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How CPAP Masks Impact Adherence, Sleepiness in Long – Term Users
Among patients with long-term usage of continuous positive airway pressure (CPAP) therapy, several mask-related side effects (MSREs) were associated with CPAP nonadherence and residual excessive sleepiness (RES), according to study findings published last week in Respiratory Research. Referenced by the study authors as the cornerstone of treatment for patients with sleep apnea syndrome, CPAP therapy has been found to significantly reduce upper airway obstruction and improve daytime sleepiness, sleep quality, and quality of life. However, the researchers highlight that CPAP remains an uncomfortable therapy with adherence that has ranged from 53% to 92% in large recent trials. “Factors that influence adherence to CPAP include disease and patient characteristics, psychological and social factors, follow-up techniques, governmental policies, technological device factors, and, particularly, MRSEs,” noted the researchers. Focusing on MRSEs, the researchers said that no real-life study has examined the relationship of MRSEs with CPAP nonadherence (< 4 h/day) or RES (Epworth-Sleepiness-Scale [ESS] score ≥ 11) in the long term. Deriving data from the prospective real-life cross-sectional InterfaceVent CPAP study, 1484 patients with sleep apnea undergoing at least 3 months of CPAP with unrestricted mask access (34 different masks) were included in their analysis. MRSEs were assessed by visual analogue scales, CPAP data via CPAP software, and sleepiness through the ESS. After examining the study cohort (72.2% male; median age, 67 years), CPAP therapy was shown to last a median (interquartile range [IQR]) 4.4 (IQR, 2.0-9.7) years, and CPAP usage was 6.8 h/d (IQR, 5.5-7.8). The prevalence of CPAP nonadherence was 8.6%. Moreover, patients exhibited an initial average score of 39 (IQR, 31-56) apneas or hypoapneas per hour in the Apnea Hypopnea Index, indicating severe obstructive sleep apnea, and the prevalence of RES was 16.17%. Among the MSREs assessed, leak-related adverse effects were the most prevalent (75.4%), but the researchers added that patient-reported leaks cannot be predicted by reported CPAP leaks. In utilizing multivariable logistic regression analyses to delineate the impact of patient MRSEs, a significant association was found between CPAP nonadherence and dry mouth (P = .004), and RES across several variables: patient-reported leaks (P = .007), noisy mask (P < .001), dry nose (P < .001), and harness pain (P = .043). “Patient MRSEs can be independently associated with CPAP nonadherence and RES, thus implying a complementary role for MRSE questionnaires alongside CPAP device reported data for patient monitoring,” concluded the study authors. Reference Rotty M-C, Suehs CM, Mallet J-P, et al. Mask side-effects in long-term CPAP-patients impact adherence and sleepiness: the InterfaceVent real-life study. Respir Res. Published online January 15, 2021. doi:10.1186/s12931-021-01618-x
Learn moreDiabetes & Sleep Apnea: Everything You Need to Know
Sleep apnea is a far greater problem than it gets credit for — especially for people living with diabetes. Difficult to diagnose without proper overnight testing, too many people struggling to breathe properly during their sleep may not have any idea they aren’t getting enough oxygen every night. But sleep apnea can impact many aspects of your day-to-day life and overall health. And its link to diabetes is indisputable. In this article, we’ll discuss what sleep apnea is, common causes and symptoms, its relationship with type 1 and type 2 diabetes, and today’s best treatment options. What is sleep apnea? Sleep apnea (also known as “obstructive sleep apnea” or “OSA”) is a condition defined by long pauses in breathing while you sleep. To qualify, the pause of breathing must be at least 10 seconds long, according to the National Sleep Foundation. The pause in breathing is the result of muscles of the back of your throat closing partially or failing entirely to stay open for varying periods of time while you sleep. The reason these pauses in breathing are worrisome and troublesome is that it can create a significant lack of oxygen in your blood which then leads to a variety of other problems. Consequences of untreated sleep apnea Daytime exhaustion and fogginess High blood pressure Cardiac arrhythmia Congestive heart failure Heart attack Stroke Depression and mood issues Memory issues Insulin resistance Increased risk of type 2 diabetes Drowsy driving OSA can develop in children, too, although less common. Causes of sleep apnea While anyone could potentially develop sleep