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Kennedy's Disease Chat Transcript10-05-02

Topics: Topic:  Sleep Apnea & CPAPs

Featured Guest:  Dave Hargett,  Sleep Activist Coordinator, A.W.A.K.E. Elk Grove Village, IL Founder of The A.P.N.E.A. Network

Host: Bruce Gaughran

 

Chat Participants:

 

Bruce 
apneanet 
johni 
patrick 
butch 
johnm 
mobiusloop2 
terryw 
don48312 
lenj 
Melski 


BEGIN CHAT


bruce -- Welcome, Johni
bruce -- Welcome Dave, are you set to go?
apneanet -- good morning bruce
apneanet -- I think so, although I was having problems with Internet
Explorer for some reason, so I'm using Netscape. Hopefully there won't be
any problems.
bruce -- It looks good so far....
johni -- Hi from damp miserable England. It's 62 degrees.
bruce -- We are going to be 88 today in Philadelphia
terryw -- {welcome terryw}
apneanet -- Chilly here in Chicago this morning. Earlier it was 43 degrees
headed to a high of about 64, but sunny.
bruce -- 43 is a little too cool. It is a reminder of weather to come.
bruce -- Welcome Terry
apneanet -- Bruce, I'm going to test the cut and paste mode by pasting in
the disclaimer, just to be sure things will be working.
apneanet -- DISCLAIMER: Please note that Dave Hargett is participating in
this chartroom as a lay volunteer and that none of his comments or opinions
are to be taken as medical advice. If you think you have sleep apnea or
are having trouble with your sleep apnea treatment, please discuss your
situation with your medical doctor or sleep specialist. Only a doctor who
is treating you can advise you on how you should be diagnosed and treated.
For more general information on sleep apnea, you can visit
www.sleepapnea.org. Untreated, sleep apnea can be very serious. The
American Sleep Apnea Association is a non-profit organization and does not
endorse any company, product, or health care provider.
terryw -- hello
melski -- {welcome melski}
terryw -- hey johni, hows it been going?
johni -- OK been on holiday in Scotland for a week. It was good.
terryw -- Johni, we have never been to Scotland. YET
johni -- It is a beautiful country, but a little short of disabled faculties in parts.
johni -- Facilities
bruce -- Welcome Melski
butch -- {welcome butch}
bruce -- Johni, is it 3:20 or 4:20 over there?
johni -- It is 3.20. at the moment. Clocks go back at the end of this
month
bruce -- Welcome Butch, glad to have you on board.
terryw -- hello melski.
terryw -- hi butch
bruce -- Dave, we'll give everyone a chance to sign on this morning and
get started around 9:30 your time if that is okay.
apneanet -- yes -- no problem. I was just testing the paste of my notes.
I'm in no rush.
butch -- Good morning to all. Had a fabulous day at NIH yesterday. I got
to meet Dr. Fishbeck and Dr. Kennedy. What an honor.
bruce -- Butch, that must have been interesting. What was the occasion?
terryw -- butch, I hear Dr. Kennedy is going to try to make it to the conference?
butch -- Dr. Kennedy is going to California to see his grand children get
baptized. I think that was the reason but it sounded like he didn't need
much coaxing to go see his grand kids.
terryw -- Oh, Annette said the he may rearrange some flights and try to make it.
butch -- He said he would try to get to the conference, but he only found
out about it yesterday. I also invited him to join our chats.
terryw -- we had sent him an invitation months ago, hmm must have not
gotten to him or wrong address.
butch -- There are two Dr. William Kennedy's
terryw -- Oh I see
butch -- Terry--I tried to send that as a private message but once again
it was posted to the chat. I am referring to NIH testing.
terryw -- how's the leg they cut butch?
terryw -- Butch,, did they have to cut deep for the biopsy?
butch -- Terry--No not at all. Charles Rannels was there also.
terryw -- We have met Charles and his wife. Very nice people.
terryw -- {welcome terryw}
terryw -- is anyone typing anything?
johni -- No not here.
johni -- It seems very slow today
apneanet -- testing for delays
bruce -- Welcome everyone, I would like to get started.
bruce -- Dave Hargett has joined us this morning to discuss CPAP and Sleep
Apnea. Dave is a committed sleep activist and ardent supporter of the
American Sleep Apnea Association and its AWAKE network. He has been an
active member and the coordinator of the Elk Grove Village, IL AWAKE group
since 1995. Dave was the 1997 AWAKE coordinator of the year. We are very
fortunate to have Dave join us today and I want to thank him from all of
us at KDA. Welcome, Dave.
apneanet -- Thank you!
lenj -- {welcome lenj}
bruce -- Before we get started I need to post this disclaimer again.
Disclaimer: Please note that Dave Hargett is participating in this chat
room as a lay volunteer and that none of his comments or opinions are to
be taken as medical advice. If you think you have sleep apnea or are
having trouble with your sleep apnea treatment, please discuss your
situation with your medical doctor or sleep specialist. Only a doctor who
is treating you can advise you on how you should be diagnosed and treated.
For more general information on sleep apnea, you can visit
www.sleepapnea.org. Untreated, sleep apnea can be very serious. The
American Sleep Apnea Association is a non-profit organization and does not
endorse any company, product, or health care provider.
terryw -- hi Len
