Not happy with your CPAP? We can help!

If you are a CPAP patient who is getting im-patient with your therapy, at the St. Joseph Center for Sleep Medicine, we want to help you to get the most from your ongoing treatment.

There are many valid reasons why patients do not stick to their CPAP regimen. Could one of the following describe you?

• Your mask doesn’t fit well – it’s too loose or too tight
• The mask is uncomfortable or leaks
• The mask irritates your nose
• The mask prevents you from sleeping comfortably on your side
• You are claustrophobic
• The machine is noisy and disturbs you or your sleep partner

These are just a few reasons a lot of patients do not keep up with their therapy. Many patients think that CPAP discomfort is normal –the price they have to pay to get the benefits of therapy – so they just stop, or they “soldier on” until they finally give up altogether.

Please be assured: CPAP discomfort is not normal. At the St. Joseph Center for Sleep Medicine we can help you deal with and conquer any difficulties you are having with your device, so you can stick to your therapy and get all the benefit possible.

At the Center for Sleep Medicine, we offer a CPAP Desensitization Clinic. In just one session, we can meet one-on-one with you and teach you the things you can do to ensure that your nightly CPAP therapy is comfortable. By and large, our Clinic patients have had a great deal of success, many of them going from not using their CPAP at all to using it from 4 to 8 hours a night.

CPAP is one of the most effective, non-invasive ways to treat sleep apnea, help you get a good night’s sleep and help avoid the health risks that go along with your condition. If you are having trouble using your CPAP device, we encourage you to talk to your primary care provider about a referral to the St. Joseph Desensitization Clinic. If you would like further information about the Clinic and how it could help, please feel free to call us at the St. Joseph Center for Sleep Medicine at 907-1774.

Kevin Hammond, RPSGT, CRT

St. Joseph Center for Sleep Medicine

Not all Testing Equipment is alike

Hello,

I write this blog post today to help you understand the differences among home testing devices circulating in the community.

In today’s economy, some have turned to home testing as a less costly option for sleep apnea screening. Here is Medicare’s definition of the different categories of sleep testing:

Type I – “gold standard” for sleep studies – Provided by the St. Joseph Center for Sleep Medicine
This is an attended study, performed in a sleep lab with the oversight of a sleep technologist with full sleep staging. This test monitors the transition through all your stages of sleep. It includes the use of an electroencephalograph (EEG) brain wave monitor which tells the technologist when you are asleep and when you are awake. Type I devices must also include the following channels:

• EOG – monitors eye movement
• ECG –monitors heart rate and rhythm
• Chin EMG – monitors muscle activity
• Limb EMG – monitors leg or arm movement
• Respiratory effort at thorax and abdomen – monitors breathing
• Nasal air flow
• Pulse Oximetry – records your oxygen levels
• Additional channels for CPAP/BiPap levels, CO2, pH and pressure

Type II home sleep test (HST) studies – Provided by the St. Joseph Center for Sleep Medicine
With a Type II portable monitor, unattended studies can be performed at home without the oversight of a sleep technologist. These devices have a minimum of seven channels. Type II devices must include the following channels:

• EEG – monitors brain waves to tell a professional if you are awake or asleep
• EOG – monitors eye movement
• ECG – monitors heart rate and rhythm
• EMG – monitors muscle activity
• Airflow
• Respiratory effort
• Pulse oximetry – records your oxygen levels during sleep

Type III home sleep test (HST)
With a Type III portable monitor, unattended studies are performed with a minimum of four channels. Type III devices must include the following channels:

• 2 respiratory movement/airflow channels
• ECG/heart rate
• Pulse oximetry

The home sleep test was initially developed for screening. Now, type II or III home tests are being used increasingly for diagnosis of sleep apnea. Although less costly, the home sleep test is not always the best method to diagnose a sleep disorder. For example, the Type III test does not monitor brain activity so the professional is not aware if the patient is actually asleep or not; this can affect the test’s accuracy, possibly resulting in prescribing unnecessary therapy.

As I stated at the beginning, the Type I testing – a full test in a lab under the supervision of a technologist – is the gold standard. In many cases, we can still recommend the type II home test, which still monitors brain activity, so the results will show the patient’s sleep-awake patterns – which in turn will provide a more accurate result than the type III device.

Till next time, keep dreaming!

Kevin Hammond RPSGT, CRT
Lead Polysomnographic Technologist
St. Joseph Center for Sleep Medicine

Sleep Apnea Basics

I was reading a pamphlet called Sleep Apnea Facts and Figures that was produced by the ResMed Company and would like to share with you some important facts that were researched.

1. Approximately 76% of congestive heart failure patients have a sleep breathing disorder
2. Obstructive Sleep Apnea is noted in 49% of atrial fibrillation patients
3. 43% of patients with mild Obstructive sleep apnea and 69% of patients with severe obstructive sleep apnea have hypertension
4. 65% of stroke patients have sleep disordered breathing
5. 48% of type 2 diabetes sufferers have sleep apnea
6. Severe sleep apnea raises death risk by 46%
7. Prior to sleep apnea diagnosis, patient’s utilized 23-50% more medical recourses.

