Sleep-Tight blog

CPAP Compliance

2009-12-05T18:29:00.000-08:00

Many studies of CPAP compliance rates have been done. Those that use objectively and usually covertly measured compliance, report long-term compliance rates of 41-73%, with most in the 60% range. These rates go up considerably with a compliance program. Key elements to achieving good compliance are education, comfort, and follow-up. Patients that understand the long-term consequences of their disease are more likely to be compliant. Likewise, a proactive follow-up program can provide needed encouragement and earlier identification of problems.

With regard to humidification: Generally speaking it is advantageous to incorporate [heated] humidification into a CPAP/BIPAP delivery device. The human nose heats and humidifies the air we breathe during the course of a normal human breath. When delivering an artificial breath, as with a CPAP or BIPAP machine, often times the flow of air is too fast for the nose to do its job. Many times this leads to dried sinuses, and can cause a great deal of irritation and discomfort for the user. Heated humidification has been proven clinically to adequately heat and humidify the artificial CPAP/BIPAP breath to mimic that function normally handled by the nose.

Auto CPAP

2009-12-05T18:28:00.000-08:00

Auto CPAP is a newer variant that continuously monitors the patient and sets the air pressure to the lowest value that prevents obstruction. This value may change during the night, and may change over weeks and years. Patients report increased comfort with Auto CPAP, since they are generally exposed to lower pressures throughout the night.

Auto CPAP can be used in lieu of traditional titration when the patient uses auto titration for one or more nights. The clinician reads the profile of the pressure that was used during the trial, to determine the pressure the fixed CPAP unit will have. Alternatively, Auto CPAP can be used on a permanent basis. In this scenario, no titration is necessary, because the device is self Titrating. This model of therapy, is gaining popularity because of its simplicity and increased patient comfort. However, there are not enough outcome studies to show it is more cost effective than fixed CPAP.

CPAP (Continuous Positive Airway Pressure)

2009-12-05T18:25:00.000-08:00

A mask through the patients nose delivers continuous Positive Airway Pressure (CPAP). A constant stream of room air, often heated and humidified, is sent from a small blower at the patient’s bedside. The pressure is not enough to interfere with normal breathing, but it is thought that the stimulation of the airflow on the upper airway is enough to keep the airway open. Each patient requires a different amount of airflow. The effective airflow for each patient is traditionally obtained in the sleep lab as part of a titration study. In some labs, this study may be done on the same night as the sleep study – a so-called Split Night Study. In others, a titration study is done on the following night.

The technical applies the CPAP and sets the pressure value; the value is increased or decreased, until the lowest effective level is found. The patient is then provided with a CPAP machine fixed at that setting. This model of treatment suffers from the same problems as in-lab diagnostic testing. It requires trained technicians in a sleep clinic. The Patient encounters the same backlog, the same bottleneck, and inconvenience. If the time between diagnosis and treatment is prolonged because of accessibility, the risk of legal liability may become an issue.

CPAP is a treatment, nothing more. It is not a cure. It is worn, every night. The effect on the Apnea/Hypopnea index and overall sleep is immediate. Patients often report waking up the next morning, feeling like a new person. The effect on nocturnal blood pressure is immediate as well. A drop in daytime blood pressure may be seen in a few days or weeks. All of these effects are reversed if the CPAP is not worn.

The American Thoracic Society has an official statement on this matter, “CPAP is effective in eliminating Obstructive Sleep Apnea, Oxyhemoglobin desaturation, and respiratory related arousal from sleep. CPAP is also associated with improved morbidity as manifested in primarily a reduction is daytime sleepiness, and improved cardiopulmonary function. Although the long term effects of nasal CPAP have not been fully determined, available data suggests a possible reduction in mortality.”

Treatment Options of OSA

2009-12-05T18:22:00.000-08:00

Weight loss is an effective treatment for the obese patient. Weight loss studies have shown that as the body mass index (BMI) goes down, the Apnea Hypopnea Index (AHI) goes down as well. While generally effective, effective weight loss requires a life style change, which can be difficult to initiate, and even more difficult to sustain, and naturally, it has no effect on non-obese patients.

CPAP, or continuous positive airway pressure, is the most effective treatment for Obstructive Sleep Apnea. If used properly and consistently, it is highly effective in virtually every patient. There are several variants of CPAP, Bi-level CPAP (BIPAP), Auto CPAP, Etc.

