Insomnia, Snoring, Sleep Apnea

The world and life of a sleep tech

Posts Tagged ‘Sleep Apnea’

Sleep and Your Weight

Posted by amykr on June 1, 2012

We talk about our weight all the time.  We try new food plans, we take up different exercise programs and we say positive affirmations until we are blue in the face.  We ask our doctors for help and they tell us to try harder, eat less and exercise even more.  When was the last time you were asked how well you sleep?  Our quality of sleep affects our weight more than we can ever imagine. 

 Why You Need to Get 7-8 Hours

We run on less and less sleep so we can get more done and connect to more people.  This lack of sleep has a harsh effect on our brain.  It will not only effect how we make decisions, deal with emotions and are able to concentrate but it will also affect our appetite.  Sleep deprivation causes us to make rash decisions.  This can lead to more volatile emotions and negative emotions like stress and anger.  This leads to stress eating.  It can also lead to eating foods that are high in fat, sugar or salt. 

Sleep deprivation also increases the feelings of hunger.  People who are sleep deprived will eat more frequently to help keep them awake.  Again the foods they choose tend to be high in fat, salt and sugar.  This just makes it harder to stay on your choice of food plans.

Sleep Disorders Affect Your Weight

Sleep apnea has been associated with many health problems but the biggest problem where your weight is concerned is the effect it has on your hormones.  In particular you Cortisol levels tend to be elevated and stay elevated throughout the night.  The stress response every time you stop breathing or have difficulty breathing as obvious by snoring your body responds with the fight or flight reflex and Cortisol is produced and stays elevated   High Cortisol levels keep you from being able to lose weight. 

Treating sleep apnea and snoring requires you to talk to your doctor about the problems you are having sleeping.  You will want to explain all your symptoms not just that you are having difficulty sleeping.  People with sleep apnea do not always snore so do not assume that you do not have sleep apnea if you do not snore. 

There are many doctors who will say “well, if you lose weight you will not have sleep apnea and snoring” but in order for you to be successful with the weight loss you really need to treat this problem.  Your body does not like to be stressed and if you are changing your food and your exercise but you are still stressing your body every night you will not be successful at losing weight.  You need to be your best advocate.

Do Not Underestimate the Small Stuff

Weight loss is a challenge under the best circumstances.  There are little things you can do to help you to make the weight loss journey a little easier.  Sleep is one of the biggest influences that require very littlImagee specific work.  Making sure you sleep 7-8 hours a day and that the sleep quality are two of the little changes you can do that will help you achieve your goal.

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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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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 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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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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You expect me to sleep with all that!

Posted by amykr on January 9, 2009

People who come to the sleep lab always seem to expect the worst. It does not help that their friends have told them all sorts of horror stories and that the internet is full of misinformation. So when most people come in they are usually either totally clueless as to what will happen or they are terrified that we are going to tie them to the bed and attach all sorts of things to them. Really a sleep study is not bad at all.

The first thing you should know is that at my sleep lab we our rooms look like your bedroom or a hotel room. There is a queen size bed and a flat screen tv in each room. People do not need to share rooms. However you also can not share your room with your spouse. I know you wives out there are excited to have a snore free night to yourselves.

The next thing you should know is that we do attach some wires to you with tape and paste. These wires are so we can monitor the electrical activity in your brain and in certain muscles. The wires are very thing with a cup or a snap at the end. They are tied together in a bundle so that you will not get tangled in them. I have never ever lost a patient do to self hanging during a sleep study. I also use sticky pads like when you have an EKG done.

The third thing you should know is that the tests are recorded for sound and video. This is so the physician can see and hear anything unusual. There are people who act out their dreams and who sleep walk that we need to have on video. This way the doctor can see what was going on and will be able to get the proper diagnosis.

The fourth thing you should know is what we are looking at while we, the technician and the physician, are sitting at the computer. We have 6 channels that look at brainwaves from different portions of your brains. We monitor your eye movements so we can tell when you are dreaming (do not worry we never see what you are dreaming.) We have three wires on your chin to monitor for teeth grinding. We monitor your heart and your oxygen levels. We monitor your leg movements to see if you have leg movement or leg cramps during the early part of the night. We monitor your snoring to see how loud it is. And finally we monitor your breathing with two belts, one around your chest and one around your belly. We also put on a thermister and pressure transducer to monitor your breathing in and out of your nose and mouth.

Finally you should know about the CPAP but I will leave that to another blog entry because there is so much to talk about just with that. I will also talk about what conditions we are testing for. I think people should know we are not just looking for sleep apnea.

I hope this makes you feel a little more comfortable about what will happen when you arrive at our lab. You are always welcome to visit any time you are in Apopka.

One of the rooms at Emery Sleep Solutions

One of the rooms at Emery Sleep Solutions

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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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