What is the Cure for Cpap Intolerance?

Cpap intolerance is a serious thing.  Because, as wonderful as cpap is at treating sleep apnea, some people just can’t stand using it. And while cpap is the gold standard in treating obstructive sleep apnea, and does so quite effectively, there’s a whole range of responses to it. Some people fall in love with it, others hate it. And there’s a wide range of responses in between.

However, the average compliance rate is only 30-60%. But if cpap is so effective, why is cpap intolerance so high? And how can we more effectively treat sleep apnea? Let’s take a look at this subject. We’ll also lightly touch on a couple of technological advances that might eliminate cpap intolerance.

Cpap  Intolerance

It’s really amazing the number of people who go through all the trouble of having a sleep study. Then have a follow-up appointment. And after that, come in and get set up with an expensive cpap machine. Only to find they have what we shall call cpap intolerance.

That really says more about the cpap machine itself, then it does about the patients. It must be frustrating to go through the test, follow up, and cpap set up, only to not be able to tolerate the darn thing.

And yes, there might be patients who just don’t give themselves long enough time to adapt to cpap. There are also those patients who have tried to the point of ridiculousness and still haven’t adapted. And those patients might never adapt to it. That must be REALLY  frustrating!

And while we know that knowledge is power; we also know that it’s a bit more complicated than that. There’s that little issue of trust. But all the knowledge and all the trust in the world can’t overcome plain old cpap intolerance. Then there are those people who not only tolerate cpap, they adapt to it quite well. These people live a more enriched life.

Like the following patient.

You Saved my Life!!

I work for a Sleep Center in Fargo North Dakota called Precision Diagnostic Services. We have contracts with hospitals in several states, so we get to see many patients each week. And though I’ve heard of people who say their lives are better now that they’re on cpap, every now and then we get someone who’s especially thankful.

In fact, just recently, a patient called our main office, thanking us for literally saving their life. For that, they are “forever grateful”.  And their spouse is equally grateful.

Even the people at their workplace notice a difference. They drove the 3o miles to their workplace without getting tired once. They said they sat at their desk and were actually able to concentrate and get work done. In fact, they’re so awake, they “almost feel hyper”. And at one point in the conversation, they were so moved by the change in their life they actually got a bit teary-eyed.

Although most responses aren’t this exuberant, it does reflect the gratitude of many people whose lives have been changed by the use of cpap. Which brings us to the question of just why so many people can’t tolerate it.

A Full Range of Responses

When I see someone in the sleep lab, I have them try on a cpap mask or two. I do this before the study even starts because I want to know how they’ll respond to it. And I’ll get responses all the way from “Get this thing off me!!”, to “”Wow, this thing is awesome! Can I keep it on?”

However, the overall compliance rate with cpap is anywhere from 30-60%. Think about that. For every 10 people started on cpap, only 3-6 will continue with treatment.

But why is the overall success rate so low? And how do we improve those odds? Well, the good news is, that for those who can’t tolerate cpap, there are other ways to treat sleep apnea.  Although as of this writing, cpap remains the gold standard of treatment.

However, research is ongoing to find other, perhaps, better ways yet. And it’s fun to speculate what things will come out in the future.

The Future of Sleep Medicine

There are many factors to consider when looking into the future of sleep medicine. Things like the economy, insurance, peoples attitudes and belief systems. But the technology itself is quite fascinating. Let’s take a brief look into the future, shall we?

First of all, what kind of technology will we have 25-50 years from now? What new forms of treatment will come out? 2 things come to mind: Artificial intelligence and Nano-technology.

Artificial intelligence or AI is a machines’ ability to learn to reason, and problem solve. As well as the capability to perceive and use language. But while computers can be programmed to do some very complex tasks, they’re far from true artificial intelligence. But what does that mean for sleep medicine? Will the sleep technologist of the future be an android, like Lieutenant Commander Data on Star Trek?

Nanotechnology? , on the other hand, involves making ‘machines’ from individual atoms or molecules. These ‘machines’ can be programmed to perform different tasks. In fact, research is currently studying ways to use nanotechnology in the treatment of heart disease.

