Archive | Sleep Apnea

Major Surgery to Fix Sleep Apnea is Painful

Making the big decision to either continue on with CPAP therapy, or to go through with a major surgery to correct the problems that untreated sleep apnea presents is a very big deal.

Don’t let anyone tell you otherwise, or you may be in for the biggest surprise of your life.  There are several different types of surgery that help out with sleep apnea, and many of them come with long recovery times.  There are benefits however, and this is what makes the decision making process so difficult from the patient’s perspective.

Nasal Passage Surgery

Clearing the nasal passage is one type of surgery.  It has proven effective for quite some time now and a previous study illustrates this point.  Here is the study:  Clinical effect of surgical correction for nasal pathology on the treatment of obstructive sleep apnea syndrome.  This particular study showed positive results in 56% of obstructive sleep apnea patients which is pretty incredible.  But what about the remaining 44%?  Those patients are still symptomatic and need another form of treatment.  And if CPAP is just not going to work for them, the chances are they are going to look at yet another form of surgery to correct their bad sleep.

Tongue Surgery for Sleep Apnea

Getting your tongue hacked up is yet another surgical procedure that is on the rise for men and women to treat OSA.  As the tongue is a major part of the body which can impact the airway, reducing its size has also led to some success and some major discomfort for people who go that route.  Here is a study:  Combined bipolar radiofrequency surgery of the tongue base and uvulopalatopharyngoplasty for obstructive sleep apnea.

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Dad Snoring

My Father Snores

Who else has woken up in the night and heard your dad snoring so loud that he literally wakes you right up?  It’s crazy to think that someone can wake you up from your sleep, but while you are sitting there wide awake listening to the freight train sounds from the snoring, your dad is still sleeping like nothing is happening.  It is amazing, but the reality is that this exact event is taking place all over the world, every single day of the year millions and millions of times.

Because snoring is never known by the person who is committing the crime of loud snoring, it is often very difficult to explain how bad it can be.  Who has sat around the breakfast table before and told your father how loud they were snoring, and then had them look at you like you are crazy?  It’s so hard to recognize the fact that the snorer simply doesn’t remember any of the snoring, but that is reality.  People who snore have no clue what they are doing, and how loud it is all night long.

Making Sure Dad Knows How Loud His Snoring Is

Here is a simple solution.  One night, get a tape recorder, or a video camera, and simply record the snoring while it is going on.  You don’t need to record hours and hours of it, just a few seconds.  But be sure to record the audio.  When you have a few minutes of the snoring recorded, you can simply play back all of the loud sounds the next day to your father.  If your dad is not convinced that his snoring is a major problem, then you are out of luck.  But there is a good chance that he will recognize it is a problem, and he should talk to a doctor.  There is a good chance he has un-diagnosed sleep apnea, and that can be a major health risk.


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Getting Cleared for Surgery with Undiagnosed Sleep Apnea

Getting Any Surgery and Medical Clearance

Whenever patients are considering having surgery, there is a typical process that usually takes place around the world.  First the patient meets with their primary care doctor, or some other physician.  Next, if the decision is made to get surgery, or at least investigate it further, that same patient will often be referred directly to the surgeon’s office to discuss the procedure.  But, before the surgery every takes place, the patient needs to be medically cleared for the surgery.  This means that the patient must pass a judgement by the doctor’s involved, that he/she is physically able to have surgery and get past the stress and other potentially fatal challenges that surgery may pose.  This is where there is a huge problem.

Screening For Sleep Apnea Prior to Surgery

Although most patients assume that their doctors are taking the best care of them, and are looking out for their overall health, that unfortunately is not the case.  Because we are focused on sleep apnea here, it is shocking to learn how few surgeons actually are certain that their patients do not have sleep apnea prior to surgery.  Over the past few weeks, I have met with over 8 surgeon offices in the San Franciso, California area, and was shocked at my findings.

Not only did absolutely ZERO of the medical offices screen for sleep apnea prior to conducting their surgical procedures, but not a single surgeon’s office made any reference or question about sleep apnea signs or symptoms on their intake sheets that new patients are handed out.  This was appalling to say the least.

When I questioned the staff at all of these offices if they were concerned that they may be performing surgeries on patients who have moderate or even severe sleep apnea, they did not seem concerned at all.  And of course that was shocking to learn.  The almost identical response that each office gave me was that “Screening for sleep apnea was the job of the primary care doctor”.

OK, I hear you on that, and totally agree, but that is the utopian world way of thinking.   The reality is that roughly 90% of current sleep apnea patients are un-diagnosed, which means that a massive amount of patients who make their way to the surgery table have sleep apnea but not a single doctor knows it.

