IF
YOU HAVE BEEN DIAGNOSED WITH SLEEP APNEA AND BEEN GIVEN CPAP OR BIPAP
READ TOPICS 'A' 'B' 'C' 'D'
'A' Cpap Desensitization
Steps
Follow the following steps if you are unable to tolerate
CPAP:
1) Wear
the CPAP mask at home while awake for one hour each day.
2) Attach the mask to
the CPAP device, and switch the unit "on". Practice breathing
through the mask for one hour while watching television, reading or performing
some other sedentary activity.
3) Use the CPAP during
scheduled one-hour naps at home.
4) Use CPAP during initial
3-4 hours of nocturnal sleep.
5) Use CPAP through an
entire night of sleep.
Advance by one step after each five days,
once the first step can be carried out without anxiety.
'B'
CPAP Tolerance Recommendations
• We have ordered the
Continuous Positive Airway Pressure Unit (CPAP) or BiPAP for you after
determining the best pressure level in our Sleep Center .
• As you know, this
device is a treatment for your sleep disorder and should be used every
night and/or anytime that you sleep.
• It is important that
you read the following recommendations and suggestions to help you with
the proper use of this device.
1. Since your sleep is now deeper and more
restful than before, you may notice a decrease in the number of hours
of sleep you require to feel rested in the morning. If that is the case
and you continue with the same schedule you had before using CPAP, you
might conclude that you now have "insomnia." All you have to
do is to go to bed later or get out of bed earlier.
• Make sure you go to bed and
get out of bed at the same time every day. This may be difficult for some
people but the effort it takes to establish a regular sleep/wake cycle
will be justified by helping you feel more rested in the morning.
• If you are taking medications
to reduce your blood pressure, please try to monitor blood pressure for
the first three months. CPAP use can sometimes improve your blood pressure.
Report any dizziness to your doctor.
• After a week of using CPAP,
you should not be sleepy during the day. If you are still sleepy, please
give us a call. This may be an indication of a problem with your CPAP
device.
• Your snoring should disappear
completely. If at some point your bed partner notices you are snoring
again, please let us know. You may need your CPAP unit adjusted.
• The noise of the machine may
initially be bothersome to you or your bed partner; generally it is a
matter of just getting used to it. If after several weeks it continues
to be bothersome you can explore options for making it quieter with your
home-care company.
• Try to place your machine
in a dust free area. Generally, most people place the CPAP machine on
a bedside table. It is important the filter not be obstructed by debris,
bed clothes, or draperies and it be kept clean.
• During the first few weeks
of treatment you may experience some sneezing and perhaps a sensation
of nasal obstruction. This is normal. Nasal congestion is the most common
side-effect of CPAP therapy. Many times this will resolve itself as you
become adjusted to your CPAP unit. It may take up to four weeks.
• If the cool air is bothersome,
you can run the tubing beneath the covers or wrap with a heating pad to
warm the air passing through the tubing. Your home-care company may be
able to provide you with an extra length of tubing if needed.
• A common cause of nasal congestion
is the drying and cooling of the upper airway by your CPAP device. This
is responsible for the feeling of dryness in the throat or nose. This
is normal. Many times this will resolve itself as you become adjusted
to your CPAP unit. It may take up to four weeks. If dryness persists,
it is possible to prevent or alleviate the dryness by increasing the humidity
in the room where your CPAP device is located. A room humidifier placed
about eight feet away from you CPAP unit can accomplish this, or your
home-care company can supply a humidifier which attaches directly to your
CPAP device.
• If you become congested while
using CPAP the use of a saline nasal mist or gel at bedtime and when you
wake up during the night will help to decrease this. Such products are
available at most drugstores and you do not need a prescription for them.
Two are " Ayr " and "Ocean."
• If, after four to six weeks
of CPAP use and taking the above two measures you continue to experience
irritation of your nose, please contact your doctor. There are some prescription
medications that might help.
• If you wake up during the
night or in the morning with a dry mouth and throat, you may be sleeping
with your mouth open. Contact us or your home-care company for suggestions
to help you learn to sleep with your mouth closed.
• It is necessary to follow
the cleaning and maintenance instructions given to you by your home-care
company. Proper cleaning and maintenance will extend the life of your
equipment and insure it functions properly.
• The CPAP machine eliminates
the interruptions of your respirations at night regardless of your weight.
However, losing weight will improve your health and may allow us to decrease
the pressure used on your machine. In some cases, we have been able to
discontinue the use of CPAP altogether. However, if you gain weight we
may need to increase your pressure. If you have a gain or loss in weight
please contact us.
• If you require surgery or
hospitalization for any reason make sure you inform your physician of
your diagnosis and the need to use this machine with all sleep. Please
take your device to the hospital so it can be used during your hospitalization,
particularly when you are sedated before and after your surgery. We will
be happy to cooperate with your doctors if they consider it necessary.
