Have you ever wondered what is happening in your brain when you are asleep?  Have you ever wanted to find out why you are often forgetting things that other people have no difficulty in recalling? There very well may be a direct correlation to what is going on here if you suffer from Obstructive Sleep Apnea or OSA.

Neurologists have in recent years been able to monitor the inner workings of the brain, and it has become clear that sleeping and dreaming is a very important part in the overall success of memory.  For example, while being monitored, healthy individuals without sleep apnea were examined while asleep.  It was determined that the brains of these individuals were constantly reviewing and replaying the daily events of that previous day, often hundreds of times per hour.  It is believed that this process is what is responsible for stamping memories into certain parts of our brains.  Without this, we may have a much harder time remembering things, names, events, dates etc…

Now, if you are an individual who suffers from snoring and sleep apnea, you are dealing with an entirely different set of physical disabilities while you are asleep.  The main problem is the constant arousal which is taking place when your oxygen levels decrease and your brain is aroused.  This sets off a change in the brain waves as well which disrupts the replaying of events and makes it much harder for you to remember events from the past which other people can do with ease.

What this means is that not only are blood vessels and the heart and cardiac system affected by sleep apnea, but also your brain can be damaged and your lifestyle affected too.

air traffic worker sleeping

Within the past few weeks, there has been an awful lot of news about the air traffic controllers in the United States falling asleep while working.  This has gotten to the point where President Obama is demanding that these workers who serve the general public in a critical way need to be held responsible immediately.  The most recent air controller has been suspended from work while an investigation begins.

What might be the cause of these employees falling asleep on the job?  They are all initially suspected of having sleep apnea.  Sleep Apnea is a sleeping disorder and is widespread throughout not only the United States, but the rest of the world.  The most common symptom that sleep apnea patients present in their daily lives is chronic fatigue or sleepiness.  The reason for this is simple: they are not getting a good nights sleep because their airway is being obstructed which causes them to constantly arouse and wake up over and over again all night long.

Sleep Apnea would make the most common sense for the air traffic controllers, as all of them have passed several drug tests, and have been through a very rigorous screening process prior to being hired into their important safety positions.  The physical dilemma that an undiagnosed sleep apnea patient has is they can’t understand why they are so sleepy all day long.  Often the sleepiness goes on for years before a proper diagnosis is made, and during that time the patients find creative ways to minimize the effects the symptoms have on their daily life.  For example, many sleep apnea patients who are sleepy all day long compensate by drinking enormous amounts of caffeine to stay away on the job.  It is not common for workers with sleep apnea to drink 10-15 cups of coffee per day just to keep from falling asleep while working.

There is some very positive news if the air traffic controllers do have sleep apnea, it can be fixed quickly and easily.  First the air controllers would need to be tested with a sleep study to make the diagnosis.  That can take anywhere from one to two week to complete.  Next, there are several treatment options that can be chosen which range from sleeping in a different body position, to CPAP therapy which involves wearing a mask to sleep each night, or even oral surgery.  It is not the end of the world if you have sleep apnea, so it should not cost anyone their job if they diagnose and treat it properly.

With so many patients not wanting to use CPAP for snoring and sleep apnea, there is a new medical and dental solution combination that is working very well for many patients.  By themselves, minimally invasive snoring surgeries are often unsuccessful in terms of long term treatments.  The same is often true for people who snore all night long who decide to use an oral appliance to open up their airway.  But what both doctors and patients are finding out right now, is that the combination of the two treatments when used together, is very effective and is also a long term plan to stop both snoring and sleep apnea from affecting the day to day lives for those who suffer.

