Insomnia, Snoring, Sleep Apnea

The world and life of a sleep tech

Posts Tagged ‘amy korn-reavis’

Should I Have a Home Sleep Study or Go to the Lab?

Posted by amykr on March 23, 2010

Technology has come a long was and studying sleep is no exception. We are now able to perform sleep studies in the home as well as the sleep lab. This is a great thing because it allows more people to be tested for sleep disorders then every before. The drawback is that there are limitations to what can be done in the home versus the lab.

In home sleep studies are generally modified unsupervised sleep studies. This means that the equipment is delivered to the patient and then they are responsible for applying it and taking it off. In some areas a technician will come out in the evening to apply the equipment and you will wear it the rest of the night, then you may have to take it off or the technician will come back in the morning and remove it. Generally these types of studies are limited in nature and only monitors certain parameters, oxygen level, heart rate, breathing, and whether you are awake or sleep and position. Because the study is limited it is designed strictly to diagnoses sleep apnea. Other conditions a person may have will not be diagnosed, such a periodic limb movement disorder and teeth grinding. This type of testing is also not good for patient with significant health issues such as congestive heart failure or COPD.

In lab testing has several differences. The first one is there is a technician there with you if any problems should arise. If one of the wires become dislodged it can be fixed right away. You do not need to have another study performed. The technician is also there to answer questions should you have any during the nights. The most important role of the technician, however, is that they can intervene if there is a significant health issue during the night. They can also do a special type of study called a split night, or combination study, which allows you to be diagnosed and treated for your sleep apnea on the same night. This way if you have severe sleep apnea you can be treated right away instead of waiting. You also are able to be evaluated for other conditions you may not know you had.

Treating sleep apnea after the home sleep study can occur in two different ways as well. You can be brought into the sleep lab for a titration study. During this test the technician finds a mask that works for you, educates you about CPAP and how it works and then finds the right pressure to eliminate most of the apneas and snoring. This test also allows the doctor to look for the other disorders such as periodic limb movements.

The other option for treatment is to have a homecare company deliver an auto-titrating CPAP. This machine is set to allow a range in pressure that adjusts as you have events during the night. The technician will fit you for a mask and then leave the machine for you to use. The drawback is that there is no one there during that first night to assist you if there is an issue. The other issue is that unless you call your doctor or the company that delivered the machine they may not be able to correct any problems that happen until they download the information in the CPAP memory.

Overall home sleep studies do have a place in the diagnosis and treatment of sleep apnea. They are very good for diagnosing the straight forward sleep apnea patient. If, however, there is any issues that need to be addressed right away or if a person needs some assistance this may not be the best choice. A full sleep study allows for the possibility for quicker treatment and intervention. There is also the ability to diagnose other conditions that might go unnoticed in the home setting. That and the personal care involved in testing help to create a successful long term care situation.


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When to Question a Snore

Posted by amykr on March 3, 2010

Your wife or husband tell you they need to go to bed before you or they will never sleep. You know if you are going on a trip you can not share a room with anyone else because they will complain. Do you know when a snore is something you need help for or just annoying?

The fact is that no matter what a snore is not normal. If you snore there is something in your anatomy that says you need to have it evaluated. It may be just that you have a large uvula that vibrates when you breath at night. It could also mean you have sleep apnea, a condition where you stop breathing or breathing is partially obstructed and your oxygen levels in your blood drop.

If you have plain snoring this can be treated with several medical treatments including medications, surgery, or an oral appliance. You might also benefit from positional therapy. This is where you avoid sleeping on your back. You can use a special pillow or other device. My personal favorite is to take a t-shirt, sew or glue a pocket down the center of the back of the shirt and place 3 tennis balls into the pocket then close it. Every time the person rolls onto their back they become uncomfortable and roll to their side.

If you are not sure if you might have sleep apnea take the Sleep Quiz. If you have a score of 9 or greater than it is time to speak with your physician. Sleep apnea is important to treat because sleep apnea can contribute to many health issues including depression, high blood pressure and diabetes.

If your child is a snorer you should take the time to talk to his or her pediatrician. Sleep disorders can very easily be disguised as irritability, short attention span and can lead to other health problems. It can be caused by enlarged tonsils and adenoids. It can also be caused by a small airway. The current research is discussion new medication treatments to help children.

No matter who in the family is snoring it is something that is not normal. It is something that should be evaluated by a professional. If they can sleep quieter than everyone will get a better night sleep.

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Sleep and Quality of Life

Posted by amykr on January 19, 2010

Sleep may not seem productive because we believe we are not doing something we define as productive. Unfortunately, this belief causes many people to put sleep at the bottom of their priority list. Te long term effects of sleep deprivation will keep you from having a quality of life you have always wanted. Sleep. If you want to have energy and clear thought then you really need to consider your length and quality of sleep.

Sleeping is a personal need. For most adults between 7 and 8 hours is the average amount needed. This is an average and there are people who need a little more or a little less. of course when we are children and even teenagers we need more sleep. When we get older we may need less sleep, but contrary to popular opinion older people do need between 6 and 8 hours of sleep.

Sleep time allows two important processes to happen. It allows us to process our thoughts and move them from short term to long term memory, and it allows our body to heal itself. These two processes are so important especially as we grow older.