But how could these 2 technologies eliminate cpap intolerance? Let’s take a peek 50 years into the future, shall we?

Cpap Intolerance is History!

The year is 2067.  Your smart home alerts you to problems with breathing while you sleep, and notifies your Doctor. Their computer reviews the data and recommends a sleep study. Soon after,  you receive an alert asking you about this appointment. Do you wish to keep it? Change the date, or cancel it?

You’ve been feeling a bit tired and cranky lately, so you decide to keep the appointment. At your visit, your Doctor injects you with some nanobots that will monitor your brain activity, breathing, and oxygen levels. While your smart bed records your body position. Oh and don’t worry. All those nanobots will disintegrate when their tasks are complete.

During your sleep study, the information is downloaded to your Doctors computer. And by the time they see the data, their computer has already written up a care plan. Their computer recommends treatment for sleep apnea and sets up a follow-up appointment with your Doctor.

During your next Doctor visit, you’re injected with more nanobots that will monitor nerve and muscle activity. They’ll stimulate your nerves and muscles to activate as they should. Thus keeping your airway open, and assuring all muscles work to keep you breathing well. Therefore eliminating even the need for cpap itself.

Cpap intolerance
Me in my office

But, could cpap become a thing of the past? Or is this just fantasy? Advancements being made in technology lead me to believe it’s very possible.

 

Till next time…Blessings.

What can you Expect From a Typical Sleep Study?

I previously wrote an article explaining a typical sleep study. In that

account, I basically described the sleep study itself. However, you can’t really know about something unless you’ve experienced it. That’s why I’d like to attempt to define what you can expect from a typical sleep study. So, if you’ve never had one, and wonder what a typical sleep study is like, this will help you understand it a  little better.

Welcome to my world
Typical Sleep Study
Me in my office

When I share experiences as a sleep tech. I don’t like to gloss over anything. I prefer to be open and share the good the bad and the ugly. In doing so, I hope to give you a better understanding of the world I live in. So that if you ever need a sleep study, you’ll have some fairly realistic expectations.

Personally, I really enjoy my life as a sleep Technologist. And I’ve talked with many other Technologists who enjoy what they do as well. Being a sleep Technologist definitely has its rewards, as well as its challenges. It’s nice to know that I’m helping people, but it’s even more awesome to actually hear people tell me how much better they feel.

Although I usually don’t get to hear from a patient unless their spouse or someone they know comes in for a sleep study. But when they tell me about that friend or relative of theirs, it makes my day.

With that in mind, let’s look at what can you expect during a typical sleep study.

First Night Syndrome

It’s quite natural to be a bit nervous when you come in for a typical sleep study. even if you’ve talked with others who have had one, or you researched it online. This is now you about to experience this. And the reasons you’re here can bring questions and concerns to mind.

You might be concerned about the effects of sleep apnea on your health. Then there’s the concern about using CPAP. Are you claustrophobic? What if you can’t stand wearing the mask? And will you be able to sleep with all those wires attached to you? Let alone some strange person watching you sleep. And even though we don’t ‘watch you sleep’ it can feel that way. Or maybe you think that the study is just a waste of your time and money.

However, once you’ve decided to come, don’t worry about bringing some personal item in with you. For instance, several years ago, an older gentleman brought a teddy bear with him. He said his granddaughter gave it to him ‘so you won’t have to sleep alone’. More recently I had a big tough looking dude bring his blanket in with him, ‘because it smells like my dog’.

So don’t feel weird or embarrassed about bringing something with you that has meaning to you.

There’s also what we call ‘first-night syndrome’.  This happens when a person who usually has no problem falling asleep,  now just can’t get to sleep no matter what. It’s called first-night syndrome because this can occur the first night in a sleep lab.

But there are also problems we can face with the equipment.

Houston, we Have a Problem

Unfortunately, the equipment doesn’t always work flawlessly. However, those of us techs who’ve been working long enough can pretty much take care of many technical difficulties ‘on the fly’. Rarely do we have to cancel a study because of some issue we can’t resolve.