Snoring Surgery

The sleep surgery options that have been used for many years now range in a broad way from very minimally invasive approaches, to surgeries which involve splitting the jaw and removing parts of the soft palate.  These more substantial jaw breaking sleep surgeries are very complex and are extremely expensive, and often, they do not work.  This has made many people either decide to not look into any type of surgery, or to decide on something else to treat their obstructive sleep apnea.  The more minimally invasive surgical procedures are typically compelted within 5-10 minutes and always allow patients to simply walk out of the clinic afterwards.  These types of procedures are usually completed by an Ear, Nose & Throat  (ENT) surgeon and involve the use of lasers to remove certain pieces of tissue from the throat.  There are several different actual procedures and one of them that is very popular right now is called the Pillar Procedure.

Oral Appliances

The dental solution that so many people have been focusing on in recent years has been to use what is called an “oral appliance” to help the snoring and sleep apnea.  Appliances are dental devices which are made specifically for each individual’s mouth and are created after impressions are taken in the dental office.  These oral appliances help snoring by moving the mouth’s tissue away from the airway or by moving the lower jaw outwards to create more space within the airway.  It is also not 100% effective for treating snoring, but it does not require a major surgery, and with a bit of luck and some help from a basic medical procedure, oral appliances can be very effective in terms of a snoring treatment.

How do sleeping pills affect someone who is dealing with sleep apnea?

For so many people in today’s drug induced world, sleeping pills are prescribed quite often from doctors for many different reasons.  A very high percent of the population who take sleeping pills complain of having a hard time either falling or staying asleep at night.  One question remains though, if a person has already been diagnosed with sleep apnea, how do sleeping pills affect your sleep with OSA?

Sleeping pills are not recommended for anyone to be taking if they suffer from sleep apnea, unless they are using CPAP therapy properly.   The sleeping pills can cause someone to have a slower reaction time to get out of an apnea event while breathing and may allow oxygen levels to drop very low.  The sleeping pills basically act as a tranquilizer to the body, and if you combine that with un-treated sleep apnea, it is a recipe for disaster.  On the other hand, for someone who is using CPAP, the air pressure that is being supplied to the body will force breathing to continue at a proper pace, and should be un-affected by the sleeping pills.  Either way, you should speak with a physician about the best ways to deal with proper sleep before ever taking any prescription medications, especially if you know you suffer from sleep apnea or have a history of being tired and symptomatic of OSA throughout the day.

How could sleep apnea be described in very basic terms, is it just as simple as someone who snores?

In fact, sleep apnea is much more than just snoring, and although snoring is often present with people who have the sleeping disorder “Sleep Apnea”, it is not always the case, and at the same time, just because you snore does not mean you also have sleep apnea.

I snore almost every night, but when I take a home sleep study, the results come back that I do not have sleep apnea.  So by this definition sleep apnea is not snoring always.  What is interesting about my sleep study results is that from night to night, my readings in terms of the Apnea Hypopnea Index (AHI) can vary significantly from 1.2 per hour to over 4 per hour.  This it turns out is normal for everyone. No two nights of sleep are identical, and therefore the amount of snoring you may have one night can be very different on a second night.  This is one of the difficulties in understanding if someone’s snoring is causing a serious or potentially serious health risk.  There are many instances recorded of people who snore who develop sleep apnea over time, but for many years do not suffer from any symptoms and lead a healthy and normal life.

Some recommendations that can benefit everyone who snores during sleep is to have a check up with your family doctor, and request to undergo a sleep study.  The sleep study can be performed either at home or in an overnight sleep lab environment.  There is a test which is recorded for the sleep study that is called a Polysomnography Test, which will record your breathing and also your oxygen levels and a few other pieces of data including the level of snoring you have.  Once you have these results of the sleep study scored, you will be able to determine with your physician if your snoring is sleep apnea or not.  There is really no reason not to do this as insurance often covers the complete or partial costs of this diagnostic sleep test.

For all the patients who have insurance through Kaiser Permanente(KP), you should not worry at all.  This managed care medical group actually has an excellent program in place to test, diagnose and treat their sleep apnea patients.  Also, because Kaiser handles all aspects of medical care, they are able to keep the entire sleep apnea program in-house which results in better patient compliance.

