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