And usually, if there’s a problem, you, the patient, probably won’t  even know about it. We’ll do our troubleshooting without letting you know there’s  problem. That’s usually because we’re pretty confident we can fix whatever the issue is. And if we can’t fix it, then we’ll let you in on it. But only after we’ve come to the place of needing to cancel your study. Although this rarely happens.

For example, I had this wonderful experience years ago:

I got my patient hooked up without incident. However, when I fired up the study, BAM! Something wasn’t right. The signals were totally unreadable. I went in and re-prepped some of the leads I thought might be suspect. And actually made several trips into the patient’s room, checking different things; eventually making all kinds of adjustments. At first, I really had no idea what in the world could be wrong.

But all I told the patient was that the signals weren’t perfect, and I was just making some adjustments to ensure a good quality study. I can’t remember what all as wrong, and actually, I thought I might need to cancel this study. That’s how bad it really was

Ultimately, however, I miraculously got the study up and running nicely (as I wiped the sweat from my brow). Oh, and that’s another thing, we’ll never let you see us sweat. Anyway, through all this, the patient had no idea how bad things really were. But in the end, the study turned out really well.

And the next morning the patient told me how impressed they were that I made extra sure the study was good!! If they only knew!!

But there are times when we do need to cancel a sleep study.

This is not a Typical Sleep Study!

Yes,  there are times when a study needs to be canceled,. And again, it’s rare. But sometimes a problem just can’t be resolved. Like the time I wasn’t feeling 100%. And by the time I got to the lab, I had developed a fever, complete with aches and chills. I obviously couldn’t be around patients that way. And all I wanted to do was lay down and go to sleep.

Also, there are times when our equipment just won’t co-operate. I, as well as other Technologists, have had computers die on us at the last minute.  That’s not fun. That and other technical difficulties beyond our control have caused more than one cancellation.

And again, while it’s rare to have to cancel a sleep study, things happen; or don’t happen, as the case may be. Although we do our best to make sure your study will be done when scheduled. And we do have other Technologists who might be available to come in at the last minute. But we’re all generally pretty busy, so that can be a bit of a juggling act.

Conclusion

So you’ve seen what a typical sleep study might actually feel like to you.  As well as addressed some of the technical difficulties that can occur. I’ve also  shared openly and honestly some things that can occur during a not-so-typical sleep study. But if you still have any questions or concerns, please feel contact me.

Till next time…Blessings.

Can you Really Trust Medical Advice?

Do you trust what medical researchers tell you? Or are you suspicious of their motives? Do money and greed steer the results of research? Or is there some real value in it all? But really, how can you trust what you hear? One time something is good for you, the next time it’s not.

From My Perspective
Trust
Me in my office

Sometimes I just want to express my thoughts without getting all technical and having to do a bunch of research. Not that I’m lazy. Well, not too lazy, anyway. But I really just want t0 open up and say some things on my heart. So with that, allow me to share what I feel are roadblocks to learning.

Wait a minute, you say, I thought this was about trusting medical advice?

It is.

Who can you Trust?

We hear over and over that knowledge is power. And I’ve said that myself many times. But it’s really not quite that simple. There’s more to it than that. For instance, I can tell you the truth about something, but if you don’t trust me, will you believe me?

Think about the last time you heard of some new medical advancement.  Did you instantly take hold of this new knowledge? Because you know that research comes out saying something is bad for you. Then, new research comes out, showing that thing really isn’t so bad. And we can’t say that science has reached the end of all knowledge. So who knows what’s really good and what isn’t?

In addition to all this, information can be worded to make it say what the writer/speaker wants you to hear. You can hear two opposing viewpoints on the same topic; drawing two different conclusions based on how the information was presented.

But something else is preventing you from learning.

Those Thoughts can Kill you

What keeps us from learning something new? Why can it be so hard to get something through to us? It’s not like we want to be stupid. In fact, it’s usually just the opposite. We really want to know stuff. So why, when presented with something new, do we resist this new knowledge?

