Better Sleep Better Health

One of the questions we often are asked at Oregon Sleep Associates is “how do I know which CPAP mask to choose?”

It’s true that in today’s market there are literally dozens of masks available to the CPAP user. But this doesn’t mean that the choosing a mask needs to be difficult. Let’s look at some different types of masks and their features, uses, and pros and cons:

Part 2: FULL FACE CPAP MASKS

Patient sleeping using a Full Face style mask.

Full Face Masks (FFM), or oral/nasal masks, are larger than nasal masks but operate in a similar manner. These masks extend below the bottom lip to create seal that encompasses the user’s mouth as well as the nose. These masks are used when a person demonstrates a “mouth leak” when asleep. A mouth leak occurs when the jaw relaxes and air escapes through the mouth. Mouth leaks can also happen when the therapy pressure is high enough to force the mouth open even when wearing a chinstrap. If the pressure is escaping through the mouth, the CPAP can’t do its job and keep the airway open. The full-face style masks allow a user to breathe through either their nose or mouth without worrying about loosing pressure. Because of the larger surface area the FFM cushion must cover, these masks can sometimes have trouble sealing well. Fortunately, new designs and seals have been created to counteract these problems.

Here are some examples of Full Face CPAP Masks:

The ComfortGel Full FFM from Philips Respironics feature soft gel cushioning like the nasal ComfortGel Blue but works stops mouth leaks as well.

The Forma FFM by Fisher & Paykel offers a soft foam cushion and silicone seal that extends below the user’s chin to keep the mouth leaks in check.

ResMed’s Mirage Quattro FFM features a double walled silicone interface to ensure a complete seal.

General Pros And Cons of Full Face CPAP Masks:

Pros:

• Allows patients to breathe through nose or mouth
• Corrects mouth leak without need for chinstrap
• Available in a variety of sizes and cushions like the nasal masks
• Works well even at higher pressures
• Disperses pressure over a larger surface area, reducing sensation of high pressure

Cons:

• Larger surface area to seal can lead to mask leaks
• Larger mask size may look intimidating to new/claustrophobic users
• Generally louder than other masks
• Line of sight often obscured by forehead connection

If you’re in the Portland, OR area swing by our DME office where you can find these and many more masks. Or if you’re not in the Northwest check out the deals at BuyPAP.com. Also check out our facebook page and follow us on twitter for more updates.

Nasal CPAP Mask, notice the seal around the nose and four attachment points to the headgear.

One of the questions we often are asked at Oregon Sleep Associates is “how do I know which CPAP mask to choose?“ It’s true that in today’s market there are literally dozens of masks available to the CPAP user. But this doesn’t mean that the choosing a mask needs to be difficult. Let’s look at some different types of masks and their features, uses, and pros and cons:

Part 1: Nasal CPAP Masks

Nasal CPAP Masks are the traditional style of CPAP mask. They are generally triangular shaped to cover the user’s nose and create a seal to the face. Most connect to the headgear at four locations, 2 on the mask body and 2 on the forehead support. Nasal CPAP masks are suitable for most patients without a severe mouth leak and come with a variety of seals depending on the manufacturer and model. These seal options as well as multiple size cushions for each mask allow for a more customized experience for all users.

Here are some examples of Nasal CPAP masks:

 The ComfortGel Blue Nasal Mask seals to the face using a soft blue gel, forming a comfortable interface.

The Zest from Fisher & Paykel offers a foam cushion with silicone flap to ensure a good seal.

General Pros and Cons of Nasal CPAP Masks

Pros:

• Works for most users
• Many cushion and seal types
• Low surface area to seal
• Tried and true designs

Cons:

• Possible irritation of bridge of nose
• May require more fittings to find appropriate size
• Dependent on Chin Strap to correct any mouth leaks
• Line of sight obscured by forehead connection

As always, you can find these and many more masks in our DME office, or if you’re not in the Portland OR area buy them online at BuyPAP.com. Also check out our facebook page and follow us on twitter for more updates.

At Oregon Sleep Associates we have many years experience helping people choose the right CPAP mask for success with their sleep apnea treatment. We will be occasionally reviewing products we feel may help new or experienced CPAP users.

