are family practice, emergency medicine, internal medicine or pediatric specialists. Many also have nurse practitioners who do the primary care. They deal with emergency short term problems and understand how to assess a problem quickly and treat it. This is also a great option if you do not have insurance because they are priced for a short term relationship. They do have services like work and school physicals and flu shots available. It is one of the new care paradigms that make sense for our current economy.

As our economy changes we have to be in control of our well being. The best way to do this is to be well informed and prepared when we see our doctors. Planning what questions to ask and having your information ready for the doctor will allow you to optimize your time and take care of all your issues.

Amy Korn-Reavis, RRT, RPSGT has been in the respiratory field for over twenty years. She has worked in all areas and is currently focusing on sleep and how to help the community feel better by sleeping better. She is the manager of Emery Sleep Solutions an independent testing facility located in Apopka, Florida. She is also the coordinator of A.W.A.K.E. Orlando a support group for people with sleep disorders http://awakeorlando.ning.com. If you have any questions about sleep or are looking for someone to speak at your community function she can be reached at areavis@emerymedicalsolutions.com

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High Tech Helps in Sleep Disorder Testing and Treatment

Posted by amykr on March 29, 2009

With all the new ways of communicating you knew that it would eventually leak to the medical field. In sleep it has changed to allow us to perform studies and follow up with patients in a whole new way.

Home sleep studies has come up with a whole new arsenal of new equipment to test for sleep. The newest technology the WatchPat uses peripheral arterial tension to determine if you stop breathing in your sleep. All you do is where a monitor around your wrist and a probe on two fingers all night. It is simple for anyone to wear.

There are several companies that monitor more information that include oxygen level, heart rate, body position, snoring, air flow and chest movement. This allows the doctor a bit more information to determine what is going on during the night. The information is downloaded after the patient wears it for the night and then scored by a sleep technician. Some example of these are the Respironics Stardust, Watermark Ares and the Clevemed Scout. The drawback is that the test is limited to testing for sleep apnea only. It also can not tell when a patient is asleep and when he or she is awake.

Bluetooth technology is now allowing a complete sleep study to be done at home. A technician comes to the house sets up the patient with a fell sleep setup including head leads, leg leads, ekg, pulse oximeter, flow and respiratory belts. They then attach it to a wireless box and set up a laptop with a camera and Bluetooth and a technician will monitor it from a central location. The benefit of this is that you get to sleep in your own bed. The drawback is no one is immediately available and if there is an issue except through the computer. The other one is that many insurance policies will not pay for a study performed this way.

Treatment for sleep apnea has also gone high tech. The newest technology puts modems in inside CPAP machine s so you can monitor the patient’s usage and any issues they might have from the first night. This will allow the technicians that monitor the CPAP as well as the doctors to find out if there are issues earlier instead of waiting for a patient to call and ask for help or give up.

All this technology is here and there is more being developed and released all the time. Remote will allow access for patients who might miss an opportunity for care.

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Being Your Best Advocate; Part 1

Posted by amykr on March 26, 2009

Being your Best Advocate
Part 1

There are many changes going through the healthcare industry. Regulations are getting tighter. Insurances have bigger deductibles and have more exclusionary clauses then a legal genius can figure out. There are in network and out of network providers. There are different deductibles. There are DME riders. The list goes on and on. The one thing I can say for sure is that the public is both better and worse educated then ever in history. So it is you, the individual, who is really the only one that can help you to achieve your optimal health.

With so much information on the web making a decision about what information is correct and what is not can be difficult. There are some simple rules that can be used to determine if this site is a good one for accurate information. If it looks or sounds like an advertisement, it basically is one. If the research they are talking about is not publish in a medical journal or back by a university you have wonder where it was done and how much of it is designed to give you specific results. Specific companies can give you great information but they are still trying to sell products so if you look up the website for a specific sleeping medication it will give you accurate information about side effects and how to take it but it is still designed to sell you that medication.

To start if you are looking for information about a condition or medication where can you look for the most reliable information? There are many great websites I have used in the past to gain medical information especially about conditions I may not have dealt with before. For general knowledge I like:

Webmd
Ivillage
AARP
Yahoo Health
National Institute on Health

There is also information on your health insurance company’s web site that you can explore. There are multiple medical magazines online for specific issues. I write about sleep and respiratory therapy. The magazines I go to that do not cost anything (I subscribe to professional journals also but that is above what the average person should have to do). Some of the ones I look at:

Advance for Sleep
Sleep Review Magazine

Then there are the professional organizations and the organizations for individual conditions. These are great support for those with the issue because they can keep you informed of research and changes in treatment, allow you to communicate with others who have your conditions and to learn the basics about the condition so you know what to expect. If you would like me to find one for you just e-mail m e and I will be happy to help. I am going to attach here some of the ones we use for sleep disorders.

