tag:blogger.com,1999:blog-84348588024907759142024-02-18T20:41:13.864-08:00Miss Sleep's BlogMaking America SLEEP Great AgainMiss Sleephttp://www.blogger.com/profile/13887032613494084398noreply@blogger.comBlogger37125tag:blogger.com,1999:blog-8434858802490775914.post-18297510221232579952017-01-04T15:43:00.000-08:002017-01-04T15:43:31.746-08:00Multiple Sclerosis and Sleep Apnea<div class="separator" style="clear: both; text-align: left;">
<span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif; font-size: x-large;"><b>In 2009, I was diagnosed with Multiple Sclerosis...</b></span><span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif; font-size: large;"> </span></div>
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<span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif; font-size: large;">My life has never been the same. As a mother of six, a business owner and a loving wife; this disease has had a tremendous effect on my life.</span></div>
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<span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif; font-size: large;"><br /></span><span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif; font-size: large;">"Multiple sclerosis is an unpredictable, often disabling disease of the central nervous system that disrupts the flow of information within the brain, and between the brain and body." (1) Multiple sclerosis is not very well understood and scientist still do not know what causes MS. </span><br />
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<span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif; font-size: large;">Patients with MS suffer from a deterioration (demyelination) of the myelin sheath, which surrounds the nerve fibers throughout their nervous system. </span><span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif; font-size: large;">It is believed to be caused by environmental factors that are not yet known, which affect a person who is predisposed. One thing that is known about multiple sclerosis, is that three times more women get this disease than men. </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg54vSCrJH-v9iekz7bGAJ6g78Q3zFMHILKfmPrqwpcXpeRsRxDXCmbuDlcgOj6iRGSiXlpHlu13EvPQYf6FRl8-WknKupYGRfj6AVJIWhinXEgtUKJ2X7MJnYN8ejFwdm16uwQ1jtkd4nK/s1600/untitled.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif;"><img border="0" height="145" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg54vSCrJH-v9iekz7bGAJ6g78Q3zFMHILKfmPrqwpcXpeRsRxDXCmbuDlcgOj6iRGSiXlpHlu13EvPQYf6FRl8-WknKupYGRfj6AVJIWhinXEgtUKJ2X7MJnYN8ejFwdm16uwQ1jtkd4nK/s320/untitled.png" width="320" /></span></a></div>
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<span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif; font-size: large;"><br /></span><span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif; font-size: large;">When people think of sleep apnea, they generally think of more common comorbidities (diabetes, obesity, heart failure, hypertension, etc). BUT THE VAST MAJORITY OF PEOPLE ARE UNAWARE OF THE RELATIONSHIP BETWEEN SLEEP APNEA & MULTIPLE SCLEROSIS.</span><br />
<span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif; font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif; font-size: large;">A new study performed by the American Academy of sleep medicine indicates that around 1/5 of a patient suffering from multiple sclerosis will also suffer from obstructive sleep apnea. The study also indicates that almost half the patients who suffer from multiple sclerosis are at an elevated risk of suffering obstructive sleep apnea.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgccL8xQJaS_y-aKXHGUGtyGs3wb7d14RNA2fHvXrAQ9DaKcAVd7TnW89nZ4cQFpPxQWLMs6h2PZSsI5IIFri93i-ChDEo_NLHLGqZsu9RCV33PmGvRr2iMSZG2B9oGNgE8LOxOG2wEhVpq/s1600/5775962841a8d.image.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif;"><img border="0" height="186" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgccL8xQJaS_y-aKXHGUGtyGs3wb7d14RNA2fHvXrAQ9DaKcAVd7TnW89nZ4cQFpPxQWLMs6h2PZSsI5IIFri93i-ChDEo_NLHLGqZsu9RCV33PmGvRr2iMSZG2B9oGNgE8LOxOG2wEhVpq/s320/5775962841a8d.image.jpg" width="320" /></span></a></div>
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<span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif; font-size: large;"><br /></span><span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif; font-size: large;">Understanding this relationship is very important and could change the way multiple sclerosis is viewed. This is because one of the most common symptoms of multiple sclerosis is debilitating fatigue. Patients, like myself, who suffer from multiple sclerosis will often find themselves exhausted for days on end, regardless of how much sleep we get it.</span><br />
<span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif; font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif; font-size: large;">BUT it is important to understand that fatigue is also a very common symptom of obstructive sleep apnea. Since obstructive sleep apnea greatly reduces the amount of REM sleep a patient is able to get during the night, patients who suffer from sleep apnea will also suffer from debilitating fatigue.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhoujNcFhSqdrkG8B75CzPW_89rcDtUQdua0lWEwcaBU_h6VJ8EogtjC6yegtYg3riH7Duvxd73MLt376Hn7hR_s_eLIMkEloAkiYcxFW_gC6cb8B20qWHp84J-n61FG6FG2OGWdk8D4FYF/s1600/image_3.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif;"><img border="0" height="173" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhoujNcFhSqdrkG8B75CzPW_89rcDtUQdua0lWEwcaBU_h6VJ8EogtjC6yegtYg3riH7Duvxd73MLt376Hn7hR_s_eLIMkEloAkiYcxFW_gC6cb8B20qWHp84J-n61FG6FG2OGWdk8D4FYF/s320/image_3.jpeg" width="320" /></span></a></div>
<span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif; font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif; font-size: large;">THAT IS WHY it is important that patients suffering from multiple sclerosis, inquire with their physicians who are involved in their treatment about the possibility of them also suffering from obstructive sleep apnea. By tackling the possibly correlated obstructive sleep apnea, one could greatly reduce the debilitating effects of multiple sclerosis</span><br />
<span style="font-family: "Helvetica Neue", Arial, Helvetica, sans-serif; font-size: large;"><br /></span><span style="font-size: large;"><span style="color: #e06666; font-family: "Helvetica Neue", Arial, Helvetica, sans-serif;">-Miss Sleep</span></span><br />
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<span style="font-size: large;">References</span></div>
<span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;">(1). National multiple sclerosis society. "What is MS?" http://www.nationalmssociety.org/What-is-MS</span><br />
<span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;">(2). Sleep apnea.com "The link between Sleep Apnea and MS." https://www.sleepapnea.com/blog/ post/88621749594/the-link-between-sleep-apnea-and-ms-by-gina</span><br />
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MISS SLEEPhttp://www.blogger.com/profile/08325394467143123162noreply@blogger.com0tag:blogger.com,1999:blog-8434858802490775914.post-45426443085125805832017-01-04T12:05:00.000-08:002017-01-04T12:05:03.917-08:00Answers To Frequetly Asked Questions By Physicians about HOME SLEEP TESTING<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDG6U4UticoA_f4Jyr3k7qE7mdJZxsvAhUXiVWYZMSQfgHK97ZqIlwarW1bOfubWXaErDbMMXyynrxO7CM7mP8chcSJ12jMBMPPl2heHAO-Kt3dokV9eeZ8bClJ-JHTJI-x_eNmn5jeTre/s1600/apnealinkpatient.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><br /></a></div>
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<span style="font-family: "arial";"><span style="color: white; font-size: x-large;"><i>How will Home Sleep Testing help my practice?</i></span></span><br />
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<span style="font-family: "georgia" , "times new roman" , serif;"><i><span style="font-size: large;"><u style="color: white;">Home Sleep Testing has been </u><span style="color: white;"><u>around for many many years</u> and is now being utilized by many in as the primary tool for diagnosing Sleep Apnea. This is partly because Home Sleep Studies are shown to be around 1/2 to 1/4 the cost of the cumbersome In-Lab Overnight Sleep Study. Many insurance companies now require a HST as a first line diagnostic tool. "With proper screening, up to 75% of patients suspected of having moderate to severe Sleep Apnea will only need to have a HST performed to get their diagnosis, making an in-lab study unnecessarily expensive. (1)</span></span></i></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhw8Mxy21Fq_Hqs0qPNFAZWNNsjABOiV2xWm-5BByd4533aNzxDKsmhpbWejK-eflBDD6WILR7Sy_srTdjE_Hs1E22hNwJ7ttyphlr4IKtaV7eo3Pe6BYKr1E7hWfbLwNLeh7V052eAATaN/s1600/hst-image_orig.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="color: white;"><img border="0" height="197" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhw8Mxy21Fq_Hqs0qPNFAZWNNsjABOiV2xWm-5BByd4533aNzxDKsmhpbWejK-eflBDD6WILR7Sy_srTdjE_Hs1E22hNwJ7ttyphlr4IKtaV7eo3Pe6BYKr1E7hWfbLwNLeh7V052eAATaN/s320/hst-image_orig.png" width="320" /></span></a></div>