The Mirage™ FX nasal mask series is a recent addition to ResMed’s venerable line up of CPAP interfaces. The design focuses on providing a lightweight and simple alternative to traditional CPAP masks.

Highlights:

• Consisting of only four parts including the headgear, the Mirage™ FX weighs in at only 2.5 ounces. This makes it one of the lightest masks on the market today.  ResMed achieved weight reduction by paring down the rigid plastic frame inherent in most nasal masks.

  

• The soft silicone cushion of the Mirage™ FX forms the body of the mask, and the 44 integrated exhalation vents have been positioned in circular pattern around the interface elbow. Having this many vents in this configuration seems to help with noise, making the Mirage™ FX one of the quietest masks we’ve encountered.
• The cushion material is soft and forgiving, which is a nice feature for those who find nasal masks to be irritating or painful to wear all night. The cushion only comes in two sizes, standard and wide, which both fit in the same frame. ResMed claims that the cushions are “one size fits all” but in our experience “one size fits most” may be more accurate. Some people with large or long noses may not find this mask to work well for them but the majority of users will be fine.

• The forehead piece seems to be more of an attachment point for the headgear rather than a stabilizing pad seen on some masks. This may help in giving the user a feeling of having less equipment anchored to their face.
• Headgear on the Mirage™ FX features ResMed’s SoftEdge™ design and is nicely cushioned at the back of the head. The headgear is attached to the frame at the standard four points with hook and loop fasteners and seems very easy and intuitive to adjust. For those wishing to look stylish in their CPAP, this mask is also available as the ResMed Mirage™ FX for Her, which comes with a smaller pink headgear.

Summary:

Overall we’ve found the Mirage™ FX from ResMed is a great option for both new and experienced CPAP users. Its lightweight and open design create a feeling of “less mask” and a more natural therapy experience. The custom options are a nice touch and ease of use makes this a great choice. If you are a patient at Oregon Sleep Associates and would like to check out the FX contact our DME or if you are not in the Portland area,  you can always find the lowest prices on the Mirage™ FX here.

Oregon Sleep Associates is proud to announce the American Academy of Sleep Medicine has renewed our sleep center full accreditation status for the next 5 years.

The American Academy of Sleep Medicine is the only professional society dedicated exclusively to the medical subspecialty of sleep medicine. As the leading voice in the field of sleep medicine, the AASM sets standards and promotes excellence in health care, education and research. Accreditation with the AASM is considered the gold standard of sleep medicine and reflects a commitment to ensure that sleep disorders patients receive the highest quality of care.

Since opening in 2005, Oregon Sleep Associates has helped thousands of people get a better night’s sleep by diagnosing and treating all manner of sleep disorders. We offer a five bed sleep center outfitted with comfort features including Sleep Number beds, private bathrooms, cable television and wifi to ensure your stay with us is a pleasant one. Results of overnight testing are available immediately after the sleep study in most cases. OSA also specializes in Cognitive Behavioral Therapy for Insomnia and can provide patients with portable home monitoring as well. Our DME office carries the latest in CPAP devices and masks from the industy leaders in PAP technology.
If you are having problems sleeping and would like help, visit us at www.oregonsleepassociates.com or contact our main office at 503-288-5201 to schedule a consultation with one of our sleep specialists.

One more example of how driving while tired can affect your safety and the lives of others:

From KATU News:

“SCAPPOOSE, OREGON- A crash on Highway 30 blacked out power to several towns along the busy highway just as rush hour hit Tuesday morning.

Reports that the power was out in Scappoose came in to KATU News just before 8 a.m. Later reports indicated that no one was hurt in the crash and that power was out from Warren to Scappoose.

Oregon State Police said a car hit a power pole near Berg Road on Highway 30 just before 7:30 a.m. and power lines were down at the scene.

The driver, identified as Pamela Somers, 57, of Rainier, fell asleep at the wheel and her car drifted across traffic lanes on Highway 30 before hitting a sign and a power pole, according to police.

The impact sent power lines down onto Berg Road. Somers suffered minor injuries and no other vehicles were involved. Somers was taken to a Longview hospital.

Electrical utility crews scrambled to get the power back on to thousands of residents. Traffic signals along Highway 30 were also knocked out, causing delays for commuters.”

