Would you rather wear positive airway pressure (PAP) therapy each night or take a pill before bed? For most, it would seem they would love to choose the latter option as PAP machines can be viewed as burdensome. Wearing a mask to bed has long been an issue for many sleep apnea sufferers who are seeking a better night of sleep. As sleep apnea treatment continues to evolve, there is a growing population of patients interested in taking a pill before bed and not worrying about wearing a mask throughout the night. However, is it worth throwing out the mask and taking the chance that a pill can be as effective as the tried-and-true PAP machine?
Many studies have been done to assess the North American population for the presence of obstructive sleep apnea (OSA). These studies have shown that up to 80% of all patients with moderate to severe sleep apnea have not yet been diagnosed.1 With the population aging and obesity on the rise, we are not making a dent into this statistic, despite the growing awareness and the advancements in home sleep testing.
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Continuous positive airway pressure (CPAP) is the gold standard treatment for obstructive sleep apnea (OSA). In OSA, the upper airway muscle tone reduces excessively during sleep, allowing structures supported by these muscles to collapse into and block airflow partially or fully. CPAP treatment involves blowing slightly pressurized air through a mask, which fits over the nose and/or mouth, to push against airway structures so they do not collapse into the airway during sleep. Unfortunately, many patients are not compliant with CPAP treatment because of discomfort from the pressure or mask and adverse effects (e.g., aerophagia [air in the stomach]).
Obstructive sleep apnea (OSA), the most common type of sleep apnea, can be a serious sleep disorder, as breathing repeatedly stops and starts during sleep. Caused by throat muscles intermittently relaxing and blocking the airway, it can impair a patient's ability to reach desired deep and restful phases of sleep.
It’s finals week here at Cal State Long Beach, and we’re in the process of adopting a new mascot. I voted for the giraffe, a regal and noble animal with attractive coloring and a long tongue, but it came in dead last behind the pelican. The pelican? Seriously? The one with the big bag for carrying fish in its beak? The overwhelming winner was the shark; we have a world-famous shark research program here. But shark mascots are everywhere, and they all look like the “Saturday Night Live” land shark from years ago. And they have so many teeth. But I digress.
Every sleep professional knows that getting the right equipment (and getting it to work right) is crucial for any patient. Sometimes the companies that make durable medical equipment (or DMEs) are extremely helpful when working with patients, while others are not. We asked some of our members to explain their relationship working with DMEs, for better or for worse.
During my site visiting years, I spent a considerable amount of time on planes reading accreditation applications. One thing that always puzzled me was that many centers included high and low ranges for sleep stages as a percentage of total sleep time. Despite the fact that my site visiting hit its peak in 2010, I think these numbers usually came from the 1974 opus by Williams, Karacan and Hirsch, which appears to be out of print. Patients with inadequate Stage 3 or excessive REM were branded as abnormal. But abnormal how?
Murray Johns developed the Epworth Sleepiness Scale (ESS) and published his methodology in 1991. (1) He subsequently tested its reliability in a group of 104 medical students (2) and found a test-retest correlation of r = .82. For those of us who are fans of Karl Pearson and his product-moment correlation coefficient (and I know there are many fans out there), this is a very large correlation and indicates that the measure is reliable.
This is the final installment in a six-part series on the evolution of the sleep technologist role. AAST has engaged professionals from across allied healthcare to address, from their perspective, the value of collaborating more closely with sleep technologists and/or incorporating the discipline into their area of health. Nurses, Heal Thyself! I am a nurse. I have been for 20 years, and I have been tired for those entire two decades. I am not alone. As nurses, we are called upon to be superheroes ... impervious to things like hunger, pain, sadness and fatigue. We keep going. As the years go on we become crusty and curt. We proudly earn the nickname ‘Nurse Ratchett’. We show up. We put aside our fatigue to care for patients because we consider the need for sleep to be a character flaw; only for the weak. A true nurse can churn out shift after shift, even on minimal sleep because we will never abandon our patients.
This is part three in a six-part series on the evolution of the sleep technologist. AAST has engaged professionals from across allied healthcare to address, from their perspective, the value of collaborating closer with sleep technologists and/or incorporating the discipline into their area of health. Evolution, by any stretch of the imagination, can be a hard concept to grasp. It involves acknowledging that what is happening at the moment might not be the best thing to bring into the future, but trusting that the unknown is going to lead you to where you should be. How we take care of our patients today needs to adapt to the changing healthcare environment, where reimbursements are fluctuating and insurance payors are creating an uncertain future. The way in which we have always done things needs to adapt to this new healthcare reality. The sleep field has evolved tremendously over the years, and the role of a sleep professional continues to grow within the sleep realm.