Insomnia, Snoring, Sleep Apnea

The world and life of a sleep tech

Posts Tagged ‘cpap’

The Challenge of Proper CPAP Mask Choice

Posted by amykr on July 29, 2011

It is always a challenge when we have met a person for the first time and we ask a few questions and than we have to help them choose a mask that will work for him or her. This is a very interactive experience that can take a short period of time, or what usually happens is that it takes quite a bit of time making the decision. There are basically five ways to make this experience easier and more successful
1. You need to come in with your mind open. Many people go into the experience thinking they know what want in a mask. This may be because a friend has a CPAP and is successful with a mask they chose and so you figure it will work for you. It could also be because you went researching on the internet and thought the newest mask on their looked like something you want. The truth is that there are so many masks on the market because there are that many different needs for different people.
2. Claustrophobia does not mean that a smaller mask is a better mask. The fact is that nasal pillows and can sometimes feel stronger and make you feel more claustrophobic. A mask that allows you to breathe through your mouth may be more comfortable. There are masks on the market that do not block your line of vision and will make you feel more comfortable.
3. If you take steroids or blood thinners your skin will react differently to masks. Your skin will be more fragile. The person working with you needs to be aware of this so they can choose a mask that puts less pressure on the bridge of your nose. There are extra cushions if needed but the ideal is to find the right mask that does not put pressure on your face.
4. Do not be afraid to ask to try a different mask. You will be using this mask for a long period of time and you have the right to try as many masks as you want. You are not annoying the technologist. We would rather have someone tell us that there is a problem with the mask during the night than to find it out after the test when they cannot do anything about it.
5. If you think you will need time to get used to the mask and the therapy see if you can come in before the night of your study. In many labs they will have you come in for a PAP NAP during the day. They will allow you to trial masks and get used to the pressure during the day. It is a great opportunity to take your time and not feel the pressure of having to go to sleep on the machine right away.
CPAP therapy can help you to improve your health and allow you to feel more energetic. Being successful using the therapy requires that you find just the right mask whether it is a full face mask, nasal mask or nasal pillows. The goal is for you to find a mask that will allow you to sleep comfortably and breathe easily.

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5 Reasons Why People Fail at Using CPAP

Posted by amykr on February 15, 2011

CPAP therapy is considered the gold standard for treating sleep apnea. It is a machine that uses a mask of some type to deliver a specific pressure of air to help keep the airway open. The problem with CPAP therapy is that it does take getting used to in order to be successful in using it nightly. There are some very specific reasons that people fail to be able to adjust to it and there a definitely ways to overcome these obstacles to be successful and feel better.

1. There is a lack of communication. Many patients are afraid they are disturbing someone if they call when they are having issues with their CPAP. The truth is that if you want to be successful using your machine you need to communicate your issues with a professional. Depending on who you are working with you should call your doctor, the company that set up the machine or the sleep lab who performed your study. There can be many issues but if no one knows you are having problems then the problem can not be fixed.
2. You have the wrong mask. If you had a sleep study where they fit you with a mask you must remember that you were only there for a short time. A mask might seem right during the study but may not fit as well at home. You may also find that although the mask is good the first couple of night after wearing it for a week it may not be as comfortable. In most cases insurance will pay for a change of mask during the first 2-4 weeks after your machine is delivered. This may not be true for those who have an HMO where the insurance company may dictate which mask you are given. In those cases it may benefit you to purchase a mask that might fit you better. It may cost you but it will be worth it in the end. Also those who have sensitive spots from the mask may benefit from having two masks to rotate through to change the pressure point.
3. You do not use the humidifier. Many patients think that the humidifier is an optional piece of equipment but it is not. It is essential that you use the humidifier and that you set it to the appropriate setting. In the winter you will need more humidification then during the summer due to the air being dryer. If you do not get enough humidity you will find your mouth, nose and sinuses will get sore, swollen. You may also find that you will develop a stuffy nose due to the welling of the nasal tissue and the increase of mucus being secreted to deal with it.
4. The pressure is too high or too low. The goal of the sleep lab is to find the lowest pressure needed to eliminate most of your respiratory events. However, just because they achieved a final pressure does not mean that it is the best pressure for you. Remember you are only in the sleep lab for one night and it is not the optimal sleep conditions. You are wearing wires, sleeping in a strange bed and it is usually the first time you have ever tried on a CPAP mask. The pressure achieved may be a little high or a little low. It may be that you need a higher pressure then you can handle. No matter what the issue there are certain procedures that must be followed before lowering the pressure. You will probably be asked to try a different mask. This is to see if the issue is not pressure but comfort. You may then have to see the sleep specialist before he is willing to turn you pressure down. This is because he is ultimately responsible for making sure your care is the best you can receive.
5. You did not give yourself enough time. This is long term therapy. That means you will be using this equipment for a long time. So give yourself a little time to get used to it. For the first few days if you feel uncomfortable wearing it at night. Put it on while you are sitting in your recliner in the living room. Wear it for about an hour. Get used to it. Then increase your time wearing it. Usually be the end of the first one or two weeks you should be ready to sleep with it.