If you feel tired when driving, it is vital that you pull over to take a nap. Trying to power through your fatigue does not work and can endanger the lives of everyone on the road. If you are constantly fatigued after a full night’s sleep, you may be suffering from an underlying sleep disorder. To be screened for sleep disorders contact the sleep specialists at Oregon Sleep Associates.

We’ve covered REM behavior disorder and it’s strange effects before, but this story shows how this odd condition can affect an entire family’s well-being.

As reported on ABC’s Good Morning America and KATU News, Adam Kearns of Keizer, Oregon and his wife of ten years were recently ordered by the court to have no contact with one another after he was arrested on assault charges. The charges stem from an incident earlier this year in which Adam punched his wife in the face three times while in bed. The twist is that Kearns was actually asleep during the incident and after hitting her, he laid back down and continued snoring.

His wife went to the hospital and police were called. The law makes no provision for REM Behavior Disorder and requires police to make an arrest if a domestic assault occurs within the home. Kearns’ wife, Randi, says he was never violent towards her in any way and the law is keeping their family, including two young children, apart. Adam has undergone testing at a local sleep center and been diagnosed as having REM Behavior Disorder. Despite the fact that this is a documented sleep disorder and patients cannot control their actions when asleep, the courts are pursuing prosecution. He said it’s frustrating that authorities don’t believe him when it comes to this newly-diagnosed condition. “You can only tell somebody something so many times,” he told KATU news.

Coaches and players looking to get the upper hand during the basketball season would be wise to heed the lessons learned from a recent study conducted at Stanford.

As reported in the journal SLEEP, researchers conducted a study on 11 players on the Stanford varsity basketball team. The aim of the study was to determine whether increased sleep times would benefit on-court performance. The players’ baseline sleep schedules were recorded over 2-4 weeks. Then they were asked to change their schedules to allow for a minimum of 10 hours per night sleep time for 5-7 weeks. The players’ sprint times and free-throw shooting accuracy were tested before and after the change in sleep duration.

The added sleep time each night paid off substantially. Sprint times dropped and overall accuracy improved. In fact, players’ free-throw accuracy improved by 9% and their 3-point shot accuracy went up by 9.2%. These numbers could mean the difference between a win or a loss and lend credence to the importance of getting enough rest.

Getting adolescents to get the sleep they need can be a hard task to accomplish. Today’s world is filled with distractions that keep kids and teenagers awake. But a new study released in the latest issue of the journal SLEEP suggests that parents that take the hard line when it comes to bedtimes are truly helping their children’s futures.

The study looked at 385 children from different schools in South Australia. Researchers found that 17.5% of the those studied reported a parent-set bedtime. That group demonstrated earlier bedtimes, more sleep, and improved daytime functioning compared to their peers without parent enforced bedtimes. This is significant because especially in children sufficient sleep time is essential for cognitive and physical development. Lack of sleep has been linked to lower school test scores, depression, increased traffic accidents, and childhood obesity.

Teens may not like it when their parents make them go to bed, but in the long run the benefits of sufficient sleep may far outweigh the costs of struggling over bedtimes.

As the summer months approach and thoughts drift to vacation plans around the country and abroad, many people who have been treated for Obstructive Sleep Apnea with continuous positive airway pressure, or CPAP, may wonder how to maintain a healthy night’s sleep away from home.

Traveling by airline with a CPAP

Since 9/11 many restrictions have been put in place to increase security on airlines. One inconvenient measure has been the reduction of the number of bags allowed as carry-ons. This is one instance where having a CPAP machine and knowing your rights can come in very handy. The FAA classifies CPAP as a medically necessary device. This means that passengers are allowed to bring the machine and its bag on board as an extra carry-on. Savvy travelers can will find that CPAP bags, when well packed, can provide much needed valuable real estate in these times of $50 checked luggage. TSA handlers are generally well versed with CPAPs but may ask you to remove the machine from it’s bag for additionally screening, including swabbing for explosive residue, at the security checkpoints. If you happen to encounter an overzealous TSA agent that tries to make you check your CPAP, present them with this document issued by the Department of Transportation stating the machine is to be allowed through. An official note from your doctor showing medical necessity doesn’t hurt either, especially in foreign lands.

