Monday, December 12, 2011

A Sleep Study on the Subway????

A Couple of New York doctors decided to do a sleep study on a New York subway?

Ever wonder if napping on a bus or on a subway ride was even worth the trouble??? Well after seeing New York's subway passengers constantly sleeping (or attempting to sleep) on a subway that is known for screaming and guitar playing passengers, these doctors decided to perform a sleep study to see if they could get into any stage of sleep deeper than stage 1.....Using a homemade quasi-PSG (they jimmy-rigged using an I-Pod) they sought out to see if restorative sleep on the subways of New York was possible.

Click here to read the New York Time's article....

Friday, October 28, 2011

The 10 Most Sleep Deprived Cities

The CDC has recently released a study which identifies the cities that have the highest percentages of sleep deprived people. They are as follow:

  1. Detroit
  2. Birmingham, Alabama
  3. Oklahoma City, Oklahoma
  4. New Orleans, Louisiana
  5. New York, New York
  6. Cincinnati, Ohio
  7. Louisville, Kentucky
  8. Raleigh, North Carolina
  9. Columbus, Ohio
  10. Boston, Massachusetts
The rankings are based on individual sleep habits as reported in an annual study by the CDCP of more than 350,000 adults in all 50 states. The findings took into account the percentage of time people don’t get enough sleep or rest, and the percentage of people who say they don’t get enough sleep more than half of the time.

-Mr. Sleep


Wednesday, October 12, 2011

Insurance companies requiring Home Sleep Tests prior to the Sleep Lab!

United Health Care appears to be the leader in the push to bring Home Sleep Testing (HST) to the forefront of diagnostic sleep medicine. As of October 1st, all UnitedHealthcareWEST, Neighborhood Health Partnership and River Vally members will be required to have a pre-authorization for all sleep studies. If a provider attempts to perform an in-lab study on a patient who meets United's criteria for a Home Sleep Test, their pre-authorization will be denied. This denial will in turn leave HST as their only available option to diagnose the patient's sleep disordered breathing. United's new policy will also require patients to undergo at-home titrations using Auto-Titrating CPAP devices, in the place of in-lab titrations when appropriate. (click here to read United's Official Policy).

Last month Premera Blue Cross (a Blue Cross licensee out of Washington) announced its plans to mimic United's approach to diagnostic sleep medicine. These changes were announced just one month prior to when United's policy was to become effective (click here to read the Premere Blue Cross official policy).

Given the fact that cuts in Medicare are likely to occur in the next few years, we can expect to see more and more insurance companies start to accept the HST model. If Medicare decides to start pushing its patients towards the HST model, this would break up the near monopoly of diagnostic sleep medicine that sleep labs have long enjoyed. Instead of being the source for the majority of all sleep diagnostic needs, sleep labs will eventually become the secondary source for diagnosis, relegated to studying patients who do not qualify for HST (cheyne-stokes breathing, neuromuscular disorders, pulmonary issues, etc).

While the HST model will ultimately save the payers money, many feel that its implementation will not be in the best interest of the patient. Individuals with pulmonary issues, cardiac problems and neurological problems (PLM's, RLS, etc) that are undiagnosed, will likely have have to wait longer to receive therapy. Since these disorders are easily identifiable during an in-lab sleep test, patients with these issues currently receive expedient care. This is because overnight tests often detect many other disorders, aside from sleep disordered breathing. Under the HST model these patients will first have to undergo a HST which (depending on the unit used) will likely not pick up any of these disorders. They will then have to return to their physician who will likely have to refer them to an overnight facility where these types of disorders can be observed.
-Mr. Sleep


Premera Blue Cross. (2011). Diagnosis and Medical Management of Obstructive Sleep Apnea Syndrome and

Upper Airway Resistance Syndrome


United Healthcare Online. (2011). July 2011, Network Bulletin. https://www.unitedhealthcareo


Monday, October 10, 2011

Medications that cause abnormal dreams...

Often times people with sleep disordered breathing state that they do not dream. Since REM sleep is often when SBD is at its worst, patients often cannot ever recall dreaming since they do not experience enough consistent sleep to significantly dream. Once these patients are placed on CPAP and get uninterrupted REM sleep, they often start to call CPAPs "DREAM MACHINES." But often times frequent dreaming can come with its own set of problems. I once had a patient who experienced so many bad dreams that he decided to discontinue CPAP. 