The process for Kaiser patients who are suspected of having sleep apnea goes something like this:

1. Patients receive a referral to have a sleep study conducted at home
2. Patients are then given a home sleep study device.  Currently, most of the Kaiser hospitals use the Itamar WatchPAT home sleep testing device to diagnose obstructive sleep apnea
3. After the study results are completed, the patient is then explained what the diagnosis is.
4. If you are diagnosed with sleep apnea, the next step is to have a home titration study conducted.
5. The home titration is performed with an Auto-PAP machine which will record your data.  This machine is a form of a CPAP machine and requires that the patient wears a CPAP face mask which will allow the transfer of air pressure to the face.
6. After the machine is worn for several nights, the data is recorded to see how the apnea and breathing events changed with CPAP air pressure.  If there as improvement, that is great news and is usually expected with this type of therapy.
7. The attending sleep doctor will write a prescription for the patient for an Auto-PAP machine, and the patient will then start using therapy.
8. If the patient does not have DME benefits, the patient will need to purchase a CPAP machine on their own over the internet or some other ways.  The usual cost for an Auto-PAP machine that is purchased online with a mask and humidifier is roughly $800-$900 with shipping in the United States.  Prices may vary a bit depending on what specific mask is used.
9. If at any point the patient has questions about the sleep apnea or CPAP machine, they can follow up with the Apnea clinic at Kaiser.

Overall, Kaiser has a very comprehensive Sleep Apnea Clinic which makes sure that patients don’t fall through the cracks.  If you are suspecting that you or a loved one who has Kaiser Insurance is suffering from un-diagnosed sleep apnea, you should instruct them to speak with their physician about it and have a home sleep study soon.

One of the benefits for all patients who enter the medical world is the ability to make use of modern day technology.  This is particularly useful for patients who have undergone sleep apnea surgery.  Many of the surgical benefits that are anticipated are often achieved after a good surgeon performs the agreed upon surgical procedure for treating sleep apnea, but there are also times when patients don’t get the benefits they had expected.

Don’t worry though if you are a patient, there is a definite way to test out how well your surgery has helped your respiratory disturbances, it is known as the sleep study.  In today’s modern world, everyone is also able to get a home sleep study right from there house.  There are several national and many local sleep testing service companies which will send you the necessary medical equipment to do just this.

If for any reason you are not sure if the surgery that was performed is actually helping you out, ask your doctor to prescribe a home sleep study, and soon enough you will have the results to compare.  One thing that you may already realize is very important, would be to have a sleep study also performed prior to having surgery.  This way you will have some diagnostic results to compare everything to.  This will almost certainly be part of your pre-surgery program, as any good sleep doctor or ENT surgeon will want to make sure the surgery is absolutely necessary.  If you find yourself in a situation where a surgeon is wanting to perform the surgery on you without you ever having a sleep study, that may be a sign that its time to find a new surgeon, and a serious red flag.

There is some good news to report finally out of the AASM.  The American Academy of Sleep Medicine is finally after many years of being against the practice, moving to adopt home sleep apnea testing as an approved and promoted form of diagnosing OSA.  This is very significant because for so very long they were not backing this form of testing, even though so many insurance companies were completely for it.  This article is going to try to uncover some of the reasons for why the AASM was so horribly slow in getting up to date with new technology and what types of factors might be influencing their strange decision making with regards to sleep medicine.

Let’s first start out with the most well known person in the world and the founder of the AASM, Dr. William Dement from Stanford University. Dr. Dement invented the overnight Polysomnograpy Testing which for so many years since its inception has been considered the “Gold Standard” for testing for sleep apnea.  He also discovered REM sleep many decades ago, and he also teaches the most popular class in the history of Stanford University called “Sleep And Dreams”.  What is remarkable also is that Dr. William Dement began approving and support home sleep testing over 10 years ago because he was very impressed with the technology and the accuracy of the results.  So why did the AASM, the organization that Dr. Dement founded take so very long to get to the point where it is right now?  In my opinion, the answer is simple, it all has to do with money and greed, not anything at all with good sleep medicine.