I can tell you something, but if what I tell you goes against what you firmly think is right, will you believe me? And because we don’t like to be wrong, we can get quite defensive when told we are. That’s why once you do believe something as fact, it can be pretty hard to change the way you see things.

O.K., maybe you’re one of those in search of the truth, and you really keep an open mind. Ya, you’re out there too. But for the rest of us, we can be pretty stubborn when it comes to changing our minds about something.

And, we tend to hear what we want to hear. Therefore, we can subtly re-interpret what we’ve just read or been told, making it say what we want it to say. As a result, we can go through life like that; defending our position with a passion…Because we don’t want to be wrong, right?

So, when you’re confronted with information that goes against what you want to be true, something has to give. And what you want to be true usually won’t easily give way.

However, honest research is going on, and…

You can Trust Established Facts

Medical research is ongoing, and we’re constantly finding better ways to manage all kinds of disorders. And much research is also advancing how we treat sleep apnea. Additionally, new research is built on what’s already been established.

For instance, we know that we need to breathe, and when we don’t we could die. So, treatment for sleep apnea involves holding your airway open so you can breathe. That fact won’t change. And research is ongoing as to what the best way to hold your airway open is. Right now, Continuous Positive Air Pressure, or CPAP  is the ‘gold standard’ for treating sleep apnea. But with more research, new and better ways are in the works.

Also, we’ve also learned that there’s a link between sleep apnea and heart disease. Studies that determine cause and effect have established this link by following patients through the years. And new research is based on this. Therefore, when it comes to sleep apnea, we’re basing treatment on time-tested results.

So while we might not know all there is to know about sleep apnea, we can trust the knowledge we have so far. And treatments will just keep getting better as we continue to learn about this disorder. It’s fun to think about where we’re going to be in the near, and far future.

Conclusion

So, we’ve taken a little look into the issue of trust. And while we know we can’t believe everything we hear, we can trust some things. And to say that knowledge is power is a bit of an oversimplification. We not only need to trust the source of the information, we may need to ‘get past’ certain mindsets that get in the way of learning.

Till next time…Blessings.

Can a Chin Strap Effectively Replace CPAP?

Perhaps you’ve seen the advertisements selling a chin strap to treat sleep apnea. A chin strap. To treat sleep apnea. Really? But does it work? Some people claim that it helps them. Others say it’s a scam. Which is it? Let’s take a no spin look at this, shall we?

The Chin Strap
Chin Strap
Women Wearing Chin Strap

Cpap remains the gold standard of therapy for sleep apnea. But unfortunately, many people can’t tolerate this form of treatment. The good news is, there are other forms of treatment available. One such device in the news recently is the chin strap. And while not new, it appears to have a ‘new’ function. It not only holds your mouth closed but claims it will keep your airway open as well.

But does it live up to its claim? Let’s take a no spin look into this. We’ll also see how it compares to other forms of treatment.

To begin with, there are several different styles of chin straps. But they all do 2 basic things: they hold your mouth closed, and support your jaw so it stays in place. With that, we’ll look at what holding your mouth closed does and doesn’t do. But first, let’s see why holding your mouth closed is actually healthier for you.

Mouth Breathing is bad for Your Health

When you breathe through your mouth, the air isn’t warmed and moisturized like it is with nasal breathing. This causes dry mouth, which encourages bacteria growth, leading to cavities. Nasal breathing not only warms and moisturizes the air, it also acts as a filter, reducing dust and allergens.

Also, when you breathe through your nose, Nitric Oxide is produced in small quantities. This gas actually makes you absorb more oxygen, which is even more important while you’re sleeping. This is because your breathing becomes slower and shallower in your sleep.

Keep in mind that many people see their Dentist more than their Doctor. Therefore it’s usually the Dentist that notices mouth breathing issues. Additionally, mouth breathing in children can actually cause abnormal facial and dental development.

However, holding your mouth closed by itself does not keep your airway open. But if you’re using cpap, and you can’t tolerate a full face mask, and you breathe with your mouth, a chin strap can be a good addition to your treatment.

