More Sleep Apnea Bites the Dust
September 2, 2010
I had a crazy day today with a packed schedule full of patients, but the one thing that made it worthwhile for me was the feedback I got from three different patients about either how well they were sleeping, or how their lives were changed as a result of sleep apnea treatment.
While rounding at the hospital early this morning to see my post op patient, she was doing remarkably well one day after her multiple soft palate and tongue procedures for obstructive sleep apnea. She was already swallowing liquids pretty well, and ready to go home. She also noted that despite the pain and the poor sleep environment of being in a hospital with all the noises and distractions, she felt more refreshed than normal when she woke up this morning.
Another patient that I hadn’t seen in 6 or 7 years came in for ear wax removal, and just happened to thank me for changing his life. I had no idea what he was talking about. He reminded me that I had sent him to a dentist for his sleep apnea and he has been successfully using his dental device all this time.
A third patient came in one month after routine nasal surgery and remarked that his breathing is not only normal, but he’s not snoring anymore, and his sleep is much more refreshing and he’s dreaming more.
These are some of the examples of patients that have found success with either CPAP, oral appliances, or with surgery. Some people find success after their first option, while others go through everything before finding a solution that works.
Admittedly, not everyone that I see has great results like that ones above, but the vast majority do, while the remainder have partial or limited success.
This is what keeps me going, knowing that I’m able to help people breathe better and sleep better, regardless of which option they choose. It’s truly a privilege for me to be able to help people in this way.
What’s your success story? Please share your story with me in the comments box below.
Tips for Traveling with Your CPAP Machine
July 20, 2010
One of the most common excuses for not wanting to use CPAP is that "I travel a lot." Even after I explain that many people travel just fine with their CPAP machines, some people are stll reluctant. With advances in technology and increased awareness by the lay public, government officials and medical professionals about the importance of using CPAP for obstructive sleep apnea, traveling with CPAP, although initially a challenge, can be done with relative ease. People use CPAP on planes, and even go camping with it. With the FAA's recent ruling and instructions on carrying and using CPAP on airlines, it's become even easier to travel with CPAP machine. I know there are various types of PAP devices, but for the sake of simplicity, I'll call these devices the generic name, CPAP.
Flying with Your CPAP
The Federal Aviation Administration (FAA) recently ruled that airline passengers must be allowed to use respiratory assistive devices, such as a CPAP machine (Nondiscrimination on the Basis of Disability in Air Travel – May 13, 2009). However, don't think that you'll just breeze by security checkpoints at the airport. Here are some common tips that are recommended when you fly with your CPAP machine:
1. Never check your CPAP machine.
2. Always have with you a prescription for your CPAP machine and your latest sleep study. You never know if your unit gets lost or stolen, or breaks down.
3. Attach a medical equipment tag, identifying the contents as such.
4. Let the TSA security agent know that you have a CPAP machine. Remove it from the back and have it scanned separately.
5. Request that security agents change gloves and wipe down the table before inspecting your machine. Wrap your device in a clear bag while being scanned to prevent contamination with germs and other chemicals.
6. Keep a record of the model and serial number in hand, just in case.
7. If you're going to use your CPAP machine in-flight, check beforehand if there's an outlet next to your seat, and if you have the right adaptor.
8. If the flight attendant says something about your CPAP being another carry-on, let him or her know that it's a CPAP machine and under the Americans with Disability Act, it's not counted as an added carry-on.
9. Consider having your doctor give you a letter describing the need for your CPAP machine.
10. Most CPAP units will automatically convert to the correct local voltage. Check with your instruction manual or manufacturer to confirm this. You may, however, need a plug adaptor, as well as an extension cord, in case your outlet is far away.
Tips On Water
Many people are so focused on the logistics of their machines, that sometimes they forget about distilled water. Make sure you have plenty of distilled water available if you're going to use it on the plane, or at your final destination.
If you're not going to use your CPAP device on the plane, then make sure you empty and dry the water chamber before flying. If you're planning on using your CPAP device on-board, there are two options to be able to pass large amounts of fluids past TSA security checkpoints: Have your doctor prescribe distilled water in a pharmaceutical grade bottle. A 500 mL bottle should hold about 16 oz. Another option is to purchase papFLASK, which is designed to pass through security checkpoints with ease.
For whatever reason you don't have distilled water available, using bottled or even tap water is OK, but try to find distilled water as soon as reasonably possible. Mineral deposits in tap water can build up within the PAP machine and can cause damage if it continues long-term.
Camping or Backing Up with CPAP
For travel to areas that don't have electricity, or in case you have a blackout, there are numerous battery options available. Each manufacturer will usually have a back up battery recommendations and adaptors.