Tonsillectomy and Adenoidectomy is the preferred treatment for children, and is almost always effective. The results for surgery in adults are mixed however. There are many different kinds of surgeries. Radio Frequency Ablation creates scarring to stiffen the palette. Splints can be inserted into the palette for the same reason. LAUPP or Laser Assisted Uvulo-Palato-Plasty, Mandibular Advancement – effective, but major surgery; and methods to tighten, advance, and tie down, or otherwise keep the tongue from falling back into the throat can be complicated procedures, to say the least. Surgical interventions typically measure success as a percentage reduction in the AHI. The AHI is often still above the threshold of OSA – and there is a fair chance of recurrence after several years. Still in all, surgery is a viable option, especially for the non-compliant CPAP user.

Oral appliances are worn at night, to temporarily advance the mandible. They may be used in conjunction with CPAP. The attitude of the sleep community regarding oral appliances is mixed, and this is an area of treatment that is still undergoing significant development. People are now beginning to look at the long-term consequences of wearing an oral appliance every night, such as changes in the teeth and jaw. There is one treatment not listed here: positional treatment. Sewing a tennis ball into the back of the nightshirt; this treatment has been largely discarded by the sleep community as being insufficiently effective, and also difficult to manage.

Of these treatments, CPAP is the overwhelming treatment of choice in the sleep community. Surgery would be suggested only after earnest trials of CPAP have proven ineffective. Drug therapy is the goal for many in the sleep community. There have been some promising early trials, but there is currently no drug treatment for Obstructive Sleep Apnea, and no compounds are near release that has an acceptable efficacy, or side effect profile.

Pediatric OSA

2009-12-05T18:20:00.000-08:00

This presentation focuses primarily on adults, but it is worth talking about pediatric patients for a moment.

Kids are most at risk from the ages of 3 to 9. During this time, the development of the airway is such that the tonsils are largest, in relation to the rest of the airway. These relatively large tonsils and adenoids are the leading cause of OSA in kids.

The link between ADD of ADHD and Obstructive Sleep Apnea has received a lot of attention in the popular press, but they may have overstated the case. The exact overlap between Obstructive Sleep Apnea and ADHD patients is unclear.

OSA does result in poor sleep, tired adults get sleepy, tired kids get cranky fussy, and have a short attention span, just like kids with ADHD. In adults, a suspicion of depression should trigger a suspicion of OSA. In kids, a suspicion of ADHD should trigger a suspicion of OSA as well. Remember, ADHD and Obstructive Sleep Apnea are two very different diseases, but they share many of the same symptoms. The overall prevalence in kids is about the same as in adults.

In summary, we begin with the clinical definition of Obstructive Sleep Apnea: A total closure of the upper airway resulting in reduction or cessation of airflow, despite persistent respiratory effort.

Unfortunately nobody knows what causes sleep apnea, but major symptoms of the disease include snoring, gasping and/or choking while sleeping, daytime sleepiness, and chronic fatigue. It should be noted that several of these symptoms are similar to those found in adult depression.

In addition, OSA is more common in obese patients, than in the rest of the population. The prevalence of OSA in the US is approximately 4% for men, and 2% for woman; and, even more so than diabetes, a significant portion of people with obstructive Sleep Apnea has not been diagnosed.

Finally, we discussed the prevalence of OSA in children, approximately the same as in the adult population, and noted, symptoms commonly associated with ADHD, should trigger a suspicion of OSA as well.

Prevalence of OSA

2009-12-05T18:19:00.000-08:00

Estimates to the prevalence of Obstructive Sleep Apnea in the Unites States are 2% for woman, and 4% for men.

There are many studies giving higher prevalence number for specific populations - 9% for middle-aged white males, up to 24% and even 40% in some populations.

The links between OSA, age and obesity, lead most to conclude that the number of Obstructive Sleep Apnea will continue to grow. This prevalence of 18 million people with OSA is on par with Diabetes and Asthma. It is estimated that 50% of the people that have diabetes, don’t know it.

These are the people commonly referred to as the missing 10 million. There is a lot of effort in healthcare to reach out to these individuals to encourage treatment. The picture for OSA is bleaker than that; only about 10% of the people suffering for OSA have been diagnosed.

Remember that each one of these undiagnosed patients is costing the health care industry twice as much as everyone else, and getting into 6 times as many car accidents.

Obesity and OSA

2009-12-05T18:17:00.000-08:00

Here are the results of a few studies looking at obesity and Obstructive Sleep Apnea. There is a clear and strong link between obesity and sleep apnea.

Fat deposits in the neck narrow the airway, greatly increasing the chance of acquiring sleep apnea. OSA is seen as a disease of obesity, and this is a fair assumption. But don’t be fooled, not all of OSA patients are obese.