So lets examine it further.  What is the AASM?  The AASM is a group of doctors who are known as “Sleep Doctors”.  If a physician has the AASM symbols on their business card or their white coat, it means they are board certified in sleep medicine.  Also, to be part of this “Academy” you also pay fees which are used for all types of things including new multi-million dollar buildings in Illinois for the administrative offices of the AASM… and also for “other things”.  Anyways, by and large, the overwhelming majority of AASM accredited doctors are Sleep Doctors who own local sleep labs.  These sleep labs make the bulk of their money by completing overnight PSG in lab sleep studies on patients who are suspected of having sleep apnea.  Hopefully by this point, the article here is starting to uncover what is really going on.

So lets assume that a board certified sleep doctor owns a sleep lab.  And lets assume that they are being re-imbursed by insurance companies or Medicare when they complete an “in-lab” sleep study with about $1500 per patient.  Let’s also assume that over 70% of their revenue comes from these types of tests.

Then, lets start thinking about the alternative to in-lab sleep testing.  The HOME SLEEP STUDY, which the AASM has failed to recognize for so many years as legitimate.  Anyways, this type of sleep study only brings in $200-300 on average per study.  That is less than 25% of the revenue.  So here is the point, sleep doctors would much rather continue to perform in lab sleep studies compared to home sleep tests because they earn so much more money on them.  The rationale that the home sleep studies are not as valid is completely not true, and in-fact, it is often the exact opposite.

When you consider the healthcare system our country has, just realize that there are way too many reasons why the current system is not sustainable.  The way that sleep doctors and the AASM have handled sleep medicine proves that there are way too many special interests involved to be giving the taxpayers and the patients a fair shot at good, affordable, and best practice medicine.  It is a good step for the AASM to be moving in this direction, but there is much suspicion that they will have some more tricks up their sleeves to support their constituents(sleep doctors) so be aware.

Sleep Doctors Can Make Money in Many Different Ways

One of the most lucrative types of doctors out there these days are the sleep doctors of the world.  The main reason for this is that there are just so many ways to make money as a Sleep MD, and so many different ways to have health insurance companies cover the costs.  The world of sleep medicine is not one which most people have every heard of, or even understand, so within this investigative article, I will try to explain everything I know about the world of sleep medicine in the modern day society.

Sleep doctors are expected to deal with the 80 plus sleep disorders that exist.  That’s right, there are many different sleep disorders, but the reality is that they deal almost exclusively with two main ones.  Restless Leg Syndrome being a common sleep disorder along with Insomnia which we have all heard of.  Those two make up usually about 10% of the patients that sleep doctors see.  The overwhelming majority of patients a sleep doctor see though are patients who suffer from Obstructive Sleep Apnea or OSA.  This effects millions of people all over the United States and the rest of the world everyday and is often undiagnosed.

Let’s focus on how sleep doctors earn money and bill insurance and Medicare for their sleep apnea patients by looking at a list of billable medical services:

1. Initial consultations and office visits with patients who are referred to them by primary care physicians
2. Overnight in-lab sleep studies
3. Interpreting the sleep study diagnostic results
4. Follow up consultations to review the sleep results
5. Ordering in lab overnight titration sleep studies for patients who were previously diagnosed with sleep apnea
6. Interpreting the titration results
7. Consultations to review the titration study results
8. Prescribing and explaining therapy such as CPAP
9. Quarterly follow up office consultations to review how the therapy is going and if the sleep apnea is getting better
10. Annual titration studies to find out if anything has changed
11. Providing the medical equipment such as CPAP’s and masks to the patients and then selling the CPAP supplies in the future

This list above is actually a typical process that a sleep apnea patient would need to go through with a sleep doctor who owns a sleep lab as mostly is the case.  Every single office visit and consultation and especially the sleep studies are all billed to the health insurance company, and many times the amounts will exceed $10,000 or more when everything is all said and done.  For patients who have only a high deductible insurance plan, this is often not a doable options for them, and they will usually cancel the entire appointment because they will not be able to afford it at a later date.  Much of the un-needed expenses that the patient and insurance company pay for are associated with the overnight sleep study and the excessive office visits.  The typical office visit for a PPO insurance patient to meet with a sleep doctor ranges between $150-$230 per 30 minute visit.