For more extended periods, various people have written about using a 12 volt deep cycle marine battery with a sine wave inverter. There are numerous other battery options so do your research. Different manufacturers have different voltage needs, so also check with your manufacturer. Since a humidifier uses a lot of energy, most people recommend not using the humidifier if you're only camping for a few days. There's lots more information about batteries in CPAP support sites such as sleepguide.com, cpaptalk.com, talkaboutsleep.com, or apneasupport.com.
Have A Back Up Plan
Some patients carry around their oral appliances with them whenever they travel, either using it in place of their CPAP machines or just in case the device breaks. Some people use both the oral appliance and their CPAP machines simultaneously. If you've never tried an oral appliance and you're interested in an alternative option, it may be worth giving it a try now before you need to travel for long extended periods.
No More Excuses
With advances in technology and more acceptance by the medical community as well as the lay public, there's basically no reason (unless it's psychological) you can't travel with a CPAP machine. With knowledge and some flexibility and creativity, anyone can travel with CPAP, even in the more remote areas of the world. There have even been descriptions of solar power being used to recharge batteries used for CPAP. If you travel frequently to the same location, consider purchasing a second unit. Prices for middle of the road CPAP models are in the $300 to $700 range.
The first major challenge is in finding a way to make CPAP work for you. The second major challenge is in un-tethering your machine from your bedroom. Many people are living vibrant and normal lives, despite having to use their CPAP machines while traveling. Or is it because they are using their CPAP machines regularly while traveling? You decide.
Expert Interview: All About CPAP Machines
July 14, 2010
In this Ask Dr. Park teleseminar, I interview Mr. Chip Smith and Mr. Brian Werther of Restoration Medical on CPAP machines. This will be a comprehensive discussion on the various different models, features and manufacturers, including:
- the difference between APAP, BiPAP, CPAP, EPR, and C-Flex
- data recording features for various models and manufacturers
- insurance coverage issues
- and much, much more….
Click here to order the MP3 file.
Ask Dr. Park: An Insider’s Guide To Sleep Apnea Surgery
July 2, 2010
Secrets To Sleep Apnea Surgery…
Are you confused by all the conflicting information about sleep apnea surgery? Does it work? Which procedure is right for you? Which surgeon do you choose? In this Ask Dr. Park Teleseminar Program you will learn about Sleep Apnea Surgery. Even if you’re not considering surgery the good think to learned what the other option are and the rational of offering a surgery.
Learn:
- Why consider Sleep Apnea Surgery?
- Are you a candidate Sleep Apnea Surgery?
- In-depth descriptions of different Sleep Apnea procedures.
- How to find the right Sleep Apnea surgeon.
Click here to purchase MP3 recording.
10 Tips For CPAP Success
June 30, 2010
Learn the Insider Secrets of Highly Successful CPAP Users…
Get your FREE access to the audio replay and mp3 download of this interview with Aurelio Henriquez who has extensive experience helping patients with sleep apnea succeed in using their CPAP machine.
Since 2002, Aurelio has helped hundreds of CPAP users overcome their struggles while he was with the NY Methodist Sleep Disordered Center as a Polysomnographic technologist and then later as the technical lab director for the Columbia University Sleep Disorder Center.
Learn:
• What to expect when you first try CPAP in the lab
• How to avoid the #1 mistake every new CPAP user makes
• Where to get the best CPAP equipment for the best price
• What one thing you MUST do BEFORE using CPAP to dramatically increase your chance of success
• What makes some people fail and some to succeed on CPAP and how you can be successful
The Biggest Ear Problems for Sleep Apnea Sufferers
June 10, 2010
If you have obstructive sleep apnea, chances are, you’re likely to have some sort of an ear problem. There are a number of reasons why you’re going to be prone to various ear problems, but in many cases, the problem is not actually coming from the ear. To better manage your ear issues, you first have to understand your ear anatomy, and the different types of inflammation caused by sleep apnea. In the last part of this article, I’ll go over some tips to help you solve many of your ear-related issues.
What You Must Know About Ear Anatomy
The ear drum is a thin membrane that separates the middle ear cavity from the outer ear canal. Sounds waves vibrate the ear drum, which connects via a sophisticated lever and piston amplifier system that transmits sound waves to the inner ear. Normally, the middle ear cavity should have the same pressure as the outer ear canal. This is made possible by the function of the eustachian tube, which connects your middle ear cavity to the back of your nose. Whenever you swallow or yawn, your palatal and throat muscles open up the eustachian tube temporarily, equalizing pressure between the middle ear and the nose. You can think of the middle ear as a sinus—an out-pouching from the nose into an adjacent pocket of bone or soft tissue.