American Sleep Apnea Association , this organization has local support groups for people affected by sleep disorders.

Restless Leg Syndrome foundation Great information for people with restless legs or period limb movement disorders

National Sleep Foundation Is a government run study on sleep and all the issues pertaining to it. It has great information about drowsy driving, jet lag, plus all the sleep conditions out there.

The web has become a great place to access information and people. This is a great tool. It is still only one tool. In my next article we will talk about taking this information and working with your doctor to make a plan to guide you to your best health.

Amy Korn-Reavis, RRT, RPSGT has been in the respiratory field for over twenty years. She has worked in all areas and is currently focusing on sleep and how to help the community feel better by sleeping better. She is the manager of Emery Sleep Solutions an independent testing facility located in Apopka, Florida. She is also the coordinator of A.W.A.K.E. Orlando a support group for people with sleep disorders http://awakeorlando.ning.com. If you have any questions about sleep or are looking for someone to speak at your community function she can be reached at areavis@emerymedicalsolutions.com

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Is Home Sleep Testing For Me?

Posted by amykr on March 25, 2009

Home sleep testing has been very controversial over the last year. The idea of home sleep is can be threatening to a lab. This is not the case. I believe that this type of testing is perfect for those patients who refuse to come in to a sleep lab, a person who has no insurance or a large deductable, or the person who is in an area where there is a long wait.

The home sleep equipment we use is the Respironics Stardust. With this equipment we monitor your breathing, your snoring, your oxygen level, your heart rate and your body position. What we are not able to test is if you are asleep and what stage of sleep you are in, whether you grind your teeth or move your legs or if you have heart problems.

The nice thing for those with no insurance is that it will cost about half of what a full sleep study costs. Many companies will even give you a slight discount if you pay up front.

If you are found to have sleep apnea there are several ways it can be handled. The most common and probably the most accurate is to come into a sleep lab and have a titration study performed. This will allow you to have someone who will find the best pressure of CPAP (Continuous Positive Airway Pressure) machine. It will also allow a trained technician to help you choose a mask that works for you. The added benefit is that all the things you missed testing in the home sleep test will be tested with the titration study. Other options such as Auto titrating CPAP can be used as a way of titrating a person but they are not always available at every facility. Surgical solutions and Oral appliances are offered by some physicians. I will write about these options in a follow up article.

As our economy changes healthcare will have to change as well. This type of innovation allows more people to have tests that might not have been able to afford testing otherwise. As we move forward I am sure there are more innovations coming up. I am excited to see and share new technology as it becomes available.

Amy Korn-Reavis, RRT, RPSGT has been in the respiratory field for over twenty years. She has worked in all areas and is currently focusing on sleep and how to help the community feel better by sleeping better. She is the manager of Emery Sleep Solutions an independent testing facility located in Apopka, Florida. She is also the coordinator of A.W.A.K.E. Orlando a support group for people with sleep disorders http://awakeorlando.ning.com. If you have any questions about sleep or are looking for someone to speak at your community function she can be reached at areavis@emerymedicalsolutions.com

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Exercise as a Solution to Insomnia

Posted by amykr on March 22, 2009

You have seen the commercials with the moth. Take a pill and you will sleep. Or the one for the over the counter medication, you don’t even have to talk to your doctor to take that. Many people do not want to take medication. For those looking for alternatives to medicine you might want to look at exercise. This will not overcome a sleep disorder such as restless leg syndrome or sleep apnea.

There is also a connection between inactivity creating insomnia. The body’s circadian rhythm does not work properly and does not allow you to get the deep sleep your body requires. This leads to issues such as depression, fatigue, high blood pressure and insomnia. This issue also causes an increase in weight which can lead to sleep apnea. So you can see that there is a vicious circle that our lifestyle causes.

There are multiple studies that reinforce the fact that exercising helps to sleep better at night. The big questions are when and what type help helps to make falling asleep and staying asleep easier. To start with the research does prove that that morning exercise is better then evening exercise. It helps to support our natural body rhythm, also called circadian rhythm, to function fully. When you work out later in the day it sets the body to be awake. It also causes a reduction in the slow wave sleep, the deep restorative sleep our body needs to heal and grow.