It is important to attempt to understand some of the factors that can cause abnormal dreams. Many people are aware that stress and anxiety can cause bad dreams to occurs. But many people are unaware that many common medications can also alter ones dreams. These drugs include certain antidepressants, antibiotics, beta blockers, blood-pressure medications, cholesterol medications and drugs for Alzheimer's and Parkinson's diseases. Abnormal dreams are most common when an individual first starts or decides to quit taking drugs such as these (Beck, 2011). Although not completely understood, many sleep physicians tend to think that abnormal dreams can occur whenever REM sleep is disrupted. If you or someone you know starts to experience frequent nightmares, it is important to alert your physician.

-Mr. Sleep

Beck, L. (2011). The Next Nightmare. The Wall Street Journal.

Tuesday, October 4, 2011

The Respironics True Blue Nasal Mask

A New Round of Nasal Masks from both ResMed and Respironics have recently hit market. It is likely not a bad idea to have some knowledge about these new masks, since both organizations are marketing them heavily to sleep labs. The True Blue Nasal Mask is the newest mask from Respironics. 

From a patient's perspective:

The True Blue Mask boasts new technology which Respironics calls the "Free Form Spring". The spring somewhat resembles the adjustable piece on the nozzle of a gas pump, as the spring will push the cushion into sealing and will also adjust the cushion accordingly as the mask frame is pulled to either side. The technology appears to be efficient at keeping the mask from leaking. One can demonstrate this to a patient during a mask fitting by bending the mask frame to either side to simulate how a leak could normally form. The mask will remain sealed despite the mask frame being pulled around 20 degrees to either side. The clips at the front of the mask frame are also extremely convenient. Some masks such at the ResMed Quattro require the patient to push the clip in at a very specific angle, which can be difficult for the elderly or others with dexterity issues. The clips on the True Blue are extremely easy to latch, as one can latch them from almost any angle. Another added feature is the gel cushions that rest on the patients forehead. These three pads cover a large surface area and are extremely soft, making them ideal for patients who have problems with skin irritation from the forehead piece. The one downside to the True Blue is that it is a bit cumbersome when compared to some of the other smaller nasal masks. I think the bet that Respironics is making is that all the new features this mask offers will compensate for it being just a little bit large.

From a clinician's perspective:

I currently have around three patients wearing the True Blue Nasal Mask. They all three have stated that the mask is extremely comfortable and state they have not had any problems with the mask leaking. If a technician takes some time to show them how the Free Form Spring will help prevent leakage, I have noticed that it can cause patients to get excited about the mask. Often times these little features can be used as selling points which get the patients excited and more involved in their therapy. The one issue that clinicians could take with the mask is the fact that the it comes in five different sizes (P,S,M,MW,L). Stocking five different mask sizes along with five different cushion sizes separately can be somewhat of an irritant to clinicians. That being said I do believe that from what I have seen thus far, the mask is truly innovative and is worth stocking. I will report back to you later once I have had more experience with the True Blue.

-Mr. Sleep

Friday, September 30, 2011

Sleep Eating

The woman featured in this video caught herself sleep eating with a video camera. Night time eating syndrome (NES) is characterized by late night binge eating that often times happens without the person's knowledge. NES as with most sleep walking disorders can be caused by high levels of stress and is also thought to be related to Sleep Apnea along with Restless Leg Syndrome. NES is a dangerous condition as sleep eaters usually target foods with high fat/high sugar. Many people who suffer from NES will take steps to prevent it such as locking the refrigerator, using motion detectors and even eating extra large dinners (so they will not be hungry during the night).

The woman featured in this video is literally asleep while she is raiding the refrigerator and almost appears zombie like while binge eating. (click here to view).

Tuesday, September 27, 2011

No more Medicare referrals for HME providers?!?!?!

Sleep Labs May Soon Be Able To Set Up Their Own Medicare/Medicaid Patients With CPAP Equipment!!!