Whenever you go up an elevator or descend during a flight, the atmospheric pressure either goes up or down, and this creates either positive or negative pressure in your middle ear. With very slight pressure changes, you’ll feels a bit of fullness and hearing loss, but with severe pressure changes, you may even have pain and discomfort. If you keep swallowing, then you’ll keep popping open your ears. As a result, you’ll feel anything from fullness, hearing loss, popping, clicking, buzzing, or even ringing. This is why it’s recommended that you chew gum during descents in flights, or give the baby a bottle to feed.
Causes Of Inflammation
However, if you have any degree of inflammation in your nose, then additional swelling can prevent proper equilibration of air between your middle ear and nose. A number of different causes can aggravate swelling, including viral colds, allergies, weather changes, and even acid reflux.
You’re probably very familiar with the effects that a simple cold or allergy can have on your nose and ears. In most cases, you’ll have a few days of discomfort. But in certain situations, your cold or allergy may go away, but your ears will continue to be stuffed for days or weeks. Sometimes, the vacuum pressures that are created can cause fluid to accumulate, giving you what’s called serous otitis media. Rarely, this fluid can get infected and turn into the classic bacterial infection or otitis media. Fortunately, not too many people have true bacterial infections—most never make it past the vacuum pressure or clear fluid stages.
A Vicious Cycle
If you don’t have obstructive sleep apnea, the entire process can come and go within a few days to weeks. However, if you have sleep apnea, due to the additional inflammation that’s created, a simple ear or sinus problems can linger for weeks, and sometimes even months for the following reason: Any additional inflammation in the nose or throat causes swelling which can aggravate more frequent obstructions, leading to stomach juices to come up into the throat and nose, including in the area of the eustachian tubes. Furthermore, frequent obstructions and arousals leads to an imbalance of your involuntary nervous system, where your nose is going to be overly sensitive, especially to weather changes (pressure, temperature, and humidity changes). This is called chronic or non-allergic rhinitis.
For some people using a CPAP machine can blow air into the middle ears, through positive pressure. This can be a frustrating issue that’s difficult to cure completely.
Solutions For Your Ear Problems
So if you have obstructive sleep apnea and are prone to ear problems, what can you do? The first thing to make sure of is that you’re treating your sleep apnea condition optimally. If your CPAP pressure is too low, or your dental device is undercalibrated, or your UPPP procedure was only partially effective, then you’ll still have residual obstructive sleep apnea and are still feeling the effects of intermittent obstructions and arousals.
Second, make sure that your nasal breathing is optimal. By definition, your nasal passageways will be either narrowed, inflamed, or both. Having a chronically stuffy nose can create more of a vacuum effect downstream, which allows the tongue to fall back more often when in deep sleep, due to muscle relaxation. If you’re using CPAP, then it’s likely that your pressures may be too high, which can make it uncomfortable, and even blow air into your ears. Whether through vigorous saline irrigation, allergy avoidance, medications, or surgery, it’s important to make sure you’re able to breathe well through your nose.
Lastly, it’s important to lower inflammation in your throat by making sure you’re not eating within 3-4 hours of bedtime. Having even 2-3 apnea or hypopnea episodes per hour, although acceptable, can still suction up juices into your throat. Since you’re going to suction up normal stomach juices anyway, it’s important to keep the acidity and juice volume as low as possible. The same rule applies to alcohol, since not only does it produce more stomach acid, it also relaxes your tongue and throat muscles, causing you to stop breathing more often.
Ear problems are an inevitable part of having obstructive sleep apnea. By knowing what can cause ear problems and how you can deal with it, you can minimize the discomfort to a point where it’s tolerable or minimal.
CPAP Compliance vs. Adherence
June 9, 2010
Throughout all the talks and papers on CPAP usage at this year's SLEEP 2010 Meeting, it seems like the word compliance is being used less and less, and instead, sleep researchers are using the word adherence. Unfortunately, the practical meaning hasn't changed—it describes how long users are able to use CPAP on a nightly basis. Various researchers use different definitions, but one definition that is commonly used (since it's what Medicare uses) is at least 4 hours per night in at least 70% of nights in a 30 day period. So if there are 56 total hours in a week if you sleep for 8 hours, on average you have to sleep at least 20 hours per week on CPAP to be "adherent." That's about 35% of your total sleep time.
Considering that most people aren't able to use CPAP at all (published "adherence" rates range from under 20% to over 80'%), this is a very liberal criteria for what is considered the minimum time that's considered "acceptable" by the sleep community.
Even if you're considered "adherent," it's assuming that you're receiving optimal CPAP pressures with no leaks. So if your final AHI at your "optimal" CPAP pressure is 16, then if you use your CPAP machine enough hours per week, then you're considered "adherent."
There has to be a better way to measure how well and for how long people use their CPAP machines. We should also incorporate the quality of CPAP use, in addition to quantity.
What do you think about these definitions?