Although, there are times when holding your mouth closed isn’t good.

When not to use a Chin Strap

Because a chin strap holds your mouth closed, you really shouldn’t use one if you have sinus congestion or anything else that makes it difficult to breathe just through your nose.

Also, a chin strap will only reduce snoring coming from your throat. There’s a flap of skin at the back of your throat called the soft palate. Air flowing across that can cause it to vibrate, resulting in a snore. A chin strap will have some effect in this case. However, it will have no effect on snoring originating from your sinuses.

Additionally, if you suspect that you have sleep apnea, or have been diagnosed with OSA, a chin strap might not be effective at all. Some symptoms to be aware of are:

  • Waking with a headache
  • Being REALLY tired all the time
  • Mood swings
  • Depression
  • High blood pressure
  • Snoring and/or pauses in breathing
  • Waking up choking

If you have any of these symptoms, you might have sleep apnea and should have a sleep study.

However, the chin strap also supports your jaw, keeping it from falling back against your throat. So you’d think that it would do some good,. right? But a study done on 26 adult patients with OSA, found that a chin strap alone was not effective in treating sleep apnea. Granted, this is a rather small study.

But what about oral appliances? Don’t they do the same thing as a chin strap? How do these 2 devices compare?

Let’s take a look.

Chin Strap vs Oral Appliance

Chin Strap Vs Oral ApplianceA chin strap holds your mouth closed, while oral appliances don’t to the same degree. And while both the chin strap and the oral appliance hold your jaw forward, oral appliances have been proven to do this more effectively.

So even though a chin strap is less expensive than an oral appliance, it’s also less effective. But please be aware, because while you can get cheap oral appliances online, they won’t work as well either. Why’s that? Because the most effective oral appliance is the one fitted and adjusted just for you. These types of oral appliances are adapted to you, preferably in a sleep lab, where the Technologist can fine-tune them to get you breathing well.

However, you can’t use an oral appliance if you have dentures or loose/missing teeth. So if that’s you, and you also can’t tolerate CPAP, talk with your Doctor. There are surgical procedures that may help.

Now let’s take a brief look at cost.

Cost Comparisons

CPAP can run anywhere from $1,500 to $3,500.

On the other hand, an Oral Appliance can range from $1,800 to$2,000. And oral appliances are favored over CPAP. Also, most insurance companies cover these devices. Of course, you can get less expensive devices online for Less than $50.00. But as we’ve seen, this really isn’t a good option.

Cost of Anti Snoring Chin Strap? Anywhere from $6.99 at Walmart, up to $59.99.

So then…

Is a Chin Strap right for me?

Remeber, there’s a difference between simple snoring, and snoring with sleep apnea. Talk with your Doctor about any concerns you have before buying anything.

And again, the cost is certainly a concern for most of us. Therefore there’s a tendency to take the cheapest route. So why not just buy a chin strap or oral appliance and be done with it. But is it that easy? If you haven’t even been diagnosed with sleep apnea, how do you know you’re giving yourself the right treatment?

Maybe all you do is snore.  But, where is your snoring originating from? Is it from the soft palate, that flap of skin at the back of your throat? Or is it coming from your sinus area? Or both? And what if your snoring is a sign of something worse, like sleep apnea?

And if you live alone, you have no one to tell you what you do in your sleep. Maybe you’ve woke yourself up snoring or snorting. If that’s the case, don’t take any chances with a simple chin strap or cheap oral appliance. That’s the time to have a talk with your Doctor.

Suspect sleep apnea especially if you have certain body characteristics that make you more likely to have OSA. The physical characteristics that you inherit make it either more or less likely that you’ll have this disorder. The 3 main physical traits are the shape of the bony structures of the skull and face, body fat distribution, and how the upper airway muscles function.

So then, CPAP machines and oral appliances are more expensive, but they also work the best. And while chin straps do serve a purpose, they work better in conjunction with CPAP.

Conclusion

We’ve taken a look at the chin strap, and also compared it with other devices for sleep apnea. We’ve discovered that the chin strap is limited in its function. And while there’s a tendency to ‘go the cheap route’, when it comes to your health, please don’t play with your life like that.