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<span style="font-family: "georgia" , "times new roman" , serif;"><i><span style="color: white; font-size: large;">In spite of this, it surprising how many doctors still do their best to refer patients to overnight sleep facilities in almost every case they see. I thought that it would be beneficial for everyone to provide <u>some answers to some of the common questions that physicians ask about Home Sleep Testing...... </u></span></i></span><br />
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<span style="font-family: "georgia" , "times new roman" , serif;"><i><span style="color: white; font-size: large;">Enjoy :)</span></i></span><br />
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<span style="color: white; font-family: "arial"; font-size: large;"><u>Answers to Physicians' FAQs about Home Sleep</u></span></div>
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<span style="color: white;">Healthier patients, better acceptance: Home Sleep Testing (HST) is typically preferred by patients over in-lab studies. They appreciate being able to sleep in their own bed with no one watching them. Patients also appreciate the convenience of an HST. There are no long drives to a sleep lab, and no waiting for an opening to make an appointment. Cost is also a very big concern for patients, particularly those with high co-pays and deductibles. The full cost of an IDS HST is typically less than the co-pay of a lab visit. See the patient section of this website for more benefits to patients. </span></div>
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<span style="color: white;">More revenue and better relationships per patient: Medicare requires at least two office visits for all Obstructive Sleep Apnea (OSA) patients now: one prior to testing (HST or PSG in a lab) to confirm the patient is a candidate; and a second follow-up between the 31st and 91st day of PAP treatment to determine if the patient is showing clinical improvement. In a sleep lab situation, these visits are typically handled by the sleep physician; while primary care physicians (PCP) prefer to keep their patients in their office. Therefore, IDS provides the PCP with easy-to-read test reports and simpler treatment and titration when utilizing today's auto-titrating PAP equipment with their built-in compliance and efficacy reporting. There may even be additional CPAP initiation codes that can be billed depending on the situation (speak with your CPAP supplier for more information) and insurer. These extra office visits are great opportunities for the PCP to learn more about their patient and strengthen their doctor-patient relationship.</span></div>
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<span style="color: white;">Test results interpreted by a board certified sleep physician: Our panel of board certified sleep physicians reviews and interprets each study and makes treatment recommendations.</span></div>
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<span style="color: white;">Faster results: Many hospital-based and independent sleep labs require a consult with the sleep physician prior to testing. They also have a limited number of beds, making appointment scheduling a long, drawn-out process. IDS not only allows PCPs to refer directly, but provides results in as few as 5 days, and typically less than 10, from the date the PCP orders the test. Patients will likely be treated, on therapy, and getting relief in a week, rather than months later as in many sleep lab programs.</span></div>
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<span style="color: white;">Less hassle: The IDS HST referral form and process is extremely simple. IDS handles insurance verification when needed, allowing the PCP's staff to save time by not having to get approval for a specialist referral.</span></div>
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<span style="color: white; font-family: "arial"; font-size: small;">How reliable is HST technology?</span></div>
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<span style="color: white;">HST technology has been around for more than two decades. It has effectively lowered healthcare costs in Australia, Europe and Canada. Within the past five years, improvements to the technology have made it even more reliable. HST devices now include faster sampling rates on the oximetry channels (better correlation between channels) and simpler setup procedures for patient self-application.</span></div>
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<span style="color: white;">It's difficult to do direct comparisons between the sleep lab and the home because of individual differences from night to night. However, HST is probably slightly less reliable for patients with a borderline Apnea Hypopnea Index (AHI) because sleep time is not measured. That is why Medicare and other insurers have said that it cannot be used as a screener; HST should only be used to confirm sleep apnea in patients with clinical symptoms.</span></div>
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<span style="color: white;">For peer-reviewed articles supporting HST and the historical perspective, refer to the section titled Clinical Evidence. </span></div>
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<span style="color: white; font-family: "arial"; font-size: small;">Who is a candidate for HST?</span></div>
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<span style="color: white; font-family: "arial"; font-size: x-small;">HST is intended for patients who exhibit clinical symptoms of Obstructive Sleep Apnea (OSA). Patients with other sleep disorders (i.e. Restless Leg Syndrome (RLS), narcolepsy, REM-behavior disorder), co-morbid conditions (which may impact the diagnostic relevance of the SaO2 data such as COPD or CHF), and patients in whom you only mildly suspect sleep apnea <u>ARE</u> <u>NOT</u> candidates for HST. Patients with hypertension or diabetes <u>ARE</u> candidates, as are those that exhibit symptoms of insomnia. In fact, middle-aged women with OSA may present as sleep maintenance insomniacs<span style="font-family: "helvetica"; font-size: 10pt;">—</span>their OSA could be made worse with hypnotics (Reference: Shepertycky et al.). Signs to watch for include:</span></div>
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<li><span style="font-family: "arial"; font-size: x-small;">Loud snoring</span></li>
<li><span style="font-family: "arial"; font-size: x-small;">Witnessed apnea events</span></li>
<li><span style="font-family: "arial"; font-size: x-small;">Excessive daytime sleepiness</span></li>
<li><span style="font-family: "arial"; font-size: x-small;">Morning headaches</span></li>
<li><span style="font-family: "arial"; font-size: x-small;">History of high blood pressure</span></li>
<li><span style="font-family: "arial"; font-size: x-small;">Memory problems or poor judgment</span></li>
<li><span style="font-family: "arial"; font-size: x-small;">Depression</span></li>
<li><span style="font-family: "arial"; font-size: x-small;">Gastroesophageal reflux</span></li>
<li><span style="font-family: "arial"; font-size: x-small;">Impotence</span></li>
<li><span style="font-family: "arial"; font-size: x-small;">Nocturia</span></li>
<li><span style="font-family: "arial"; font-size: x-small;">Difficulty concentrating</span></li>
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<li><span style="font-size: xx-small;"><span style="font-size: xx-small;"><span style="color: white; font-size: small;"><span style="font-family: "arial"; font-size: x-small;">Personality changes or irritability</span></span></span></span></li>
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<span style="color: white; font-family: "arial"; font-size: small;">How do I perform the clinical assessment?</span></div>
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<span style="color: white;">First, you will uncover patients at risk for OSA in one of two ways. They are:</span></div>
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<li><span style="color: white;"><span style="font-family: "arial"; font-size: x-small;">Ask the patient to complete the Epworth Sleepiness Scale.</span><span lang=""></span></span></li>
<li><span style="color: white;"><span lang=""><span style="font-family: "arial"; font-size: x-small;">Ask the patient the Five Simple Questions for OSA Screening which include:</span></span><span style="font-size: x-small;"><span lang=""></span></span><span lang=""><span style="font-family: "courier new";"><span style="font-family: "courier new";"></span></span></span><span lang=""><ul>
<li><span style="font-family: "arial";"><span style="font-size: x-small;">Do you snore?</span></span><span style="font-size: x-small;"><span lang=""></span></span></li>
<li><span style="font-size: x-small;"><span style="font-family: "arial";">Are you excessively tired during the day?</span></span><span style="font-size: x-small;"><span lang=""><span style="font-family: "arial";"></span></span></span></li>
<li><span style="font-size: x-small;"><span style="font-family: "arial";">Have you been told you stop breathing during sleep?</span><span style="font-family: "arial";"></span></span></li>
<li><span style="font-size: x-small;"><span style="font-family: "arial";">Do you have hypertension?</span><span style="font-family: "arial";"></span></span></li>
<li><span style="font-size: x-small;"><span style="font-family: "arial";">Is your neck size greater than 17 inches (male) or 16 inches (female)?</span></span></li>
