Tuesday, October 25, 2011

Sleep Medicine, sleep apnea: know more

Continuous Positive Airway Pressure (CPAP) is beneficial to many people in resolving the symptoms associated with their sleep apnea and disruptive snoring. From time to time, however, problems can develop that are often easily remedied. Studies have found that CPAP wearers who educated themselves about basic troubleshooting had greater success and compliance with CPAP long-term.

Below are some common difficulties CPAP users run in to and some suggested solutions for each. As a general guideline, it is helpful to have the contact information for a durable medical equipment (DME) or homecare company available—their experienced staff can be a valuable resource in correcting some of these problems.

Redness, Irritated Skin, Facial Sores

These are often signs that a mask may be strapped on too tightly—most masks are designed to produce the best seal with the mask secure on the face, but not tight. Try loosening the headgear for the mask. Rubbing a small amount of Vaseline, or a similar jelly-like substance, around the edge of the mask that contacts the skin can also help alleviate irritation.

In some situations, a different style of mask may help. For example, if you are using a nasal mask (triangular shaped mask that fits only over the nose), switching to a nasal pillow style mask may be beneficial. This can be particularly helpful for people who sleep on their side and press their head into the pillow. Contact your DME or homecare company to talk about trying a different mask style.

Dry Mouth in the Morning

Waking up with a dry mouth and throat is generally the result of Sleep Medicine with an open mouth while wearing a nasal or nasal pillow style mask, which will allow air to blow out of their mouth, causing the mouth to dry out over the course of the night. In this situation, a chin strap can be tried—this is basically a large elastic band or headgear designed to fit around the chin and over the back of the head to keep the bottom of the mouth held closed during sleep. If a chin strap doesn’t work, then switching to a full face style of mask may be considered—these masks are designed to fit over both the nose and the mouth, so air will still be delivered correctly even if the mouth is open.

Typically, the addition of a humidifier will resolve dry mouth symptoms. If a passover or cool humidifier is being used, switching to a heated humidifier (which adds a higher level of water moisture to the air) is a good next step to try.

Some medications can also cause mouth dryness. If this is the case, consult with your physician about possibly changing to a different medication if desired.

Nasal Congestion, Dryness, Nose Bleeds

Similar to mouth dryness, the addition of a humidifier, or switching to a heated humidifier from a passover model, can usually resolve these symptoms. Using a saline nasal spray or decongestant before putting CPAP on at night can also be beneficial. For people with fine nasal features or a thin nose, switching to a different style of mask may be helpful—for example, some people find a nasal pillow style mask, which delivers the air pressure directly inside their nostrils, dries their nose out faster than a more standard nasal mask, which simply delivers the air towards the nose.

Moisture Accumulating on the Face

In this situation, decreasing the level of humidity added to the air will likely resolve the problem. For patients who sweat easily at night, using the passover (cool air) humidifier instead of a heated model is helpful. Also, try having a small fan on a nightstand or dresser to keep the head cool during the night. A smaller style of mask (i.e., switching from a full face mask to a nasal pillow mask with a chin strap) may also be beneficial.

Claustrophobia

Switching to a smaller mask type (particularly a nasal pillow style mask) is often the best remedy for a feeling of claustrophobia or being smothered. If you’re having difficulty adjusting to the mask, ask your doctor about ordering a desensitization session—these can be done in a relaxed lab setting during the daytime, when a variety of masks and pressures can be tried without having to go through the anxiety-inducing process of being hooked-up to wires and equipment necessary when doing a titration at night.

Pressure Feels Too High: Sensation of Drowning or Unable to Catch Breath

This often occurs for people who have severe apnea and require a high pressure to breathe normally while asleep—but find the pressure is too high to be comfortable when awake or trying to get back to sleep. In this situation the use of a “ramp” feature is very helpful, and most CPAP machines have a “ramp” button on them designed to lower the pressure for a period of time (usually at least 15-20 minutes) to allow a person to get back to sleep.

Pressures can also feel too high for individuals who have had a significant health change, such as weight loss. Consult your doctor if this is the case. A repeat CPAP titration may be recommended to see if the pressure needs to be lowered. For some people, a trial of BIPAP may also be suggested. Compared to CPAP, which uses one continuous air pressure, BIPAP uses two different air pressures—a higher pressure when inhaling, and a lower pressure when exhaling. Patients with hypoventilation, difficulty exhaling, and some cardiac or neurological conditions often find BIPAP easier to use than CPAP.