You should be able to use CPAP
all night long, every night. If, after trying these suggestions, you cannot
sleep through the night, please contact the home-care company, your physician,
or us . It is very important you use your CPAP. Don't worry about who
to call, just call anyone of us and we will be sure you get the help you
need!
'C'
Drowsy Driving Tips
These suggestions will help prevent you
from the risk of drowsy driving.
1. If you feel tired
or drowsy don't drive. Sleepiness is a major cause of motor vehicle accidents
and accounts for 40% of all fatal crashes reported on the NYS Thruway.
No matter how much you think you can control sleepiness, you can't.
2. Ensure you follow
your doctor's advice about the treatment for your sleep disorder. For
example, if you have sleep apnea and use CPAP, ensure you use it fully
the night before your trip.
3. Get a good night's
sleep before driving. Do not cut yourself short of sleep if you plan a
long drive the next day. Get to bed early and do not stay up late packing.
4. Avoid alcohol both
the night before your trip and during your trip. Alcohol will disrupt
sleep and make you more tired the next day. Sleepiness and alcohol are
additive in increasing impairment of your driving ability.
5. Avoid any sedative
medications, including sedative antihistamines like Benadryl that are
often contained in cold or allergy medications, the night before you drive
as they may have long lasting effects the next day.
6. Travel during non-sleeping
hours. Accidents due to sleepiness are more common during the nighttime
hours.
7. If sleepy, stop and
rest. Drink coffee, walk around or have a brief nap in your car if you
are sleepy. Have a 10 -15 minute break after every 2 hours of driving.
8. Drive with a companion.
Share the driving. Relax in the back seat until it is your time to share
the driving again.
'D'
Healthy Sleep Tips For Patients with Obstructive Sleep Apnea
1) WEIGHT REDUCTION:
Reducing your weight is likely to make a difference to your condition.
Certainly, increasing weight will make your snoring and sleep related
breathing irregularities worse. It is important that you try to reach
an ideal body weight and maintain the weight loss. Reducing your weight
will also decrease the risk of developing cardiovascular disease. Remember
to be more physically active as well as eating less.
2) ALCOHOL INTAKE:
Alcohol is a potent sedative that can induce irregular breathing
apneas in healthy people. Alcohol will not only increase the number of
apneas but also will make them longer and cause the oxygen level in the
blood to become reduced. It is very important that alcohol be avoided
within four to six hours of bedtime.
3) OTHER SEDATIVE MEDICATIONS:
Sedative medications include sleeping pills, antihistamines,
anti-allergy pills, some cold medicines, some anti epilepsy drugs, and
some medications used for psychiatric conditions. As with alcohol, sedative
medications are likely to worsen your breathing irregularities. Consult
your physician before taking sedative medication. Definitely do not use
any sedative medication with alcohol, as the effects will potentate several
times.
4) SLEEP DEPRIVATION:
Try to maintain a regular sleep pattern with a full 8 hours of
sleeping time. Any loss of sleep will increase your sleep drive the next
night and your breathing irregularities are likely to become more severe.
5) SLEEP POSITION:
Sleeping on your back is likely to increase the amount of breathing
irregularities as your tongue tends to obstruct the back of your throat
resulting in a decrease in the size of the upper airway. Controlling your
position during sleep is not easy. You may like to try placing a tennis
ball in a sock pinned to the back of your pajama jacket to prevent you
from rolling onto your back. A marble sewn into a pocket on the back of
your pajama may also work.
6) BED POSITION:
Elevate the head of your bed 4 to 6 inches to take some of the
pressure off your diaphragm. This will ease breathing during sleep. You
can put bricks or wood blocks under the legs of the head of your bed so
it will be on a slight incline.
7) COLDS and ALLERGIES:
Any infection affecting your nasal passages or throat will cause
swelling and tend to worsen breathing irregularities. Treat nasal allergies
or infections promptly and keep in close communication with your physician.
8) MEALS:
Large meals should be avoided at least two hours before bedtime.
A large meal will increase the pressure on the diaphragm and worsen your
breathing. It may also predispose you to regurgitation of stomach contents
during sleep, which will provoke irritation of the upper airway. Eat your
large meals at least three to four hours before bedtime.
9) SMOKING:
Nicotine and other substances contained in cigarettes when inhaled
will provoke irritation of the upper airway and worsen your breathing
irregularities. Try to stop smoking altogether.
IF
YOU HAVE DIFFICULTY IN FALLING OR STAYING ASLEEP READ TOPICS 'E' 'F'
'E'
Sleep Hygiene Tips
Falling Asleep:
If you can't get to sleep, rather than trying harder and harder
to fall asleep, try getting out of bed and doing something else. Preferably,
move to another room and return to bed only when sleepy.