CPAP therapy is an important part of keeping you healthy if you have sleep apnea. Giving up before you give the therapy some time will do nothing to improve your health and in the long run can have very serious consequences. Remember your doctor and the people who have worked with you want you to be successful.

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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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New Equipment for CPAP Users on the Way

Posted by amykr on October 15, 2009

There are many CPAP users out there who do not use their machines. Much of this is due to the fact that this type of therapy is requires a strong desire by the user to stick with the therapy. The good news is new masks, machines and humidifiers are making this type of care more comfortable. Several new pieces of equipment are being introduced in the next couple of months.

A new machine is being introduced by Phillips Respironics. This new CPAP, according to the literature, takes care of many of the issues that users tend to have. It has CFLEX, a therapy mode that allows the breath to be delivered similar to a natural breath rather then a machine. This setting also has an adjustment so that the user can find the flow that is comfortable for their personal breathing pattern.

The equipment is also able to communicate with your doctor and medical equipment company. It has a program that will allow them to monitor the progress of the person using the machine and if they are having any issues they can be corrected in a timely manner instead having to wait for a doctor’s appointment and discussing it with them. All the patient needs to do is make a phone call. The doctor of the equipment company can then access the machine and know if it is being used, if the user is still have issues with snoring, apneas, or with the mask and they can then change the setting to help the person be more comfortable.

The final issue they have looked at is proper humidification without the water collecting in the tube. In the old humidifier the temperature was not controlled at the mask. This new machine looks at humidification at the mask so that excess water does not accumulate in the tubing causing a sloshing sound and accidentally drenching the patient as they move during the night.

New masks come out constantly. Phillips Respironics and Resmed have both come out with changes to the masks they offer. Respironics has two new full face masks. The FullLife mask is a restructuring of typical full face mask to make it more comfortable as well as making it lighter. The most unique thing is that it no longer has a forehead pad but has a headgear with a chin strap to adjust the pressure across the bridge of the nose. The Total Face Mask is a mask that seals around the whole face. This allows patients with unusual shaped faces or patients who can not tolerate nasal or full face masks a new option.

Resmed announced they have added a Softgel interface to their line of masks. This will allow for a comfortable fit for patients who need a little more support to their masks.

For people who have had their machines for 5 years or longer many insurance companies will replace older machines, however they may require you to re-qualify by having another sleep study to prove you still have sleep apnea. Mask, hoses, filters and other equipment are replaced every 3 to 6 months but most people have to call their equipment provider to ask for these to be replaced. If a CPAP user wants a new mask most likely they will have to ask their doctor for a new prescription. Masks generally are not interchangeable. Once you choose a mask you must get a new prescription to change it. The same is true for a humidifier. If a person does not get a heated humidifier when they initially get their machine they must get a prescription and may even need another sleep study in order to get one.

Once you have started on CPAP therapy staying current with the changes in equipment may help in keeping a user compliant with care.

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What is CPAP?/ Sleep Awareness Week

Posted by amykr on March 3, 2009

For those who have sleep apnea a CPAP is your introduction to the first good night sleep you have had in a long time. The problem is that you have to get used to it. So what is it and how does it work. To put it simply a CPAP is a very fancy air compressor. That is not to say you can go to Wal-Mart and buy and an air compressor and use that because I am sorry that will not work.

When someone comes in for a titration study we start by helping them choose a mask that works best for them. We have many masks. We have masks that cover the mouth and nose, masks that cover the nose only and masks that sit under the nose and fit into the nostrils. They come in different sizes and shapes and we give you a chance to try on different ones until you find one that is comfortable. Many patients even change to a different mask during the night because they want to try something different. Mask choice is important because it is what is touching you.

Next there is a heated humidifier. Why you ask do we have ha heated humidifier. Well we are going to create a little wind here and if it is dry it will dry out your nose and mouth. The heat allows more moisture into the air so it is more comfortable.