The best type of exercise is aerobic for the morning. An exercise that allows the heart rate to increase for at least 40 minutes 5 days a week such as walking, jogging, biking or elliptical. If you are going to do this make sure you also take time to stretch. Do not overdue it because pain will undo everything you are working toward. Stretching exercises like yoga or Pilates work but not as well. If you need to exercise at night be aware that it can increase your sleep problems. If you have to do you’re exercising at night stretching exercises such as yoga or Pilates would be the better choice since it does not have as strong effect on sleep.

This seems like a difficult thing to add 40 more minutes to your morning especially when you are not getting enough sleep already. It does take about 30 days of this to really see a consistent change. More importantly this is not the solution for everyone. It is a good solution for those who have insomnia and who are in good health. As always you should check with your doctor to see if this is a good solution for you.

Amy Korn-Reavis, RRT, RPSGT has been in the respiratory field for over twenty years. She has worked in all areas and is currently focusing on sleep and how to help the community feel better by sleeping better. She is the manager of Emery Sleep Solutions an independent testing facility located in Apopka, Florida. She is also the coordinator of A.W.A.K.E. Orlando a support group for people with sleep disorders http://awakeorlando.ning.com. If you have any questions about sleep or are looking for someone to speak at your community function she can be reached at areavis@emerymedicalsolutions.com

References
http://www.capitolsleepmedicine.com/SleepandExercise_May07.pdf

http://holisticonline.com/Remedies/Sleep/sleep_ins_exercise.htm

http://www.webmd.com/fitness-exercise/news/20031104/morning-exercise-may-help-you-sleep

http://www.acsm.org/AM/Template.cfm?Section=ACSM_News_Releases&CONTENTID=9806&TEMPLATE=/CM/ContentDisplay.cfm

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The Relationship between Pain and Sleep

Posted by amykr on March 20, 2009

The idea that treating just one symptom at a time is how medicine has worked. In recent years doctors have been taking a more holistic approach in caring for their patients. This has allowed research to be done looking at how such a thing as pain, both acute and chronic are associated with sleep. Thsi issue is important on many levels. With our community getting older this issue of pain caused from chronic issues such as arthritis, fibromyalgia, and back injuries are getting more common. This causes insomnia, increased sleep onset, and sleep fragmentation. All this means is that it keeps people from getting a continous sleep and may prevents deeper sleep and REM sleep, the period of time when you dream. This brings on a variety of symptoms including depression, fatigue, irritibility, short term memory loss, slower reflexes and slower mental processing. It also appears that pain levels of people who have a sleep problem during the acute phase of the condition are at an increased chance to have more severe chronic pain. With this knowledge it becomes more important to manage the whole patient. If the patient is having sleep issue including snoring, restless leg syndrome, or sleep apnea then they need to be treated especially in patients with chronic pain. It also becomes evident that if you have chronic pain that it needs to be managed properly. Treatments including medication, biofeedback, massage, and meditation have been used to help to relieve or decrease the intensity. The sleep part needs to also be treated. Sleep hygeine is the first thing to look at; a good bedtime routine and comfortable sleep environment. Treatment for other sleep issues such as teeth grinding, restless leg syndrome and snoring. Amy Korn-Reavis, RRT, RPSGT has been in the respiratory field for over twenty years. She has worked in all areas and is currently focusing on sleep and how to help the community feel better by sleeping better. She is the manager of Emery Sleep Solutions an independent testing facility located in Apopka, Florida. She is also the coordinator of A.W.A.K.E. Orlando a support group for people with sleep disorders http://awakeorlando.ning.com. If you have any questions about sleep or are looking for someone to speak at your community function she can be reached at areavis@emerymedicalsolutions.com

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Orientation: A lesson in Patience