On September 16th 2011, the AASM presented the final draft of a proposal to create a pilot program that integrates sleep management and HME delivery. The model is basically a test program that will give sleep physicians much more control over their patients sleep therapy. This would include dispensing equipment to Medicare/Medicaid patients, that they themselves diagnosed.

The pilot model will be overseen by both the AASM along with the center for Medicare/Medicaid Innovation. According to Nancy Collop, the president of the AASM, the programs aims at" improving patient care and giving more power to the sleep physician to guide the patient through the process."

Flaherty, 2011. AASM shifts sleep strategy. HME News

Sleep Apnea Screening for Smart Phones

Looks like the Smartphone craze has finally caught up with sleep medicine...An organization called Sleep Group Solutions has launched an app that patients can download that screens them for OSA and then helps them get in contact with clinicians in their area.

The app actually has the ability to send the data from your screening to clinicians in the area, thus saving a potential patient a phone call. To download the app, visit the MSleeptest website...

-Mr. Sleep

Monday, September 26, 2011

Bizkit the Sleep Walking Dog

Bizkit the Sleep Walking Dog


Sleepwalking occurs when the sleeper comes out of slow wave sleep in a state of low consciousness and performs activities that are usually performed when the sleeper is fully awake. (1) These activities can be harmless activities such as talking, walking around, and cooking. Sleepwalkers have also been known to perform activities that require high motor function such as driving a car. There have also been about 69 known cases known to date of homicidal somnambulism or sleep murder! (2)

Although in the video Bizkit does not hurt anyone else, he probably woke up surprised and with a sore head. I wonder what he was dreaming about? Enjoy!

-Mr. Sleep

Friday, September 23, 2011

The airport sleep box!!!

A private place to sleep in airports would certainly be better than sleeping on a chair one foot away from a complete stragner, wouldn't it? Well it looks like Russia might be the first country to capitalize on these sleep deprived individuals who have no place comfortable to rest during a layover. May I present, THE SLEEP BOX!!!

The video is pretty self explanatory and I think that all airports should invest in these boxes (for my own sake). I do not know about you but I've never been particularly fond of sleeping in airports.

Oh and if I were a CPAP vendor, I would take note of this post. I'm sure some patients might need a CPAP equipped sleep box!

-Mr. Sleep

Wanna save on your kids college tuition!

Then make sure they sleep 9 hours a night.....

A new study undertaken shows that if your children sleep less than 9 hours per night, than they are likely to learn at a less than optimal level! This could mean less scholarships and more tuition!

Click the link below to read the full article:

-Mr. Sleep

Why thank you so much sir!

Taking good care of your patients really pays off, especially when they bring you an unpretentious little red to enjoy after work....

Thursday, September 22, 2011

The Mirage FX

A New Round of Nasal Masks from both ResMed and Respironics have recently hit the market. It is likely not a bad idea to have some knowledge about these new masks, since both organizations are marketing them heavily to sleep labs. The Mirage FX is the newest nasal mask from ResMed, an organization which was co-founded by Colin Sullivan (the man who published the first paper on Obstructive Sleep Apnea).
From a patient's perspective:

The Mirage FX is a compact mask that is designed to be simple, comfortable and lightweight. I have only fit one patient with the mask so far but when I did he stated that the mask was much more comfortable than his previous one. ResMed boasts that the Mirage FX is simple to assemble, as it is composed of only three different components (not including headgear). As the mask is indeed simple to assemble, this makes it optimal for patients who have issues with dexterity. It also has a quick release snap above where the tubing connects to the mask for patient convenience, as some patients can have trouble disconnecting the tubing.
From a clinician's perspective:

The Mirage FX's standard pricing is around $100 dollars although HME's can likely get better pricing if they order it with ResMed machines. While this is a little on the expensive side, it does appear to be a high quality mask that will likely result in patient satisfaction. ResMed also boasts that the Mirage FX makes reciprocal supply distribution easy for providers. Instead of having to stock a variety of different sizes in bulk (shallow wide, small shallow, etc) the Mirage FX is backed by studies that show that 90% of people will fit its medium (or standard) size cushion. This would make both fitting and stocking the mask and its cushions less complicated for clinicians.
I only have one patient on the mask and have not yet had enough clinical experience with it to speak to its quality with any certainty. But the mask does appear promising.....I will post again when I know more.
-Mr. Sleep