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<span lang=""><span style="color: white; font-family: "arial"; font-size: x-small;">If your patient answers "yes" to at least two questions he is a candidate for HST.</span></span></div>
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<span style="color: white; font-family: "arial"; font-size: x-small;">Finally, do a cardiopulmonary assessment to rule out exclusionary disorders such as COPD and CHF. Examine the upper respiratory airway looking for enlarged tonsils, obvious asymmetries or blockage of the nasal passages and document your findings in the patient’s chart.</span></div>
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<span style="color: white; font-family: "arial"; font-size: small;">How fast can I get the report?</span></div>
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<span style="color: white;">IDS typically contacts the patient and ships a device the same day the order is received. We process the data and provide an interpretation within a matter of hours of it being returned by the patient. Typical turnaround time is 7-10 days from the physician's order to test results.</span></div>
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<span style="color: white; font-family: "arial"; font-size: small;">What is the cost to the patient?</span></div>
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<span style="color: white;"><span style="font-family: "arial";">That depends on the patient's insurance. For example, the cost for a patient with Medicare and no supplemental insurance is $30.25 (depending on Medicare allowable). The cost will never be more than $250, even for those without insurance. </span><span style="font-family: "arial";">To put it in perspective, an HST is between one-fifth to one-tenth the cost of an in-lab sleep study.</span></span></div>
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<span style="color: white; font-family: "arial"; font-size: small;">What data will I get?</span></div>
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<span style="color: white;">IDS uses the ResMed ApneaLink Plus Type III device which records four channels from two sensors. A nasal pressure cannula records airflow and snoring, while a finger sensor records oxygen saturation and heart rate. The Type III ApnaeaLink device also records respiratory effort. See the section titled Sample Test Report for more specific examples.</span></div>
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<span style="color: white;"><span style="font-family: "arial"; font-size: small;">Will my older patients be able to follow instructions?</span><span style="font-family: "arial"; font-size: x-small;"> </span></span></div>
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<span style="color: white;">IDS provides an instructional DVD that illustrates how to apply the device and very detailed printed instructions which have been developed based on our success in home overnight oximetry testing. The instructional brochure contains professionally drawn illustrations developed just for IDS patients who may have trouble reading the instructions. The illustrations include diagrams showing them applying the nasal cannula, sliding on the finger sensor, confirming the device is working and packing equipment back in the envelope. We also provide a toll-free, support line that is available 24/7. IDS Patient Support is staffed by qualified sleep technicians for patients who still have questions or experience difficulties. Our success rate of 98% easily exceeds published industry standards.</span></div>
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<span style="color: white;"><span style="font-family: "arial"; font-size: small;">Can I do follow-up studies?</span> </span></div>
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<span style="color: white;">Medicare, and possibly other insurers, will only allow the new HST code to be billed once per year. However, an overnight oximetry test can be performed to determine whether or not a patient still has oxygen desaturations while on CPAP.</span></div>
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<span style="color: white; font-family: "arial"; font-size: small;">A DME in my area is doing the testing themselves. Can they do that?</span></div>
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<span style="color: white;">For Aetna, Humana and private pay patients, they can. However, Medicare excludes a company or its affiliate from diagnosing and treating a patient. Unlike oximetry testing in which the DME can deliver the device and act as a "courier of equipment". The DME is not to be involved in HST in any way according to CMS rules.</span></div>
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<span style="color: white;">IDS is the only company that, as an independent diagnostic testing facility (IDTF) without any co-ownership ventures with DMEs, can test patients with any insurance, in any state without risk of penalties.</span></div>
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<span style="color: white; font-family: "arial"; font-size: small;">Another company is including the clinical evaluation as part of their HST service. Isn't that a better option?</span></div>
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<span style="color: white;">Medicare has made it clear that both the evaluation and the follow-up visits must be done by the treating physician (there are allowances for nurse practitioners under the treating physicians to be involved). These services are fine for private pay patients or insurers whose policies differ from Medicare's, but it's difficult to track of which policies approve and which policies disapprove.</span></div>
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<span style="color: white;">The intent of IDS <em>Sleep</em> is to help PCPs become more comfortable talking with their patients about their sleeping habits. Treating sleep apnea has been shown to improve glucose control in diabetics, lower blood pressure, reduce the risk of heart disease and stroke and increase energy, allowing patients to exercise and lose weight. With discussions at the nation's capital focusing on pay-for-performance and the medical-centered home, we believe this approach benefits patients and makes PCPs more likely to succeed should such changes be implemented.</span></div>
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<span style="color: white; font-family: "arial"; font-size: small;">What's going to happen to the sleep labs? My hospital just spent a lot of money to build one.</span></div>
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<span style="color: white; font-family: "arial"; font-size: x-small;">HST is for uncovering sleep apnea specifically. We anticipate that as physicians begin asking questions about sleep, other issues which require a comprehensive evaluation in a sleep lab will be uncovered.</span></div>
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<span style="color: white; font-family: "arial"; font-size: small;">Where can I find guidelines for administering Auto-Titrating Positive Airway Pressure (APAP) treatment following a positive test and clinical evaluation?</span></div>
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<span style="color: white; font-family: "arial"; font-size: x-small;">The AASM (American Academy of Sleep Medicine) provides practice parameters on their website.(2)</span></div>
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<span style="color: #e06666; font-size: large;"><b><i>-Miss Sleep</i></b></span></div>
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<span style="color: white; font-family: "georgia" , "times new roman" , serif;"><span style="background-color: transparent; text-decoration: underline;">REFERENCES</span></span></div>
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<span style="color: white;"><span style="font-family: "georgia" , "times new roman" , serif;">(1). (Sep, 2013). K. Philips. <i>Home Sleep Tests V.S. In Lab Tests; Which is Best? </i>Alaska Sleep Education Center. Retrieved from: </span><span style="background-color: transparent;"><span style="font-family: "georgia" , "times new roman" , serif;">http://www.alaskasleep.com/blog/home-sleep-tests-vs-inlabsleep--tests</span></span></span></div>
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<span style="color: white;"><span style="font-family: "georgia" , "times new roman" , serif;">(2) (June, 2008). Instant Diagnostic Systems. "Frequetly Asked Questions By Physicians" Retrieved from: </span><span style="background-color: transparent;"><span style="font-family: "georgia" , "times new roman" , serif;">https://www.instantdiagnostic.com/ids/(S(cinbyq2bvejyljiyo4gw24bp))/ content.aspx?content=Physician_Home_Sleep_Testing_FAQ</span></span></span></div>
MISS SLEEPhttp://www.blogger.com/profile/08325394467143123162noreply@blogger.com0tag:blogger.com,1999:blog-8434858802490775914.post-49672395519915818162016-12-18T19:54:00.003-08:002016-12-18T19:59:40.855-08:00Welcome to the RE-LAUNCH of my SLEEP HEALTH BLOG! :)<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQM5rdyJcXJfKj8peo54rsHrS75WIuPB1gHNDo8qkqAVlYyxMLDxEMvjpY8HGQ0uyO3WcGZ4FMQf3S4v6N-T25zJ725ltlP_1yAHNrjqx31nLVmbXAnow4x6M-wrn-ATSDWKa9OG6hqPnW/s1600/unnamed.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQM5rdyJcXJfKj8peo54rsHrS75WIuPB1gHNDo8qkqAVlYyxMLDxEMvjpY8HGQ0uyO3WcGZ4FMQf3S4v6N-T25zJ725ltlP_1yAHNrjqx31nLVmbXAnow4x6M-wrn-ATSDWKa9OG6hqPnW/s320/unnamed.jpg" width="282" /></a></div>