apneanet -- Comment from Dave Good morning, everyone. I'm happy to be here
to answer your questions about sleep apnea. Bruce was kind enough to send
me a few questions, so I have prepared some replies in advance to some
basic questions. We will probably post most of them early in the session
to give you a good overview of sleep apnea symptoms, diagnosis and
treatment, and then I can answer any specific issues that you would like
to discuss. I am a sleep apnea patient myself. I've been using CPAP at a
pressure of 12 or 13 for the past 8 years. For me, this treatment has
changed my life. My apnea had been causing my quality of life to
deteriorate, including both my personal life and my ability to do my job.
CPAP therapy made me normal again. Over the past few years I have become a
sleep activist and work to inform people everywhere about sleep apnea and
its impact on a person's health. I've been a support group leader for 7
years and I recently became a member of the Board of Directors of the
American Sleep Apnea Association, the non-profit organization devoted to
increasing awareness of sleep apnea. So I'm grateful to be able to reach
out to all of you participating in this chat this morning.
lenj -- Hello everyone
bruce -- Dave, what exactly is sleep apnea?
apneanet -- What is sleep apnea? Apnea means "without breath". Simply put,
a person with sleep apnea quits breathing in his or her sleep, often
dozens of times an hour. These respiratory events also tend to cause
arousal's in the brain and prevent the patient from getting deep sleep
and/or REM sleep. There are three types of apnea: most common is
obstructive, where the airway collapses during sleep, usually during the
effort to breathe. Central apneas are those that occur when the brain
forgets to tell the body to breathe; there is no respiratory effort during
these apneas. A mixed apnea is an apnea event that combines elements of
both obstructive and central. Perhaps 90% of apneas are obstructive, 8%
central, and 2% mixed, but those are my own understanding of the
frequency, not from any scientific research. In general terms, most people
will have their most severe apnea when lying on their backs, as the force
of gravity can work to collapse the airway. Apnea is also more likely to
be at its worst during REM sleep, when the body loses its muscle tone and
is effectively paralyzed. But apnea can occur in any position, even when
sitting upright! To be counted as an apnea, you must quit breathing for 10
seconds or more. Another type of event is a hypopnea, which is a reduction
in airflow of greater than 30%, with an associated drop in oxygen
saturation of 4%.
lenj -- I had a CPAP, but for last 2 years a BIPAP, pressure 11
apneanet -- lenj, hope the PAP device has been helping you!
lenj -- USUALLY WORKS WELL EXCEPT WHEN MY NOSE PLUGS UP .
terryw -- How do I convince my doctor to send me in for a sleep study when
I think I am affected by Sleep Apnea. I use an HMO.
apneanet -- terry, HMO's are always fun to deal with! Getting the doctor
to recognize sleep apnea is the first step.
apneanet -- Or at least the symptoms of apnea. Then you can talk about the
consequences of NOT being treated and how it's more expensive to NOT be
treated.
apneanet -- People with untreated apnea are up to 4 to 5 times more likely
to have heart attacks and strokes and accidents. That can get expensive
for an HMO.
lenj -- You are right, I had a heart attack. They paid for 3 sleep studies,
a w.cpap and finely to get me a bipap.
terryw -- I need one of these studies done, Susanne has told me for years
that I stop berating on & off at night.
butch -- Dave--How does the sleep cycle get interrupted when you might
stop breathing for several seconds.
apneanet -- Butch, you asked about the sleep cycle getting interrupted due
to the lack of breathing.
apneanet -- We go through several stages of sleep as determined by the way
our brain waves look during sleep. There is REM (Rapid Eye Movement)
Sleep, where we do most of our dreaming.
apneanet -- There are 4 stages of Non-REM sleep, numbered 1, 2, 3 &4. The
deep or delta sleep is stages 3 and 4, where we get our physically
restorative sleep.
johni -- I wish I could get to stages 3 and 4. My sleep is just not
physically restorative!
apneanet -- John, Actually as we grow older we get less and less of the
delta sleep (that physically restorative sleep), so that is fairly normal,
unfortunately.
johni -- Thanks Apneat. I feel a little better knowing that
apneanet -- When an apnea occurs, the brain eventually notices that it has
too much carbon dioxide and not enough oxygen and sends a signal to open
the airway by tightening the muscles. This also raises heart rate and
blood pressure. The signals also cause the brain to "arouse" and move from
one stage of sleep to another. This prevents the brain from reaching the
deeper levels of sleep that we need.
johni -- What is HMO and PAP device. No abbreviations. PLEASE
terryw -- Johmi, HMO in the USA means Health Management Organization I
think
terryw -- health
apneanet -- John, HMO is Health Maintenance Organization, a kind of
medical plan here in the US.
terryw -- Thank you. Apneanet
apneanet -- By PAP device, I meant any kind of Positive Airway Pressure
Device, either CPAP (Continuous), BI-level (two pressures) or
autotitrating (determines the correct pressure for treatment)