Tuesday, September 20, 2011


While almost everybody knows about the more common sleep disorders (such as sleep walking or sleep talking), most are unaware that there are much more bizarre things that can occur while you are sleeping, without your knowledge. People with NREM disorders (such as sleep walking) can in some cases have higher exhibit high motor functions in their sleep. Individuals have been documented walking, talking and even driving during sleep. But in a more unusual case, in 2004 a woman in Texas had sex with FIFTEEN complete strangers, ALL WHILE SLEEPWALKING AND WITHOUT HER KNOWLEDGE! (click here to read).

Sleep sex (or sexsomnia) is a NREM parasomnia in which people engage in various sexual acts, while they are still asleep. In many cases, individuals who suffer from sexsomnia, can commit acts that would be considered sexual assault if they had been commited consciously. Below is a clip I found that sums up the disorder pretty well.

I love how the above video noted that men were found engage in sleep sex more than women......Why does that not surprise me?

-Mr. Sleep


"Sleepwalking woman had sex with strangers". New Scientist. 15 October 2004.


After just one month a transfer patient (from where I will not say) was able to produce what is likely the dirtiest filter I've ever encountered. Even though at each initial setup I make a point to remind the patient (multiple times) to check the filter once a week, I also still have patients who come in with filters that are beyond dirty! I just cannot stress how important repetition is when it comes to educating individuals about sleep therapy.

-Mr. Sleep 

Friday, September 16, 2011

An alternative to CPAP or another wannabe?

          Legend has it that it all started one night when an Australian professor, physician, and soon to be inventor was watching his friends bulldog sleep. As Colin Sullivan MD sat there and watched his friends bulldog choke and gasp for air, he suddenly realized that higher air pressure could keep the dog's airway open! By 1980 Colin had invented the first ever CPAP (Continuous Positive Airway Pressure) device. Although the first machines were loud and the masks were crude; they were effective. Ever since CPAP has became the dominate clinical solution to treating sleep apnea.

                                                           A patients airway after surgery
          But although CPAP remains the dominate solution, there have been many different approaches to treating OSA that have sought to overtake or replace CPAP. There is the Uvulopalatopharyngoplasty surgery or UPPP. This surgery removes tissue from the upper airway. As a clinician I can tell you that I have seen many patients undergo this surgery who then return to the sleep clinic who's sleep apnea is unchanged or even worsened in some cases. Although it does work on some, in my opinion the results are not very promising or consistent.


          I know at this point your probably thinking that this post is getting a little strange. But a recent study in the British Journal of Medicine has spawned a small movement of patients and entrepreneurs dedicated to using the giant horn featured above to treat sleep apnea.(1) It actually makes sense. Blowing this large horn requires a lot of respiratory drive. This respiratory effort along with the vibrations the horn makes will strengthen the patients upper airway if the horn is played regularly enough. How permanent is this change? Do I need to keep using the horn? What if I have severe OSA? These are all good questions that will likely be unanswered until the device is used rigorously by a large number of patients. Below is a video that explains the process.

          The idea of strengthening the airway by exercising it is a very good idea. Instead of just using the CPAP to band aide your apnea, people are actually able to restore their airway back to normal with this form of treatment. But I don't think that this horn will ever REPLACE CPAP. I just can't imagine clinics issuing horns for people to use at home. Most of the places that offer these horns tend to have more of an alternative medicine feel. Can you imagine doctors prescribing giant horns? I can already picture the look on a patient's face when they hear they are about to be given a giant horn. It just does not have a clinical feel and does not really fit into most people image of health care. Also it likely would not fit into many peoples lifestyles. People have families, have to travel, are really busy, and just don't have great environments to play a loud horn in. Although strengthen the muscles in the airway I believe could have a lot of potential for the future of sleep medicine; I do not believe the didgeridoo is the appropriate way of achieving it.

