Sleep Blog

In the bygone days of the mid-to-late 1800s, especially with the westward expansion in the U.S., many traveling sales folks had one goal in mind: make money and make it now. Two days later, the traveling sales folks would be in a different town, hopefully without anyone in the audience of the public spectacles they made of themselves to hawk their goods.

The ailment of the day was painted or printed on anything possible, including potions that could kill. They soon became known as “snake oil,” named after Clark Stanley’s Snake Oil Liniment.

The intent of those traveling salesmen, and yes, sometimes traveling saleswomen, was to make money. Nothing else mattered, just as long as their pockets, or perhaps wallet or purse, was full of greenbacks earned by selling their snake oil. If someone was in the audience that knew them from another town, things usually went back for these sales folks selling their finest snake oil.

Not much has changed over the past 130 years or so, it seems. When it comes to the world of sleep medicine, especially many sleep disorders, in particular, cures and treatments dreamed up by those wanting to hawk their snake oil is still very much alive and well.

Continue Reading »

No Tags

If you enjoyed this post, make sure you subscribe to my RSS feed!

This is a story from “the Doctor is Always Right Dept.” or the “Physician, cause no harm dept.” …

A provider calls a doctor to discuss a prescription for a new xPAP machine for a patient. The sleep study shows the person needs a bi- level machine with an IPAP (the inhalation pressure) at a pressure greater than 20. The doctor gave the patient a prescription for a CPAP (which has only one pressure) at 10. Here’s how the call went:

Provider: Doctor, the sleep study called for a bi-level machine at these pressures …

(doctor cuts off provider mid-sentence)

Doctor: That’s okay, I know what I wrote.

Provider: Are you familiar with the difference between a bi-level and a CPAP and what purpose pressure levels serve?

Doctor: Don’t try to speak down to me. I am a doctor. If you want to talk to me like that, tell me just where you earned your medical degree!

Provider: Doctor, I’m really not. I am trying to make sure the patient gets the equipment they need to treat their apnea. I’m seriously concerned about your patient, as the prescription you wrote is for less than half the pressure shown to be therapeutic during the sleep study.

Doctor: I’m the doctor and I write the prescriptions. Handle it as I ordered.

(doctor hangs up)

A day later the patient goes to the provider’s location to pick up the equipment.

Patient-to-Provider: What’s this? I’m supposed to be getting a bi-level machine.

The provider explains the conversation to the patient at this point.

Patient: I’m going to a different doctor, one who has his head screwed on straight and knows what he is doing when it comes to sleep apnea. I’ll be back with a prescription for what I really need.

________________________

Yes, this kind of thing happens a lot, unfortunately. Yes, before you ask, this was a real conversation, which makes this all the more sad and pathetic. The moral of the story: be a well- educated, well-informed patient, as no one else will be your advocate if you don’t advocate for yourself.

Aside from being valid, the excuses, such as “woe is me” and the “I’m tired of fighting the idiots” are tired and poor excuses. They do go back to the heart of the matter, which is summed up best in this old attorney joke:

Attorney 1: What do you call the person who was graduated at the bottom of his class from medical school?

Attorney 2: Sir?

Attorney 1: No, you call him the same thing you call the person who was graduated at the top of his class: “Doctor.”

Just food for thought. Always be on your guard. Know what’s going on. Know and understand terminology, your equipment, and such.

Educate yourself about all your health conditions as much as possible, and stay on top of things. If you can’t do that, for whatever reason, such as having too little time, not having a network of people to turn to for help, not understanding “medical-ese” or whatever else, turn to someone — in real life, not on the Internet — to tag along with you who does understand the issues involved, but who does have a grasp of your health conditions and is willing to be your advocate.

It doesn’t take much to make a major screw-up. If you start a trip on the Boardwalk in Atlantic City and begin walking, wanting to end up in Malibu, California, you better have a map, a compass, an azimuth, or a GPS device and know how to use the tools. You also need to know from where you are starting and where you want to end up at the final step of your trip.

