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.

what Happens While You’re Sleeping?

While you’re sleeping.

In this article, I give a brief history of the evolution of sleep studies. I’ll  also take a little peek into the future and think about what’s to come. SleepingSo keep in touch, as I’ll be adding on to this information, and more, as I continue to study this fascinating field.

Of Rabbits and Monkeys

Researcher’s in the 1700’s demonstrated that living tissue has electrical properties. This paved the road for further work into recording brain activity, known as electroencephalography, or EEG. And by the mid-1800’s scientists were hooking up electrodes to the heads of rabbits and monkeys. Thus making the first recordings of brainwaves.

Where We’ve Been

It was 1925 when Dr. Hans Berger plugged a person in and recorded the first human EEG. Up until this time, sleeping was thought of as a state of unconsciousness; a merely passive process where we just rested. Now, however, sleeping is known to be a very active state; with a number of things going on.

Then in the 1950’s, Dr. William C. Dement, considered the father of sleep medicine, conducted the first sleep studies. These studies identified the different sleep stages and the discovery of REM sleep.

Sleeping
Man hooked up for a sleep study

However, sleep studies weren’t very popular in those early days. Not only because medical science had not yet embraced this field as something even worth noting. But researchers had to stay up all night and monitor a sleeping person. Yet, in spite of all that, the field grew. With more sensors being added as we learned what to look for. And that evolved into what we see in the sleep lab today.

In 1965, Obstructive Sleep Apnea was first described. And treatment for sleep apnea at that time was a tracheotomy. A tracheotomy involves making a surgical opening through your neck into your windpipe; thus allowing you to breathe.

And in 1978 a small group of sleep professionals met, with the goal of forming an organization; now known as the American Association of Sleep Technologists, or AAST. One of the first things they did was create an education and examination board; known as the  Board of Registered Polysomnographic Technologists or  BRPT. Together, these organizations provide us sleep professionals with standardized testing as well as ongoing training.

But it wasn’t until 1981 that Dr. Collin Sullivan, from Sydney Australia, invented the first CPAP machine. This revolutionized the treatment of sleep apnea. And advancements in both diagnosing and treating the various sleep disorders continues.

Where We’re Going

The gold standard for diagnosing obstructive sleep apnea is an in lab overnight sleep study. However, insurance companies are now giving the O.K. For home sleep testing, or HST’s. However, most HST’s can’t determine when you’re sleeping; they only monitor breathing. Therefore, they’re not very accurate in evaluating sleep disorders. However, further advancements could change that.

One of the ways this might come about is with the advancements in smart homes. Imagine downloading the sleep lab app, and apply whatever type of device we’ll have by then, and presto! An in lab quality sleep study done in the comfort of your own home, complete with live monitoring 24/7! And then, of course, your in-home follow up Doctor visit via the internet.

As a Sleep Technologist, I see the field evolving before my eyes. It’s quite exciting to think about where we’ll be in 10-20 years; and beyond. And being a Star Trek fan, I imagine (in the far future) sleep studies being conducted on a holodeck. Even though that technology might, realistically, be impossible, it’s fun to imagine.

And of course just keeping the public up to date via the internet or other forms of media is critical. Knowledge is power. And a well-informed public is more likely to access the help that they need. For us Sleep Technologists, this means keeping up with advancements in sleep medicine and taking on the role of educator.

Conclusion

Up til now, we’ve taken a rather short journey into the history of sleep studies. We’ve seen how our ideas of sleeping have changed. As well as took a look at where we could be going. I’m doing ongoing research and will share with you some of the highlights of this fascinating field.

If you have any questions or concerns about the ever-expanding field of sleep studies and how it might impact you, please leave a comment below.

Till next time…Blessings.

My Wife Always Complains About my Snoring

My wife’s made me aware of my snoring for several months now.

Snoring
Me, chillin’ by our Lilac Bushes

So I’ve finally decided to talk with my Doctor about having a sleep study. Please join me in my journey as I share some personal experiences and other insights.

This then is my story…kind of.

Is it More Than Snoring?

A sharp jab to my side jars me from a sound slumber.

“Kent, you’re snoring!” (It’s never “Honey, you’re snoring”. No, when it’s bad, I’m always on a first name basis). I usually end up mumbling something, turn over, and go back to sleep. There are, however, times when I wake myself up choking or something else that’s quite disturbing.

For example, I travel to different hospitals and occasionally stay at hotels. One time in particular, I was rudely awakened; finding myself totally unable to breathe. I also had a bad burning sensation in my throat and the most horrible taste. I was literally halfway onto my feet before I fully woke up, and ran to the bathroom.