Posted by amykr on March 17, 2009

have been doing a great deal of orientations lately due to unforeseen staffing issue. Anyway, it is always interesting when you orienting a new person to see what they really know and what they tell you they know. Somehow they never quite meet. But it gives me a chance to expand my horizons, teach new things, and learn that greatest of skills: patience. (This lesson usually coming after I have had another run-in with my 16-year-old.) It was on one of those orientation nights when I realized doing a set up for a sleep study and doing it correctly are two different things. I also realized that my need for doing things according to AASM protocol confuses a great many new people. In particular, the need for all my technicians to measure the patients head. It amazes me how so few technicians know how to do this. And then, even if they do, they do not understand how to put on a lead without pushing on the lead so hard that you think it is going to become a permanent part of the patient’s body. To me, this is a basic skill that was learned within the first two weeks of becoming a technician. Then, there is the middle of the night lead fix. Now, I was taught you want to disturb the patient as little as possible, so if you can wait for an arousal or awakening, great. Do you really want to go knocking on the door, reintroduce yourself, and explain what you are doing to a person at 2:30 in the morning? I personally think the more unobtrusive you are, the quicker the patient will go back to sleep. I do not even turn the light on. I can usually correct the problem just from the light the hallway gives off. There is always the concern about the patient who will wake up swinging, but those patients usually tell you before lights out not to touch them when you wake them in the morning. Of course, I have had a patient or two over the years take a swing at me, but I have learned how to duck very quickly when necessary. Lastly, it amazes me how little people document. Of course I am of the belief if you did not write it, it did not happen. (A lesson taught to me at one of the hospitals by their lawyer during orientation.) I think that lesson has stuck with me low this 20 plus years. I think new techs are afraid to write too much. Me, personally: I am afraid of writing too little. I tell all new techs that they should pretend they are the reading doctor and they have received the study the next day but they have no video. Write to me so that I know why what I am seeing looks the way it does. If that does not work, I use the lawsuit scenario. Its five years from now, you just received a request to show up at court about a sleep study you did eight years ago. How are you going to know what you did? What was going on? Write it out and it will never be a problem. That usually scares people to my way of thinking. I know that orientation is important and needs a great deal of attention, but I really hope that they will get easier over time. I really believe that as our field gets more regulated and licensed, we will all be working on the same page to create the best sleep studies possible.

 

Reprinted from Advanceforsleep.com

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ADD/ADHD and Sleep

Posted by amykr on March 15, 2009

This is an area that has  not had enough research.  The general consensus is that either ADD causes sleep disturbances like insomnia and fragmented sleep (sleep that is not continuous.) Or that sleep deprivation can bring on the symptoms of ADD/ADHD.  So how do you know what to look for?  How do you know what came first?

The first thing is to look for obvious signs of a sleep disorder.  Does your child snore?   If you listen to your child and when they snore you hear interruptions followed by gasping you might be hearing sleep apnea.  These issues can be caused from enlarged tonsils and adenoids, allergies or obesity. 

There could also be a condition called restless leg syndrome.  This is a creepy crawly sensation in the legs or arms that makes your child feel like they have to move.  It usually happens in the evening and continues through bed time.

These issues cause sleep deprivation because it will disrupt sleep, delay the onset of sleep and can prevent deep slow wave sleep or REM sleep, the stage when you dream.  The side effects of sleep deprivation are fatigue, irritability, inattentiveness, and in children sometimes aggression. 

The best thing you can do is start by talking to your doctor about any sleep issues your child might have.  You might also want to talk about any other health issues such as asthma, allergies, or vitamin and mineral deficiencies.  There could also be side effects to medication. 

The best thing you can do is to help your child is to create a good sleep environment.  You set the best example.  Eliminate caffeine, increase exercise and outdoor play, not eating at least two hours before bed time, and avoiding sleeping medications help to increase your child’s sleepiness. 

Create a room for sleep.  Have room darkening curtains on the windows, this will also help to keep noise out.  Do not have a television in your child’s room, the stimulation from it will not allow the brain to prepare for sleep. 

Finally, a hot bath and a routine that you follow each night will help your child and his mind get ready for bed.  The routine teaches the brain this is what we do for bed so its time to quiet down.  The hot bath and the body cooling down afterwords is a cure to the brain that it is sleep time. 

In the end there is no concrete rule that sleep causes ADD/ADHD or that ADD/ADHD causes sleep problems.  As more research is done we will get more answers that will help children to sleep and learn optimally.

