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.

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.

Many people have trouble sleeping and search for a remedy on the shelves of their local grocery store. But even though they don’t require a prescription, over the counter medicines can carry some significant health risks.

Many over the counter sleep medications are one of two substances. The active ingredient in medications such as  Sominex, Nytol, and Tylenol PM is Diphenhydramine, an antihistamine with drowsy effects. This substance is more well know as the common allergy medication Benadryl. Diphenhydramine has several side effects including:

• Dry mouth
• Dizziness
• Prolonged drowsiness lasting into the next day
• Memory problems

The other most common OTC sleep medication is Doxylamine, found in Unisom and Nyquil. This medication can offer more sedation than many prescription hypnotics and is also an antihistamine.

These substances may help to ameliorate short term insomnia but should be treated with caution. Individuals who are pregnant or have health complications such as glaucoma, enlarge prostate, heart problems, or asthma should not use them. In addition, the effects of these drugs can depress respiratory effort and worsen the effects of sleep apnea, leading to more disrupted sleep. Also the “hangover effect” can be worse than many prescription sleep aids and can increase daytime fatigue. These medications should not be used nightly or to treat chronic Insomnia.

If you suffer from Insomnia, doctors recommend addressing the root source of the condition, not the symptoms. Many health issues can cause Insomnia and there are both pharmacological and natural ways of treating them. Contact a sleep center near you to get tested for an underlying sleep disorder and to treat your insomnia properly.

As 2010 gets put to bed, it is time to look at the stories about sleep that were most talked about this year:

• More Children Are Medicated for Insomnia -  Illustrating a disturbing trend in medicine, many children are given prescription sleep aids for Insomnia.

• US Military Finds Bright Light Can Improve Alertness, Reduce Post Traumatic Stress - Another link between exposure to light and our circadian rhythms.

• Tired Teenagers At Risk For Depression – Teens’ schedules are causing increased rates of depression in today’s youth.

• Shift Work Hurts Productivity – Important news for businesses with employees on late shifts.

• Sudden Infant Death Syndrome Linked to Low Levels of Serotonin – New research sheds light on the possible causes of SIDS, a scourge that continues to puzzle scientists.

• Sleep Suffers During Wartime Deployment – The stress of war is affecting our troop’s sleep and peace of mind, making it harder to adjust upon their return home.

• Insomnia And Sleep Duration Linked to Early Death – Startling news on the connection between lack of sleep and mortality.

• Percy Harvin’s Trouble With Sleep Apnea – The Viking’s receiver’s continued woes with his sleep disorder.

• Biggest Loser Contestant on CPAP – Contestant Sherry Johnston talks about sleep apnea and continuous positive airway pressure.

• Obstructive Sleep Apnea Linked to Heart Disease – A recent study finds that the common sleep disorder is even more serious than previously thought.

It’s that time of year again. The airports are crowded with people traveling home, the store shelves are packed with gravy and stuffing, and turkeys everywhere are looking around nervously.  After the feast is over, we’ll all loosen our belts and relax for a nap. Invariably, some Uncle or Aunt will repeat what they say every year, “Did you know that it’s the Tryptophan in the Turkey that makes you tired?” And everyone will nod and then drift off. But this year, you can amaze your family by jumping up and exclaiming, “Not true!”

Your startled relatives will be surprised to learn that despite popular belief, the Tryptophan in the Thanksgiving turkey is not a strong sleep inducing factor. Tryptophan is a essential amino acid for humans derived from our diets. In it’s purified form it can be a mild sleep inducing substance. However, to get large levels of Typtophan to the brain, it must be taken on an empty stomach. When consumed with other foods, Tryptophan loses it’s effectiveness because it has to compete with other substances trying to cross the blood brain barrier.

“Tryptophan is taken to the brain by an active transport system shared by a number of other amino acids, and there’s competition among them—like a crowd of people trying to get through a revolving door,” said Simon Young, a neurochemist at McGill University in Montreal, Canada in National Geographic.