apnea, the following are characteristics or habits that increase your risk of developing the condition, according to Harvard: Obesity: about 2/3s of people with OSA are overweight or obese Family history of OSA or snoring Abnormally smaller lower jaw or other abnormal facial characteristics Recessed chin Being male: far more people with OSA are male versus female Smoking cigarettes Large neck circumference Large tonsils Drinking alcohol before bedtime Post-menopausal (for women) Hypothyroidism (low levels of thyroid hormone) Acromegaly (high levels of growth hormone) Being over the age of 40 years old Being African-American, Pacific-Islander, or Hispanic While there is another type of sleep apnea that results from your brain failing to manage normal breathing, that type is rare. The type most commonly experienced by the general population is obstructive sleep apnea and affects approximately 18 million people in the United States. Symptoms The signs and symptoms of sleep apnea are often easy to dismiss or easy to mistake as individual issues rather than many symptoms related to the same condition. The National Sleep Foundation lists the following as common signs and symptoms of sleep apnea: Chronic snoring Constantly feeling sleep-deprived Difficulty concentrating Depression Irritability Sexual dysfunction Learning and memory difficulties Falling asleep during normal daytime activitiesDisturbed sleep If you are a chronic snorer or suspect any of these symptoms may be regularly present in your life, talk to your primary care doctor about scheduling with a sleep specialist who can assess you for sleep apnea. Sleep apnea and diabetes: how are they related? Research has demonstrated over and over again that OSA and diabetes have an undeniable relationship, and are often found in the same patient. Let’s take a look at some of the most significant research. Sleep apnea increases blood sugar levels OSA has been found to increase oxidative stress, inflammation, neuroendocrine dysregulation, and alter glucose homeostasis, according to this 2016 study from the American Diabetes Association. The study’s finding urges healthcare professionals to assess every patient with type 2 diabetes for potential signs of sleep apnea, and vice versa — assessing patients with sleep apnea for high blood sugar levels. “Early recognition and interventions for OSA can be expected to improve insulin sensitivity and control of hyperglycemia in many patients. Clinicians must remain vigilant for signs and symptoms of OSA and monitor compliance with CPAP along with weight management, diet control, and medication adherence in patients with type 2 diabetes.” Sleep apnea linked to insulin resistance and type 2 diabetes This 2018 report on OSA evaluated dozens of studies on the condition and its implications and connections with other conditions. It was determined that patients with OSA had an increased risk of developing hypertension, insulin resistance, type 2 diabetes, non-alcoholic fatty liver disease, dyslipidemia, and atherosclerosis. Sleep apnea increases your risk of type 2 diabetes This 2017 study from Taiwan determined that patients with OSA had a much higher likelihood of developing type 2 diabetes. In contrast, the study also determined that patients with type 2 diabetes did not necessarily have a higher likelihood of developing OSA. This simply means that OSA seems to be a precursor for developing type 2 diabetes, but type 2 diabetes is not a precursor to developing OSA in patients who have not already developed this sleep condition. A 2018 study from Japan echoed similar findings. “OSA patients are more likely than non-OSA populations to develop type 2 diabetes, while more than half of type 2 diabetes patients suffer from OSA.” Using a CPAP to treat OSA improves insulin resistance A CPAP device — which stands for “continuous positive airway pressure” — is the primary method of treatment for OSA, and this 2018 study from Japan found that consistent use of a CPAP improves a patient’s levels of insulin resistance. “CPAP improved glucose metabolism determined by the oral glucose tolerance test in OSA patients, and several studies have shown that CPAP improves insulin resistance, particularly in obese populations undergoing long-term CPAP.” This is significant in terms of treating a patient with both OSA and type 2 diabetes. By treating the OSA, the patient may see modest to moderate improvements in their blood sugar levels and overall diabetes health, too. Both type 2 diabetes and OSA increase risk of cardiovascular disease “As both diabetes and OSA lead to cardiovascular disease, clinicians and healthcare professionals should be aware of the