Related articles

• Exercise Helps Men Battling Diabetes and Sleep Apnea (nlm.nih.gov)
• Weight Loss May Help Sleep Apnea Symptoms (nlm.nih.gov)

Fatigue

Being tired and feeling like you just don’t have any energy is the most common sleep apnea symptom.  Almost 100% of sleep apnea patients complain of fatigue to their partners or doctors at some time if not everyday.  The fatigue is also known as the silent killer for several reasons.  A very common way to cover up fatigue caused by sleep apnea is to drink excessive amounts of coffee and caffeine every day.  This only covers up the problem, and by no means does it cure the tiredness.  What is also does is it changes the normal and natural heart rate that a normal human should be having with all of the stimulants like coffee and coke and other high caffeine drinks.

Snoring

Just like the other most common symptom of sleep apnea, snoring is also very high on the list.  There is a slight difference though between the two symptoms.  Not everyone who snores has sleep apnea.  There is such a thing as casual snoring which does not affect the person and is something that often goes untreated during a lifetime.  Loud and disruptive snoring is something totally different.  It is a sleep apnea symptom because it often leads to obstructions in the airway and the loss of oxygen to the rest of the body.  With the airway being either completely or partially closed throughout the night, it causes patients to develop severe sleep apnea symptoms.  Snoring is also just plain rude to be doing all the time whether you sleep with a partner or by yourself.  There are even noise violations issued to sleep apnea patients because their snoring is so loud.  One of the great things about snoring and some other sleep apnea symptoms is that they all can be treated with modern day medicine and even some surgical procedures.

Treatment of sleep apnea symptoms is often accomplished through the help of first getting an official diagnosis of sleep apnea.  That is possible with the help of either a family medicine or sleep medicine doctor.  You will need to undergo a sleep apnea test which is very simple.

Related articles

• Weight Loss May Help Sleep Apnea Symptoms (nlm.nih.gov)
• Exercise Helps Men Battling Diabetes and Sleep Apnea (nlm.nih.gov)
• CPAP for sleep apnea – BMJ video (casesblog.blogspot.com)

Sleeping on the Job

There is not one person who actually wants to be falling asleep while they are working.  The facts show that more than 1 in 4 Americans has been caught sleeping or nearly falling asleep during working hours within the past two months.  That is a very high number and the root cause is believed to be something totally different than too much work.  The cause is actually from horrible sleep.  Obstructive Sleep Apnea or OSA is what most scientists and doctors believe is the true reason for why so many people fall asleep during the day.

Not Enough Quality Sleep

Most of the people who are caught sleeping on the job do not complain of too little sleep.  What they complain of is waking up in the morning and not feeling rested.  When you go further to ask them how many hours of sleep they have each night, sometimes the numbers are more than the 6-8 hours which most people consider normal.  So what is happening here?  The answer again is poor sleep quality.  When you are trying to sleep but keep waking yourself up all night long, that is poor sleep.  When you are stopping your breathing all throughout the night, that too is poor sleep.

Sleep Apnea

The worst sleepers often have sleep apnea.  This is a very simple sleeping disorder, but it can be devastating to the sleeper, and also to the family members who live close by.  Sleep apnea occurs when someone’s airway becomes blocked and stops allowing the air to flow freely to the lungs.  This as anyone can imagine causes a drop in oxygen levels which can actually kill you or cause heart attacks or strokes.  The reason that people do not feel rested is because they are constantly being aroused all through the night.  The brain actually wakes up the person who has the sleep apnea and causes them to move about to open up the airway.  This is the true reason behind why so many people fall asleep during work days, even though they slept for many hours the night before.