A slight variation, for example, if you are hiking the distance, of but one degree will keep you hundreds, if not a thousand miles or more (I didn’t change the degree calculations, sorry) from your destination — either too far north or too far south, and that is if you start out in the right direction, which would be a westerly direction. If you ended up walking southerly, you will likely end up in one of the Southern states or Mexico.

The same principle holds true in regard to your health care: a slight deviation can produce results far from the optimal result. Be your own best advocate or enlist someone to fill that role for you. It is a necessity, not just a “nice thought,” as someone told me the other day. The person said that after they complained to their treating physician about not liking the feel of the air pressure from their bi- level machine during the first night of use at home. The person had been diagnosed with severe obstructive sleep apnea, had several related health issues, including cardiac issues and memory loss.

The doctor told the person that if they didn’t like it they shouldn’t use it, adding that it “won’t do any harm.” Interesting. I told the person to get a large life insurance policy, list their spouse as the beneficiary, and make funeral arrangements. The person didn’t like the answer, asking me to tell them “the truth” as they wanted to hear, which was that things would be okay and that apnea isn’t a serious health issue.

Unfortunately, too many in the medical community are far too uneducated — or know just enough about sleep apnea, nay, sleep disorders, overall, to be dangerous — and live with stereotypes and thinking that is at least 20 years old.

Too many in the medical community are not up-to-speed, up-to-date on the gravity of sleep disorders. Until a comprehensive outreach program is launched, a comprehensive education program — one that uses public service announcements on TV, radio, print publications, and the Internet — things will not change.

Sleep disorders are at the same stage where diabetes was around 40 years ago or so. I’ve been working to get several campaigns launched — ones that are conceived, planned, designed, and people at-the-ready — but getting the funding for such an endeavor is like holding your breath under while being prodded with a stick.

Do you have 40 years to wait for your health care providers to get up- to-date on sleep disorders so they can begin treating you appropriately?

Not using an xPAP will land you in the grave. It may be tomorrow, it may be a year from now, or maybe five years. It depends on how much damage has been done to the body already. The cause of death will be listed as something else, such as heart attack, heart failure, sudden cardiac death, and the list goes on. The true underlying cause — the sleep apnea — will probably not make it in print on the death certificate, yet it provided such a large role in the ultimate outcome.

The choice is yours: be educated, advocate for yourself, or suffer the consequences at the end of the road.

________________
Technorati Tags: medical care, health care, medical treatments, medicalese, medical equipment, physicians, health, illnesses, diseases, disorders, sleep apnea, CPAP, sleep disorders, BiPAP, IPAP, providers, home health care companies, durable medical equipment, stereotypes, diabetes, cardiac issues, memory loss, consequences

No Tags

If you enjoyed this post, make sure you subscribe to my RSS feed!

For most children and teens, the beginning of a new school year is just around the corner. Not only will they be hitting the books again after a three-month-long summer break, but many of them will also participate in after-school activities.

Research over the past few years has shed light on a serious problem affecting student-athletes nationwide: the number of children and teens who are considered obese is rising. According to the American Academy of Sleep Medicine (AASM), obesity raises the risk of cardiovascular disease and other health problems, but it also increases the likelihood the person will develop obstructive sleep apnea.

William Kohler, MD, medical director of the Florida Sleep Institute in Spring Hill, director of pediatric sleep services at University Community Hospital in Tampa, and an pediatric sleep physician, warns that the health problems brought on by obesity should serve as a wake-up call, to not only student-athletes and their parents, but also to their instructors and coaching staff.

"Apnea can increase the risk for stroke, diabetes and cardiovascular disease," says Dr. Kohler. "When the child or teen puts on weight, the throat can narrow, and anything which narrows the posterior pharynx can lead to the development of sleep apnea. It’s is a serious disorder that can be harmful, or even fatal, if it is not recognized and treated."

Clinically, apnea is when a person stops breathing for a period of 10 seconds or longer at least 15 times per hour. This can happen hundreds of times each night, leading to disturbed sleep. This often results in excessive daytime sleepiness, in both children, teens, and adults.

Children or teens who are chronically tired may have cognitive, attention or behavioral problems, whether in the classroom or on the playing field, says Kohler, adding that they may be irritable or cranky or have ADHD.