association between diabetes and OSA,” explains the same 2018 study from Japan. The study suggests that healthcare professionals should heavily consider treating patients with type 2 diabetes and/or OSA with a CPAP device to reduce the known stress both conditions have on a patient’s cardiovascular system. OSA increases the risk of STDR (sight-threatening diabetic retinopathy) This 2017 study from the United Kingdom found that patients with type 2 diabetes and existing diabetic retinopathy had a significantly increased risk of developing proliferative diabetic retinopathy, which is defined by the patient’s worsening vision. Using a CPAP device to treat the OSA resulted in a reduction of the progression of the STDR in these patients, but it was determined that further studies are needed to focus more intensely on the benefits of treating OSA to inadvertently treat STDR. Patients with type 1 diabetes have a higher risk of OSA “The prevalence of asymptomatic OSA is high in a cohort of patients with type 1 diabetes,” determined a 2017 study from Denmark. Other risk factors for the type 1 diabetes population included being older, overweight, and existing diagnosis of nephropathy (kidney disease). “OSA was present in 32 percent of the patients with normal BMI, in 60 percent of overweight patients, and in 61% of obese patients,” explains the study. Additionally, the study found that patients with type 1 diabetes and OSA showed very few symptoms, particularly very rarely reporting sleepiness compared to patients without OSA. This makes it harder to catch, diagnose, and treat. Healthcare professionals treating patients with type 1 diabetes should keep in mind that this population should be potentially screened for OSA if they are also over the age of 40, overweight, and have nephropathy. Treatment options If you think you may have sleep apnea, the first place to start seeking help is through your primary care doctor. Most likely, if you share your bed with a partner, it isn’t going to be news to you that you have a severely loud or disruptive snore. You might even want to try setting your phone up to record the sound of your own snore. This alone could reveal long gaps in breathing or very turbulent, inconsistent snore rhythms. Your doctor will then recommend you partake in a sleep study which means you’ll stay overnight at a “sleep center” to have your breathing monitored for an entire night. They will also monitor your eye movement, muscle activity, heart rate, respiratory effort, airflow, and the amount of oxygen in your blood. This will give your healthcare team a clear understanding of whether or not you have sleep apnea, and how severe your sleep apnea may be based on just how little oxygen your body is getting while you sleep. The number one treatment for sleep apnea, as mentioned earlier, is a CPAP device. A CPAP looks more uncomfortable than it really is, which can deter patients from pursuing getting treated in the first place. A CPAP is a mask that fits over your mouth and/or your nose, and it blows air into your airway to help keep it adequately open while you sleep. Research has found that it is by far the most effective treatment for sleep apnea, but one tricky aspect of this method is getting patients to use it consistently. The device itself also makes a light and soft noise when it’s turned on, which is similar to the sound of a noise machine. Ideally, the sound itself doesn’t interfere with your sleep and possibly improves your sleep by providing white noise. What else can you do to treat sleep apnea? Let’s take a look at all of the options recommended by the National Sleep Foundation: Continuous positive airway pressure (CPAP) device: A mask that covers your mouth and/or nose and delivers air to help keep your airway open while you sleep Oral Pressure Therapy (OPT): Similar to a CPAP device but without the mask, this treatment is a mouthpiece that delivers air to help keep your throat properly open while you sleep. Expiratory Positive Airway Pressure (EPAP): This device covers your nostrils with a disposable adhesive valve that opens and ensures your airway stays open. Dental appliances to reposition jaw and tongue Upper airway surgery to remove excess tissue: If you have an anatomical facial abnormality, it could be corrected with surgery and enable your jaw and throat to stay open properly during your sleep. Lose weight: Weight-loss can have a significant impact on sleep apnea. If you’re reluctant to use a device, let sleep apnea be the motivation you need to lose weight. Avoid, reduce, or limit alcohol intake Quit smoking Sleep on your side instead of on your back While sleep apnea doesn’t sound terribly alarming at first, it can create a great deal of stress in the body and in your life if left untreated. This easy-to-miss condition can put your longterm health in danger. Don’t hesitate to get tested if suspect you may be struggling with sleep apnea. Source: https://diabetesstrong.com/diabetes-sleep-apnea/