If you have trouble getting to sleep, establish a routine for an hour
or so each night before bedtime, such as reading, taking a warm shower
or bath, light exercise, or resting quietly.
Avoid too much mental stimulation during the hour or so prior to bedtime.
Read a "light novel or watch a relaxing TV program; do not finish
office work or discuss family finances with your spouse, for example.
Stress:
Almost everyone experiences an occasional night of lost or disturbed
sleep. It is a natural, perhaps adaptive, response to acute stress.
Naps:
If you are having troubles falling asleep at night avoid naps
in the early afternoon or early evening.
Getting Up:
No matter how poorly you have slept the night before, always
set your alarm to arise at the same time each morning.
Exercise:
Regular exercise can be an effective aid to sleep. It releases
energy and mental tensions. It is better not to exercise strenuously 3-4
hours before bedtime.
Noises:
Occasional loud noises from aircraft, streets, or highways disturb
sleep even in people who do not awaken and who cannot remember the noise
in the morning. These sleep disturbances can reduce restful sleep. People
who sleep near excessive noise should try heavy curtains in their bedrooms
or ear plugs to protect the amount of restful sleep they get.
Hunger:
Hunger may disturb sleep. A light snack, especially warm milk,
seems to help people get to sleep.
Food:
Various foods stimulate the body and disturb sleep. Avoid coffee,
tea, and cola drinks near bedtime. Avoid late heavy meals.
Sleep Patterns:
Everyone has a unique sleeping pattern. Some adults need 10 hours
a night. Other adults need only 5 hours a night. Many people function
best with approximately 8 hours of sleep. Your requirement for sleep is
unique. What is effective for your husband, your wife, or your friends
is not what may be helpful to you. If you need only 5 hours of sleep a
night, do not worry about it, or try to force longer sleeping hours. Instead,
learn to use your extra waking hours for something you would like to do
or get done.
Quantity and Quality:
Everyone's sleep needs change. The amount and quality of sleep
varies in the course of each person's life. The infant may require 16
hours of sleep each day; an elderly person may sleep 3 to 4 hours at night
with frequent naps during the day. Changes in the length and depth of
sleep are a normal part of life. Within limits the quality of our sleep
is more important than quantity.
Symptom of A Medical Problem:
Sleeping problems may signal a medical condition such as anxiety,
depression, and other disorders. It is important to get a proper diagnosis
and treatment of the underlying cause of a chronic sleep disturbance.
Pregnancy:
Excessive sleepiness the first 3 months of pregnancy is normal
don't worry about it. Pregnant women also tend to sleep about two more
hours at night.
Medications/Alcohol:
An occasional sleeping pill may be of some benefit, but chronic
(nightly) use of sleeping pills may actually hinder good sleep. Natural
sleep is the best sleep.
Sleeping medications should be used with caution and only upon the advice
of a physician, especially in the elderly, pregnant women, people with
respiratory disease, kidney disease, or a liver impairment.
If your doctor prescribes a sleep medication, ask for clear directions
and information about the particular drug you are to take. Some sleeping
pills have a prolonged effect, and can impair your coordination and driving
skill the following day.
Sleep medications should be used only for the short-term management of
a sleep complaint. Do not self-medicate or increase the dosage yourself.
If you feel that your medication is losing its effect, report this to
your doctor.
Although alcohol may help to induce sleep, the chronic use of larger quantities
of alcohol causes disturbed sleep and dependency.
'F'
Stimulus Control Therapy
- Develop a sedentary evening routine, which begins before
the desired bedtime
- Use the bedroom only for sleep.
- Go to bed only when you feel sleepy or tired.
- If sleep does not occur easily or within a reasonable
time, get out of bed, go to a comfortable living area and do something
relaxing.
- Return to bed when you feel sleepy or tired.
- Get up at the same, predetermined time each morning
regardless of how poorly you slept that night.
- Avoid daytime naps.
Melatonin
For Jet Lag
These suggestions will help
prevent the symptoms of jet lag by the use of Melatonin. This medication
has not been rigorously studied in humans and therefore some caution in
its use is advised. It has been approved by the Federal Drug Administration
for over-the-counter use.
If traveling To the East:
Take 3mg Melatonin for two nights before departure at the time
you would normally go to bed in the new time zone. e.g., when traveling
from New York to Europe with a 6 hour phase advance: If your usual bedtime
is 12 midnight, take the melatonin at 6pm for two nights then at 12 midnight
(in Europe) for two nights after arrival.
If traveling To the West:
Take 3mg Melatonin at your usual bedtime for two nights prior
to departure, then at your usual bedtime for two nights after arrival
in the new time zone. e.g., when traveling from New York to San Francisco
with a 3-hour phase delay: If your usual bedtime is 12 midnight, take
the melatonin at 12 midnight for two nights prior to departure, then at
12 midnight (in San Francisco) for two nights after arrival.
