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