Certain Asian populations have a equal susceptibility to OSA as the U.S. despite having much lower rates of obesity. This is likely due to Cranial Facial differences. Looking at the first study, remember that although 2/3 of the participants were obese, 1/3 were within 30% of their ideal bodyweight.

Symptoms of OSA

2009-12-05T18:15:00.000-08:00

You can probably guess one of the most common symptoms of sleep apnea – that’s right – snoring. 50% of chronic snorers have sleep apnea. Snoring is the Hallmark symptom of Sleep Apnea. It is important to note though, that not all Obstructive Sleep Apnea suffers will be snorers. Gasping or choking is often the action that directs the bed partner to seek help. The loud snoring wakens the bed partner; they will look over and see their mate is not breathing. This can go on for 40, 50, 60 or more seconds. It can be a very frightening thing to see. The literature refers to this as ‘Witnessed Apnea’.

In some cases of OSA, the patient will self awaken with palpitations or a racing heart. In this case, individuals think they are awaking from a panic attack - a spike in blood pressure and an increase in heart rate accompany this arousal. These symptoms can be misinterpreted as a panic attack. Daytime sleepiness is a good predictor or sleep apnea, but it is not very sensitive - many OSA patients little to no daytime sleepiness.

The same applies to the workplace. Chronic fatigue can also lead to personality changes. A common complaint of chronic OSA patients is that they get a full 8 hours sleep, but still wake up tired. Look at these last four symptoms; do they remind you of anything else? They look a lot like depression. Anytime there is a suspicion of depression in a person/patient, you should ask a few simple questions to see if the person/patient is a candidate for Obstructive Sleep Apnea diagnosis.

Depression and OSA are 2 very different diseases. Treating an OSA patient for depression does nothing, just as treating a depression patient for OSA does nothing as well. However, the symptoms of the 2 diseases do overlap, and it is important to rule both of them in, or out.

Causes of OSA

2009-12-05T18:13:00.000-08:00

What causes Obstructive Sleep Apnea? The truth is, nobody knows.

When we sleep, the brain ‘turns down’ most of the motor functions, except the heart and lungs; this essentially keeps us from acting out our dreams. During sleep, the muscles of the upper airway also lose tone. When this happens, the negative pressure of an inhalation may be, in some, enough to collapse the airway. Fatty deposits, facial structure, or other factors may result in someone having a narrower than normal airway. It is believed that this narrowing, combined with an inherit predisposition to the disease, leads to Obstructive Sleep Apnea.

Each obstruction typically ends with an ‘EEG Arousal’. The brain can then recruit enough muscles to open the airway. Some research suggests there might be a neurological component to obstructive sleep apnea. Serotonin and Dopamine levels have been linked to Obstructive Sleep Apnea, both inside and outside the brain. Age is a factor, because of the general loss of muscle tone, but nobody knows for sure what the underlying cause, or causes are.

Definition of OSA

2009-12-05T18:11:00.000-08:00

Obstructive Sleep Apnea is the partial or total closure of the upper airway, resulting in reduction, or cessation of airflow despite persistent respiratory effort.
The location of airway collapse varies from patient to patient. It may be due to a soft palette, enlarged tonsils, or the base of the tongue falling back into the throat. Please note that OSA requires breathing effort – the throat collapses during the attempted inhalation phase, and the patient continues trying to breathe, despite the obstruction.

Another type of apnea event is Central Apnea. This happens when the patient stops trying to breathe. Central Apnea’s may be present in Obstructive Sleep Apnea, but they are not the primary events. A patient with predominantly Central events does NOT have sleep apnea, and other treatments would be indicated. Far fewer patients have Primary Central Apnea than Obstructive Sleep Apnea.

What is obstructive sleep apnea?

2009-12-05T18:08:00.000-08:00

What is obstructive sleep apnea, and why should we care about this disease? Why is it important? What are the symptoms? How is it diagnosed? What are the treatment options? Why should we care about obstructive sleep apnea? Is it a ‘disease-of-the-week?’ - A nuisance disease without serious consequence? There are many reasons sleep apnea is, and should be taken very seriously.

Hypertension
Hypertension is a serious side effect of sleep apnea, independent of obesity. The throats of the sleep apnea suffer collapses throughout the night. Each event of this occurrence ends with an arousal of near awakeness. Each episode like this represents a spike in blood pressure. It has been clinically proven that there is a direct relationship between daytime high blood pressure and obstructive sleep apnea. It has also been proven that effective treatment of sleep apnea can yield a 10 mm drop in systolic blood pressure; making it as effective as drug therapy in the hypertensive sleep apnea patient.