Till next time…Blessings.

Is a Home Sleep Test as Good as an in lab Sleep Test?

What is a Home Sleep Test, and is it as good as in lab sleep test?

Home Sleep Test

It’s exciting to see the advancements in sleep medicine.  Along with all the changes taking place in the insurance industry, Technology, and the economy in general. Many of these developments are changing how sleep studies are performed. For instance, a Home Sleep Test is becoming more common.

So, let’s take a rather brief look at a Home Sleep Test, and see how it compares with an in lab sleep study.

About Insurance

First of all, insurance is a major player in sleep medicine. And in order to keep premiums down, insurance companies push for the least expensive tests. The reason behind this is that the less the insurance company pays out, the lower your premiums will be; which makes sense. There’s also the economic pressure to keep costs down.

Now consider that one Technologist can do two, maybe three in lab sleep studies at a time. However, that same Technologist can handle more Home sleep tests at once. And a Home Sleeps test, or HST doesn’t cost as much. So you can see where this trend is going.

But, are HST’s as good as in lab sleep tests? Let’s first take a look at the type of sleep tests available. Then we’ll look at a typical Home Sleep Study. We’ll also compare costs and see who can have an HST. I’ll also explain why some people shouldn’t have an HST; in fact, can’t even qualify for one.

Types of Sleep Tests

The Centers for Medicare and Medicaid Services or CMS defines 4 types of sleep studies, based on what’s being monitored. A type 1 study is an in lab sleep study,  attended by a Technologist. This has been the gold standard of sleep tests, as it’s the most thorough.

Types 2-4 are home studies. These studies are defined by the number of channels recorded. Type 2 studies record more channels than type 3 studies. While type 4 studies record the fewest channels. And while an in lab study can test for a whole range of sleep disorders, an HST only monitors breathing.

Another downside to an HST is that something can come unhooked during the night while you’re sleeping. And that could make the study incomplete.

With that in mind, let’s take a look at a typical Home Sleep Test.

A Typical Home Sleep Test

You go into the sleep center the evening of your study and pick up the equipment needed for the night. The Technologist will go over everything with you; showing you how to put things on, and should answer your questions.

Then, in the comfort of your own home, you hook yourself up and (hopefully) go to sleep. In the morning, you bring the equipment back to the sleep center, where they’ll download your data. If it’s determined that you need CPAP, you’ll be set up with what’s called an auto-PAP machine. This type of device is set to automatically change pressures through the night based on how you’re breathing.

You can keep the auto-pap. But you might also have the option to get a CPAP machine. In that case, you’ll bring the auto-pap in and they’ll download the data. Then they’ll  use that to determine your optimal pressure. And they’ll give you a CPAP machine set to your best therapy level.

Other Home Sleep Test Information

Cost of a Home Sleep Test vs an in lab study

An in lab study can run anywhere from $600, to $5,000; with an average being around $1,000. However, a Home Sleep Test runs anywhere from $150 to $500. And insurance covers both.

Who should not have an HSAT?

A Home Sleep Test just monitors breathing. Therefore, it only detects sleep apnea, but none of the other sleep disorders. That’s why a careful assessment of your medical history is important. For example, if you have any heart or lung conditions, you might need an in lab study.

Other reasons you might need an in lab study

If your Doctor suspects you might have some other sleep disorder, he/she could order an in lab study. And anyone 18 years and younger would need an in lab study as well.

So, While A Home Sleep Test is becoming more common, it’s not for everyone. And even with all the advancements in sleep medicine, there might always be a place for in-lab sleep studies.

Conclusion

We’ve taken a rather brief look at a Home sleep test. We’ve seen the advantages of an HST. And also discovered why a Home Sleep Test isn’t for everyone. We’ve also seen why this type of test might become more common in the future.

How about you? Have you had a Home Sleep Study?  Would you like to share your experience? Or do you have questions about HST’s vs in lab studies? Please leave a comment and let me know what you think.

Till next time…Blessings.