johni -- Thanks
bruce -- Let's take a step backwards for a moment and perhaps you could
talk about the symptoms.
apneanet -- What are the most common symptoms of a person who has sleep
apnea? The most obvious symptoms are loud, chronic snoring, excessive
daytime sleepiness, and observed pauses in breathing during sleep. Those
three alone are good evidence for having sleep apnea. Other symptoms
include unrefreshed sleep, fatigue, morning headaches, increased
irritability, high blood pressure, impotence, memory loss, inability to
concentrate, and frequent urination throughout the sleep period.
bruce -- Dave, how is sleep apnea normally diagnosed?
apneanet -- How is sleep apnea diagnosed? Usually the patient is dragged
into the doctor's office by his or her bed partner, who is tired of losing
sleep due to the snoring and interrupted breathing of their partner. If
that patient is middle-aged, overweight and has a large neck (>16 in
women, >17 in men) and is having symptoms, more than likely the patient
does have sleep apnea. Keep in mind, though, that persons of any age, from
infant to 100 can have apnea, as can persons who are thin. The only
scientific way to measure apnea is to have an overnight sleep study, where
you sleep in a sleep center, with a number of sensors attached to your
body that measure various items throughout the night while you are
sleeping. This includes brain waves, leg movements, blood oxygen
saturation, airflow, snoring, eye movements and respiratory effort. When
the results of these studies are scored, the technologist will provide a
summary report to the sleep doctor who will interpret the study. Often
this can take a few days or even a week or two, depending on the backlog
of work in that sleep center and in the doctor's office.
apneanet -- sorry for the long answers but it helps make things clearer, I
hope!
terryw -- this is great info Apneanet, It just takes a while with this
refresh to catch up on the reading.
apneanet -- I understand Terry. Take the time needed to read.
terryw -- good ?
butch -- Dave--is it that as we grow older we are less active and possibly
not as physically tired as we once were?
apneanet -- I don't know that that is the cause. It's simply a matter of
observation so far, that the older a person gets the less delta (also
called slow wave) sleep we get. Now it is known that delta sleep is when
growth hormone is secreted. Obviously the older we get the less of that we
need, so that may be part of the brains regulatory process.
bruce -- Butch poses a good question. We are less active and don't utilize
our muscles as much. Good thought.
terryw -- I have Restless leg syndrome also which makes it hard to sleep
but Klonopin helps me quite a bit.
apneanet -- Yes, Restless Legs Syndrome makes many people have trouble
falling asleep due to the feeling in their legs. Many have to get up and
walk around. The newsletter of that organization is called The Night Walkers!
johni -- Does that mean my choking episodes are not due to apnea then ?
apneanet -- John, waking up with choking episodes in the night is often a
symptom of sleep apnea.
terryw -- I choke sometimes Asleep or not.
lenj -- The bipap has totally eliminated my nighttime choking episodes (dry
drowning as Terry calls them)
apneanet -- For most apnea patients there is a cycle of loud snore,
silence (when we stop breathing), then a loud gasp or snort or choking as
we are aroused and try to grab some air!
johni -- I just thought it was a part of Kennedy's and that I have to live
with it!
apneanet -- The sad thing about apnea is that often the patient denies
there is anything wrong. We just think we're getting old and that this is
the way life is. It is usually the spouse or bed partner who notices things first.
butch -- Is there any way to change the format of the chat to have the
last posting at the bottom of the page instead of at the top? It is very
hard to catch up when arriving late to the chat.
terryw -- butch, I have talked with the MDA and they are working on that
but have no definite fix date for us.
butch -- Bruce, I just thought it would be quicker to read like a text
page instead in the reverse.
bruce -- If your doctor agrees to have you see a specialist, what should
one expect during a "sleep study?"
apneanet -- a sleep study is being "wired for sleep".
apneanet -- You'll go to a sleep center where they will attach wires to
your head to measure your brain waves, plus measure your chest and
abdomen's respiratory effort, the airflow in your nose, your snoring, your
oxygen saturation level, and your leg kicks (if any).
bruce -- Interesting, I have always associated leg kicks with KD.
apneanet -- They also measure the movement of the eyes. All of this is
aimed at capturing data to help them categorize your sleep and whether you
have arousal's or not. When they review these 16 channels of information
they look at 30 seconds of time for the entire period of your sleep and
score everything.
terryw -- I hate the leg kicks
bruce -- so does my wife....
apneanet -- You also answer some questions before and after the sleep
study. The doctor then interprets the results of the study to determine
whether or not you have sleep apnea or another disorder or no disorder.
butch -- You guys are lucky--My wife gives me a REPORT OR SLEEP STUDY
especially on a loud snoring night. I didn't hear a thing.