There is a long hose that connects the machine to the mask.

Then there is the machine. Today’s machines are so different then ones even a couple of years ago. They are small, about the size of small loaf of bread. They are quiet. They are easy to travel with. They are more comfortable. The manufactures have created computer programs in them to make them feel more natural and breathe with you.

Now how do we choose a pressure? Well that is what the sleep study is for. We start the machines on a very low pressure. We watch you sleep and then slowly increase the pressure until you have no more snoring, apneas or arousals. Basically we find the sweet spot where you sleep the best. The sleep specialist reviews the study and then chooses what will be the best pressure for you.

Once the doctor writes the prescription for the machine a homecare company will arrange to have one delivered to you and will review how to use it. Keep the phone number of that company because when you need new masks and headgears you will need to call them. If you have any questions or problems you will need to call them. If you change insurance or address you will need to call them so they know where to send your new masks.

As always if you have any questions do not hesitate to ask I want to help. If you use one and want to share your experience please do.
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 http://www.emerysleepsolutions.com

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Extra Side Effect of One New Years Resolution

Posted by amykr on January 2, 2009

Many people suffer from insomnia. We work hard, relax little and suffer from input overload. As woman we also suffer from hormonal changes that can increase insomnia. What can you do about this if we do not wish to take medications?

One New Years resolutions that might be able to help is exercising. There are some rules thought. It works best in the morning according to Dr. Youngstedt’s research at University of California at San Diego. He found that it can help regulate the body’s internal clock also know as circadian rhythm based on when you do your exercise. That outdoor exercise has the added effect of light exposure which helps to regulate this rhythm as well. He also recommends that people with insomnia try exercising different times of the day as some people it does help to exercise in the evening.

Since many of us commit to exercise as part of the New Year it might help to try exercising in outdoor light, do small intervals throughout the day or to experiment with the time you exercise as a way for you to improve you sleep.

I hope you are having a great and productive New Year.

http://www.acsm.org/Content/ContentFolders/NewsReleases/2003/TROUBLE_SLEEPING__A_LITTLE_EXERCISE_MIGHT_HELP.htm

http://www.physsportsmed.com/issues/1997/10oct/young.htm

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TV and the Cure for Snoring

Posted by amykr on December 27, 2008

 You see them on television and read about them in magazines.  They cost anywhere from $30 to a bed that cost $1000+ Do they really work?  Are they worth the money?

Well it depends on what you are thinking of getting.  I will start with some of the ones that make us laugh in the sleep lab and move on from there.  There are several sprays on the market that say they will fix snoring.  Well they do lubricate the back of the throat so they may reduce snoring a little bit at the beginning of the night if your snoring is caused by too small an airway in the back of the throat, but if your snoring is caused by anything else it does nothing.  The same goes for the strips  you put on your nose.  Snoring generally does nto come from your nose so a piece of tape and plastic is just not going to fix snoring or sleep apnea. 

Now there are several t shirts out there that help you stay off your back.  If you have positional snoring or apnea these do work.  But it would be cheaper to take an old t shirt sew a pocket down the center of it and put some tennis balls in it.  This is to train someone not to sleep on their back and it works well.

There are mouth pieces.  A good one is fitted by a dentist and will run about $300-$500 but it is custom made for you and will keep your airway open.  The ones you see on television might work or they might not it depends on what is causing the snoring and if you have TMJ it could agrivate it. 

There are also pillows out there that will help with positioning.  They have a tendency to be pricey and some of them are quite uncomfortable.  So consider that before your buy it.

The last thing is the beds that adjust.  If you elevate your head you are likely to find a position that will eliminate your snoring.  It works but again buying a bed is a very costly investment.

If you do snore or you snore and gasp the best thing to do is chat with your primary care physician about the problem.  There are several things that can cause snoring and yrou doctor will be able to help you to find the right answer for you.

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How do you wake up

Posted by amykr on December 24, 2008

This may not sound scientific but it is a good question. Do you wake up to the loud peeping of an annoying alarm clock, or your favoriet music, or your dog licking your hand? How you rest may be tied to it. If you know that as soon as you relax and fall asleep you are going to be awoken by something that is going to annoy you then you will not let your body relax enough to get the sleep you deserve.

The same is true if you have a bedpartner who you know will wake you during the night. He or she may kick, grind their teeth, snore or stop breathing. All these things are disruptive to anyone who shares the room with them. If this is the issue you need to chat with your doctor about your partner’s issues. They might have ideas how to discuss this issue so that you both can get a good night’s sleep.