          The newest approach that I have heard is featured above. The Provent nasal valves claim to "reduce" the effects of OSA and are supposedly backed by double blind studies. The way that these plugs work is actually pretty smart. They completely cover each nostril. When the patient breathes in the valves lets them pull air through each valve unrestricted. But then when they breathe out their nose, the valve partially restricts the flow of air flowing out. This builds up pressure in the airway which serves as the famed nasal splint that CPAP also uses to keep the airway open. A patient who uses these plugs would not need a mask, tubing, a machine, etc. (Below is a not-so-impressive video of how the device works).

          But there are a few issues that I have already identified with this type of therapy. First of all is that once you have the nasal plugs in it is very difficult to breathe out through your nose. Provent states that patients wearing Provent at night have to get used to breathing through their mouth while they are falling asleep. This could be uncomfortable for some. This made me wonder "What about mouth breathers who are unable to breathe through their nose? Or those who can brethe through their nose but for whatever reason also breathe their mouth?" Provent reps claim that patients naturally breathe through their nose at night, unless it is blocked. As a sleep technician I have seen hundreds of people who have no nasal blockage who breathe through their mouth at night, even on CPAP. This is not even counting those with deviated septums, chronic congestion problems, skin irritation, chronic nasal bleeding, etc. But like everything Provent is obviously not for every patient. But this does not mean that it does not have its place in sleep medicine.

         The second issue I have with the Provent nasal valve is in its claim to "reduce" the effects of OSA. A reduction of OSA in my opinion should NOT be the desired end result. A complete reduction should be. If a patient's OSA get reduced by half, that patient could still be waking up constantly, they could still be having breathing events that will likely cause health problems down the road, and still possibly be bothering their bed partners with snoring. In my opinion more research needs to be done that specifically states how often it can cure OSA. If this research does exist I would certainly like to see it.

          Although there are issues that need to be worked out I must say that this therapy does have its place. Lets face it, no matter how skilled and persuasive of a clinican or physician you are; there are those who will never adapt to CPAP. These patients could just not care, be unable to adapt, not want to pay their co-payments, and/or believe that CPAP is just a money making scheme. These patients could benefit from Provent. If you cannot cure them with CPAP then reducing their OSA becomes much more attractive. It also can bring in revenue for Providers on patients that would be lost otherwise. People who do not like CPAP also find Provent to be attractive since it is much less cumbersome than CPAP. Also for people that it can cure, perhaps this could be a more desired method of treatment than CPAP.

          Ventus Medical, the organization that created and sells Provent has done a really good job bringing its Product into the market. They have hired a sales force that understands the business and all the different players. They are currently pursuing a HCPC code for their product so that insurances will cover its usage, and most importantly it does not seem like they are not attempting to replace CPAP. They are approaching providers with an alternative to CPAP that providers can attempt to use to treat the percentage of their patients that have failed CPAP. Recently the product was even shown on the hit daytime show The Doctors. It will be interesting to see how the products performs in the market. As always I will keep you posted on my experiences with it.

-Sleep Guy

(1). Puhan M et al. Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomized controlled trial. British Medical Journal. 2006. 332:266-270.

Thursday, September 15, 2011

The Narcoleptic Dog

Narcolepsy is a sleep disorder that causes excessive sleepiness and frequent daytime sleep attacks. Although it is often lampooned in movies it is a very debilitating disorder which is not very well understood. Cataplexy is a symptom of narcolepsy which causes a sudden weakness brought on by excitement or strong emotions. As you can see in the following video, it is when the dog gets excited that it loses muscle strength and falls asleep. It is worth a look.

-Sleep Guy

Tuesday, September 13, 2011


I can't help but be reminded of those before and after weight loss photos that you see on television if you stay up too late. "I lost over 45 lbs! I now look and feel so much better and am now able do to so many more things that I couldn't do before!" Well it appears that the Respironics BiPAP Auto SV Advanced devices are shedding some pounds and are also able to do more than they previously could.