Not enough of the Tryptophan from Thanksgiving turkey reaches the brain to cause drowsiness. In fact, though turkey contains a fair amount of the amino acid, many other foods such as beef contain more. Yet we never hear about a “post steak” nap.

So what does make us nod off every year after the meal?

Well, Thanksgiving usually involves eating thousands of calories which we normally wouldn’t ingest all at once. This amplifies the normal post lunch tiredness as your body tries to digest and metabolize this massive amount of food and leads to nap time. So this year after you munch away, try going out for a nice walk to burn off some of those excess calories.

Happy Thanksgiving!

Anyone who has worked an overnight shift knows how difficult it is to adjust back to a normal schedule. You feel like a sleep deprived zombie, never able to fully fit in during the waking hours. New evidence suggests that the toll taken may also be passed along to businesses in the form of lost productivity.

The research, as reported by the American Academy of Sleep Medicine, found that the key for maximum productivity is to schedule shift start times that allow the worker to sleep right before reporting for duty.  The study used a mathematical formula to see the effects of 24 start times, each varying by one-hour increments. The hypothetical work schedule lasted six days. Each shift was nine hours and started at the same time each day. The findings suggest that the best shift start times begin in the late morning or early afternoon, whereas shifts that begin between 8 PM and 12 AM were found to be the most limiting to both sleep and work performance.

The lead investigator on the study, Angela Bowen, suggests that government labor regulations may need be changed to take into account different shift start times. “Shifts of equal duration differ in how fatiguing they are depending on the time of day when they are scheduled,” said Bowen. “The same limitation on the number of duty hours may be either overly restrictive if during the day or too liberal if during the night.”

If you currently are an overnight shift worker, the AASM suggests taking steps to maximize your sleep time. Wear sunglasses on the way home and minimize light and sound exposure in your bedroom. Try to sleep immediately after your shift in the late morning until the early evening. On days off, do not switch back completely to a normal schedule. Instead, try a compromise by going to sleep about 3 AM.

If you would like more information on sleep and shift work, check out sleepeducation.com or contact the sleep specialists at  Oregon Sleep Associates.

Every year, especially during the summer months, millions of people take trips all across the globe. After meticulous planning , packing, and preparation they board planes towards their destinations, hoping for an enjoyable vacation away.But unfortunately, many of these travelers will experience something unexpected that can disrupt and even ruin their time off:  Jet Lag

Travelers experience “Jet Lag” because of a disruption of their Circadian Rhythm. The Circadian Rhythm is the 24 hour cycle that helps regulate the body’s sleep and wake times. This cycle uses light to essentially “set its clock”. As a person travels between time zones, their body has trouble adapting to the different environment. For example, if you are normally in the Pacific time zone and travel east to New York, your bedtime is now 3 hours ahead of when you would normally go to sleep. Conversely, if you travel west 3 hours, you may find it very hard to stay up since you are staying awake 3 hours past your bedtime.

Jet lag can make people tired and angry, sometimes ruining what is supposed to be a good vacation. Fortunately, there are some things one can do to combat the effects of Jet Lag. Here are some tips to help you deal with this problem:

• Select a flight that arrives in the early evening and go to bed at 10 PM local time.

• Anticipate the time change by getting up and going to bed at times closer to your destination’s  time zone for several days before your trip.

• Avoid alcohol, caffeine, and heavy exercise around bedtime.

• Bring earplugs and blindfolds to help dampen noise and light during sleep.

• Get outdoors and into the sunlight. Daylight will help regulate your biological clock.