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<span style="clear: left; margin-bottom: 1em;"><span style="color: white;"><span style="font-size: x-large;"><u><i>As a Registered Sleep Technician and a Respiratory Therapist</i>;</u></span><span style="font-size: large;"> building awareness about Sleep Medicine has always been a major passion of mine. Through this blog, my aim was to help spread awareness about <a href="https://en.wikipedia.org/wiki/Sleep_apnea">Sleep Apnea</a> and all other important aspects of Sleep Health. </span></span></span></div>
<span style="color: white; font-size: large;"><br /></span>
<span style="color: white; font-size: large;">A number of years ago I was diagnosed with <a href="https://en.wikipedia.org/wiki/Multiple_sclerosis">Multiple Sclerosis</a>. All of the various care I have been undergoing, combined with my family and my sleep therapy business, left me with little time to contribute to this blog. </span><br />
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<span style="color: white; font-size: large;">BUT.... <b><u>Now I am back!</u></b> I have decided that building awareness about the dangers of unhealthy sleep is too important. I am fortunate enough to be in a position to spread my knowledge of this vitally important topic; to those who do not have my clinical background.</span><br />
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<span style="color: white; font-size: large;">So I welcome you to follow my blog as I will be sharing educational material, my own personal experience/opinions and anything else that I think will help people become more aware of the importance of sleep health. If I can even just make one person's life better though my blog, then it will be more than worth my efforts.... :) </span><br />
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<span style="color: white; font-size: large;">Sincerely...</span><br />
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<span style="color: #e06666; font-size: x-large;"><b><i>Miss Sleep</i></b></span><br />
<br />Miss Sleephttp://www.blogger.com/profile/13887032613494084398noreply@blogger.com0tag:blogger.com,1999:blog-8434858802490775914.post-39973851510054338062013-01-13T15:59:00.001-08:002013-01-13T16:00:53.282-08:00A Grande Starbuck's coffee has FOUR TIMES MORE CAFFEINE than a Redbull!<i><span style="font-size: x-large;">Many people like to boast that "that they do not drink energy drinks, </span>cause they just don't like all that caffeine<span style="font-size: x-large;">."</span></i> But millions of Americans love to start the morning with a visit to Starbucks. But what many people do know is that <u>Starbucks coffee contains a disproportionally large dose of caffeine</u>, when compared to other caffeinated drinks. HERE ARE A COUPLE SURPRISING FACTS:<br />
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<span style="font-size: large;"><span style="color: #38761d; text-align: -webkit-auto;">A </span>Grande<span style="color: #38761d; text-align: -webkit-auto;"> 16oz Coffee from Starbucks contains </span><b style="color: #38761d; text-align: -webkit-auto;"><u>FOUR TIMES MORE CAFFEINE</u></b><span style="color: #38761d; text-align: -webkit-auto;"> than an 8.4oz </span>Redbull<span style="color: #38761d; text-align: -webkit-auto;"> </span></span></div>
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<span style="color: #274e13;"> <span style="font-size: large;">330mg VS 80mg</span></span><br />
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<span style="color: #274e13;"><span style="font-size: large; text-align: -webkit-auto;">A </span><span style="font-size: large;">Grande</span><span style="font-size: large; text-align: -webkit-auto;"> 16oz Coffee from Starbucks contains </span><span style="font-size: large; text-align: -webkit-auto;"><u>almost <b>2.5 TIMES MORE CAFFEINE</b></u></span></span><span style="font-size: large; text-align: -webkit-auto;"><span style="color: #274e13;"> than an 16oz McDonald's Coffee.</span><span style="color: #38761d;"> </span></span><span style="color: #38761d; font-size: large; text-align: -webkit-auto;"> </span></div>
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<span style="color: #274e13; font-size: large;">330mg VS 133mg</span><br />
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Even though a morning jolt can make the mornings easier to deal with, it is important that people are aware of the potential effects of drinking TOO MUCH CAFFEINE. Although moderate caffeine consumption isn't likely to cause harm, drinking more than 500mg can cause:<br />
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<span style="font-size: large;">Insomnia</span></div>
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<span style="font-size: large;">Nervousness</span></div>
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<span style="font-size: large;">Irritability</span></div>
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<span style="font-size: large;">Fast Heartbeat</span></div>
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<span style="font-size: large;">Upset Stomach </span></div>
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<span style="font-size: large;">Muscle Tremors</span></div>
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At 260mg of Caffeine, it would only take two tall 12oz coffees from Starbucks to put you over 500mg!</div>
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-Mr. Sleep</div>
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References:</div>
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Mayo Clinic Online, (March, 2011). "<a href="http://www.mayoclinic.com/health/caffeine/NU00600">Caffeince: How much is too much?</a>" 1998-2013. Mayo Foundaition for Medical Education and Research. </div>
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Center for Science in the Public Interest. (2013). "<a href="http://www.cspinet.org/new/cafchart.htm">Caffeine Content of Food and Drugs</a>"</div>
MISS SLEEPhttp://www.blogger.com/profile/08325394467143123162noreply@blogger.com0tag:blogger.com,1999:blog-8434858802490775914.post-55403672893633709412013-01-08T18:05:00.002-08:002013-01-08T18:14:35.714-08:00Celebrity Sleep Deaths....<span style="font-family: Times, Times New Roman, serif;"><span style="font-size: x-large;"><i>"Isn't that just snoring?"</i> </span><span style="font-size: large;">This is what you hear a lot, when you talk about Sleep Apnea. Many people are unaware that Sleep Apnea is a very serious disorder that can kill you (<a href="http://www.news-medical.net/news/2008/11/10/42664.aspx">Sudden Cardiac Death</a>). Sl<span style="line-height: 18px;">eep apnea also causes serious and life-shortening disorders: high blood pressure, heart disease, stroke, automobile accidents caused by falling asleep at the wheel, diabetes, depression and other ailments (<a href="http://www.sleepapnea.org/learn/sleep-apnea.html">ASAA</a>). </span></span></span><br />
<span style="font-family: Times, Times New Roman, serif;"><span style="line-height: 18px;"><br /></span></span>
<span style="font-family: Times, Times New Roman, serif;"><span style="line-height: 18px;"><span style="font-size: large;"><u>Today I learned that these celebrities all died at the hands of Sleep </u></span></span></span><br />
<u><span style="font-family: Times, Times New Roman, serif;"><span style="line-height: 18px;"><span style="font-size: large;"><br /></span></span></span>
<span style="font-family: Times, Times New Roman, serif;"><span style="line-height: 18px;"><span style="font-size: large;">Apnea</span>: </span></span></u><br />
<span style="font-family: Times, Times New Roman, serif;"><span style="line-height: 18px;"><br /></span></span>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpTkLbOPY_zVuDL0xZUK5d1iImXqBlG1KDQz0evwLXBnQUXGF0CTW84jKueqJw1kb-fZo_QyykB2Cus-yQXJpmSKHesv_PJkDJtIaa28syoWtMm8Z7yqSVqlnZrGQXQDMt8OPfqWbfIwvM/s1600/Jerry+Garcia-3.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpTkLbOPY_zVuDL0xZUK5d1iImXqBlG1KDQz0evwLXBnQUXGF0CTW84jKueqJw1kb-fZo_QyykB2Cus-yQXJpmSKHesv_PJkDJtIaa28syoWtMm8Z7yqSVqlnZrGQXQDMt8OPfqWbfIwvM/s320/Jerry+Garcia-3.JPG" width="256" /></a></div>
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<span style="font-family: Times, Times New Roman, serif;"><span style="line-height: 18px;"><br /></span></span></div>
<div style="text-align: center;">
<span style="font-family: Times, Times New Roman, serif; font-size: large;"><span style="line-height: 18px;">Jerry Garcia </span></span></div>
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<span style="font-family: Times, Times New Roman, serif; font-size: large;"><span style="line-height: 18px;"><br /></span></span></div>
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<span style="font-family: Times, Times New Roman, serif;"><span style="line-height: 18px;">(Grateful Deal)</span></span></div>
<span style="font-family: Times, Times New Roman, serif;"><span style="line-height: 18px;"><br /></span></span>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiddMLu_BHW_sd9fPfSRAjuo6B4uKxbWM8xb99JlKal6C-tjXgtW-hlZz2FLis09bDh_2GjT40bCmePn6rDOaQSTygg1RczY35zIhylI3RDIgnjOeXrp2n_5EHzdIOeigCw9V2s9NBRW_1F/s1600/candy02.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiddMLu_BHW_sd9fPfSRAjuo6B4uKxbWM8xb99JlKal6C-tjXgtW-hlZz2FLis09bDh_2GjT40bCmePn6rDOaQSTygg1RczY35zIhylI3RDIgnjOeXrp2n_5EHzdIOeigCw9V2s9NBRW_1F/s320/candy02.jpg" width="264" /></a></div>