apneanet -- Leg kicks or even arm movements that occur rhythmically during
the night are called Periodic Limb Movements of Sleep PLMS or Periodic
Limb Movement Disorder PLMD. This is a separate sleep disorder that can be
controlled with medication. However, some sleep apnea patients also kick
during the night and it is thought to be associated with the arousal's of
the brain when we stop breathing. Maybe a "kick start" to get us breathing
again?
apneanet -- Leg kicks or even arm movements that occur rhythmically during
the night are called Periodic Limb Movements of Sleep PLMS or Periodic
Limb Movement Disorder PLMD. This is a separate sleep disorder that can be
controlled with medication. However, some sleep apnea patients also kick
during the night and it is thought to be associated with the arousal's of
the brain when we stop breathing. Maybe a "kick start" to get us breathing
again?
johni -- Can this condition come and go? Because I have not had an episode
for ages.
apneanet -- I'm trying to catch up on questions too!
apneanet -- John, most apnea patients have it for life, but some are on
the edge and a little weight gain or loss can make a difference. If you
have only occasional choking episodes it might not be related to sleep
apnea. Generally an apnea patient will snore, be tired all the time and
have excessive daytime sleepiness.
johni -- Thanks Apneanet. I doubt I am a sufferer then. Just a restless
sleeper with KD
terryw -- is moaning at night or making strange breathing noises a sign of
sleep apnea?
apneanet -- Terry, strange breathing noises might be related to apnea.
Some people snore others just breathe "funny". Moaning is more likely to
be associated with something else like sleep walking, sleep talking, etc.,
which are called parasomnias.
terryw -- its only when my throat is in certain positions
terryw -- I have the be tired all the time and have excessive daytime
sleepiness.
don48312 -- {welcome don48312}
bruce -- Welcome Don
terryw -- Hello Don
lenj -- When my sinuses act up my nose plugs, and I drool a lot and mucous
builds up in my throat. I wake up, even with the bipap. Is there anything
I can do to prevent this build up.
apneanet -- Lenj, do you use a humidifier with the BI-pap? A heated
humidifier can help with a lot of sinus issues. Also the use of nasal
steroid sprays and/or allergy medications can help keep the nasal airway
open. I've used a nasal steroid spray (prescription, like Nasonex) for 8
years now, as long as I've been on CPAP.
lenj -- Thanks, I have the humidifier but I didn't hook it up. But I
recently moved from Buffalo to Vegas. I will start tonight
apneanet -- Len, I suspect the Vegas air is much drier than Buffalo,
especially with air-conditioning. I use my humidifier all year long.
butch -- It is great to know that there are medications to help with some
of these sleep disorders. I guess without proper sleep we will be more
tired through the whole next day.
apneanet -- Butch, there are medications to help with some disorders, but
Not with sleep apnea.
butch -- Dave--sorry I thought it was said that meds will help in some
way.
apneanet -- butch, for apnea any meds that are used are to help clear the
nose. With the use of most CPAP devices, you need to be able to breathe
through the nose, so having a clear nasal passage is important, but that
actually does nothing to directly treat the apnea.
terryw -- Thank you Apneanet, this is a great subject and I am sure that
many who could not join the chat today will find the transcript that we
send out very informative.
bruce -- How does a PAP help the process of breathing?
apneanet -- Most cases of apnea are obstructive, so the airway is
collapsing, bruce. The key to breathing normally is to keep the airway
tissues from collapsing and blocking the airway. That is what a CPAP does.
The pressurized air is blown through tubing to a mask and is used to act
as an air splint that holds open the airway and allows us to breathe
normally.
apneanet -- Most cases of apnea are obstructive, so the airway is
collapsing, bruce. The key to breathing normally is to keep the airway
tissues from collapsing and blocking the airway. That is what a CPAP does.
The pressurized air is blown through tubing to a mask and is used to act
as an air splint that holds open the airway and allows us to breathe normally.
don48312 -- {welcome don48312}
mobiusloop2 -- {welcome mobiusloop2}
terryw -- Apneanet, have you heard of a laryngeal Spasm? not sure of the
spelling.
apneanet -- Heard, terry, but not sure what it is. Not enough to talk
about it. I do have my limits!
terryw -- no problem
bruce -- Welcome Mobiusloop2
johni -- I am going to send a copy of this transcript to my Consultant, if
that is O K
terryw -- sure Johni
johnm -- {welcome johnm}
bruce -- Johni - there are some good white papers and other information at
http://www.apneanet,org
bruce -- Welcome Johnm
johni -- Thanks Bruce
apneanet -- I'm going to post a long note here about treatments for sleep
apnea. There are several options, although the CPAP device is often the
first and only item that many patients need.
apneanet -- This note is nicely divided into paragraphs, but the cut and
paste supported here runs everything together, so I apologize for that.
apneanet -- oops, apparently that message is too long. let me try again.