Heart Failure
Heart Failure is also related to obstructive sleep apnea, independent of traditional risk factors. A full 40% of Congestive Heart Failure (CHF) patients have been found to have obstructive sleep apnea. If left untreated, sleep apnea increases the risk of heart complications by 5 fold. RDI, a measure of sleep apnea severity, which we will define shortly, is an independent predictor of death, in coronary artery disease. During a sleep apnea event, not only is there a drop in oxygen levels, and an increase in blood pressure, it also releases a number of inflammatory agents; these agents are considered to greatly increase the risk of cardiovascular disease. Left Ventricular Hypertrophy also seen in patients with Obstructive Sleep Apnea improves with treatment of OSA.

Increase Accident Rates
Increase Accident Rates are independent of general daytime sleepiness. This means the untreated obstructive sleep apnea patient is 6 - 7 times more likely to be in an automobile accident, even if they do not feel drowsy during the day. New Jersey has just signed the first Drowsy Driver Law recognizing the seriousness of driving without getting an adequate amount of sleep. In some countries, drivers diagnosed with sleep apnea risk losing their job if they are not compliant is getting treatment for Obstructive Sleep Apnea.

Diabetes
The link between obstructive sleep apnea and diabetes is getting stronger. There is growing empirical evidence that sleep apnea starts a chain of events that leads to diabetes. Recent research has identified all the links in this chain, and every week new studies are solidifying this relationship. There is preliminary evidence that suggests diabetes can lead to obstructive sleep apnea. If both of these finds are verified, the potential for a downward spiral is significant.

The Cost of Untreated OSA
If none of the previously mentioned reasons gives you motivation to treat your sleep apnea, perhaps this reason will inspire a closer look at addressing the disease – money. A patient with untreated sleep apnea costs the health care system twice as much as a control patient (patient without sleep apnea). Follow up studies on the treated sleep apnea patient shows that the per-patient costs do come down in the year following treatment, and after 2 years, are no higher than control patients. A study done in Manitoba looked at the cost of patients 10 years preceding diagnosis, overall costs were double, and overnight hospital stays were also doubled over the entire 10-year span. Once again, costs came down after treatment. These results have been replicated by different studies using different measurements of health care costs. On a personal level, I have seen this manifest itself in the clinical environment. Once a patient is effectively treated for OSA, their inpatient hospital stays for their various [other] disease processes, simply put – decreases.

In summary, there are many reasons to care about OSA. Hypertension, stroke, and cardiovascular disease are all complications of OSA. The link to diabetes continues to grow stronger as well. Untreated sleep apnea patients are 6 times more likely to get into a car accident, and the finally, in today’s environment of skyrocketing healthcare costs, an untreated sleep apnea patient, costs the health care system twice as much as someone without sleep apnea.

Sleep-tight CPAP Aftercare

2009-12-05T17:53:00.001-08:00

Although CPAP revolutionise your life, adjusting to its use can be quite challenging. The primary reason for users giving up CPAP is due to lack of tailoring to be as comfortable as possible. This is an involved process which means you need continuous help from experts.

Our aftercare service makes the difference between success and failure. We offer tailored service to our customers who need specific care such as special masks, pressure cycle, humidification, tailor-made pillows and consultation with our sleep technologists or doctors.

Your sleep cycle can be altered. It all depends on your body condition on the day. Therefore, the ability to analysis CPAP data effectively it is the key to fine tuning CPAP machines from good night sleep.Moreover, doctors can log on to our aftercare website and check on patients nightly diagnostics.

Please do not hesitate to contact our online sleep care system www.onlinesleepclinic.com.

Why Sleep-Tight.co.uk?

2009-12-05T17:44:00.000-08:00

SLEEP TIGHT supplies some unique CPAP respiratory equipment at competitive prices with a comprehensive aftercare service.

Our machines come with very advanced data monitoring software which can be downloaded in real time to the internet and analyzed by our sleep technologist (RPSGT).

Also, we provide a large range of sleep diagnostic devices including level 2. 3 and 4, and offer a very affordable rental service.

SLEEP TIGHT is part of an international company with offices in Asia, America and the UK and able to supply most CPAPs and respiratory equipment. We keep up to date with the latest advances in treating sleep apnea.

These are our services that we offer to users of our equipment.

1. All our products come with a two years full guarantee/warranty on any faulty parts.
2. Text and email service for peace of mind to remind you when to change mask and filters etc.
3. Ability to order parts cheaply.
4. Traditional shop! Why not come and visit us and try out different masks and CPAP machines in a relaxing environment.
5. Call us. Our expert helpline is available at any time.
6. Option to a rent if on a budget. After a period of time you can also return it if you can’t get used to particular rental machine.
7. Save money with our coupon system.
8. We supply a range of related sleep aid options.