Not being able to breathe was bad enough. But with only a locked door between me and any chance of rescue only made it worse. I did end up catching my breath but also threw up some crud. That only happened once (so far). But more and more I wake with some real thick phlegm stuck in my throat. I can still breathe o.k., but it’s a bit uncomfortable.

My wife’s complaints of my snoring surprised me at first. But now that surprise has turned to concern. And because I’m aware of the dangers of untreated sleep apnea, I began to wonder if I might have fallen victim to this thing. So while I don’t fit the profile of a typical person with obstructive sleep apnea (OSA), that doesn’t automatically rule me out.

But just what does a typical person with sleep apnea look like?

A Typical Sleep Apnea Person

Although the average person with OSA is an overweight middle-aged male, almost anyone can have sleep apnea. In fact, I’d be willing to bet that 100% of the population of planet Earth has moments throughout the night where they stop breathing for a time. So it’s not just a matter of if you stop breathing, but how often do you stop breathing. And how long do you stop breathing for?

As for me, I’m 6 ft. tall (72 inches), and I weigh 180 pounds. That puts my  Body Mass Index (BMI) at 24.4, which is average for a fellow my age (I’m 60). Yet I’m displaying some of the symptoms of OSA.

And my wife has made me aware of my snoring for some time now. Plus, every now and then I do wake myself up choking; though it doesn’t happen often. But, I rarely wake up with a headache, and only score a 3 on a sleepiness questionnaire.

Also, my dad died of a heart attack at 71; although I don’t recall snoring being an issue with him. I’m also not on any prescription medications, and really don’t feel too bad. And even though I spend many hours a night (and day), at a computer, I do try and stay pretty active. For instance, I have a couple road bicycles, and my wife and I like to go for walks as well. But, I figure I should at least get a checkup.

Would you Have a Sleep Study?

I’m trying to imagine what it would be like to not know what happens during a sleep study. What if I wasn’t aware of the dangers of sleep apnea? Would I even have any reasons to talk with my Doctor? I’m not sure, but the following are some things that come to mind:

My wife says my snoring is really bad, and sometimes I breathe really shallow.  I’m tired sometimes, but isn’t everybody? Why should I waste my money on some expensive test, and for what? What if I don’t have this sleep acne, or whatever they call it? And if I do and get this breathing machine, what will that do? Help me sleep better?  I really don’t sleep all that bad now. Oh, I won’t snore, and that’ll make my wife happy. But I could just get some of those breathe right strips and be done with it, no?

The problem with that thinking is that breathe right strips open your nasal passages, and can stop the snoring caused by that. However, they do nothing in the way of holding your airway open. And that’s where the problem is. Besides, CPAP does more than give you a better nights sleep. That’s really just a beneficial side effect. It can literally save your life.

What if it’s More Than Just Snoring?

On the one hand, I hope that I don’t have obstructive sleep apnea. Or should I say sleep apnea that needs to be treated.

You see, there are various degrees of OSA. The severity of sleep apnea is based on a formula we call the AHI scale. This AHI scale stands for Apnea Hypopnea Index. It’s calculated based on the number of times you stop breathing each hour. But we don’t even count every time you stop breathing, only those times you stop for 10 seconds or more.

Also, if your airway is going to collapse, it will after you’ve breathed out. So try this once, breathe out and then stop breathing for at least 10 seconds. This describes apneas. That’s when your airway closes completely. If your airway only partially collapses, we call that a hypopnea.

Now consider that you usually will stop breathing for way more than 10 seconds before waking. And your heart is taking quite a beating during this time. But you’re not going to die from suffocation. Your brain will wake you long before then. However, your heart can only take so much.

So, if I do need CPAP, I’ll be very compliant with treatment. ‘Cause, even though I’m not afraid to die, I don’t want to just yet.

Now What?

So I met with my Doctor yesterday(Friday), and I have some doubts about having sleep apnea. And although he did order a sleep study, we both agreed that it’s not really that much of an issue with me. I think I’d still feel better if I had the test, and at least rule it out. However, I’m going to spend some time looking more into this and see if I really need to go through with it.

I’ll keep you updated.

Conclusion

I’ve shared some of my personal concerns about snoring and sleep apnea. And this has also made me more aware of what a person might be thinking who doesn’t know the dangers of OSA.

Now, what about you? Whether you’ve had a sleep study or not; or even if you suspect you might have sleep apnea, I want to hear your insights. Please leave an appropriate comment or question.

Till next time…Blessings.