apneanet -- In general terms, there is rarely a "cure" for sleep apnea
patients. This is a lifelong, chronic disorder, but it can be treated
effectively in most patients. For very mild cases, sometimes losing
weight, stopping smoking, stopping alcohol just before bed, or making
changes in how the patient sleeps positionally can make a difference. The
most common form of treatment is the use of a PAP (Positive Airway
Pressure) device. These work by blowing air under pressure through tubing
to a nasal mask worn by the patient (there are several forms of masks and
other ways to deliver the air to the body). This pressurized air acts as
an air splint to hold open the airway, allowing the patient to breathe
normally. This prevents the obstructions from occurring, so that the
patient is not aroused and can get a "normal" night's sleep. This pressure
is measured in centimeters of water pressure and will usually range from 5
to 24, with the 8-10 range about average. There are three types of PAP
devices: CPAP is one continuous flow of air at one set pressure BI-level
PAP or BI-PAP offers two pressures - a higher one for inhalation and a
lower one for exhalation. The machine senses the breathing mode and
adjusts as needed. Auto-titrating devices realize that the pressure needed
to keep the airway open can vary depending on the stage of sleep and the
patient's position, so it monitors the patient and adjusts the pressure to
provide only the pressure needed for that breath. This results in the
patient getting an overall average lower pressure, while still delivering
the pressure needed to keep the airway open during the most severe apneas.