As opposed to the older Legacy model (featured in the upper left corner) the newer System One model (featured in the upper right corner) is much smaller and has some new added features:
  • Firstly, the System One SV has a smaller SIM card port which all Respironic's System One CPAPs now come with as standard. This enables the device for fitting with a wireless modem which broadcasts a daily report on the patient compliance/therapy details straight to the clinicians. The modems are extremely helpful for patients who are immobile, hard to reach or simply reluctant to return for a face to face download.
  • Secondly, the System One SV now has Respironic's ambient humidity technology which utilizes a sensor to make sure that the humidity does not go above or below its target setting, thus decreasing rain out.
  • Lastly, the device is noticeably quieter than the larger legacy unit and due its small size, is much more convenient for traveling.  
I know that ResMed has (or is on the verge) of releasing a smaller version of its rather large Adapt SV. I have not yet had the opportunity to use this unit, but when I do I will report my experiences back to you.

-Mr. Sleep

Thursday, September 8, 2011

Could socks really help with Sleep Apnea?

The long list of possible non-traditional remedies for OSA continues to grow! New research undertaken at University of Brescia in Italy indicates that wearing compression socks reduces the amount of daytime fluid accumulation that occurs in the legs at night in patients who suffer from chronic venous insufficiency. 

This decrease in turn reduces the amount of fluid flowing into the neck at night, thereby reducing the number of apneas and hypopneas by more than a third. Below is a link to the news:

 It looks like Respironics and ResMed will have to start producing special CPAP socks to accommodate these patients.

-Mr. Sleep

Wednesday, August 31, 2011

Almost 50% of DME claims denied!!!

When submitting claims to insurance providers it is extremely important one be attentive to every minor detail. Investing in billing software can help reduce the number of denials an organization receives and is highly recommended by most accrediting agencies. But competent individuals with experience in dealing with the legions of different insurance providers out there is crucial!

Below is a link to an article about a wide spread payment report recently presented by the DME MAC jurisdiction which show that almost 50% of claims submitted by DME's from Jan 2001 through June 2001 resulted in denials! The lesson here is to watch you billing closely, whether in done in house or not....

-Sleep Guy

Wednesday, August 10, 2011

A CPAP machine/mask Combined?

              A rather exciting new technology has recently come to my attention. The device (feature below)  combines the CPAP interface with the CPAP device itself! The device is called the Transcend CPAP. The Transcend CPAP's air delivery system is attached to the headgear of the CPAP mask which attaches straight to the patients face mask. The product claims to be compatible with many of the popular mask cushions that are already on the market and also boasts a "clinically proven" humidification that appears more convenient than traditional CPAP humidifiers. This device's competitive edge clearly lies in its convenience. Since the CPAP is smaller it is more mobile and has a system of batteries making the Transcend CPAP's usage possible in situations where their is no external power source. While this product obviously is new and has not been through the regirous test of time that has traditional CPAP delivery systems have undergone; it will likely generate much patient interest. In short, it would not be wise to ignore this exciting new technology. I will keep you updated on this device as I learn more.

-Sleep Guy

Wednesday, June 1, 2011

I wonder what his pressure is?

            It looks like Shaq has joined Regis Fieldman as a celebrity CPAP user. This means that Shaq has been playing ball for years while at the same time suffering from a consistently poor nights sleep before each game! I for one find it very irresponsible that none of the PROFESSIONAL TEAMS he has played for over the years did not get him a sleep study earlier. Sleep apnea devastates sleep and makes you extremely tired as a result! A lesson to NBA coaches.... if you hear your players complaining about their sleep, GET THEM TESTED!!!!

Instead he waits until he retires to start using CPAP!!!

-Sleep Guy

-Sleep Guy

Have you ever actually given it a read?

Wednesday, May 4, 2011


          Everyone has had their own encounter with sleep talking. Most people have been told that they were calling out someone's name, talking nonsensically, or mumbling while they were sleeping. Sleep talking is a parasomnia that can occur in any stage of sleep and can also be associated with sleep terrors, sleep walking, sleep related eating disorders and REM behavior disorders. (1) While most sleep talking is brief and nonsensical, there are some individuals who take sleep talking to the extreme. These somnoliqusits as they are often called can recite vivid narratives in their sleep that are quite detailed and lengthy.

Dion McGregor was one of these individuals. His  vivid and voluble descriptions of his dreams were recorded by his roommate from 1961 to 1967. (2) They are truly fascinating....It is especially intersting listening to how his tone and emphasis fluctuate as he narrates his dreams. You will notice that he is a very enthusiastic story teller, especially for being ASLEEP!!!