 

Sites where you can get more information

http://www.webmd.com/add-adhd/guide/adhd-sleep-disorders?

http://www.sleepdisordersguide.com/blog/sleepdisorders/sleep-disorders-in-children-with-attention-deficit-hyperactivity-disorder-adhd/

http://www.sleepforkids.org/html/adhd.html

Amy Korn-Reavis, RRT, RPSGT has been in the respiratory field for over twenty years. She has worked in all areas and is currently focusing on sleep and how to help the community feel better by sleeping better. She is the manager of Emery Sleep Solutions an independent testing facility located in Apopka, Florida. She is also the coordinator of A.W.A.K.E. Orlando a support group for people with sleep disorders http://awakeorlando.ning.com.  If you have any questions about sleep or are looking for someone to speak at your community function she can be reached at areavis@emerymedicalsolutions.com


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Change in Life Change in Sleep

Posted by amykr on March 12, 2009

Its 2 am and you are still awake or you have worken up for the third time or even worse you have woken up because it feels like someone cranked the furnace all the way up. Your sleep will change as you are going through menopause, that is a fact. But you need to be aware of what is normal and what is not. You also need to make sure that you get treated for these problems.

In one study almost 60% of people 50+ who had sleep problems were never asked by their doctor about their sleep and were not offered help. Some doctors feel that is because sleep problems are inevitable when we age and others think even if they do ask there is not much that can be done. This is of great concern to me because there are so many people who could be feeling better and have more energy if they knew what was wrong.

The first thing is insomnia. That is a prolonged sleep onset or in laymans terms you spend the night staring at the ceiling counting the cracks that have developed since last night. There are some great medications out there to help with this. It could also be a side effect from a medication you are taking. If you are into natural remedies Melatonin has been studied to be an effective treatment option as well.

Pain can also be an issue it can cause insomnia or fragmented sleep, the up and down all night sleep. The bed part is that if you do not get the sleep you need you will be more irritable and your body will take longer to heal. If you have found that you have chronic pain and you can’t sleep talk to your doctor he might be able to help.

Hot flashes are annoying and come at the most inopertune times such as when you are trying to sleep. There may be no help for them or they may be a sign that you have a sleep disorder such as obstructive sleep apnea. The incidence of sleep apnea increases increases as we get older. 10% of the population has it. So if you have increased snoring or you wake up gasping talk to your doctor because there is a simple test to find out if this is the problem.

Restless leg syndrome also increases as we age. Sometimes it is caused from low iron levels in our blood. It can also be caused from some mineral deficinecies. Most of the time these are not the causes. There is help and there was even a recent study that compression stockings might help to relieve the symptoms rather then taking medication. Again the best thing to do is talk to your doctor about your options.

Remember the problem with untreated sleep problems are many. it can lead to memory issues, fatigue, high blood pressure, irritability or more significant health issues. Talking to your doctor can help to fix these problems but you may have to be the one to initiate the conversation.

Amy Korn-Reavis, RRT, RPSGT has been in the respiratory field for over twenty years. She has worked in all areas and is currently focusing on sleep and how to help the community feel better by sleeping better. She is the manager of Emery Sleep Solutions an independent testing facility located in Apopka, Florida. She is also the coordinator of A.W.A.K.E. Orlando a support group for people with sleep disorders http://awakeorlando.ning.com. If you have any questions about sleep or are looking for someone to speak at your community function she can be reached at areavis@emerymedicalsolutions.com

http://todaysseniorsnetwork.com/sleep_problems.htm

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The Internet is the Greatest Bridge Ever Built

Posted by amykr on March 6, 2009

I have been in health care for over 20 years. I can honestly say that my patients have never been better informed and neither have I. The ability for new ideas and new research to be shared in an open forum and to allow patients and caregivers to discuss issues and to give each other help has changed how healthier is administers.

There are certain drawbacks like incorrect information being given. But the good out ways the bad. On a weekly basis I receive in emails lists of new research articles that have been published worldwide about sleep. On twitter, face book and linked in I get to discuss issues with fellow technicians about what is going on across the country in practice, legislation and new practices. It allows for a better quality practitioner to go with the more informed patient.

 It also allows for follow up with the patients in an easier way. We can create websites and videos tp help prepare our patients. We can offer help via e mail newsletters.

I can think of no better time to be a health care practitioner then now.

 Amy Korn-Reavis, RRT, RPSGT has been in the respiratory field for over twenty years. She has worked in all areas and is currently focusing on sleep and how to help the community feel better by sleeping better. She is the manager of Emery Sleep Solutions an independent testing facility located in Apopka, Florida. If you have any questions about sleep or are looking for someone to speak at your community function she can be reached at areavis@emerymedicalsolutions.com or you can visit the facility’s website at www.emerysleepsolutions.com

This article is from a challenge put out by www.growingbolder.com.  A wonderful website designed for people persuing the second half of their life with gusto.

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