apneanet -- CPAP is usually the first type tried. If it works for the
patient, they stay on CPAP. For patients who have difficulty exhaling
against the pressure needed to keep the airway open, a BI-level device
allows for a lower exhalation pressure. This is also often used in cases
of central apnea, where the pressure differential can help the brain
remember to breathe. Auto-titrating devices are the newest thing on the
market, with higher prices, but they can help patients who have trouble
adjusting to the standard CPAP. For patients with mild to moderate apnea,
especially for someone who has difficulty using a CPAP, the use of an oral
appliance can be another way to treat the apnea. Most often these are
devices made to order by a dentist. While there are devices to help hold
the tongue forward (so it doesn't flop into the back of the throat), most
oral appliances are like mouthguards that fit over both the upper and
lower teeth. They are generally used to advance the lower jaw forward,
thereby increasing the size of the airway at the back of the throat.


apneanet -- Most sleep specialists consider surgery as a last resort, for
patients where CPAP does not work or where the patient cannot tolerate the
use of CPAP. There are several types of surgeries that can be tried, but
many patients who have surgery re-develop symptoms several years down the
road; or they find that a single surgery doesn't help and must have
several types of surgeries, most of which are painful! Surgeries can range
from removing the uvula and tightening up the soft palate, to removal of
tonsils and adenoids, to removing parts of the soft palate, to nasal
surgeries to open up the nasal passages, to moving the tongue forward, and
to breaking the jaws and advancing them forward. One surgery that will
usually fix the problem is a tracheotomy, where a tube is placed in the
throat, below the obstruction problems, so that it avoids the entire upper
airway. For apnea patients, this trach can be capped during the day, but
must be left open during the night. This option isn't chosen very often,
although it was once the treatment of choice.


bruce -- With the auto-refresh, this will take some time to read.
johni -- Yes but to fully absorb this information it will be necessary to
use the transcript
terryw -- yes
apneanet -- I agree that reading the transcript is something that folks
will need to do to get the full flavor of my replies. It is a complicated
subject.
butch -- Dave, I understand--The airways being open make it easier to
breathe through the sleep cycle. So uninterrupted sleep is attained.
lenj -- NOTE: If anyone wants to see a BIPAP, I will have mine at the
Conference next week in Balt.
mobiusloop2 -- sorry to be so late but I finally got to sleep about 5 this
morning
bruce -- My brother uses a CPAP (the last two years) and it has made a
significant difference in his life (energy)
bruce -- Dave, has there been any negative side effects from using the
CPAP?
apneanet -- I don't know personally anyone who has had any negative side
effects from using CPAP that were really bad or that couldn't be fixed.
The worst for most people is that they swallow air and wake up bloated in
the morning (this is not really common, either). This is often resolved by
changing the pressure or by using a chin strap to be sure they keep their
mouth closed during sleep. As far as long term goes, CPAP has only been
around since 1985 so we haven't seen any yet. But the quality of life in
so many measures and the risk of serious ailments is brought back to
normal through use of CPAP that it would be hard to argue that there is
any net negative impact at all.
terryw -- AP, are you saying this causes gas?
apneanet -- terry, most apneics who are untreated are all over the bed
most of the time. When they first start using CPAP and sleeping more
peacefully, many of them wake up stiff and sore for a few weeks because
they are not used to lying in one position! That happened to me.
apneanet -- For those people who swallow the air, they wind up burping or
passing gas, yes, but it is really simply too much air in their stomach,
not gas as we think of it.
terryw -- OK
terryw -- are the masks uncomfortable?
bruce -- My brother had to try several different masks to find the right
one (comfort, etc.).
terryw -- I like to turn over from side to side in bed is this possible
with a CPAP or BI-PAP?
terryw -- my muscles get really sore & stiff if I don't turn & adjust
myself real often when I sleep
lenj -- After you get comfortable with the mask, you can roll from side to
side with out problems. Practice makes better, not perfect
lenj -- However you roll over when slightly awake. In a deep sleep you
pretty much stay in the same position
patrick -- {welcome patrick}
bruce -- welcome patrick
don48312 -- been catching up trying to read backwards on this pitiful
site. hi all
don48312 -- packing 4 the Baltimore party
patrick -- Hi all, I tried to get on earlier, but the MDA site wouldn't
accept me.
terryw -- real soon don :)
mobiusloop2 -- Yeah, Don, me too!
don48312 -- lol, ill not hold my breath
don48312 -- had a sleep study and passed with flying colors.
apneanet -- By the way, some people with gastric esophogeal reflux disease
(GERD) or sometimes called heartburn, who also have sleep apnea, find that
treating their apnea with CPAP relieves or eliminates their GERD.
apneanet -- It's thought that all the extra pressure caused by trying to
breathe during apneic events can help pull up the acid reflux into the
airway, so that's why treating the apnea fixes the GERD.
mobiusloop2 -- I have interrupted sleep. Is this sleep apnea?
apneanet -- Interrupted sleep means what to you? Frequent awakenings? Do
you fall back asleep quickly or do you have trouble falling asleep?
mobiusloop2 -- Usually I can get back to sleep in 5 or 10 mins
terryw -- I take the Klonopin and it puts me into a sub-Coma where I don't
move, legs don't kick, and I am usually a light sleeper and the slightest
noise awakes me. but with the Klonopin my wife could start a chainsaw near
my head and I would not hear it. That can be good or bad LOL.
lenj -- Terry, I'd get rid of the chainsaw
johni -- I wonder whether Klonopin would help me sleep better?
don48312 -- I would be very afraid to give my wife a chain saw or any
other sharp instrument when I sleep, lol
terryw -- LOL
apneanet -- johni, if you have PLMD or RLS (see previous dialogue), then
Klonopin might be of assistance to you. Mirapex is another newer drug that
is often used for the same disorders.
don48312 -- my MDA doc prescribed Neurontin for me and it makes me sleep
like a baby, and cleared up my choking episodes
patrick -- {welcome patrick}
johni -- Apneanet How can we come back to you with questions when we have
studied the transcript of this session?
apneanet -- I'm open to questions sent to me at my website:
www.apneanet.org.
johni -- Thanks apneanet.
apneanet -- email dave @ apneanet.org and I'll get the questions.
butch -- {welcome butch}
bruce -- What does it normally cost to be tested and, if necessary, to

