Q & A AT APRIL SUPPORT GROUP MEETING

Dr. Fred Nachtway, a Pulmonary Disease specialist in the John Muir Physician Network led an evening of Questions & Answers at the Spring (April) Support Group meeting. One of the advantages of the Sleep Apnea Support Group is interfacing in an informal setting with specialists in the field. Questions ranged from CPAP equipment to the four sleep stages to the advantages and disadvantages alternative treatments for Sleep Apnea.

Link Between Acid Reflux and Sleep Apnea Challenged

ScienceDaily (Apr. 13, 2010) — New research in Wisconsin suggests that a link between Gastroesophageal Reflux (GER) and obstructive sleep apnea (OSA) may not exist. Researchers from the Medical College of Wisconsin studied the sleep events of nine patients with GER without OSA, six patients with OSA but without GER, 11 patients with OSA and GER, and 15 control subjects. Although GER is thought to be induced by decreasing intraesophageal pressure during OSA, study results showed that esophageal pressures progressively increased during OSA. The incidence of GER during sleep in patients with OSA and GER did not differ from the remaining three groups. Researchers speculate that OSA may not induce GER or other reflux events

“WHAT’S NEW” AT SUPPORT GROUP MEETING

Matt Chirco, the owner of Oxygen Plus, Inc. presented to the Support Group some of the latest in CPAP technology. Here he illustrates the new Respironics “EasyLife” CPAP mask to the Support Group. Matt said, “The ‘EasyLife’ is ideal for avoiding irritation at the bridge of the nose. (see article below).

The Medicare schedule is the minimum period allowed for reimbursement.
* “Conventional Wisdom” is based on widely accepted Patient/DME experience assuming proper care of the equipment.

RESPIRONICS NEW “EASY LIFE” MASK

Philips Respironics named their new mask “EasyLife.” The “EasyLife” nasal mask nearly eliminates the need for manual mask adjustments. Its lightweight design features a unique dual-cushion construction – the inner cushion creates an instant, selfadjusting seal, while the outer cushion provides comfortable support. The only manual steps necessary are the headgear adjustments. The Forehead pad adjusts automatically – eliminating a fitting step- and requiring minimal headgear force. Only four parts: mask frame, headgear, outer support cushion, inner seal cushion. Angled exhalation micro ports make operation quieter and redirect exhaust air away from the bed partner. Outer support cushion lets the mask rest lightly and comfortably against the face, eliminating the risk of over-tightening the headgear. Inner seal cushion creates an instant, selfadjusting seal.

If you are using an “EasyLife” or have tried it and would like to offer a “firstperson review” please e-mail me your comments at; r.b.griff@sbcglobal.net. If you wish to remain anonymous I will print your comments and credit them to “Sleepless in Walnut Creek.”

WHAT IS CENTRAL SLEEP APNEA?

An Apnea occurs when a person has no airflow at the nose or mouth for 10 seconds or longer. The most common form of Sleep Apnea is Obstructive Sleep Apnea and a person has interrupted breathing due to airway blockage in the back of the throat, and usually the obstruction is behind the tongue. The person never stops trying to breathe during these breathing interruptions, and sometime there is gasping. In contrast, Central Sleep Apnea occurs when a person does not even try to breathe, but lies motionless until a breathing pattern begins again. One such type is called Cheyne-Stokes Breathing (CSB) pattern and notable by alternating cycles of deep breathing and cessation of breathing and is usually associated with such conditions as congestive heart failure, kidney failure, stroke or other brain disorders.

Central sleep apnea (CSA) occurs when the brain does not send the signal to breathe to the muscles of breathing. This usually occurs in infants or in adults with heart disease, cerebrovascular disease, or congenital diseases, but it also can be caused by some medications and high altitudes. Under normal circumstances, the brain monitors several things to determine how often to breathe. If it senses a lack of oxygen or an excess of carbon dioxide in the blood it will speed up breathing. The increase in breathing increases the oxygen and decreases the carbon dioxide in blood. Some people with heart or lung disease have an increase in carbon dioxide in their blood at all times.

If present, treatment of the underlying disorder often improves central sleep apnea. For example, descending to a low altitude is effective in treating high-altitude periodic breathing. Similarly, instituting dialysis is often effective for Cheyne-Stokes breathingcentral sleep apnea (CSB-CSA) due to kidney failure or optimizing medical treatment for heart failure. Heart transplantation will resolve CSB-CSA due to end-stage heart disease.

Up to 20% of central sleep apnea cases have been suggested to resolve spontaneously. If the patient is not symptomatic, observation may be the only appropriate step. This may be the case in patients who have central sleep apnea during sleep-wake transition, patients without significant oxygen desaturation, or in those who experience central sleep apnea during continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea.

No clear guidelines are available on when or whether to treat central sleep apnea in the absence of symptoms, particularly when central sleep apnea is discovered after an overnight sleep study (polysomnography – PSG) is performed for another reason. Clearly, when the symptoms are present, treatment is warranted. The decision to treat should be made on an individual basis.

Central sleep apnea may occur in premature infants (born before 37 weeks of gestation) or in full term infants. It is defined as apneas lasting more than 20 seconds, usually with a change in the heart rate, a reduction in blood oxygen, or hypotonia (general relaxation of the body’s muscles). In infants CSA usually occurs with prematurity or other congenital disorders. Central sleep apnea can be diagnosed with a sleep study or overnight monitoring while the patient is in the hospital. Central sleep apnea in children is not the same thing as sudden infant death syndrome (SIDS).

In infants, central sleep apnea is treated with an apnea alarm. This alarm monitors the infant’s breathing with sensors and sounds a loud noise when the infant experiences an apnea. The alarm usually wakes the infant and the parents. Most infants usually “out-grow” the central apnea episodes, so the alarm monitoring is stopped after the episodes resolve. In infants with other congenital problems, apnea monitoring may be needed for a longer period.

Since Central Sleep Apnea usually occurs in adults with other medical problems, it is best to discuss this with your doctor.