Restless Legs Syndrome
Restless Legs Syndrome is an overwhelming urge to move
the legs usually caused by uncomfortable or unpleasant sensations in the
legs.
The sensations have the following features:
• Occur during periods of inactivity
• Become more sensitive in the evening and at night
• Are relieved by movement of the limb
• Often cause difficulty staying or falling asleep, which leads
to feelings of daytime tiredness or fatigue
• May cause involuntary jerking of the limbs during sleep and sometimes
during wakefulness
If you do have restless legs syndrome (RLS), you are not alone. Up to
8% of the US population may have this neurologic condition. Many people
have a mild form of the disorder, but RLS severely affects the lives of
millions of individuals.
Do I need any tests
to diagnose RLS?
After ruling out other medical conditions as the cause of your symptoms,
your healthcare provider can make the diagnosis of RLS by listening to
your description of the sensations. No laboratory test confirms your diagnosis
of RLS; however, a thorough examination, including necessary laboratory
tests, can reveal temporary disorders, such as iron deficiency, that may
be associated with RLS. Some people (including those with PLMS and without
the abnormal limb sensations of RLS) will require an overnight testing
of sleep to determine other causes of the sleep disturbance.
Is RLS hereditary?
RLS often runs in families. Researchers are currently
looking for the gene or genes that may be responsible for RLS.
Is there a known cause for RLS?
Research into the cause of RLS is ongoing and answers are limited. The
type of RLS that runs in families is known as primary or familial RLS.
The syndrome can also appear as a result of another condition, which worsens
the underlying RLS. If you have no family history of RLS and no underlying
or associated conditions causing the disorder, your RLS is said to be
idiopathic, meaning without a known cause.
How common is RLS?
Rigorous epidemiologic studies into the true prevalence of RLS are underway.
However, several studies have been conducted that look at the rate of
response to questions such as Do you have a creepy, crawly sensation in
your legs at night when you attempt to sleep? Positive rates have ranged
from 3% to 15%.
What are the newest treatments for RLS?
No drugs have been approved by the U.S. Food & Drug Administration
(FDA) for the treatment of RLS. Several drugs approved for other conditions
have undergone clinical studies in RLS and are found to be helpful. Our
Medical Bulletin contains the latest treatment information.
What non-drug treatments are recommended for RLS?
Self-directed activities that counteract your sensations of RLS appear
to be very effective, although temporary, solutions to managing the disorder.
You may find that walking, stretching, taking a hot or cold bath, massaging
your affected limb, applying hot or cold packs, using vibration, performing
acupressure, and practicing relaxation techniques (such as biofeedback,
meditation, or yoga) may help reduce or relieve your symptoms. You may
also find that keeping your mind actively engaged through activities such
as reading a gripping novel, performing intricate needlework, or playing
video games helps during times that you must stay seated, such as when
you are traveling.
Can taking vitamin or mineral supplements help my RLS?
If an underlying iron or vitamin deficiency is found to be the cause of
your restless legs, supplementing with iron, vitamin B or folate (as indicated)
may reduce or even alleviate your symptoms. Because the use of even moderate
amounts of some minerals (such as iron, magnesium, potassium, and calcium)
can impair your body's ability to use other minerals or can cause toxicity,
you should use mineral supplements only on the advice of your healthcare
provider.
Are there any medications that can make RLS worse?
Yes. These drugs include calcium-channel blockers (used to treat high
blood pressure and heart conditions), Reglan (metoclopramide), mose antinausea
medications, some cold and allergy medications, major tranquilizers (including
haloperidol and phenothiazines), and the antiseizure medication, phenytoin.
One report indicates that medications used to treat depression increase
the symptoms of RLS. Always be sure that your healthcare provider is aware
of all the medicines you are taking, including herbal and over-the-counter
medications.
Are there any substances that should be avoided?
The use of caffeine often intensifies RLS symptoms. Caffeine-containing
products, including chocolate and caffeinated beverages such as coffee,
tea, and soft drinks should be avoided. The consumption of alcohol also
increases the span or intensity of symptoms for most individuals.
I suspect that my child may have RLS. Is this possible?
RLS affects people of all ages. Previously, RLS was believed to be a disorder
affecting only adults. Many adults can now trace back their first symptoms
to childhood when they were told their discomfort was "growing pains."
Evidence connecting RLS and Attention-deficit hyperactivity disorder is
growing.
IF YOU HAVE ANY QUESTIONS
PLEASE CALL MWCSD @ (810) 225-7595 (Brighton,MI); (517) 887-6733 (Lansing,MI)
OR IF YOU NEED TO SEE A SLEEP SPECIALIST CONTACT YOUR FAMILY DOCTOR FOR
REFERRAL |