purchase a CPAP? Is this something normally covered by insurance?
terryw -- good ? bruce
apneanet -- What is the normal cost of treatment? Is this covered by
insurance? Medicare? The price of a sleep study, including the
interpretation by the sleep doctor will often run about $2000. The price
for a CPAP machine, tubing, headgear and mask will vary depending on the
type of device chosen, but the billing amount will often be in the
neighborhood of $1500. As with all medical procedures and devices, though,
the final cost paid will be determined by the insurance company's
agreements with the home care providers and/or the hospital or sleep
center. Most health insurance companies do cover the diagnostic testing
for sleep apnea. Most also cover the purchase or rental of the durable
medical equipment (the CPAP) used to treat apnea, but some may not. Others
may pay the initial cost but may not pay for replacement masks and tubing,
which do need to be replaced about every 6-9 months. Medicare recently
changed its rules and is now more liberal about the level of apnea that is
required before Medicare will pay for the CPAP device. But Medicare will
cover the machine and the consumable supplies. Keep in mind, though, that
plans differ considerably, so someone with a XYZ health plan through one
employer may be covered, but a friend with a XYZ health plan through
another employer may not be covered. Unfortunately, if the patient has no
health insurance, it is tough to find any assistance in paying the costs
involved. The American Sleep Apnea Association is a small group, with a
focus on creating awareness, and has no funding to help patients get
diagnosed or treated.
apneanet -- for those from overseas, my insurance and costs are based on
US situations. Your health care systems may be quite different.
apneanet -- for those from overseas, my insurance and costs are based on
US situations. Your health care systems may be quite different.
butch -- Sorry--I got the boot and had to return. Hope I didn't miss too
much.
lenj -- If you have insurance and Medicare, the total costs will be
covered. My Cpap I had to pay 50% on a rent to own basis. My BIPAP was
paid by insurance and balance by Medicare
bruce -- For additional information on sleep apnea, the national
association's web site is: http://www.sleepapnea.org
terryw -- We also have a link to the Apnea site on KDA site.
www.kennedysdisease.org on the links page
apneanet -- You might be interested to know that actor George Kennedy was
recently diagnosed with sleep apnea and began CPAP treatment.
apneanet -- His apnea and the need for heart bypass surgery was found when
he went in for hip replacement surgery. They had to do the bypass and
treat the apnea first!
apneanet -- By the way, if you think you might have apnea symptoms, I
suggest you take the questionnaire on my site at
www.apneanet.org/question.htm. There are 30 questions; if you answer 5 or
more with a yes I suggest that you talk to a sleep specialist. Taking it
AFTER I was diagnosed (because I had not seen it before) I could answer 23
of the 30 with a yes. I had a severe case of sleep apnea at 82 events per hour.
apneanet -- you'll have to print it out and take it on paper. It's not
interactive.
bruce -- it's 11:28, we have about 15 minutes left. What other questions,
comments do you have for our guest?
butch -- Bruce, Thanks for bring Dave on board for this very informative
chat. Dave thanks for sharing this info with us.
terryw -- I have to cut out and prepare for a KDA board meeting. Thanks
you Apneanet for the great information.
apneanet -- One other note on the severity of sleep apnea. How is the
severity of the apnea assessed? During the course of a sleep study, the
number of apneas during sleep is counted, as is the number of hypopneas.
The total number of these events is then divided by the hours of sleep to
obtain an index, called the Apnea/Hypopnea Index (AHI) also called the