SLEEP TIGHT has been in this field for a decade and have an in depth knowledge of sleep respiratory medicine. You’ll be happy with our professional advanced service and broad range of equipment. You are very welcome to visit our office where you will be able to see the equipment we offer.

RESmart Auto CPAP

2009-12-05T17:33:00.000-08:00

RESmart Auto (APAP) adopts advanced sensor technology, automatically tracking a patient respiratory condition. The intelligent control system provides patients with reliable therapy for Obstructive Sleep Apnea (OSA).

Why use auto CPAP rather than CPAP?
The optimal pressure should not be ideally fixed because the pressure requirement will be changed through the night due to many factors such as whether you have alcohol, nasal allergies, sleep position, stage of sleep cycle and body condition etc.

Why use RESmart Auto CPAP rather than standard auto CPAP?
Because general Auto CPAP pressure will respond after the patients have woken up (which is closing the gate after the horse has bolted). Instead of one size fits all RESmart Auto CPAP can be tailored to the individual sleep cycle to allow comfortable pressure for falling asleep and stronger optimal pressure when going into REM sleep.

There are several advantages of RESmart Auto CPAP.

1. It is standard with REsmart Auto CPAP to record raw airflow signal in the same manner as if one was having a sleep exam. This extra information is really useful in finding the patients optimal pressure range.

2. Pressure sensitivity can be adjusted. Some patients may prefer gradual pressure adjustment while some may prefer more responsive prompt adjustment. RESmart Auto CPAP provides either

3. We provide soft pressure function at the initial part of expiratory phase that is “RESLEX”. This is similar to what other competitive brands call C-FLEX, EPR etc.

4. Our equipment’s noise level is low when compared with other brands.

5. The price of RESmart Auto CPAP and consumable accessories are very reasonable.

6. The key point in managing nasal problems whilst using CPAP is humidification. RESmart Auto CPAP provides integrated programmable heated humidification.

7. Patented anti-countercurrent water tank.

8. Your auto CPAP comes with software packages that allow you to download data and check the results. Also, we can analysis any data for you if you upload it to our aftercare website.

9. Unique Stop-delay feature protects RESmart Auto from humidity hazard.

10. DC 12V powered and infrared controlled humidifier make user safe and feel comfortable.

11. Can upgrade Firmware of RESmart Auto regularly.

12. We can analysis your CPAP data by a simple code without needing data from CPAP machine. Patients can just let us know the code by phone or email and we can interpret for you. That is “iCODE”. This is similar to what other competitive brands call this function “SmartCode”.

Technical Specifications:

Dimensions: 220 × 194 × 112 mm
313 × 194 × 112 mm (with InH2 heated humidifier)
Weight: ＜2 kg
Product Use, Transport and Storage Operation Transport and Storage
Temperature: 5 to 40℃ - 20 to 55℃
Humidity: ≤80% Non-condensing ≤93% Non-condensing
Atmospheric Pressure: 86 to 106 kPa N/A
Standard Compliance
IEC 60601-1 General Requirements for Safety of Medical Electrical Equipment
ISO 17510 Sleep Apnoea Breathing Therapy
AC Power Consumption
100 – 240VAC, 50/60Hz
Type of Protection Against Electric Shock
Class II Equipment
Degree of Protection Against Electric Shock
Type BF Applied Part
Degree of Protection Against Ingress of Water
IPX0 – Ordinary Equipment
Pressure Range
2 to 20 hPa (in 0.5 hPa increments)
Pressure Stability
2 to 20 hPa (±0.5 hPa)
Sound Pressure Level
＜30 dB
Maximum Flow
＞15 LPM
Pressure Display Accy.
±0.5 hPa

What is Obstructive Sleep Apnea?

2009-12-01T18:27:00.000-08:00

Obstructive Sleep Apnea (OSA) is a condition in which a patients breathing passage seals during sleep, causing the patient to stop breathing. Apnea is Latin for without breath? The body responds to this lack of oxygen by arousing, or waking from sleep. This cycle leads to the patient being unable to get the needed quantity of restful sleep and results in:

Constant Fatigue
Difficulty Focusing
Irritability

Untreated Sleep Apnea is potentially fatal and frequently results in the following serious health problems:

Heart Attacks
Strokes
High Blood Pressure
Diabetes Pictured Left: A healthy, unobstructed upper airway Pictured Right: An unhealthy, Obstructed upper airway