Many people around the world suffer from insomnia. There are treatments such as pharmaceuticals, but often concerns over cost and side effects turn people off of using them. But now individuals who cannot sleep have a safe and effective alternative: Cognitive Behavioral Therapy.
Cognitive Behavioral Therapy (CBT) is a novel approach to dealing with insomnia without the need for medications. Instead of masking the problem, CBT focuses on addressing the factors that cause chronic insomnia. These factors can be personal, physiological, cognitive, and behavioral. According to the AASM, the therapy is based on two premises. First, that some of the underlying personal and physiological factors can be directly altered. Second, that maladaptive thoughts and behaviors are learned and that they serve to perpetuate insomnia. If they are learned, then they can be “unlearned” by the CBT process.  The process of the therapy typically consists of individual meetings with an insomnia specialist over several weeks. The specialist may use multiple techniques to help the patient. These techniques can include alternative medications, relaxation methods such as meditation and biofeedback, adjustment of sleep schedules, and bright light therapy. When performed correctly, CBT can be as effective in treating insomnia as medications.
Many doctors are still not aware of the existence and efficacy of CBT for insomnia. It’s best to find a sleep specialist that is specifically trained in administering CBT. Oregon Sleep Associates currently offers Cognitive Behavioral Therapy for insomnia. For more information call 503-288-5201 or visit us online at www.oregonsleepassociates.com.

You come home from work, enjoy dinner with the family, relax for a while, and settle into bed to fall asleep. But then something happens. You can’t stop thinking about your job, your grocery list, your home repairs, etc. Your mind is still racing and you just can’t relax enough to fall asleep. Pretty soon you realize it’s 3 am and you have to be up in a few hours. Just another sleepless night…

This scenario is all too familiar for many people. Insomnia, the inability to fall asleep or maintain sleep, is one of the most common sleep disorders. As outlined in Volume 2, Issue 1 of OSA’s Better Sleep, Better Health newsletter, there are many causes of Insomnia including situational stresses, shift work, and Obstructive Sleep Apnea. But what if you have seen a sleep doctor and determined you have none of these? You just feel you cannot turn off your brain.

It turns out there may actually be a previously unknown physical reason for this problem. Research published in the November 2008 issue of SLEEP suggests people may suffer from Primary Insomnia because of a lack of chemical transmitter in their brains. Gamma-aminobutyric acid, or GABA, is a common inhibitory transmitter which decreases or stops transmission of nerve impulses. The study found people with Primary Insomnia have on average 30% less GABA in their brains than those without Insomnia.

“GABA is reduced in the brains of individuals with insomnia, suggesting over-activity is present,” explains principal investigator Dr. John Winkelman in an interview on sleepeducation.com. Low GABA levels create an imbalance of brain activity. This “may lead to an inability to shut down waking signals in the brain,” he said.

Insomnia can seriously affect a person’s life and should be dealt with early on. Treatments can include short term use of hypnotic medications and cognitive behavioral therapy. For more information on sleep and Insomnia, check out our sleep center’s website.

In 2006, sales of the sleep aid Ambien® topped almost two billion dollars and placed that medication at number 13 on the list of the top 200 drugs prescribed in the US. The popularity of Ambien® and other sleeping aids suggests a growing trend of addressing sleep problems with medications. Unfortunately, with so many competing drugs and opinions based upon advertising, it is hard for a patient to distinguish what sort of treatment they need.

If you are having trouble sleeping, the first thing a doctor should do is determine what type of Insomnia you are experiencing. Insomnia can be “Transient”, occurring infrequently and in relation to temporary difficult or stressful times, or “Chronic”, occurring on a regular basis. The symptoms of insomnia can also arise as “Sleep-onset Insomnia” or they can manifest themselves after the patient has fallen asleep as “Sleep Maintenance Insomnia”. Depending on what type of Insomnia you have, sleeping pills might be an effective treatment. For example, a person has Transient Insomnia triggered by stress at work; they can’t seem to shut off their mind and fall asleep. In this situation, a short term prescription of a sleep aid might help them. On the other hand, someone else has been waking up several times a night and has difficulty getting back to sleep. In their situation it would be prudent to be screened for an underlying sleep disorder such as Sleep Apnea. Their sleep may be disrupted by the disorder, resulting in Insomnia symptoms and sleeping pills would further mask the problem.

It’s important to remember that sleeping pills should not be prescribed nor used lightly as they can have serious side effects and consequences. One recent study concluded that patients with Sleep Apnea who did not have their condition treated and were instead given sleeping aids had a substantially higher risk of car accidents. Also, some people may experience effects similar to sleep walking and may become a danger to themselves and others. Long term effects of sleeping aids have not been well documented and the FDA generally recommends short term use of most hypnotic medications.