Learn moreDry eye cases increase in patients with sleep apnea
The incidence of dry eye disease (DED) is higher in patients with obstructive sleep apnea treated using a continuous positive airway pressure (CPAP) device or other nasal mask therapy devices. There is also a gender component to this increased incidence of DED, with women with sleep apnea having a higher incidence. “As eye care providers, we need to start asking our patients whether they use a CPAP device. Dry Eye Disease is prevalent among this subgroup,” said Cynthia Matossian, MD, who is in private practice in Doylestown, PA, and Hopewell, NJ. While the prevalence of DED is considered to be about 6.8% in US adults, the percentage of patients who have been diagnosed clinically with DED is less than half of that. Related: It takes a village to care for dry eye patients The prevalence of DED among women is almost double that among men, i.e., 8.8% versus 4.5%, respectively. Generally, the prevalence rates increase with age, ranging from 2.7% in persons aged 18 to 34 years up to 18.6% in those 75 years and older, she explained. Sleep apnea affects both men genders but is substantially among men, 13% to 14% compared with 5% to 6% among women, and the prevalence rates increased markedly from 1994 to 2010. Interestingly, the recommended treatment for sleep apnea is associated with ocular disorders, that is, ocular irritation caused by airflow from a leaky mask or retrograde nasolacrimal escape of air, she noted. Related: Physicians should investigate nocturnal evaporative stress in dry eye patients Retrospective descriptive analysis In light of the statistics, Dr. Matossian and colleagues analyzed data to identify any real-world associations between DED and sleep apnea. The investigators looked at data between Jan. 1, 2013, to June 30, 2018, from the IBM MarketScan Commercial and Medicare Supplemental Databases, both of which contain the inpatient/outpatient prescription drug experience among several million patients covered by a variety of insurance plans. The study, which was sponsored by Sun Pharma, included adults if they had one or more claims of CPAP or other nasal mask device use during the study period, one or more inpatient/outpatient diagnoses of sleep apnea in the 12 months before the onset of device use, continuous enrollment in a medical or pharmacy insurance program for 12 months or longer before and after the first date of the study, and no diagnosis of DED in the 12 months before onset of device use. A total of 330,926 patients (median age, 53 years) were included in the study, 65% of whom were men. Overall, 13,176 patients had DED. The most frequent patient comorbidities were diabetes (22%) and chronic obstructive pulmonary disease (COPD) (18%). The most frequently used medications were antihypertensives (58.2%), antidepressants (32.5%), and anxiolytics (31.3%). Dr. Matossian and colleagues found important associations with the increased incidence of DED in this patient population with use of CPAP devices over time, age, duration of mask use, gender, and certain comorbidities. Related: Treating dry eye with recombinant human nerve growth factor According to Dr. Matossian, the one-, two-, and three-year DED incidence rates after starting use of CPAP or another nasal mask device were, respectively, 4.0%, 7.3%, and 10.3%. The incidence of DED increased with age; the one-year incidence rates ranged from 1.6% in patients 18 to 24 years old and 11.2% in those aged 75 years and older. The one-year incidence rate in women was higher than in men, 5.8% compared with 3.0%. The presence of specific comorbidities made a difference, that is, the incidence of DED was higher in the presence of psoriasis, with an incidence of DED of 9.1%; COPD, 5.4%; irritable bowel syndrome, 5.3%;. diabetes, 5.1%; and rheumatoid arthritis, 5.0%. The findings were that the incidence of DED was exacerbated both during the second year of use of a device compared with the general incidence of DED among the general population of U.S. adults as well as based on the length of time during which the device is used. Users of the CPAP device who were women, older, or had comorbid inflammatory or metabolic conditions may experience a higher incidence of DED. Read more by Lynda Charters Cynthia Matossian, MDE: [email protected]. Matossian has no financial interest in any aspect of this report.
