The importance of Sleep

Good Sleep is an Essential part of Life

• High blood pressure• Heart disease• Diabetes• Obesity

Sleep deprivation adversely effects general health, physical and mental performance.

Chronic (repeated) sleep deprivation is serious, and can contribute to many problems including;

• Memory lapses• Depression• Increase in accidents• Damaged relationships

Sleep Disorders are serious!

Source: Deloitte Access Economics, Wake Up Australia, 2011

The cost to the Australian economy has been estimated at $21.2 billion.

That figure included healthcare costs, lost productivity, road accidents and work-related accidents.

Going 17 hours without sleep = Driving with blood alcohol 0.05%Going 24 hours without sleep = Driving with blood alcohol 0.10%Sleep deficiency can build up over several days

Being sleepy is like being drunk

Costs may be underestimated given the prevalence of people experiencing symptoms is substantially higher than the proportion of people who are diagnosed.

I snore loudly. Do I have Sleep Apnea?

Snoring – Do you snore loudly so it disturbs others or can be heard from another room ?

Tired – Do you often feel tired during the day, or fall asleep during the day ?

Stop Breathing – Has anyone observed you stop breathing during sleep or wake up gasping for air ?

High Blood Pressure – Have you or are you being treated for high blood pressure ?

Obesity – Are you obese with a BMI (Body Mass Index) over 35 ?

Neck – Is your neck circumference over 40cm ?

Age – Is your age over 50 ?

Gender – Are you Male ?

Family – Has any member of your immediate family (father, mother, brother or sister) been diagnosed with Sleep Apnea ?

There are a number of factors that need to be considered…

If the answer is YES to 3 or more of these questions, It is recommended that the patient consults with their family doctor who probably refer them for a sleep test.

A sleep test is the only way to find out for sure if the patient has sleep apnea.

Sleep Testing

10

Parameter/Type Ⅰ Ⅱ Ⅲ Ⅳ

EEG (Brain activity) ＋ ＋ － －EOG (Eye Movement) ＋ ＋ － －ECG (Heart Activity) ＋ ＋ － －

EMG (Muscle Activity) ＋ ＋ － －Air flow ＋ ＋ ＋ ＋Snoring ＋ ＋ ＋ －

Respiration Effort ＋ ＋ ＋ －SpO2 ＋ ＋ ＋ ＋

Body Position ＋ ＋ － －Monitor ＋ － － －

There are four types of Sleep Test, based on AASM Guidelines (American Academy of Sleep Medicine)

This test is conducted overnight in a sleep lab or hospital setting supervised by a sleep technician. This is resource intensive, expensive and inconvenient.

Level I Sleep Test. An overnight PSG (Polysomnogram) - Supervised

Sticky patches with sensors called electrodes are placed on your scalp, face, chest, limbs, and a finger.

While you sleep, these sensors record your brain activity, eye movements, heart rate and rhythm, blood pressure, and the amount of oxygen in your blood.

Elastic belts are placed around your chest and abdomen. They measure chest movements and the strength and duration of inhaled and exhaled breaths.

Wires attached to the sensors transmit the data to a computer in the next room. The wires are very thin and flexible. They are bundled together so they don't restrict movement, disrupt your sleep, or cause other discomfort.

During a Polysomnogram

Level II Sleep Test. An overnight PSG (Polysomnogram) - Unsupervised

This test is conducted at home after the patient has been given some simple instructions on how to connect the sensors and recording device.

The patient returns to the sleep clinic the following day and the recorded data is downloaded, analysed and reported.

Level III Sleep Test. An overnight Home Sleep Test (HST)

Sensors are placed on your chest, on one finger and under your nose.

While you sleep, these sensors record your heart rate, the amount of oxygen in your blood and your breathing.

Elastic belts are placed around your chest or abdomen. They measure movements and the strength and duration of inhaled and exhaled breaths.

This type of test is becoming more popular, especially when there is already a strong reason to suspect sleep apnea without other associated risk factors.

During a HST

The BMC PolyWatch with respiratory band is categorised as a level III sleep diagnostic device.

This test is conducted at home after the patient has been given some simple instructions on how to connect the sensors and watch style recording device.

The patient returns to the sleep clinic the following day and the recorded data is downloaded, analysed and reported.

Level IV Sleep Test. An overnight Sleep Screening Test (SST)

Sensors are placed on one finger and under your nose.