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<span style="font-family: Times, Times New Roman, serif;"><span style="line-height: 18px;"><br /></span></span></div>
<div style="text-align: center;">
<span style="font-family: Times, Times New Roman, serif; font-size: large;"><span style="line-height: 18px;">John Candy</span></span></div>
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<span style="font-family: Times, Times New Roman, serif; font-size: large;"><span style="line-height: 18px;"><br /></span></span></div>
<div style="text-align: center;">
<span style="font-family: Times, Times New Roman, serif;"><span style="line-height: 18px;">(Stripes, Cool Runnings, Space Balls, Etc) </span></span></div>
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<span style="font-family: Times, Times New Roman, serif;"><span style="line-height: 18px;"><br /></span></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1C-zr5xAKgiDI4nd5JPdaJHvCVc1aMfkbAVqDFHh78sbnL4ND_pV6ZbJSLQFpR4S5TA3q8EU6i3sYSixJApPPhP3BJx8pl3gH2DBZ3kZvifPJ05UEw8wG-L6HgCeIL4ue9GhtiAfVv6Ww/s1600/reggie-white.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1C-zr5xAKgiDI4nd5JPdaJHvCVc1aMfkbAVqDFHh78sbnL4ND_pV6ZbJSLQFpR4S5TA3q8EU6i3sYSixJApPPhP3BJx8pl3gH2DBZ3kZvifPJ05UEw8wG-L6HgCeIL4ue9GhtiAfVv6Ww/s320/reggie-white.jpg" width="244" /></a></div>
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<span style="font-family: Times, Times New Roman, serif;"><span style="line-height: 18px;"><br /></span></span></div>
<div style="text-align: center;">
<span style="font-family: Times, Times New Roman, serif; font-size: large;"><span style="line-height: 18px;">Reggie White</span></span></div>
<div style="text-align: center;">
<span style="font-family: Times, Times New Roman, serif; font-size: large;"><span style="line-height: 18px;"><br /></span></span></div>
<div style="text-align: center;">
<span style="font-family: Times, Times New Roman, serif;"><span style="line-height: 18px;">(Packers, Eagles, Panthers)</span></span></div>
<div style="text-align: center;">
<span style="font-family: Times, Times New Roman, serif;"><span style="line-height: 18px;"><br /></span></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicZjskKp19mrqdbbajWte6t9jqXjgkqDK8APu2fyU6_aU7huLq0EeGMIWXgMQnslSkQmS5y8TV3oxUA0QHL2iWk3kpWfcDkdijwK6536ETwk64sK2ERPBDSihwOpcA1zkr-hn7bjd1bZYw/s1600/63666.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicZjskKp19mrqdbbajWte6t9jqXjgkqDK8APu2fyU6_aU7huLq0EeGMIWXgMQnslSkQmS5y8TV3oxUA0QHL2iWk3kpWfcDkdijwK6536ETwk64sK2ERPBDSihwOpcA1zkr-hn7bjd1bZYw/s320/63666.jpg" width="238" /></a></div>
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<span style="font-family: Times, Times New Roman, serif;"><span style="line-height: 18px;"><br /></span></span></div>
<div style="text-align: center;">
<span style="font-family: Times, Times New Roman, serif; font-size: large;"><span style="line-height: 18px;">Chris Penn</span></span></div>
<div style="text-align: center;">
<span style="font-family: Times, Times New Roman, serif; font-size: large;"><span style="line-height: 18px;"><br /></span></span></div>
<div style="text-align: center;">
<span style="font-family: Times, Times New Roman, serif;"><span style="line-height: 18px;">(Reservoir Dogs, Rush Hour, All the Right Moves)</span></span></div>
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<span style="font-family: Times, Times New Roman, serif;"><span style="line-height: 18px;"><br /></span></span></div>
<div style="text-align: center;">
<br /></div>
<div style="text-align: left;">
<span style="font-family: Times, Times New Roman, serif;"><span style="font-size: large; line-height: 18px;">It is important the when building awareness about sleep apnea, you stress how deadly the disorder is. In doing so, hopefully we can prevent further loss of life...</span></span></div>
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<span style="font-family: Times, Times New Roman, serif;"><span style="font-size: large; line-height: 18px;"><br /></span></span></div>
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<span style="font-family: Times, Times New Roman, serif;"><span style="font-size: large; line-height: 18px;">-Mr. Sleep</span></span></div>
MISS SLEEPhttp://www.blogger.com/profile/08325394467143123162noreply@blogger.com0tag:blogger.com,1999:blog-8434858802490775914.post-60759203207614280712012-10-25T01:01:00.000-07:002012-10-25T01:01:01.291-07:00OOPS! I forgot to wear my CPAP!<span style="font-size: large;"><b><i>Could sleep apnea be responsible for Rick Perry's</i></b></span> now infamous OOPS moment during his disastrous republican debate performance? <br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmeUYb3U_r7ydzhBy2Oal9HtkEPpgvIOAxQ9fXVUk5uj8E_pC1qRunw6DLiFHQSuVRYtzWNcNe7AUIwRXuDjtlNyr6-yYhueOktUr4xAkTvRfGKpWID6mnnN-NkOTW4UhlzI4SvmW-YEjm/s1600/perry+sleep+apnea.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="215" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmeUYb3U_r7ydzhBy2Oal9HtkEPpgvIOAxQ9fXVUk5uj8E_pC1qRunw6DLiFHQSuVRYtzWNcNe7AUIwRXuDjtlNyr6-yYhueOktUr4xAkTvRfGKpWID6mnnN-NkOTW4UhlzI4SvmW-YEjm/s320/perry+sleep+apnea.jpg" width="320" /></a></div>
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<br />
It turns out that out that Governor and former presidential candidate Rick Perry<a href="http://politicalticker.blogs.cnn.com/2012/09/23/perry-struggled-with-sleep-disorder-during-campaign/"> was diagnosed with sleep apnea</a> while he was campaigning during his failed bid for the republican presidential nomination. A spokesmen for Perry's office confirmed that the Governor had been diagnosed with sleep apnea <u>that had not treated when</u> at the time he famously forgot to recall one of the three federal agencies he had proposed eliminating (in mid debate). The OOPS moment (as it has been dubbed) was considered by most to be the moment that ruined his already troubled bid for president.<br />
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The aid who reported that the Governor was suffering from sleep apnea speculated that Governor Perry could have been suffering from the disorder for years before he was diagnosed. Since it has been shown that <a href="http://www.washingtonpost.com/wp-dyn/content/article/2008/06/11/AR2008061101039.html">untreated sleep apnea can cause tissue loss in areas of the brain that help store memory</a>, once can't help but wonder if Perry's presidential bid would have been more successful if he had been wearing his CPAP!<br />
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<a href="http://www.youtube.com/watch?v=0uvmKnFY4uk">Click here to view the incident (though it is painful to watch) </a><br />
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-Mr. SleepMISS SLEEPhttp://www.blogger.com/profile/08325394467143123162noreply@blogger.com0tag:blogger.com,1999:blog-8434858802490775914.post-91488753486460785442012-07-13T17:22:00.001-07:002012-07-13T17:28:20.863-07:00Sleep Apnea Causes Cancer???<span class="Apple-style-span" style="font-size: x-large;">As the list of disorders that are associated with Sleep Disordered Breathing (SDB) continues to grow</span>, the latest addition to the list has certainly raised eyebrows. <a href="http://www.sleepreviewmag.com/sleep_report/2012-06-06_01.asp">A new study</a> performed at the University of Wisconsin School of Medicine has demonstrated "increased episodes of hypoxia (inadequate supply of oxygen) are associated with accelerated cancer progression." (SleepReviewMag, 2012). The study (although done in vitro and on animals) suggests that sleep apnea increases the cancer mortality rate in humans.<br />
<br />
This study is fascinating and will spawn a series of sub-studies that will likely reveal more specific details about this correlation. In the meantime, it is important to spread the word about the relationship between cancer and sleep disordered breathing to family doctors, internists, oncologists and pretty much everyone else...<br />
<br />
<a href="http://www.sleepreviewmag.com/sleep_report/2012-06-06_01.asp">(Click Here For The Full Article)</a><br />
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-Mr. SleepMISS SLEEPhttp://www.blogger.com/profile/08325394467143123162noreply@blogger.com1tag:blogger.com,1999:blog-8434858802490775914.post-76820524067772431292012-06-19T12:39:00.002-07:002012-06-19T12:39:29.106-07:00OSA and diseases of the eye<br />
<span style="font-size: large;"><em>As sleep disordered breathing become better understood</em></span>, health professionals
are becoming more and more aware of how the disorder relates to other diseases. <a href="http://well.blogs.nytimes.com/2012/05/20/sleep-apnea-tied-to-increased-cancer-risk/"><span style="color: blue;">Two
new studies</span></a> have recently been published that show that people with sleep disordered breathing have a higher risk of
cancer.<br />
<br />
Another relation that is not very well known, is the relation between sleep
disordered breathing and diseases of the eye. Dr, Swaraj Bose is a board
certified ophthalmologist, a neuro-opthalmologist and an orbital surgeon who
specializes in treating patients with diseases of the eye in relation to the
brain. On his blog, he recently posted an article that examines the links