-Sleep Guy



Saturday, April 30, 2011

Could Joe Biden Have Sleep Apnea?

One of the symptoms of sleep apnea is Excessive Daytime Sleepiness. After seeing this clip of the vice president it would appear that Joe Biden does indeed suffer from EDS.

Although Mr. Biden is historically gaffe prone, he does indeed appear to be genuinely tired in this video. With the Bidens history of cardiovascular disease (his son Beau Biden recently had a stroke at age 41)  it appears very likely that the 47th Vice President of the United States could need a sleep study!

-Sleep Guy

Regis gets a sleep study!!!

          As awareness continues to build about Obstructive Sleep Apnea, it appears that even some of our countries more famous personalities our learning about the disorder. Regis Philbin the former host of Who Wants To Be A Millionare is apparently an avid CPAP user! I remember back when I was working as a sleep technician who performs overnight sleep studies, my grandmother called me to tell me that Regis had stated that he had been diognosed with sleep apnea live on Regis and Kelly (She loved that show and likely never missed a single episode). Anyway here is footage of Regis undgoing an overnight Polysomnography test or a "sleep study" as it is commonly called.


-Sleep Guy

Why providers end up using Respironics machines...

          Encore Anywhere is why. Encore anywhere is a truly amazing service for providers, physicians, and patients alike. As providers of CPAP we are expected to do everything we can to get our patients to adapt to using the CPAP they are prescribed to use every night. One must understand that getting patients to wear a mask that blows are into their airway every night is a difficult task. But if the provider is personable, persistent, and helpful; most patients reach a point where they "flip". They go from thinking "you want me to wear this device every night, you have to be kidding me" to thinking "wow wearing this device is something I want and/or need to get used to doing since it is worth it." This could happen when the doctor makes them realize what the negative impact sleeping without a CPAP will have on their health, when they actually feel how much more energy they have after wearing the device, or when their bed partner is happy they are no longer snoring. It is our job to get them to the point where they are convinced they need and/or want to use CPAP and will do so on their own.

          Encore anywhere makes this job much easier for providers. The service allows technicians to download patient's machine usage in order to print out statistics used to analyze and fine tune patients therapy. This is pretty standard in a software form. But Encore Anywhere is an actual internet site. Go to , enter you login and password, and then you are granted access to all of your patients.

          Encore Anywhere also takes patients analysis one step farther. It actually enables providers to print out a breath by breath analysis of patinets sleep while using the CPAP. This detailed analysis gives providers a much more accurate tool to use in determining what is going on with patients. It is almost like a minor sleep study.

           What is probably Encore Anywhere's most innovative feature is its ability to link providers chart notes with physicians that refer patients to their clinic. This makes it so the physicians can monitor the care their patients are receiving from providers. Whenever a provider sees a patients, sets them up with a machine, downloads their progress, or even calls a patient; providers are able to chart this encounter in Encore. The physicians will then receive a notification linking them to the information whenever they log on to Encore Anywhere. Since physicians must also follow up with these patients sleep therapy, Encore Anywhere allows them to access information about their care without the hassle of downloading the results themselves. It also forces the providers to show that they are following up with the patients and helping them adapt. This sharing of chat notes and patient history drastically improves the industries quality of care.

          Another amazing feature is the Respironics wireless modem (shown above) designed to track the patients device usage. When a CPAP is fitted with this device it sends a report of their PAP usage from the night before once a day. Instead of having to wait for the patient to physically visit the clinic to view their performance, providers can now monitor patients from any distance on a day by day basis. How useful is that!? This allows providers to monitor patients who could be at risk and really need to be using their CPAP much more closely. It also helps monitor people who cannot provide their own transportation, who travel a lot, or who may not be as likely to return to lab frequently. I know that I once had a patient who refused to return the our clinics calls for a few months because he thought he would be charged for his visit. But even though we could not get him to return to the clinic, we still were able to show his physician that he was performing well on the device. Without the modem our clinic would not be able to show that we had the patient using the device. This matters.