I often get asked, what is sleep disordered breathing?  In different patients, sleep disordered breathing is categorized in different ways. As I mentioned in my previous post, the most common of the sleep disordered breathing is Obstructive Sleep Apnea or OSA.  It happens when there is a partial or complete collapse of the upper airway that causes muscles controlling the soft palate and the tongue to relax, blocking airflow to the lungs. During an obstructive event we see that a person will have no airflow going into the lungs, yet the chest and stomach are trying to move to break the obstruction. Usually the person will wake up to gain control of the muscles and unblock the airway. Under obstructive apnea you will also have hypopnea which is the partial blockage of the airway. I explain this as short shallow breaths during sleep. Both will decrease blood oxygen levels causing other healthcare problems in the future. This is primarily cured by placing a patient on a positive airway pressure machine or CPAP / BiPAP to gently keep the airway open while the person is asleep.

Another type of sleep disordered breathing is Central Sleep Apnea or CSA. Central sleep apnea is where the brain tells one not to breathe. There is no respiratory effort for at least 10 seconds. Meaning there is no air flow going to your lungs and there is no chest or abdominal movement trying to get you to breath. This type of breathing disorder is commonly seen in patients with alveolar hypoventilation or people with heart problems.  To help patients with CSA we place them on newer technology called Auto Servo Ventilation or auto SV for short. This is similar to a positive airway pressure machine just a little more of a smarter machine.  If one is diagnosed with central sleep apnea it is best to have an in-lab check to determine your specific pressures.

Finally, there is Complex Sleep Apnea. This is a combination of all of the above. A patient will experience all these types of breathing disorders in one night. This is a very difficult syndrome to try to cure and patient may be treated and cured by any type of positive airway therapy. Once again it’s best to come into a sleep center to have this type of test performed.

Having sleep problems? We know times are tough, but don’t put your health on the back burner.  We have options, so give us a call. If you’ve already been tested and just having trouble getting used to your therapy, give us a call; we can help. ‘Til next time, keep dreaming.
- Kevin Hammond, Sleep Technologist, St. Joseph Center for Sleep Medicine

P.S., We’re starting a Patient Support Group in Bangor.  Our first meeting is October 25, from 6:30 to 8:30 pm.  Come share your ideas with fellow sleep patients and get advice and information from sleep experts.  Click the link for all the details!  - Kevin

Hello & Thanks for Stopping By!

Did you know that there are 84 classifications of sleep disorders, and 10 million Americans still remain undiagnosed? St. Joseph Center for Sleep Medicine has created this blog for the public to interact with one another so we can all become more aware of Sleep Disorders.

Are you having trouble getting used to your prescribed therapy to cure your sleep disorderd breathing? Why not post it here? Current users of Continuous Positive Airway Pressure (CPAP) or BiLevel Positive Airway Pressure (BiPAP) may be able to help give little hints that worked for them so that you can have a restful and peaceful sleep.

Probably the most common sleep disorder we see in the Sleep Center is sleep disordered breathing. Some of the signs and symptoms of sleep disordered breathing include but are not limited to:

•  Snoring with pause in breathing
• Gasping or choking during sleep
• Excess daytime sleepiness (EDS)
• Problems with mental function
• Poor judgment or inability to focus
• Memory loss
• Irritability
• High blood pressure
• Heart disease
• Depression
• Sexual dysfunction
• Neck measurement in men greater than 17”; in women, greater than 16” .
• Crowded airway
• Restless sleep
• Frequent trips to the restroom at night (nocturia)
• Morning headaches

If you experience any of these symptoms please call your physician; you may have a breathing disorder.

The most common of all breathing disorders is Obstructive Sleep Apnea (OSA). It can affect young and old alike.  When people with OSA fall asleep, their airways close or partially close so that they are not effectively breathing. This in turn wakes up the brain to tell our body to breathe effectively. Such arousals of the brain prevent you from maintaining the quality of sleep you need in order to feel refreshed in the morning.

To be tested for a sleep disorder one would either come into a sleep center and be monitored by a sleep professional.  For those who cannot spend a night in a lab, St. Joseph has home sleep units. You would come into the Sleep Center to be fitted with a unit and then sent home. The next morning you would return the unit for your results to be viewed by our sleep physician.

If you are diagnosed with sleep apnea there are many options to help or even cure it.  These include a dental device worn in the mouth at night, surgical intervention or positional therapy.  However, the most common therapy is called CPAP or BiPAP therapy.  A CPAP or BiPAP machine is fine tuned specifically to each individual patient. While the patient wears a fitted mask during sleep, the machine gently applies positive air pressure to the patient’s airway to keep the airway open and help the patient to breathe normally.

If you’re reading this and experiencing any type of signs and symptoms that may suggest you have a sleep disorder? Would you like to share your experiences?  Do you have questions? Post it all here. Together we can share our stories and become educated about sleep disorders.

Until next time, Pleasant dreams!

Kevin Hammond, Sleep Technologist

Welcome

Trouble sleeping?  Got questions, we’ve got answers.  Welcome to our Blog.  Drop in for frequent tips and suggestions for a healthy, enriching, good night’s sleep, from sleep technologist Kevin and others at St. Joseph Healthcare’s Center for Sleep Medicine.