While you sleep, these sensors record your pulse rate, the amount of oxygen in your blood and your breathing.

This is a cost effective sleep screening test used when there is already a strong reason to suspect sleep apnea without other associated risk factors.

During a SST

The BMC SleepView is categorised as a level IV sleep diagnostic device.

Sleep Apnea

Sleep Apnea (Apnoea)Apnea is the Latin name for absence of breath. 

Obstructive Sleep Apnea (often just called sleep apnea, or sometimes OSA) occurs when the airway collapses during sleep and the person stops breathing. This is usually because a narrow airway collapses or becomes blocked when muscles relax during sleep.

The person with sleep apnea may have hundreds of these episodes throughout the night, disrupting their sleep and starving the body of vital oxygen. 

Sleep apnea affects between 5 and 12% of the population with estimates of up to 75% being undiagnosed.

The ratio of male to female is around 3:1 and the highest prevalence is in the 40 to 65 year old age group.

Central Sleep Apnea (CSA or CA) is much less common. Central sleep apnea occurs because the brain doesn't send proper signals to the muscles that control breathing.

People with obstructive sleep apnea usually snore loudly and have restless sleep. 

Often these symptoms are not noticed by the person with sleep apnea, but by their partner or work colleague, who may also notice frequent pauses in breathing and snoring, lasting between 10 seconds and a minute or even longer. 

Each pause ends with a deep gasping noise and brief awakening as the person struggles to breathe, although the person doesn’t usually remember awakening. 

As a result of the problems during sleep, the person with sleep apnea is usually very tired during the day, and as the day progresses, they may struggle to stay awake. 

The tiredness can affect the person’s ability to concentrate and to function well at work, and it can be extremely dangerous if they become sleepy while driving or operating heavy machinery. 

Other symptoms which occur in untreated sleep apnea include depression, irritability, personality changes, impotence, memory impairment and increased frequency of urination at night.

Symptoms of Sleep Apnea

• Sleep apnea can occur at any age. 

• In childhood, it is commonly the result of enlarged tonsils or adenoids or of some cranio-facial abnormality. 

• In adulthood, it occurs more often in middle age, and is more common in men than in women. (Approx 3 to 1 ratio)

• It is often associated with being overweight, particular with excess fatty tissue around the neck. 

• In people not overweight, it is likely that they have been born with a narrow airway, or a facial structure which leads to narrowing. 

• Almost everyone who has obstructive sleep apnea will snore, as snoring is also the result of narrow or floppy upper airways.

Who Gets Sleep Apnea?

How is Obstructive Sleep Apnea Treated?

Positive Airway Pressure (PAP) Therapy is the “gold standard” for treating Obstructive Sleep Apnea.

Treatment therapy is delivered by an air pump, hose and Mask.

Treatment Compliance is generally considered as;

• Using for at least 4 hours per night

• Using for 70% of the time. Eg: 21day out of the last 30 days

• AHI under 5, and the lower the better

CPAP

Constant Positive Airway Pressure (CPAP) machines treat Obstructive Sleep Apnea. They are set to the treatment pressure the patient's body requires .

This is usually based on a sleep study and doctor's prescription or a previous machine setting.

This treatment pressure is the pressure required to keep the patient's airway open during sleep. 

Even if the patient is still awake, the machine will still put out this constant pressure. 

If you do not know your prescribed treatment pressure, usually a CPAP machine cannot be supplied as we don't know what to set it to.

APAP (Auto or Auto PAP)

The Automatic Positive Airway Pressure (APAP) machines are set up with a minimum and maximum setting.

The auto machine adjusts up and down between this range throughout the sleep period to treat Obstructive Sleep Apnea (OSA).

During sleep, the auto machine will increase and reduce the pressure as required.

Typically the pressure is higher when the patient is sleeping on their back and less when on their side. The pressure will also vary depending on the different sleep stages, The auto machine will cope with all these changes by varying the pressure automatically as required.

In the future, the treatment pressure may change due to weight gain or weight loss, ageing, loss of muscle tone in the throat, etc. The auto machine will keep adjusting automatically to the correct pressure, often without the need for another sleep study.

"In my personal opinion, this is more comfortable and smarter way of providing the required therapy for OSA patients."

Which type of machine is best for me?

This is a very common question, and simply answered by referring to the table below;

Questions ??