As I tell my family every day if mama is happy everyone is happy. So make sure that you take care of yourself by helping your family members take care of themselves.

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The Year of Change for Sleep Techs

Posted by amykr on December 23, 2008

published at http://www.advanceforsleep.com
Published December 22, 2008 3:02 PM by Amy Reavis

As a respiratory therapist and as a sleep tech, I do not think I have ever seen a year with as many changes as this year has brought us.

We started the year on the right note. We knew that competitive bid was coming. Then came the issue of home sleep studies. Following closely on its heals was licensure and respiratory credentials for sleep technicians. And just when you thought we had enough curve balls to handle, the economy tanked and people could no longer afford their co-pays or lost their jobs and their insurance.

I have had many friends and know several labs that were affected by all this change. It is a lot to take in. Many people I know have ignored it or believe that it will not affect them.

As a whole, sleep does not have a strong advocacy group. We have the AAST but many people do not belong. We also have a large group of respiratory therapists who belong to the AARC, which has a much stronger voice.

You do not see state associations in and very few regional ones. I know living in Florida there are two regional associations but then it seems they are competing with each other for members.

We do have some great highlights though. We have several professional magazines, one really phenomenal message board, binarysleep.com, many people who are creating CEU and college programs to teach sleep in a formal setting, and many truly dynamic people who are bringing our profession to a whole new level.

I remember when respiratory was going through the same issues. There were many people who were trained via on the job training; we had credentials but we were not licensed. Those of us who got our AAS degrees were asked why. Why take the RRT? Why worry when we are needed?

I believed in the field of respiratory and was very passionate about it. And I encouraged people to get their credentials because eventually we would be licensed. When that day came, I lost several co-workers because they refused to take the test. I remember all of this and I see history repeating itself.

This is why I know that sleep will do well. Because history shows that these young medical fields are important and that as we grow and change we not only survive but thrive.

I challenge every tech out there to do something great for our field this year. If we work together, publish papers, create state societies, or help new technicians, we will be a strong and healthy profession.

posted by Amy Reavis

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Snoring and a Restful Sleep

Posted by amykr on December 22, 2008

With greater research going on we are finding new reasons why people are tired during the day.  A research study was publish in the Chest magazine compared daytime sleepiness in snoring patients as it related to obstructive sleep apnea syndrome.  The findings were not necessarily what were expected.

 

The conclusion was that snoring independently affects daytime sleepiness and was not related to sleep apnea.  What does this mean?  It can mean many things.  It can mean that snoring itself needs to be taken seriously as it can cause an increase in the level of fatigue a person feels.   When a person experiences increased fatigue the chances of a work related accident or car accident will happen.  There is still the chance that the person has sleep apnea which has its own set of issues.  And finally the feeling of well being overall is very important and the need for a good nights sleep is necessary.

 

If you find that you are snoring take an Epworth test.  It will give you a good idea how tired you are and if you need to talk to your physician about sleep.

 

 

Sleep Disorder Screening Questionnaire

 

Please complete and return to your physician

 

Name:________________________________                     Date:_______

 

 

How likely are you to doze off or fall asleep in the following situations?

 

0 = would never doze

1 = slight chance of dozing

2 = moderate chance of dozing

3 = high chance of dozing

 

Circle the appropriate number

Situation

Chance of dozing

Sitting and reading

     0    1      2       3

Watching TV

     0    1      2       3

Sitting, inactive in a public place (e.g., a theater or meeting)

     0    1      2       3

As a passenger in a car for an hour without a break

     0    1      2       3

Lying down to rest in the afternoon when circumstances permit

     0    1      2       3

Sitting and talking to someone

     0    1      2       3

Sitting quietly after lunch, without alcohol

     0    1      2       3

In a car, while stopped for a few minutes in traffic

     0    1      2       3

 

                                                                                             Total from above: _____ (>9?)

________________________________________________________________________

 

Do you often feel sleepy during the daytime?                  Yes     No

 

Do you snore, or has anyone ever told you that you snore?         Yes     No

 

Has anyone ever told you that you stop breathing during sleep? Yes     No

 

Do you ever have a choking or gasping sensation during sleep? Yes     No

 

Do your legs ‘kick’ during sleep?                                               Yes    No

 

 

Return form to your physician

 

 

 

 

Malin Svensson, MD, Department of Otorhinolaryngology, Head and Neck Surgery, Akademiska sjukhuset, SE 751 85 Uppsala, Sweden;.  2008;134(5):919-924.  ©2008 American College of Chest Physicians

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