between sleep disordered breathing and disease of the eye. His article explains
that sleep disordered breathing can cause Non Arteritic Ischemic Optic
Neuropathy (NAION), Idiopathic Intracranial Hypertension (IIH) / Pseudotumor
cerebri (PTC), Floppy Eyelid Syndrome (FES) and Glaucoma / Normal Tension
Glaucoma.<br />
<br />
To read Dr. Bose's article, <a href="http://www.neuroeyeorbit.com/blog/?p=43"><span style="color: blue;">click
here</span></a>. <br />MISS SLEEPhttp://www.blogger.com/profile/08325394467143123162noreply@blogger.com1tag:blogger.com,1999:blog-8434858802490775914.post-6908067803670939512011-12-12T19:44:00.000-08:002011-12-12T19:45:44.065-08:00A Sleep Study on the Subway????<span style="font-size: x-large;"><u>A Couple of New York doctors decided to do a sleep study on a New York subway?</u></span><br />
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<br />
<span style="font-size: large;">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.</span> <br />
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<br />
<a href="http://www.nytimes.com/2011/12/08/nyregion/to-sleep-on-the-subway-maybe-but-to-dream-poor-chance.html?_r=1&hp"><span style="font-size: large;">Click here to read the New York Time's article....</span></a>MISS SLEEPhttp://www.blogger.com/profile/08325394467143123162noreply@blogger.com0tag:blogger.com,1999:blog-8434858802490775914.post-31234671505388554982011-10-28T09:32:00.000-07:002011-10-28T09:32:00.449-07:00The 10 Most Sleep Deprived CitiesThe CDC has recently released a study which identifies the cities that have the highest percentages of sleep deprived people. They are as follow:<br />
<br />
<ol><li>Detroit</li>
<li>Birmingham, Alabama</li>
<li>Oklahoma City, Oklahoma</li>
<li>New Orleans, Louisiana</li>
<li>New York, New York</li>
<li>Cincinnati, Ohio</li>
<li>Louisville, Kentucky</li>
<li>Raleigh, North Carolina</li>
<li>Columbus, Ohio</li>
<li>Boston, Massachusetts</li>
</ol>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.<br />
<br />
-Mr. Sleep<br />
<br />
References:<br />
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<a href="http://www.sleepdt.com/is-your-city-listed-in-the-top-10-most-sleep-deprived-cities-3/">http://www.sleepdt.com/is-your-city-listed-in-the-top-10-most-sleep-deprived-cities-3/</a>MISS SLEEPhttp://www.blogger.com/profile/08325394467143123162noreply@blogger.com2tag:blogger.com,1999:blog-8434858802490775914.post-51337893063373291772011-10-19T09:02:00.000-07:002011-10-19T09:02:18.599-07:00Swift FX for her<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGev9Ggjv7WLFmob6YLRZx4gEHUuaqbSsjR70T39bqDLWgsLanTGIzdXKuMsPjsSkUpG3_2HvbnP0wLoGqbxjRJuMXsS0R4vXFJ2zDe8ww9U_nKo22w5nVL95vKR-HVTWbHFjy3a5tYA9l/s1600/8009591-14706691-thumbnail.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGev9Ggjv7WLFmob6YLRZx4gEHUuaqbSsjR70T39bqDLWgsLanTGIzdXKuMsPjsSkUpG3_2HvbnP0wLoGqbxjRJuMXsS0R4vXFJ2zDe8ww9U_nKo22w5nVL95vKR-HVTWbHFjy3a5tYA9l/s1600/8009591-14706691-thumbnail.jpg" /></a></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhPU9_HPBT0nHgXFjUCPyilLN4kmjQWLCe4MQL4DBmodRjNtJKwTSqT3NWJYGHfzRoetNRYJOYoWN4ScCqKKuJSEsExX6S5Yf_gg18ASa8g0Ps3VL3hIVBNvH8fk9qh_6cQyNOD9LoYU6uM/s1600/8009591-14706719-thumbnail.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhPU9_HPBT0nHgXFjUCPyilLN4kmjQWLCe4MQL4DBmodRjNtJKwTSqT3NWJYGHfzRoetNRYJOYoWN4ScCqKKuJSEsExX6S5Yf_gg18ASa8g0Ps3VL3hIVBNvH8fk9qh_6cQyNOD9LoYU6uM/s1600/8009591-14706719-thumbnail.jpg" /></a></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj34WjzCIoypTmdOmN6e5YjRm780nUUUQL0lY0KvYrUjnGiBUvba7EQGUUS61qcbwaaCAOOUpz3sDcZT26YMhkuWppxMbjMjEo2UapXQF-s1ddnNqZHW4yVu5T7MzMHwMj8Ju_rI-WGdE7-/s1600/8009591-14706763-thumbnail.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj34WjzCIoypTmdOmN6e5YjRm780nUUUQL0lY0KvYrUjnGiBUvba7EQGUUS61qcbwaaCAOOUpz3sDcZT26YMhkuWppxMbjMjEo2UapXQF-s1ddnNqZHW4yVu5T7MzMHwMj8Ju_rI-WGdE7-/s1600/8009591-14706763-thumbnail.jpg" /></a></div>MISS SLEEPhttp://www.blogger.com/profile/08325394467143123162noreply@blogger.com0tag:blogger.com,1999:blog-8434858802490775914.post-75353146808436183922011-10-12T14:11:00.000-07:002011-10-12T15:28:39.626-07:00Insurance companies requiring Home Sleep Tests prior to the Sleep Lab!<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9Ssuo8dJczyFQW5iWHlEWmJWNR6orMCkPBx46AEH7QBDQ1ZXpB4POE3_QfpJh9mtgudHtrqN_FjnCXn3WoOpZEuRnXr84P5N_6NE8vTeUQQtRM-basLVGBaYmDyTVuAi0LJmzDAGyB6ye/s1600/untitled.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9Ssuo8dJczyFQW5iWHlEWmJWNR6orMCkPBx46AEH7QBDQ1ZXpB4POE3_QfpJh9mtgudHtrqN_FjnCXn3WoOpZEuRnXr84P5N_6NE8vTeUQQtRM-basLVGBaYmDyTVuAi0LJmzDAGyB6ye/s1600/untitled.png" /></a></div><br />
<span style="font-size: x-large;"><strong><em>United Health Care appears to be the leader </em></strong><span style="font-size: small;">in the push to bring Home Sleep Testing (HST) to the forefront of diagnostic sleep medicine.</span><strong><em> </em></strong></span>As of October 1st, all <span style="font-family: ACaslonPro-Bold;"><span style="font-family: ACaslonPro-Bold;">UnitedHealthcareWEST, Neighborhood Health Partnership and River Vally members will be required to have a pre-authorization for all sleep studies<strong>.</strong> 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 <u><strong>will be denied</strong>.</u> 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. <a href="https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Network%20Bulletin/NetworkBulletin_July2011supplement.pdf">(click here to read United's Official Policy).</a></span></span><br />
<br />
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 <a href="https://www.premera.com/stellent/groups/public/documents/medicalpolicy/cmi_003508.htm">(click here to read the Premere Blue Cross official policy)</a>. <br />
<br />
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).<br />
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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.<br />
-Mr. Sleep <br />
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<div style="text-align: center;">References</div><div align="left" style="text-align: center;"></div><br />
<span style="font-family: inherit;"><span style="color: white;">Premera Blue Cross. (2011<span style="font-size: x-small;">). <span style="font-family: "Arial";">Diagnosis and Medical Management of Obstructive Sleep Apnea Syndrome and </span></span></span></span><br />
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<span style="font-family: inherit;"><span style="font-size: x-small;"><span style="color: white; font-family: "Arial";">Upper Airway Resistance Syndrome</span></span></span><a href="https://www.premera.com/stellent/groups/public/documents/me"><span style="color: white;"><span style="font-family: inherit;">https</span>://www.premera.com/stellent/groups/public/documents/me </span></a><br />
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<span style="color: white;">dicalpolicy/cmi_003508.htm</span><br />
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<span style="color: white;">United Healthcare Online. (2011). July 2011, Network Bulletin. </span><a href="https://www.unitedhealthcareo/"><span style="color: white;">https://www.unitedhealthcareo </span></a><br />
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<span style="color: white;">nline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tool </span><br />
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<span style="color: white;">s%20and%20Resources/Network%20Bulletin/NetworkBulletin_July2011supplement.pdf</span><br />
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<div align="LEFT"><span style="font-family: ACaslonPro-Bold;"><span style="font-family: ACaslonPro-Bold;"></span></span></div><span style="font-family: ACaslonPro-Bold;"><span style="font-family: ACaslonPro-Bold;"></span></span><span style="font-family: ACaslonPro-Bold;"><span style="font-family: ACaslonPro-Bold;"></span></span>MISS SLEEPhttp://www.blogger.com/profile/08325394467143123162noreply@blogger.com0tag:blogger.com,1999:blog-8434858802490775914.post-89044510322976388982011-10-10T09:16:00.000-07:002011-10-10T09:21:02.092-07:00Medications that cause abnormal dreams...<span style="font-size: x-large;"><em><u>Often times people with sleep disordered breathing state that they do not dream.</u></em> </span><span style="font-size: small;">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. </span><br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiR1ovJ6O5e7kWwbb96Jki-zl5R6z9gwrLRHrgl-DgoH37Av9R45P0ofogsq8nrGCPAsarS4Uy3BW2psU8llgzZklF1Mkj7Dv9WYZZtznwBqggZBakndWZAarRuJeIHPEgl1MIrXQqSYo7d/s1600/40819-23.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="258" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiR1ovJ6O5e7kWwbb96Jki-zl5R6z9gwrLRHrgl-DgoH37Av9R45P0ofogsq8nrGCPAsarS4Uy3BW2psU8llgzZklF1Mkj7Dv9WYZZtznwBqggZBakndWZAarRuJeIHPEgl1MIrXQqSYo7d/s320/40819-23.jpg" width="320" /></a></div><br />
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<span style="font-size: small;">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. </span><br />
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-Mr. Sleep <br />