Mask Comes Off or Becomes Loose During Sleep

Try tightening the headgear a little before going to apnea—but not too tight! If the problem persists, contact your DME or homecare company about getting a different brand or style of mask the fits the face more securely—sometimes a different brand of mask, despite being the same style as what you may currently be using, can be shaped just differently enough to provide a more secure fit during the night.

Some people find that they simply aren’t able to wear a mask the entire night, despite trying several different brands and styles. In this situation, it is important to wear the mask as long as possible each night—it may be necessary to start off with fewer hours at first while getting adjusted to sleeping with CPAP. Most studies show that people will receive a significant improvement to their sleep and overall health when wearing CPAP for a minimum of four hours a night.

Mask Leaks, Whistles During the Night

These typically occur because the mask seal is getting broken during the night. Adjusting the mask for a better fit or trying a different style of mask often will resolve these problems—contact your DME or homecare company to do this. Adding a humidifier can sometimes improve a mask’s seal. For individuals experiencing these issues with an old mask, it may be time to replace the mask, as the material masks are made of will break down over time, which can cause leaks and whistling. Most insurance plans will pay for a replacement mask every six months; check with your provider for details.

Continued Snoring While Wearing CPAP

This is often a sign that the pressure may be a little low—consult with your doctor about changing the pressure; they may order a retitration in the sleep lab to double-check the pressure. This is particularly indicated for patients with a significant health change, such as weight gain, since they’ve starting using CPAP.

Some individuals do still snore despite their pressure adequately resolving all of their Sleep apnea symptoms. In these situations, a referral to an Ear Nose Throat (ENT) specialist may be helpful to determine if there are any structural issues in the airway that may be complicating how effectively CPAP is able to work.

This article has been taken from http://www.zimbio.com/Insomnia/articles/SL7OVN6oDYv/Sleep+Medicine+sleep+apnea+know+more?add=True

Wednesday, October 19, 2011

Sleep medicine, Sleep study, Sleep disorders: sleep disorders and so on

Sleep study also termed as polysomnography (PSG) is basically a multi-parametric test which is used to study sleep. In fact it is also used as typically a diagnostic tool in sleep medicine. Honestly, sleep study is basically an in depth recording of the biophysical changes during sleep where during the period of sleep, the body functions are typically monitored. This includes, brain, eye movements, muscle activity and also the heart rhythm. The focus of sleep study is however simple- to let you have a good night’s sleep.

Let’s accept the fact - deprivation of sleep can not only cause irritability but also it lowers performance level and reaction times while putting strain on the immune system. Well, many of us have had the odd night where we often pass the sleepless pillow for worrying about something like an impending exam or may be some kind of special event. However those’s occasional and now try imagine the situation if this goes for long – yes, you would be physically and mentally exhausted. Sadly, this is the situation of many people throughout the western world. Trust me; figures cannot go wrong and it is estimated that at least 40 million people in the United States of America suffer from chronic, long-term sleep disorders! Scary indeed!

Well, every patient that is suffering from chronic sleeping issues will start at the same place, a consultation with a sleep specialist. The sleep specialists are typically found in sleep labs or clinics. Once you meet with a specialist, they will review your symptoms and order additional testing such as a Sleep study, after which they will be able diagnose and treat your sleep disorder. They have the education and ability to treat many aspects of sleep conditions ranging from obstructive sleep apnea (OSA) to bedwetting with numerous sleep ailments in between.

After an initial consultation with a sleep specialist, they will likely order a sleep study that will provide a better look at your sleeping patterns. Sleep studies are usually performed at night while you sleep and are administered by a Registered Polysomnographic Technologist (RPSGT). An RPSGT is a professional that has obtained credentials through the Board of Registered Polysomnographic Technologists. In order to earn this title, a RPSGT must have attained the essential clinical hours (usually 18 months of paid clinical experience), have BCLS (Basic Cardiac Life Support) certification and passed an extensive examination and has proven proficiency in polysomnography. If a patient has been ordered to undergo a sleep study, they will visit a sleep lab or clinic and spend an evening or two being observed by the RPSGT. RPSGT’s are able to identify numerous irregularities in sleeping patterns and will then pass along this data to the sleep specialist, from which the sleep specialist will be able to prescribe a treatment.

Honestly, sleeps disorders are typically the conditions characterised by abnormal sleep patterns that interfere with normal physical, mental or emotional function. Anxiety and stress can cause serious sleep disorder, whether it be due insomnia, intermittent waking, or waking up much too early in the morning.

Needless to say that it is certainly the best time to check for any medical conditions that may contribute to a sleep disorder or anxiety disorder, and also to help determine which is the primary condition, i.e. is anxiety causing lack of sleep or is insomnia causing anxiety? Well, patients should always consider exploring the various options available for treating their sleeping issues.