An Innovative Obstructive Sleep Apnea Clinical Trial
May 6, 2010
For most people with obstructive sleep apnea, CPAP and oral devices work very well. However, some people can't tolerate or benefit from these two options. For these people, surgery may be another option.
There are numerous types of surgical procedures for obstructive sleep apnea. The more useful ones involve modifying the breathing space behind the tongue. Clinical trials have now begun testing a new way of treating tongue collapse, using a nerve stimulator based on pacemaker technology. I'm honored to be part of an innovative, IRB approved, national multi-site study of this investigational device. Please take a look at this brochure for more information.
Please contact me if you have any questions @ doctorpark@doctorstevenpark.com.
Does Everyone in Your Family Have Sleep Apnea?
February 10, 2010
More and more often, I'm coming across entire family members that are on CPAP for sleep apnea, or undergoing various other treatments for this condition. If one parent has sleep apnea, your children have an increased risk of developing sleep apnea, but if both parents have it, then it's safe to assume that your children will have it too, given that fact that they inherit your facial anatomy.
As I describe in my book, Sleep, Interrupted, all modern humans are on a continuum, where we're all susceptible to breathing problems at night. Only the end extreme is called obstructive sleep apnea. Since sleep apnea is caused by narrow facial structures, young children and even infants can have it too. Many of the various childhood maladies, such as frequent colds, ear infections, bedwetting, night terrors, and even ADHD are probably related to poor breathing and inefficient sleep, aggravating inflammation in the upper airways. There's even speculation that the rate of autism increased after doctors recommended placing infants on their backs during sleep. It's not surprising then, that parents of autistic children are found to have a higher rate of obstructive sleep apnea.
Most young children are treated with tonsillectomy and adenoidectomy for their sleep apnea, and many children do very well. However, about 1/3 who undergo tonsillectomy don't improve significantly. These are the children that probably have smaller jaws. Smaller jaws leads to more reflux and inflammation, leading to enlarged tonsils, causing more frequent obstructions. In these children, rapid palatal expansion was found to be equivalent to tonsillectomy. If you combine both procedures, the results were additive.
Some young children are able to tolerate CPAP, but for most, this is not a practical option. One advantage that children have over adults is the malleability of their jaws. Orthodontics can not only help to straighten teeth, but to expand the jaws as well. Traditional orthodontic dentists tend to remove teeth to make more room for the other teeth, but that ends up making the jaws even smaller. Forward thinking orthodontists make more room for the teeth by enlarging the jaws, both in the front to back and side to side dimensions. The earlier you start, the better the long-term results. Many dentists are beginning treatment as soon as the permanent teeth have come in.
Does everyone in your family have sleep apnea? If not, do you suspect that they all do? Please describe how you're handling this situation in the comments box below.
An Uncomfortable Situation Regarding Sleep Apnea
December 15, 2009
One of the biggest dilemmas in my personal life is how to deal with friends or family members that I’m sure have obstructive sleep apnea or upper airway resistance syndrome. Should I even mention this condition at all, outside of a professional relationship? Is it even ethical, not to mention practical, to give medical advice to close friends or family members?
Once your eyes are opened to how common sleep apnea is, you’ll see that almost every other one of your friends or family will have varying degrees of sleep apnea. Many more won’t have sleep apnea, but a lesser variation called upper airway resistance syndrome. As you get older, I guarantee that a significant number of your friends will have it. Sadly, only 10% of sleep apnea is ever diagnosed and treated by doctors, who instead tend to treat the complications of sleep apnea such as high blood pressure, depression, anxiety, heart disease, heart attack and stroke.
Ultimately, I’ve decided to take these situations on a case by case basis. Invariably, we’ll get on the discussion of what I do at work, and the topic of sleep apnea comes up. Depending on how interested he or she seems, I’ll gently suggest getting evaluated for it. I’ve had various responses to this approach. A number of my close friends have their lives changed radically after being diagnosed and treated for severe obstructive sleep apnea. Others who I know have severe sleep apnea either don’t take it too seriously, and continue their lives thinking that their fatigue, high blood pressure, and weight gain is just a normal part of getting older. In many cases, spouses of these people are frustrated because he or she won’t listen and go see a sleep specialist about this problem.
The other day, I ran into the wife of a couple that I know in my apartment complex. She relayed that her husband is sleeping much better since getting his CPAP machine and wanted to thank me for my advice. A few months before, the topic of her husband’s severe snoring came up during a conversation about what I did for a living.
As long as I can make a difference in my personal, as well as my professional life, I’m still going to do everything that I can to make people aware that sleep-breathing problems are a major cause of illness, fatigue, disability, and even death.
Have you reached out to your friends or family about sleep apnea? What was their response? Please respond with your comments below.
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