Learn moreUniversal Sleep Apnea Screening Strategy in Atrial Fibrillation Patients
Study Questions: What is the proportion of patients with atrial fibrillation (AF) who also have undiagnosed sleep apnea, and what is the adherence to sleep apnea therapies? Methods: A total of 188 patients with AF without a prior diagnosis of sleep apnea who were scheduled to undergo AF ablation underwent home sleep apnea testing, completed a sleep apnea screening questionnaire STOP-BANG (Snoring; Tiredness, Fatigue, or Sleepiness During the Daytime; Observation of Apnea and/or Choking During Sleep; Hypertension; Body Mass Index >35 kg/m2; Age >50 Years; Neck Circumference >40 cm; and Male Sex), and were followed for ≥2 years. Results: Home sleep apnea test was positive in 82% of patients; among those, 82% had a predominant obstructive component and 18% had mixed sleep apnea with a 15% central component. Sleep apnea severity was mild in 44%, moderate in 33%, and severe in 23%. The sensitivity and specificity of a STOP-BANG questionnaire were 81% and 42%, respectively. In a multivariate analysis, STOP-BANG was not predictive for sleep apnea (p = 0.31). Therapy with continuous positive airway pressure ventilators was initiated in 86% of patients with moderate or severe sleep apnea, and among those, 93% of patients remained complaint after a mean follow-up period of 21 months. Conclusions: Sleep apnea is highly prevalent in patients with AF who are referred for ablation, and a large proportion of them were undiagnosed due to the limited predictive value of sleep apnea symptoms. There was a high rate of long-term continuous positive airway pressure adherence. Perspective: Obstructive sleep apnea is a modifiable risk factor for recurrence of AF after cardioversion, on antiarrhythmic drug treatment, and after ablation. According to the 2020 European Society of Cardiology guidelines for AF management, treatment for obstructive sleep apnea should be optimized to reduce AF recurrences and improve AF treatment results. The present study suggests that in the AF patient population being considered for ablation, “low-tech” screening tools, such as the widely used sleep apnea questionnaire STOP-BANG, were not effective in discriminating patients with and without the condition. The authors, however, demonstrated that a home test showed an exceedingly high prevalence of sleep apnea, and that patients with newly diagnosed sleep apnea had high compliance rates with continuous positive airway pressure treatment. The findings of this study, if confirmed, suggest that physicians should recommend a sleep apnea test to large majorities of patients with AF, although it remains unclear which patients definitely would not benefit from the test. Source: https://www.acc.org/latest-in-cardiology/journal-scans/2020/11/25/15/46/prevalence-of-undiagnosed-sleep?fbclid=IwAR2f4hjs3j-9JKMCUeXVzgN4dyuK0b_93MELinPHiK0Tndtjit2M8O72APQ
Learn moreLeanne Sandmeyer – Customer Testimonial Responses
When I first started having trouble sleeping a few years ago, as a professionally trained nurse, I knew the best course of action was to contact my primary care provider and get a sleep study scheduled as soon as possible. It came as no surprise that I had sleep apnea, what was concerning was the fact that I was having 20 to 50 events per hour, and at times during the night stopped completely breathing altogether. My husband had been previously diagnosed with sleep apnea and had been using a CPAP machine for about 15 years. I was aware of his issues of using the equipment and was worried I wouldn’t be very comfortable and would never sleep well again after also being diagnosed. Men and women have different needs when it comes to their CPAP equipment, and the thought of wearing a full-face mask just seemed unbearable to me. Fortunately, I was prescribed a nasal mask and a very cool looking machine, so I was hopeful that it could help me. When I went met with the technician to be shown how to use the equipment it was a nightmare. While it may have been his first week on the job, it was clear no one had properly trained him what to do, so he essentially handed me the equipment and wished me well. Here I had just paid $500 out of my own pocket to be given a device that didn’t fit me properly, not sure how it even worked or what I needed to do to keep it in proper working order. For me, my nurse skills kick-in and I was able to figure out some of it on my own, but I also get some help on internet by watching a few LankyLefty videos. What I realized pretty quickly, is that starting with a CPAP machine isn’t the easiest thing to do, and for women, we have different issues than men and the equipment isn’t really designed with our interests in mind. For instance, our hair, many women have a fair amount of it and mask straps tend to slide during the night because of it. So even when I tried to tie it up, it still got in the way. If I could get 5 hours of sleep a night, I was ecstatic, because the mask would slip off during the night several times and I would replace it and try to fall back asleep. Shortly after starting the CPAP therapy, I was very discouraged and knew that if I truly wanted some kind of relief, surgery was certainly another option. But as a nurse, I also knew that surgery to correct my disorder could result in me needing additional surgeries at a later date and really should only be considered as a path of last resort. So, I kept trying other masks to find something that actually worked, fortunately I was able to keep buying other products, but not everyone can afford to purchase an assortment of masks and keep throwing them in the