          The combination of Encore Anywhere usage by physicians and also Respironics consistent superior innovation in regards to their CPAP machines have made Respironics the dominate supplier of CPAP devices. Thanks Respironics!

-Sleep Guy

Which Full Face Mask with out the forehead piece is the best?

         A rather late but needed innovation in the treatment of sleep apnea was the development of the full face mask that does not include the traditional forehead stabilizing piece. Full face masks (or FFM's) are for those who are unable (or unwilling) to breathe through their mouth at night while on CPAP. Until very recently they all have had a stabilizing piece that extended from the top of the mask and rests on the forehead. Although the newer FFM's that do not include the forehead piece can only treat patients who are prescribed a pressure of no higher than 12cm of pressure (upwards of 12cm cause the masks to leak around the eyes in some cases), they are very popular for their lack of a forehead piece. This is because the mask can barley be seen when the patient is wearing it. As opposed to mask that use the traditional fore head piece, these masks allow the patient to watch TV or read at night before going to bed without obstruction. This is very helpful since one of the main problems in sleep medicine is adapting the patient to CPAP usage. But these patients can now relax and get used to breathing on CPAP without a constant visual reminder in their eyes. These type of masks are very popular amongst women and also with those who suffer from claustrophobia. In short, they have their place in sleep medicine.

          But which one is the best? I'm not sure which came out first between the EVO comfort fit (featured in the upper left) or the Respironics Full Life (featured on bottom). But the Evo was the first which actually gained attention in the sleep community. The Full Life originally had headgear which did not really work that well. The Evo has enjoyed a significant presence in the pacific north west. It is very popular with providers of sleep medical equipment due to its low cost ($45 compared to the average FFM cost of $85). Although it does not last as long as other masks, most patients insurance's pay for two replacement cushions (the piece which touches your face) per month for masks, so this is not necessarily a problem. Although other masks can last longer they still will develop holes in their mask cushions, especially when not cleaned extensively. But many patients do not want to take the time to clean their masks all the time when they could rather pay a small co-pay (around $10 -$20) and cut down on the cleaning. The one true problem with the Evo is its headgear. It honestly does not strap on conveniently and also does not fit on the patients head. It slides around and does not fit well which leads to leaks and patient annoyance in some cases.
          Although they claim they were developing it before the emergence of the Evo's popularity I believe that the ResMed Quattro FX (featured in the upper the left) was likely made in response to the Evo. The mask is likely superior in patient care. Although the Evo has its place and fit some patients very well the Quattro FX has very good headgear and also appears to be of a higher quality. The only problem is that like all ResMed masks it costs more than double what the Evo does for providers. ResMed refuses to give providers good pricing on these mask until providers buy their machines which due to multiple factors are not as high quality as other manufacturers. But their machines are still widely used. Due to a new marketing strategy by ResMed, providers who now purchase their machines receive their masks for free. This has resulted in ResMed regaining some of their territory they lost to the Evo.

          Then there is the Respironics Full Life (featured on bottom) which has been around a while but has not been very popular. Like the Quattro FX the Respironics mask does look a little classier. The problem with it was that the mask's headgear has historically not functioned very well. But the mask has recently started coming with a new headgear which has made it much more functional. My clinical experience with this mask is limited and I will update you more once I hear about it/use it more.

          If I were a patient I would either use the ResMed FX or the Evo. The Evo is quieter most of the time. But the ResMed FX is durable, is not flimsy, and it is classy looking. If I were a provider though I would carry the ResMed Quattro FX but only use it when ever the Evo did not work. The Evo fits well, patients get new cushions twice a month for a pretty small expense, its quieter and the mask is simple to use and clean. While the headgear is somewhat difficult to use a simple adjustment during the night is all that is needed to slide the headgear into place. Patients can and will adapt. Plus a little troubleshooting hear and there for patients can help build their knowledge about using CPAP. It also make is easier for providers to make a profit while still providing quality care to patients. Many many patients get uninhibited care without complaint using the Evo. The mask provides a good balance between patient care and profitability.

(But in the interest of full disclosure I must admit I need to try using the Respironics Full Life more as I have only used it on a few patients. I'll let you know how it goes. )

-Sleep guy