OBSTRUCTIVE SLEEP APNEA AND CPAP COMPLIANCE

By Olukunle Ajagbe, MD, Laurel Sleep Disorders Center

Obstructive Sleep Apnea (OSA) affects about 15 to 20 percent of the adult population. The disease condition is still under-diagnosed, and primary care physicians have to be vigilant to find those patients with unexplained daytime sleepiness and refer them to a sleep physician.
Once patients are diagnosed, in most cases they will be started on CPAP therapy. CPAP (Continuous Positive Airway Pressure) prevents the collapse of the upper airway during sleep. Treatment with CPAP will almost always bring an immediate improvement in snoring, daytime sleepiness, fatigue, mood, and the “get up and go” feeling.

The main problem with CPAP use comes with compliance. Medicare requires at least four hours of use every night or CPAP will be taken away from the Medicare beneficiary. This is emphasized to most patients, but a better explanation should be that CPAP should be used whenever the patient sleeps, be it daytime or nighttime.

CPAP compliance issues sometimes stem from the unnatural feeling of pressure or the mask on the face; this can be resolved with gradual desensitization. If the pressure is felt to be too high, it should be discussed with the sleep physician or DME (Durable Medical Equipment) company which supplied the CPAP, as soon as possible. If there is any problem in tolerating the mask, the DME can try different masks. If the pressure is perceived to be too high, it can be reduced with discussion with the sleep physician or a ramp pressure introduced.

CPAP compliance can also be affected by the wear and tear of disposable parts. With the disposable parts falling apart, the CPAP will not be as effective. Masks, hoses, and filters can be replaced every three to six months; this has to be explained to the patient. I once met a patient who had not changed his mask in five years and had to tape it together to prevent it from falling apart. Following up with your sleep physician should prevent that problem.

A lack of understanding of what Obstructive Sleep Apnea is and the long-term effects of being untreated could be another cause of lack of compliance. I take the time to show patients a comparison of their sleep study without the CPAP versus sleep study with CPAP. Seeing the change from a “disturbed” sleep to “calm” sleep always makes a positive impact in keeping patients compliant. I also emphasize the improvement in their energy level and less sleepiness as evidence of what the CPAP is doing for them.

Self-treatment by the patient is another reason for noncompliance. If patient loses weight and rightfully feels their sleep apnea should be better, instead of discussing this with a sleep physician, they decide to stop using CPAP. Unknowingly, they will have a gradual resumption of their old symptoms. Also, if there is weight gain, symptoms come back with a vengeance. In these cases, the CPAP machine could have lost or missing parts, so it cannot be used.

The most important factor in compliance is to work closely with the DME company who supplied the CPAP and your sleep physician. Important points to note are depending on your insurance, you may lose your CPAP if you are deemed noncompliant. Do not stop CPAP without discussing with your sleep physician. Your DME company and sleep physician will always be ready to help you with CPAP compliance. Obstructive Sleep Apnea is a chronic disease condition like hypertension, diabetes, or asthma and it needs follow-up and monitoring by a sleep physician.

Source: http://www.healthycellsmagazine.com/articles/obstructive-sleep-apnea-and-cpap-compliance

CELL PHONES, SOCIAL MEDIA, AND GAMING THE SCOURGE OF SLEEP

Submitted by Laurel Sleep Disorders Center

The cell phone is an indispensable appendage that we have now. I, personally, never wanted a cell phone until my car broke down in a snowstorm 20 years ago, and I had to walk back and forth to the payphone (if anyone remembers what that is) to call the tow truck. Finally, the police had to jump my car to get me back on the road, and I got myself a cell phone the next day.

Fast forward to circa 2007, the first smart phones had just come out. Suddenly, the phone was not just a means of communication, but your internet, bank, calendar, alarm clock, flashlight, game room, and personal entertainment. Now, a cell phone is no longer a luxury; it has become a necessity as a lot of financial transactions, personal information, and services are linked to your cell phone number.

The problem now is the phone has become an enemy of sleep. A lot of people text late into the night and constantly check their phones for replied texts or emails, which disrupts their sleep. Phone calls made in the bedroom affects one’s sleep or their bed partner’s sleep. Most people are on social media until late. Facebooking, Instagramming, or YouTubing should soon be in the Oxford English Dictionary. With over 2 billion users, there is always something interesting to see on social media, be it the videos of your friend’s wedding, cat videos, reality TV, talent shows, or highlights of the game you missed.

Gaming can be subtle like crushing candy, being chased by a dog, card games, chess, fighting villages, killer birds, building a lifestyle, or farming. It can also be hardcore fighting battles with aliens, usually extraterrestrial, using three to four screens and interacting with other players in these battles. These games are catchy, that is what makes them popular, and there is a reward system that keeps you playing the games.