trash. That’s what I did for almost a year and then I came across some information on the Internet about a company creating a mask-free solution called Bleep. So, I called the CEO, Stuart Heatherington, and to my surprise he actually answered the phone. We talked about his innovation and how it was still in the development stage, but he promised to keep me in the loop. As I hung up the phone, I really hoped Stuart was going to make my dreams come true, because I was not finding anything that could actually help me sleep better. Soon enough, Stuart shipped my first set of DreamPorts to try, and after a few slight modifications to customize the fit, I was ready to give it a go. That night I slept ten hours straight, never waking to adjust or remove my mask like I did with other products. I shared my experience with Stuart and a few suggestions on how to make it even more fabulous and he promised to keep working at it. From that day on I was a loyal DreamPort user. What I loved about the DreamPorts was the simplicity of the product. I travel a fair amount and I don’t need to pack a lot of equipment to sleep peacefully while on the road. Also, because of the disposal design of the nasal connections cleaning the product is relatively simple and hassle-free. Given the pandemic and concern about keeping things germ-free, the design of the DreamPorts alleviates any major concerns. Take it from a nurse, trying to disinfect your traditional CPAP mask isn’t as easy as one would think. Simplicity of use and easy-to-clean is what makes DreamPorts such an easy choice, because at the end of the day, we all need a good night’s sleep.Any medical professional will strongly recommend getting a proper amount of sleep every night. It helps the body recover from the day’s activities, it alleviates stress and provides a host of other benefits. I have also seen many patients that suffer from heart disease who also have poor sleep patterns and one of the first things I suggest is for them to schedule a sleep study to see if they may be a CPAP candidate. In many cases, they don’t even realize they are not sleeping because they have been suffering for so long and believe it is related to their heart condition. After a proper diagnosis and getting a CPAP machine they start to sleep better, and their cardiac function also improves. In addition, they will sometimes see shortness of breath, cholesterol and other related ailments improve over time. The DreamPort solution can improve your overall health, because you stay 100% compliant. You keep the mask-free solution on all night and sleep, which translates into better health. It’s really that simple, the minute I started using it, I felt better and I slept for about 7.5 hours per night. Prior to this, I would remove my mask and it would be laying on the floor in the morning. This product works and I tell some of my patients that are struggling with their CPAP equipment to give this a try, because it works so well. If people knew how well it worked, they would immediately make the switch. Now I realize one solution won’t work for everyone, but I believe the DreamPort solution is best for women or men that struggle with wearing a mask. For women, with hair the straps can slip during the night or the creams we put on our face before bed may prevent the mask from making a tight seal, these are no longer an issue with a DreamPort. For men, if you have problems with wearing a mask because of your facial hair, or don’t love your morning strap lines, are worried about losing more hair because of the straps, or just don’t like the feeling of being strapped down all night, then you need to try this product. My husband has a mask and it can take an hour or more before his strap lines fully disappear, who wants to worry about that every day. Right now, many of us get up and need to wear a mask for a portion of the day to avoid getting sick, who wants to get into bed and put another mask on to sleep at night…seriously think about that. Go to bleepsleep.com and get yourself some DreamPorts.
Learn moreRyan Jensen Interview
Ryan Jensen is not a health care professional. His statements are based solely on his personal experience. Ryan Jensen is a top-ranked US professional football center for the National Football League’s Tampa Bay Buccaneers. Drafted by the Baltimore Ravens in the sixth round of the 2013 NFL Draft, Jensen has made a name for himself as a relentless player and advocate for ensuring optimum health and performance on and off the field. “In my line of work, a good night of sleep is critical to success on the football field. So, when I found the Bleep DreamPort it was a Bleeping no brainer for me,” said Jensen. “From the moment I started using the mask-free the solution, I immediately noticed a huge difference — better sleep without constant leaks, not to mention no lines on my face or crazy bedhead hair from all the straps. And, for the first time in years, I could sleep in any position, including on my stomach. I’m confident I sleep better with the Bleep DreamPort, and better sleep translates to greater success on the field.” The DreamPort Sleep Solution is the first mask-less CPAP solution on the market. The DreamPort is small, lightweight, headgear-free and easy-to-use. It’s the best way to get the sleep you need. Our patented design ensures no leaks with a snug fit that won’t slip during the night. No more sleep disruptions! Ryan Jensen talks about sleep apnea Ryan Jensen talks about Apnea and Football Ryan Jensen talks about his trials with a full face mask Ryan Jensen talks about transitioning to the DreamPort
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