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