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Beck, L. (2011). <a href="http://online.wsj.com/article/SB10001424052970204524604576608800923793190.html">The Next Nightmare</a>. The Wall Street Journal.MISS SLEEPhttp://www.blogger.com/profile/08325394467143123162noreply@blogger.com0tag:blogger.com,1999:blog-8434858802490775914.post-80577310230258577982011-10-04T10:00:00.000-07:002011-10-04T10:04:12.555-07:00The Respironics True Blue Nasal Mask<span style="color: black; font-size: x-large;"><em>A New Round of Nasal Masks</em></span> 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. <br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhS7BDMQ4p2bPcJks3cpC2RXPw6a4us3cSsr6vYJkMSsZCHlPlQT1_m0AjhVkZZcE4UI0Q50PGJT_S2QfUzv_TsuDEb7lK5ygbbeFEGaoBjxtTelqbFTQsV9I47t-X2wae-dJS5cQ20E8Dt/s1600/Respironics-TrueBlue-Gel-Nasal-CPAP-Mask.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhS7BDMQ4p2bPcJks3cpC2RXPw6a4us3cSsr6vYJkMSsZCHlPlQT1_m0AjhVkZZcE4UI0Q50PGJT_S2QfUzv_TsuDEb7lK5ygbbeFEGaoBjxtTelqbFTQsV9I47t-X2wae-dJS5cQ20E8Dt/s200/Respironics-TrueBlue-Gel-Nasal-CPAP-Mask.jpg" width="200" /></a></div><div class="separator" style="clear: both; text-align: left;"><br />
<span style="color: blue; font-size: x-large;"><u><em><strong>From a patient's perspective:</strong></em></u></span></div><div class="separator" style="clear: both; text-align: left;"><br />
</div><div class="separator" style="clear: both; text-align: left;"><span style="color: black;"></span></div><span style="color: white;"><span style="color: black;">The True Blue Mask boasts new</span><span style="color: black;"> 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. </span></span><br />
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<em><span style="color: blue; font-size: x-large;"><u><strong>From a clinician's perspective:</strong></u></span></em><br />
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<span style="color: white;"><span style="color: black;">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. </span></span><br />
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<span style="color: white;"><span style="color: black;">-Mr. Sleep</span></span>MISS SLEEPhttp://www.blogger.com/profile/08325394467143123162noreply@blogger.com2tag:blogger.com,1999:blog-8434858802490775914.post-14672535162049795382011-09-30T09:39:00.000-07:002011-09-30T09:47:27.371-07:00Sleep Eating<span style="font-size: x-large;"><strong><em><u>The woman featured in this video caught herself sleep eating with a video camera.</u></em></strong> </span><span style="font-size: small;">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). </span><br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPjUoalI7Sq81yd-k9Co2_6ta0VGoFT2XHW3KS5b-z2PouYzLGGFvLkRnxoD_eEavFFQmj6ahgZhAY4XZyIrABWqEcSFCoXT17qo0hBgCq0XXenZIGUaemJnY0yMIZrlrAY1KwKAGyx-qv/s1600/07well_fridge-blogSpan.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="275" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPjUoalI7Sq81yd-k9Co2_6ta0VGoFT2XHW3KS5b-z2PouYzLGGFvLkRnxoD_eEavFFQmj6ahgZhAY4XZyIrABWqEcSFCoXT17qo0hBgCq0XXenZIGUaemJnY0yMIZrlrAY1KwKAGyx-qv/s320/07well_fridge-blogSpan.jpg" width="320" /></a></div><br />
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<span style="font-size: small;"><strong><em><u><span style="font-size: x-large;">The woman featured in this video</span></u></em></strong> is literally asleep while she is raiding the refrigerator and almost appears zombie like while binge eating. <a href="http://www.youtube.com/watch?v=lxwMoWZfkmU">(click here to view)</a>. </span>MISS SLEEPhttp://www.blogger.com/profile/08325394467143123162noreply@blogger.com0tag:blogger.com,1999:blog-8434858802490775914.post-81616754182806767782011-09-27T18:41:00.000-07:002011-09-28T08:51:04.184-07:00No more Medicare referrals for HME providers?!?!?!<u><span class="Apple-style-span" style="font-size: x-large;"><b><i>Sleep Labs May Soon Be Able To Set Up Their Own Medic</i></b></span><span class="Apple-style-span" style="font-size: x-large;"><b><i>are/Medicaid Patients With CPAP Equipment!!!</i></b></span></u><br />
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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.<br />
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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."<br />
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Flaherty, 2011. <a href="http://www.sleepscholar.com/aasm-shifts-sleep-strategy/">AASM shifts sleep strategy</a>. HME NewsMISS SLEEPhttp://www.blogger.com/profile/08325394467143123162noreply@blogger.com0tag:blogger.com,1999:blog-8434858802490775914.post-69669406500884368042011-09-27T09:38:00.000-07:002011-09-27T09:38:39.449-07:00Sleep Apnea Screening for Smart Phones<span style="font-size: x-large;"><strong><em>Looks like the Smartphone craze has finally caught up with sleep medicine...</em></strong></span><span style="font-size: small;">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. </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWTLKRLT_tX8T5hJk6IWtd1v3jIUmgQ2nmrTdLO_WZwpUMMl9toOkEUfDFoOi8J94UXlmL3BVHunuHepIBXflfkBTdBWI1Hr3-7Wuy_xWPx-xF3TtIbs4sCMd37ZduwNLg1w7wn54fsRc3/s1600/iphone2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" kca="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWTLKRLT_tX8T5hJk6IWtd1v3jIUmgQ2nmrTdLO_WZwpUMMl9toOkEUfDFoOi8J94UXlmL3BVHunuHepIBXflfkBTdBWI1Hr3-7Wuy_xWPx-xF3TtIbs4sCMd37ZduwNLg1w7wn54fsRc3/s320/iphone2.jpg" width="222" /></a><br />
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 <a href="http://mobilesleeptest.com/">MSleeptest website</a>...<br />
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-Mr. SleepMISS SLEEPhttp://www.blogger.com/profile/08325394467143123162noreply@blogger.com0tag:blogger.com,1999:blog-8434858802490775914.post-88077469943009295602011-09-26T09:55:00.000-07:002011-09-26T14:15:14.794-07:00Bizkit the Sleep Walking Dog<h3 class="post-title entry-title"><span style="font-size: large;">Bizkit the Sleep Walking Dog</span> </h3><div class="post-title entry-title"></div><div class="post-body entry-content"><span style="color: white;"><span style="color: black;"><span style="color: white; font-size: large;"><em> <iframe allowfullscreen="" frameborder="0" height="315" src="http://www.youtube.com/embed/z2BgjH_CtIA" width="420"></iframe></em></span></span></span><br />
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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)</div><div class="post-body entry-content"><br />
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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!<br />
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-Mr. Sleep</div>MISS SLEEPhttp://www.blogger.com/profile/08325394467143123162noreply@blogger.com1tag:blogger.com,1999:blog-8434858802490775914.post-51761331205643050092011-09-23T11:02:00.000-07:002011-09-23T11:40:08.439-07:00The airport sleep box!!!<span style="font-size: x-large;"><strong><em><u>A private place to sleep in airports</u> </em></strong></span>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, <u>THE SLEEP BOX!!!</u><br />
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<iframe allowfullscreen="" frameborder="0" height="315" src="http://www.youtube.com/embed/UITTDgXzrzY?rel=0" width="420"></iframe><br />
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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.<br />
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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!<br />
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-Mr. SleepMISS SLEEPhttp://www.blogger.com/profile/08325394467143123162noreply@blogger.com1tag:blogger.com,1999:blog-8434858802490775914.post-66283765412332629322011-09-23T10:36:00.000-07:002011-09-23T10:39:38.319-07:00Wanna save on your kids college tuition!<span style="font-size: x-large;"><em><strong>Then make sure they sleep 9 hours a night.....</strong></em></span><br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirQ0xXj7uaDCklcM1PsQWMNZLmXtfFe7iBd5IRrIALatU2e7Wn-s8AzEzsNGeJCvh5fO0dKnG7Z9A7PZtKkKg8Crbuc6QnV1dNEMESqzHPV7d5nyfUOzVM2Thyl0B2rYj55Z4rADfRD2aE/s1600/untitled.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirQ0xXj7uaDCklcM1PsQWMNZLmXtfFe7iBd5IRrIALatU2e7Wn-s8AzEzsNGeJCvh5fO0dKnG7Z9A7PZtKkKg8Crbuc6QnV1dNEMESqzHPV7d5nyfUOzVM2Thyl0B2rYj55Z4rADfRD2aE/s1600/untitled.png" /></a></div><br />
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<span style="font-size: small;">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! </span><br />
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<span style="font-size: small;">Click the link below to read the full article: <a href="http://www.sleepreviewmag.com/sleep_report/2011-09-21_01.asp">http://www.sleepreviewmag.com/sleep_report/2011-09-21_01.asp</a></span><br />
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-Mr. SleepMISS SLEEPhttp://www.blogger.com/profile/08325394467143123162noreply@blogger.com0tag:blogger.com,1999:blog-8434858802490775914.post-44582457095191733122011-09-23T09:32:00.000-07:002011-09-23T09:33:18.604-07:00Why 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....<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVqImisqYrkXZUNfh6-sOTmmAO9HFlFWD7Nr6wWYvW2tWUmMRoNH1s41Kps3FMlrprgkOQOsOS3jQXEQM6tVgaee7bue1twMgXoiLv2odfxNkOoo9YIEB9HAyQk-fD1mHM8m4V8J1Dh558/s1600/photo.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVqImisqYrkXZUNfh6-sOTmmAO9HFlFWD7Nr6wWYvW2tWUmMRoNH1s41Kps3FMlrprgkOQOsOS3jQXEQM6tVgaee7bue1twMgXoiLv2odfxNkOoo9YIEB9HAyQk-fD1mHM8m4V8J1Dh558/s320/photo.JPG" width="239" /></a></div>MISS SLEEPhttp://www.blogger.com/profile/08325394467143123162noreply@blogger.com0tag:blogger.com,1999:blog-8434858802490775914.post-33745926320996959152011-09-22T10:24:00.000-07:002011-09-22T10:28:25.066-07:00The Mirage FX<span style="color: white;"><span style="font-size: x-large;"><em>A New Round of Nasal Masks </em></span>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 <strong>Mirage FX </strong>is the newest nasal mask from <strong>ResMed</strong><strong>,</strong> an organization which was co-founded by Colin Sullivan (the man who published the first paper on Obstructive Sleep Apnea). </span><br />