How do we achieve a good night sleep? You need to put it on your to do list. If you make sleep a priority, set that absolute bedtime, make sure you are creating a routine to help; it will help to make life more energetic. Creating the best sleep environment will help to get the most of this time of day.

At the end of the day it is important for you to take advantage of these 7 hours a day of good healthy sleep to allow you to really enjoy the rest of the day. Your quality of life depends on your quality of sleep.

Posted in health care, Sleep | Tagged: , , , , | 3 Comments »

Sleep Studies do More Then Listen to Snores

Posted by amykr on August 4, 2009

Many people go to the doctor because they have something they want fixed. They expect that a pill will do the trick. What they do not think about is what caused the problem in the first place. It is this search for the reason for problems that send many to the sleep lab for a study.
The obvious patient is the one who snores, gasps and wakes their spouse during the night. We all know or are related to this patient. Uncle Harry fall asleep in the recliner Thanksgiving afternoon, snore louder and louder, suddenly stops and then wake up snorting and gasping just to fall back to sleep again. He also has other health issues.
Then there is the overweight person. However, there weight is actually not what sends them to the sleep lab. It is other symptoms they might have that send them in to the lab. Hypersomnia, or difficulty staying awake, is usually the symptom that sends them to see how they are sleeping at night.
The people who have high blood pressure that is hard to control or unexpected can also send a person to a sleep study. If a person has sleep apnea, every time they stop breathing they put stress on their body and their heart. Eventually this stress can show up as high blood pressure, especially in the morning. Many times this type of blood pressure issue is difficult to control with medication. It is necessary to treat the cause of the issue, the apnea, in order to get the blood pressure under control.
The same problem with blood pressure can show up as uncontrolled blood sugars as well. The stress on the body caused by apnea can cause increases in blood sugars. This is especially true if a person tends to wake with higher then expected blood sugars on a regular basis. The body does not deal well with this type of repeated stress.
There are other conditions that will send a person for a sleep study. If a person has a history of moving around during their sleep especially while dreaming they may come in for a sleep study. That could be a symptom of several different conditions. The only way to diagnose what type of problem they have is through observation and testing.
People with congestive heart, head injuries and neuromuscular conditions may have sleep studies performed to assure that they are breathing well and getting enough oxygen in their sleep. This is so important to the quality of their daily life.
If your doctor orders a sleep study and you are not sure why, ask him or her. There is a good reason it is ordered. If you decide not to have the study your doctor may not be able to fully treat you. Treating a sleep disorder may help you to feel better and feel healthier over the long run.

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Insomnia and Fibromyalgia; Combination Therapy Helps

Posted by amykr on May 27, 2009

Fibromyalgia patients have to learn to deal with chronic pain. The problem is that pain and insomnia cause a vicious cycle of increased pain and decreased sleep. Insomnia has been shown in many studies to decrease a patient’s pain threshold.

Treating insomnia can be quite difficult. Medications are usually the first line of treatment. They work well in the beginning but patients build up a tolerance over a period of time. This is particularly true of Fibromyalgia patients because it must overcome the pain the patient feels. When you mix the short term effects of medication such as Ambien or Lunesta with cognitive behavioral therapy, also known as CBT, patients have much more success.

Cognitive behavioral therapy is a psychological treatment where a therapist helps a person changes their thinking about an issue so they can change the behavior. This therapy has shown a 30%-40% success rate in the treatment of insomnia. When it is combines with short term sleep medications the efficacy increases to 65%-70%.

Many patients may be reluctant to go this route because doctors in the past may have told them their Fibromyalgia was in their head. The medical profession has changed their understanding of this condition and is looking to alternative therapies to help to deal with this condition. Cognitive behavioral therapy is one tool to not only help with insomnia but to help with the chronic pain as well.

As with any therapy you should always discuss your options with your doctor because he/she knows your full case history. For those who are looking for the best way to handle the sleepless nights these therapies are a great new option.

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Why is He Here?

Posted by amykr on May 6, 2009

I love my patients, but I have to admit there are some patients that make this job more challenging. They are not the patients with severe apnea or the patients who do not believe they have apnea; They are the patients who do not have anything.

You know the ones I am referring to: you put them to bed, you read their questionnaire, and you expect to see an AHI of at least 15 events per hour. Then it is 1 a.m. and you hear nothing. Not a snore, not a gasp, nothing. You look at the study and they have had plenty of stage 3 and REM already. You look to see if maybe they had not done any sleeping on their back. Nope, they have been asleep on their back the whole time.

When you talk to them the next morning you get one of two responses. My favorite is “This is the best night sleep I have had in years.” The other type of patient is convinced he did not sleep.

We had the former patient in our lab last week. He teaches college. He scores papers on his laptop in his bed until 1 in the morning, most nights. His wife complains that he snores but he says she snores as well. The best part was when I handed him the sleep hygiene tips sheet. He said I left one item off the sheet. He informed me that he slept with his two children in bed with him. Now I was standing there trying to figure out how he did not tell his doc this before the doc sent him to the sleep lab.

I do not know about you, but if I stayed up until 1 a.m. every morning, had two squirming children in bed with me every night, and taught college all day, I would be exhausted.

So what do we learn from this patient? That every once in a while it is nice to have an easy patient.

Oh yeah, and if he even remotely looks young enough to have kids, ask if they have their own room.
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