Sometimes social media, gaming, or cell phone use might be brought on by other underlying sleep problems. Some patients with Obstructive Sleep Apnea (OSA) wake up all through the night and, with their disturbed sleep, end up playing on the computer, texting, or making calls all night long. Restless legs syndrome (RLS) can also prevent people going to sleep on time, and some use social media to distract from the disturbing symptoms of the restless legs.

If there is no discipline, texting, social media, or gaming can eat into one’s sleep time. The more into it you are, the higher the likelihood of going to bed late and getting limited sleep — hence feeling sleepy during the daytime. Taking a “makeup” nap during the daytime will definitely worsen things, as your sleep rhythm will suddenly be in disarray, and you may find yourself seeking a sleep doctor to correct your insomnia.

The solution to the social media, cell phone, and gaming problem is to create a fixed time outside the bedroom when you can interact with the different media. This should not be done in the bedroom, as it will tempt you to continue to disrupt your own sleep. After all social media interactions are over and all games finished, then you can come back to the bedroom to sleep. If, however, there are still problems with insomnia, it would be best to discuss it with your sleep physician to help ensure that there are no other underlying sleep problems.

Source: http://www.healthycellsmagazine.com/articles/cell-phones-social-media-and-gaming-the-scourge-of-sleep

THE GOLDEN AGE OF SLEEP

Submitted by Laurel Sleep Disorders Center

He walked into the exam room gingerly, 82 years young and he definitely had something on his mind. “How do you feel today?” I asked, “I really do not know how to feel since I have never been 82 before” he quipped. He was worried about new onset of fatigue he was feeling which had been going on six months with associated daytime sleepiness. He denied weight gain, and his nighttime sleep, though he snored, was felt to be the same, but he was now waking up tired. He had a sleep study, which showed obstructive sleep apnea and was started on CPAP which improved his symptoms.

Baby Boomers (date of birth 1946 to 1964) are now approaching or are in their 70s, and they will be facing a lot of sleep-related issues. To be aware of such and taking steps to resolve them will make ageing better. The normal body undergoes changes as it gets older — be it hormonal changes, musculoskeletal changes, homeostatic changes, cardiovascular changes, pulmonary changes, or urologic changes. All this put together may affect the sleep in a person.

Insomnia prevalence in the elderly is about 30 to 40 percent, it increases as one ages, it is more of an inability to maintain sleep rather than fall asleep, and it is worse in women. Sometimes, it may be made worse by phase shift (older people go to bed early and wake up earlier, at the wrong time of the morning and, in some cases, the reverse) even though they got enough sleep. Psychiatric disorders may present with insomnia and are also worsened by insomnia.

Obstructive Sleep Apnea (OSA) prevalence more than triples from the age of 40 to 80, and this might be from the increase in women developing the disease after menopause. Factors playing a role include hormonal changes, increased body weight, increased upper airway collapsibility, and reduced pulmonary function. Anatomically, as one gets older, the soft palate gets longer, pharyngeal fat pads increase in size, and the shape of bony structures around the pharyngeal airway also change.

In the elderly with OSA, apneas (cessation in breathing) are less noticeable, snoring is not as common; however, sleepiness or fatigue is noted, decreased cognitive function (sometimes mislabeled as early-onset dementia) occurs, nocturia (using the bathroom multiple times at night to urinate) increases, risk of car accidents increase, impotence, worsening diabetes control, uncontrolled atrial fibrillation, and uncontrolled hypertension are features noted in sleep apnea patients. The use of CPAP (Continuous Positive Airway Pressure) in OSA patients improves daytime sleepiness, attention, vigilance, and executive functions. It also delays atrial fibrillation progression, improves nocturia, and CPAP has also been shown to reduce all causes of mortality in OSA patients in some studies.

As a person grows older, they go from being on no prescriptions to being on many prescriptions for their different ailments. Some of these medications affect sleep, from diuretics which break continuity of sleep, to sedating or non-sedating antidepressants, even to over-the-counter antihistamines, prescribed benzodiazepines, and narcotic pain medications will definitely affect sleep. A full workup of sleep is not complete until all medications that the patient takes are taken into consideration and seen if they affect the patient’s sleep.

In the elderly, sleep is very important as they go from actively working people to retirement into the Golden Age (most of my patients say it is not Golden). Insomnia will need to be addressed if it develops, sleep apnea might develop more among post-menopausal woman. Sleep apnea might worsen some cardiovascular, neuro-cognitive, and endocrine conditions, and treatment of sleep apnea with CPAP leads to an overall improvement in these. Medications may affect sleep, and these will need to be addressed either by the primary care physician or a sleep physician.

For more information, go to our website at www.laurel-sleep.com, or call 601-649-2818 to set up an appointment to speak with our sleep physician, Olukunle Ajagbe, M.D.

Source: http://www.healthycellsmagazine.com/articles/the-golden-age-of-sleep