<div class="separator" style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none; clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOjJ6__CuFEPTWib2Qb6hImBrn9DODD7x-p-Dyd0rJ34f1l-IBQJoP74_jTFcuLfVl6UMOigvwxC7DUs15oBMvTM6nba9FabFxJKlpv9hmJybGKC84XAhuw_4XmsD1QdRYsUFe3r-CjObf/s1600/imagesCAZRWAPS.jpg" imageanchor="1" style="clear: right; cssfloat: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="color: white;"><img border="0" hca="true" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOjJ6__CuFEPTWib2Qb6hImBrn9DODD7x-p-Dyd0rJ34f1l-IBQJoP74_jTFcuLfVl6UMOigvwxC7DUs15oBMvTM6nba9FabFxJKlpv9hmJybGKC84XAhuw_4XmsD1QdRYsUFe3r-CjObf/s200/imagesCAZRWAPS.jpg" width="186" /></span></a></div><u><em><strong></strong></em></u><span style="color: white;"> </span><br />
<span style="font-size: large;"><u><em><span style="color: blue; font-size: x-large;"><strong>From a patient's perspective:</strong></span></em></u> </span><br />
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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. </div><div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none;"> </div> <br />
<div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none;"><strong><em><u><span style="color: blue; font-size: x-large;">From a clinician's perspective:</span></u></em></strong></div><div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiu-WTZfaXAAxypkpn9aC53_kNFmwfj7ZsCMZoejY8pEteUo3Pz2CByub8yx_qnituwUOEN8aWQB6RaSpskiz6MwZHs5R5qhyMDrNAT_VFksv07Fm9JHKLQlZQfcQ1hnS-Ltqjh5wnUAusY/s1600/MirageFX_62103.jpg" imageanchor="1" style="clear: right; cssfloat: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" hca="true" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiu-WTZfaXAAxypkpn9aC53_kNFmwfj7ZsCMZoejY8pEteUo3Pz2CByub8yx_qnituwUOEN8aWQB6RaSpskiz6MwZHs5R5qhyMDrNAT_VFksv07Fm9JHKLQlZQfcQ1hnS-Ltqjh5wnUAusY/s200/MirageFX_62103.jpg" width="165" /></a></div><div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none;"><br />
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. </div><div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none;"> </div><div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none;">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. </div><div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none;"> </div><div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none;">-Mr. Sleep</div>MISS SLEEPhttp://www.blogger.com/profile/08325394467143123162noreply@blogger.com0tag:blogger.com,1999:blog-8434858802490775914.post-5068521338848448282011-09-20T13:49:00.000-07:002011-09-20T13:49:35.204-07:00Sexsomnia???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! <a href="http://www.newscientist.com/article/dn6540-sleepwalking-woman-had-sex-with-strangers.html">(click here to read).</a><br />
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<u>Sleep sex</u> (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. <br />
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<iframe allowfullscreen="" frameborder="0" height="315" src="http://www.youtube.com/embed/WZh7F_YHfSc" width="560"></iframe><br />
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I love how the above video noted that men were found engage in sleep sex more than women......Why does that not surprise me?<br />
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-Mr. Sleep <br />
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References: <br />
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<span class="citation news">"Sleepwalking woman had sex with strangers". <i>New Scientist</i>. 15 October 2004<span class="printonly">. http://www.newscientist.com/article.ns?id=dn6540</span></span>MISS SLEEPhttp://www.blogger.com/profile/08325394467143123162noreply@blogger.com0tag:blogger.com,1999:blog-8434858802490775914.post-63810430923928957602011-09-20T11:22:00.000-07:002011-09-20T11:36:51.384-07:00ONLY AFTER ONE MONTH!!!!<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhw6BziJwvAFE7nTYaPc3DTwF5KPnbIlRT2-zBMHjob4F4L3RcC4-aSkPjCJth9RXjMS4HfQQMaq7gRTgYfeg-wBLEz-XsAxvPjhIFcKKqH087DJfpjH-tQLwtXwfro9eF0y0idTOFHryYh/s1600/photo.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhw6BziJwvAFE7nTYaPc3DTwF5KPnbIlRT2-zBMHjob4F4L3RcC4-aSkPjCJth9RXjMS4HfQQMaq7gRTgYfeg-wBLEz-XsAxvPjhIFcKKqH087DJfpjH-tQLwtXwfro9eF0y0idTOFHryYh/s320/photo.JPG" width="239" /></a></div><div align="left" class="separator" style="clear: both; text-align: center;"><br />
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</div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: x-large;"><em>After just one month </em><span style="font-size: small;">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.</span></span></div><div class="separator" style="clear: both; text-align: left;"><br />
</div><div class="separator" style="clear: both; text-align: left;"><span style="font-size: x-large;"><span style="font-size: small;">-Mr. Sleep </span></span></div><div class="separator" style="clear: both; text-align: left;"></div>MISS SLEEPhttp://www.blogger.com/profile/08325394467143123162noreply@blogger.com0tag:blogger.com,1999:blog-8434858802490775914.post-40826550199971992342011-09-16T15:09:00.000-07:002011-09-16T15:08:05.448-07:00An alternative to CPAP or another wannabe? <span style="color: white; font-family: Times, "Times New Roman", serif; font-size: x-large;"><em><strong>Legend has it that </strong></em><span style="font-size: small;"><em><strong>it</strong></em> <span style="font-family: inherit;">all started</span><em><strong> </strong></em></span></span>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. <br />
<u>UPPP</u><br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgziHlG8RZqurtcQjrBufaq-LpJcEE6ja-T8Q4ojkcWWWHLNFF9Y4p0X6nNPaRbfwdeSOnAA098XVFYpW8gjH3c-7pjoRUdmT-Vo5NNv5xeI3IjzHEaPSfQfDkwA287QA7bhpg4TZUFbtjD/s1600/220px-Uvulopalatopharyngoplasty.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" j8="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgziHlG8RZqurtcQjrBufaq-LpJcEE6ja-T8Q4ojkcWWWHLNFF9Y4p0X6nNPaRbfwdeSOnAA098XVFYpW8gjH3c-7pjoRUdmT-Vo5NNv5xeI3IjzHEaPSfQfDkwA287QA7bhpg4TZUFbtjD/s1600/220px-Uvulopalatopharyngoplasty.jpg" /></a></div> <br />
A patients airway after surgery<br />
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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 <u>Uvulopalatopharyngoplasty</u> 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. <br />
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<div align="center"><u>Didgeridoo</u></div><div align="center"></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXOEWT-K-L3YzTzeqMH1pEvEABJ6yt0SeE0jaDvD3PbTmXRRQCqMLa2YpEgqoIw0-opEtiI7D7U_oehk58D7vJuGKUxJnk9BS8AfrxDzIs409dkoXg9XdRfg26X7TlkaGAIfTlpO9BQUVa/s1600/el_yunque_didgeridoo_carringer_small.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" j8="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXOEWT-K-L3YzTzeqMH1pEvEABJ6yt0SeE0jaDvD3PbTmXRRQCqMLa2YpEgqoIw0-opEtiI7D7U_oehk58D7vJuGKUxJnk9BS8AfrxDzIs409dkoXg9XdRfg26X7TlkaGAIfTlpO9BQUVa/s1600/el_yunque_didgeridoo_carringer_small.gif" /></a></div><br />
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. <br />
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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.<br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrbX9xf4TtCI1e6fMlqbbXbfkVav-v0vOBQfrog2bts9auNVff5TBG-ORnxFehtK1fwwUveWiXwOTFp4k89GzX78E8eSNuOC3ZlzAxIF05xGoT4VxnlEd_awhy2LsO4AuQNuCpAr6u5R9I/s1600/gfx_about_provent.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" j8="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrbX9xf4TtCI1e6fMlqbbXbfkVav-v0vOBQfrog2bts9auNVff5TBG-ORnxFehtK1fwwUveWiXwOTFp4k89GzX78E8eSNuOC3ZlzAxIF05xGoT4VxnlEd_awhy2LsO4AuQNuCpAr6u5R9I/s320/gfx_about_provent.jpg" width="320" /></a></div><br />
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).<br />
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<iframe allowfullscreen="" frameborder="0" height="349" src="http://www.youtube.com/embed/HmfufUmxBbc" width="560"></iframe><br />
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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. <br />
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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.<br />
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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. <br />
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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.<br />
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-Sleep Guy<br />
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<div align="center">References</div><div align="center"></div>(1). Puhan M <i>et al</i>. Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomized controlled trial. <i>British Medical Journal</i>. 2006. 332:266-270.MISS SLEEPhttp://www.blogger.com/profile/08325394467143123162noreply@blogger.com0