International Travel

Most currently produced PAP machines from major manufacturers utilize international power supplies. This means they can automatically adjust for different voltages, such as 240, without the need for special equipment. This eliminates the danger of burning out a PAP while on vacation. However, travelers will still have to bring plug adapters along to fit into different sized wall outlets. And it is prudent to look up contact information for your CPAP manufacturer in the destination country. If something goes wrong with your machine, having a certified repair center nearby can mean the difference between a memorable vacation and a ruined trip.

Camping with CPAP

Many people think that having a CPAP will stop them enjoying outdoor trips such as camping , hunting, and hiking. But newer CPAP machines are very portable and easy to use without a constant power source. There are now reliable battery powered CPAP units that can be recharged on the road via car adapters. Depending on the pressure level used, these units can provide overnight power for several nights before needing a recharge. Don’t want to spring for another machine? No worries, universal battery packs are also available for most major CPAP machine models on the market. These batteries are small, long lasting, and utilize the latest in battery advances. And most major companies, such as Resmed and Respironics offer car cigarette lighter adapters which make RV or car camping with CPAP easy.

For more information about traveling with CPAP, contact a qualified DME provider like the ones at Oregon Sleep Associates.

Recently two stories of overly tired air traffic controllers have made headlines. First, an air traffic controller inadvertently dozed off at Ronald Reagan Washington National Airport, leaving two cargo planes to land themselves. Then reports came out detailing a Nashville controller purposely sleeping during a busy shift. These incidents are frightening considering the important responsibilities these individuals are given every day.

One would expect sweeping changes to the follow such revelations about air traffic security, yet as an open letter from the chairman of the National Sleep Foundation to the FAA shows, the changes needed are not happening:

“Americans are justifiably concerned by the recent spate of incidents involving air traffic controllers who fell asleep on duty.  But now that the FAA/DoT has outlined the steps it intends to take to address this problem – minor tweaking of the controllers’ work/rest schedules combined with a threat of stricter disciplinary action against offending controllers in the future – the public’s response ought to escalate from concern to alarm.

This is because the announced changes amount to tokenism – gestures more likely to assuage public anxiety than to meaningfully reduce fatigue in air traffic controllers.  For example, although it is true that extending the time off between shifts (from 8 to 9 hours) will probably result in more sleep (which is good) it will not result in adequate sleep (the amount of sleep necessary to sustain normal alertness during the night shift).  Prior research shows (and common sense dictates) that a significant portion of the 9 hour break will be devoted to commuting, eating, personal hygiene, socializing with family, etc.  If the FAA was truly serious about optimizing alertness in air traffic controllers, and if the policy makers based their decisions on scientific evidence, the time off between shifts would have been extended to at least 12 hours – and scheduled napping would now be encouraged during work shifts, rather than prohibited. Likewise, prior sleep research (and, again, common sense) suggest that the threat of more severe punishment will have no beneficial effect on alertness.  Those air traffic controllers who fell asleep did not do so because they were not properly motivated to maintain wakefulness.  They fell asleep because they had a significant, physiological need for sleep.  And they probably didn’t even realize they were falling asleep – sleep onset can be insidious. (Think about it. If sleep onset was not insidious, would anyone ever fall asleep while driving an automobile?)

Also, it should be pointed out that both the airline industry and the FAA have known about this problem for decades.  In 1981 the National Transportation Safety Board (NTSB) published a special investigative report on air traffic controller fatigue. However, the recommendations outlined in that report were essentially ignored – and classified as “Closed—Unacceptable Action” in 1989.  Since then, the NTSB (which is the congressionally-mandated special investigative body charged with determining causes of transportation accidents) has issued more than 80 new fatigue-related safety recommendations.  Care to guess how many of these recommendations have been implemented?

History is replete with accidents resulting in human death and injury caused by sleepy transportation workers, and the NTSB routinely cites air traffic controller fatigue in its findings. One tragic example is the August 2006 accident involving Comair flight 5191 in Lexington, Kentucky, in which the air traffic controller cleared the plane for take-off on the wrong runway, resulting in a crash that killed 49 people. Unfortunately, given the inadequate response to the recent incidents, we can expect more sleep and sleepiness-related errors and accidents involving air traffic controllers in the future.”