Obstructive Sleep Apnea, more than you ever wanted to know
I recommend a full work-up in a sleep lab. That's where a technician hooks you up to some EEG, oximetry, and cardiac monitors and records any apnea "live." Even though there are machines that can do much automatically via recordings at home, it can't always rule out narcolepsy and other sleep problems besides obstructive sleep apnea (OSA).
Testing can be done all in one night. They need at least 2 hours of sleep monitoring to diagnose OSA, then they can hook you up to CPAP and use the rest of the night for monitoring pressures and deciding just how much pressure you may need to keep the airway open. Most tolerate the test okay, not too intimidating. They may draw blood (blood gas) to rule out other pulmonary diagnosis and validate oximetry readings. Sometimes they have you come back a second night for the "CPAP titration" test rather than doing it all in one night.
Hopefully, a full work-up in a sleep lab will reveal that CPAP will do the trick. Compliance with the home equipment is half the battle in treating OSA. Those that are most symptomatic (daytime sleepiness etc) and who have a more severe nocturnal obstruction seem to have the easiest time at compliance. Probably because they often instantly notice how much better they sleep and how much better they feel during the day.
Sorry, you'll likely need to shave the mustache and beard right off. Masks have a terrible time making a seal through facial hair. In the U.S., Respironics is the big brand name. But there are many, and all are very comparable. Newer generation equipment automatically adjusts pressures throughout the night. Newer models also do without the "soggy" humidifiers and are fairly quiet. You do have to get used to a nose mask attached to your face with 1" corrugated tubing leading off the bed. There are gel masks and bubble masks you can try if standard masks are too uncomfortable.
I'd suggest trying CPAP (if ordered) each night for several nights before giving up, and keep in touch with the equipment vendor and your Pulmonary specialist on how you and the equipment are doing. You may also have supplemental oxygen ordered to be bled into the CPAP circuit at night.
OSA can lead to CHF and a myriad of down-the-road health conditions, so it's best to do what you can to resolve it. I suggest to stay away from sprays or pills, there's not much in scientific studies showing they work. Dental appliances are an option only when suggested by the Pulmonary specialist and only when fabricated by a specialist qualified to fit appliances to treat OSA. BreathRight strips don't work in treating OSA, but some specialists may give them a try on very mild (snoring) cases.
Most non-surgeons agree that UPPP has its place in treating OSA, but CPAP is the first and best consideration. At best, UPPP seems to work for only a few years. At worst, it corrects the snoring and the patient remains with untreated apnea events during sleep. Somnoplasty is a relatively new alternative and uses a radiofrequency wand to ablate tissue of the soft palate and base of the tongue. It's done in stages, outpatient. If I had a choice between it and surgical UPPP, I would choose the RF, but it will likely not work any better than UPPP.
In the U.S., testing alone will be from $800 to over $2,000. I just put CPAP into a google search and after a few seconds concluded you will be able to sort out the different makes and models of equipment as well as I. Medicare (DMERC) sets the industry price tags on medical equipment. CPAP = HCPCS E0601 reimbursed at around $850; and, bi-level = HCPCS K0532 reimbursed at about $1,700. Auto-adjusting CPAP does not have a separate HCPCS code, or separate reimbursement (yet.) Some wholesale vendors are able to provide auto-CPAP machines for about the Medicare allowable for regular CPAP. The laws of economics don't apply thanks to Medicare price fixing. If you are out-of-pocket buying equipment, you may be able to acquire it at about half the retail - or a pretty good CPAP machine for around $400. Supplemental oxygen is between $150 and $300 per month.
Testing can be done all in one night. They need at least 2 hours of sleep monitoring to diagnose OSA, then they can hook you up to CPAP and use the rest of the night for monitoring pressures and deciding just how much pressure you may need to keep the airway open. Most tolerate the test okay, not too intimidating. They may draw blood (blood gas) to rule out other pulmonary diagnosis and validate oximetry readings. Sometimes they have you come back a second night for the "CPAP titration" test rather than doing it all in one night.
Hopefully, a full work-up in a sleep lab will reveal that CPAP will do the trick. Compliance with the home equipment is half the battle in treating OSA. Those that are most symptomatic (daytime sleepiness etc) and who have a more severe nocturnal obstruction seem to have the easiest time at compliance. Probably because they often instantly notice how much better they sleep and how much better they feel during the day.
Sorry, you'll likely need to shave the mustache and beard right off. Masks have a terrible time making a seal through facial hair. In the U.S., Respironics is the big brand name. But there are many, and all are very comparable. Newer generation equipment automatically adjusts pressures throughout the night. Newer models also do without the "soggy" humidifiers and are fairly quiet. You do have to get used to a nose mask attached to your face with 1" corrugated tubing leading off the bed. There are gel masks and bubble masks you can try if standard masks are too uncomfortable.
I'd suggest trying CPAP (if ordered) each night for several nights before giving up, and keep in touch with the equipment vendor and your Pulmonary specialist on how you and the equipment are doing. You may also have supplemental oxygen ordered to be bled into the CPAP circuit at night.
OSA can lead to CHF and a myriad of down-the-road health conditions, so it's best to do what you can to resolve it. I suggest to stay away from sprays or pills, there's not much in scientific studies showing they work. Dental appliances are an option only when suggested by the Pulmonary specialist and only when fabricated by a specialist qualified to fit appliances to treat OSA. BreathRight strips don't work in treating OSA, but some specialists may give them a try on very mild (snoring) cases.
Most non-surgeons agree that UPPP has its place in treating OSA, but CPAP is the first and best consideration. At best, UPPP seems to work for only a few years. At worst, it corrects the snoring and the patient remains with untreated apnea events during sleep. Somnoplasty is a relatively new alternative and uses a radiofrequency wand to ablate tissue of the soft palate and base of the tongue. It's done in stages, outpatient. If I had a choice between it and surgical UPPP, I would choose the RF, but it will likely not work any better than UPPP.
In the U.S., testing alone will be from $800 to over $2,000. I just put CPAP into a google search and after a few seconds concluded you will be able to sort out the different makes and models of equipment as well as I. Medicare (DMERC) sets the industry price tags on medical equipment. CPAP = HCPCS E0601 reimbursed at around $850; and, bi-level = HCPCS K0532 reimbursed at about $1,700. Auto-adjusting CPAP does not have a separate HCPCS code, or separate reimbursement (yet.) Some wholesale vendors are able to provide auto-CPAP machines for about the Medicare allowable for regular CPAP. The laws of economics don't apply thanks to Medicare price fixing. If you are out-of-pocket buying equipment, you may be able to acquire it at about half the retail - or a pretty good CPAP machine for around $400. Supplemental oxygen is between $150 and $300 per month.
posted by nawledge at
10:06 PM
0 Comments:
Post a Comment
<< Home