Kohler notes that sleep apnea symptoms may prevent a student-athlete from participating in a critical game or deter the ability to perform well in individual or head-to-head competition. More importantly, for life issues, undiagnosed and/or untreated sleep apnea can lead to poor academic achievement. Aside from social and societal issues, not to mention economic issues in the workplace when the teen is older, it can also make a student ineligible to compete in after-school activities, Kohler noted.

"Parents need to watch for signs of sleep apnea, such as snoring, morning headache, morning dry mouth, and excessive tiredness," he said. "It’s important for the parents of a child or a teen who may have apnea to discuss the concerns with a sleep specialist. From there, appropriate action can be taken to evaluate, diagnose, and, if necessary, treat and manage the sleep apnea or any other kind of sleep disorder."

Upon meeting with a sleep specialist, the patient will discover that there are safe and effective treatments for those diagnosed with OSA. Scientific evidence shows that continuous positive airway pressure (CPAP) and bi-level positive airway pressure (often mistakenly referred to as BiPAP, a trademark name of a specific line of PAP devices from Respironics) are the best treatment for apnea.

CPAP and bi-level/BiPAP devices provides a steady stream of pressurized air to patients through a mask that they wear during sleep. This airflow keeps the airway open, preventing the pauses in breathing that characterize sleep apnea and restoring normal oxygen levels.

Several recent studies that outline the adverse effects of sleep apnea and other sleep problems among children and teens with regard to athletic and academic performance, including:

• Students with symptoms of sleep disorders are more likely to receive bad grades in classes such as math, reading and writing, and also perform poor athletically, than peers without symptoms of sleep disorders.
• The brain responses of those children and teens who don’t get enough sleep can accurately predict the impact sleep loss has on their ability to pay attention during the course of a day, in both the classroom and during an athletic contest.
• Research examining the impact of sleep in children and teens suggests that even mild sleep loss produces marked deficits in their ability to comprehend and disseminate the information critical to their success in school or as a participant in a sporting event.
• Aggressive behavior and bullying, common among schoolchildren, are likely to have multiple causes, one of which may be an undiagnosed sleep-related breathing disorder.
• Over the past decade, children and teens have been going to bed later and sleeping less. This can be attributed, in part, to a lack of awareness in the community concerning sleep need in children and teens and how the amount of sleep a child should get each night is dependent on one’s age.

Kohler offers the following tips for children and teens on how to get a good night’s sleep:

• Follow a consistent bedtime routine.
• Establish a relaxing setting at bedtime.
• Get a full night’s sleep every night.
• Avoid foods or drinks that contain caffeine, as well as any medicine that has a stimulant, prior to bedtime.
• Do not stay up all hours of the night to "cram" for an exam, do homework, etc. If after-school activities are proving to be too time-consuming, consider cutting back on these activities.
• Do not go to bed hungry, but don’t eat a big meal before bedtime either.
• Avoid any rigorous exercise within six hours of your bedtime.
• Make your bedroom quiet, dark and a little bit cool. Also, keep computers and TVs out of the bedroom.
• Get up at the same time every morning.

________________
Technorati Tags: sleep, sleep disorders, teenagers, teens, children, school, scholastic achievements, academic achievements, sleep and children, sleep and teens, student athlete performance and sleep, ADHD, ADD, CPAP, BiPAP, bi-level, Respironics, good night’s sleep, after-school activities, bedtime, wake at same time, cognitive problems, behavioral problems, attention problems, sleep study, sleep studies, PSG

No Tags

If you enjoyed this post, make sure you subscribe to my RSS feed!

Driving a vehicle requires coordination of horizontal eye movements and steering. A research abstract presented at Sleep 2007, the 21st Annual Meeting of the Associated Professional Sleep Societies (APSS), finds that even a single night of sleep deprivation can impact a person’s ability to coordinate eye movements with steering.

"Even a single night of sleep deprivation can impact a person’s ability to coordinate eye movements with steering," said the study’s author, Mark Chattington, of Manchester Metropolitan University.

Continue Reading »

No Tags

If you enjoyed this post, make sure you subscribe to my RSS feed!