Respiratory Distress Index (RDI). For example, if I have 6 recorded hours
of sleep and have 36 hypopneas and 300 apneas, I would add 300 plus 36 for
a total of 336 and divide that by 6 hours of sleep, for an AHI of 56. An
AHI of up to 5 events per hour is considered normal. The 5-15 range is
mild, 16-30 is moderate and anything over 30 is considered severe. Some
doctors use a slightly different scale, but for sure anything over 50 is
definitely severe.
bruce -- Dave deserves all the credit. I didn't warn him that his fingers
would be wore out by the end of the chat.
apneanet -- Oh, I've co-hosted 2 hour chats on apnea with many new
patients, so I'm used to typing fast!
butch -- Bruce--Thanks not thanks--fingers can't keep up with brain.
mobiusloop2 -- Yes, Thanks. I guess I'll have to wait for the transcript
to get everything
apneanet -- I realize more people will see the transcript, so please if
you are reading this and have further questions, please email me.
bruce -- Dave, how long did it take you to get use to the mask and CPAP?
apneanet -- Bruce, I'm not a good one to answer this question. Most people
do find it takes them a week or two or even longer to get accustomed to
CPAP and the mask and sleep with it all night long. I was able to do it
the first night! It does take some adjustment time.
apneanet -- Bruce, I'm not a good one to answer this question. Most people
do find it takes them a week or two or even longer to get accustomed to
CPAP and the mask and sleep with it all night long. I was able to do it
the first night! It does take some adjustment time.
apneanet -- Sorry, I don't know why some postings are doubled here.
apneanet -- I had a friend who had great difficulty with the nasal mask
and could never use it all night long. I got him to try a new device that
delivers air through the nose and doesn't use a mask and he got used to
that in one night and is sleeping much better now, two months later.
lenj -- ` Time to say goodbye. I hope to see all of you next week. I really
look forward to putting faces with the names(even your face DON)
lenj -- Dave, thank you for the info.
bruce -- Are there any more questions for Dave?
lenj -- {goodbye lenj}
bruce -- Well, I would like to thank our guest, Dave Hargett, for
attending our chat today. This has been a good session and we really
appreciate your involvement. It has been a pleasure working with you these
past several weeks. Do you have any closing comments for the group?
johni -- Thanks Apneanet. It has been really interesting and informative.
patrick -- This has been interesting and when I start having sleep
problems, I'll know how to proceed. Thanks!
bruce -- Eight minutes to go
apneanet -- I'd just like to say thank you for the opportunity to speak to
everyone. And please, if I can answer a question for you, feel free to
contact me.
johnm -- {goodbye johnm}
johni -- Got to go now. Have a great conference all that are going. We
will be with you in spirit! Bye.
bruce -- And, thanks to everyone else for attending today's chat.
bruce -- Take care Johni
apneanet -- For patients who do have sleep apnea, there is also a network
of support groups called A.W.A.K.E. (Alert, Well, And Keeping Energetic).
There are about 200 groups across the US. You can call the American Sleep
Apnea Association at 202-293-3650 to find out if there is one in your
area.
bruce -- Dave, I think we are through for today. Again, thank you.
apneanet -- You're welcome Bruce! I enjoyed it.
butch -- Dave, thanks again for being here today. I must go so I'll say
goodbye till we meet all the chat pals at the conference. See you next
chat.
butch -- {goodbye butch}
bruce -- Less than five minutes to go.
bruce -- Take care everyone, we'll see many of you next week at the
conference. Have a safe trip into Baltimore.
terryw -- {goodbye terryw}
apneanet -- {goodbye apneanet}
bruce -- {goodbye bruce}


End Chat