So, to follow up on the conversations, I asked the staff at the surgery offices if they would be concerned to operate on patients moving forward knowing that there is a high lieklihood that some of their patients fall into the category of un-diagnosed OSA sufferers.  The response was what I should have expected.  Again everybody in these offices told me it was not their responsibility.

I guess that time will only tell who’s responsibility it is if a patient dies while undergoing surgery, and if that death is found to be linked to sleep apnea.  Unfortunately, there seems to be little concern for this until it is too late.  And then even in death, it is very hard to trace a death to un-diagnosed sleep apnea, because nobody knew about it in the first place.

Oh wait a minute, the FBI is investigating one of these cases right now, maybe this will bring the matter to light.  Here is the story:

Death of woman maybe caused by Sleep Apnea

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Commercial Drivers and Sleep Apnea

Some reports say that between 1 and three commercial drivers are living with and driving with un-diagnosed obstructive sleep apnea.  While these drivers get older, it usually becomes worse and it is more prevalent in men compared to women. 

When sleep apnea happens, it is due to an obstruction of airflow.  Some patients have a large uvula, other people have a narrow jaw which can also lead to a blockage of the airway.  What is difficult for patients to understand is how dangerous this can be.  Some of the common factors which lead to sleep apnea are physiological, others are based on things like obesity.  With commercial drivers, 42% have a BMI (Body Mass Index) over 30 which is a very strong predictor of sleep apnea.

Neck circumfrence is also a easy way to guess if a patient has high potential for sleep apnea or not.  With so much extra flesh which can float down and into the airway, it makes it much easier to have sleep apnea.  But, everyone should realize that a patient does not need to be very obese patient, even average sized patients can have high risk factors for sleep apnea.

Some patients with sleep apnea have the following symptoms:

  • snoring
  • sleepiness
  • fatigued during the day
  • constant headaches throughout the night and sometimes during the day

Apnea is defined as a stop of airflow for more than ten seconds.  That’s right, a stop in airflow completely

Hypopneas are defined as a slow down or decrease in the airflow for 10 seconds or more.  Also, depending on which sleep lab or sleep doctor you are talking with, the definition of a hypopnea may vary slightly.

During an apnea event, there is a quick buildup of carbon dioxide and this in turn arouses the brain and causes the muscles in the throat to wake up.  Thankfully this happens, otherwise people would essentially die during these events.

When commercial drivers are trying to get their work done each day, the effects of obstructive sleep apnea can cause all sorts of problems with their physical work.  Falling asleep at the wheel is one of the biggest concerns for obvious reasons.  As sleep apnea has become more and more prevalent and in the news and media, testing and treatment for this condition is becoming more well known which in turn is helping out the general public.  To think that your city bus driver might be at high risk of sleep apnea is a scary thought.

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EPAP from Provent Therapy

Placing some stickers under your nostrils to help with sleep apnea is becoming more and more popular thanks to the help of new technology and affordable medical devices.  Yes, it sounds crazy, and even looks a bit crazy too, but Provent Therapy from Ventus Medical is leading the way and helping many people sleep better in a rather unusual way.  Their medical device which is available to patients with a prescription, helps to create “Expiratory Positive Airway Pressure” or EPAP, and this helps to keep the airway open during the night while patients are asleep.

Much like the ideas behind “Continuous Positive Airway Pressure” or CPAP, Provent Therapy has found a new and innovative way to treat sleep apnea, and for patients who use the therapy, its a life saver.  Many patients who are usual CPAP users, but who are not always able to bring their CPAP devices along with them wherever they go while away from home (work related travel, a weekend out camping, or any other reason) have started looking for alternatives to sleeping without any treatment.  This void is easily filled by this new treatment.  What is becoming even more common is that CPAP patients who use provent therapy as an initial test, sometimes find out that it helps them so much that they make a switch to using this therapy for their long term treatment of sleep apnea.

We expect that Provent will become more and more popular within the coming years, and may be re-developed into some new ways which will make it even more effective.


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More Dentists Needed To Help Patients Treat Sleep Apnea

Who has ever asked your dentist about getting help with your sleep apnea?  Maybe a few of you have.

And how many times do patients learn that their dentist does not get involved with treating sleep apnea?  Almost everyone who answered yes above.

If your dentist tells you they are not able to treat sleep apnea, or they would rather refer you as a patient to a different dentist who specializes in fitting oral appliances, don’t freak out.  That is the common case right now in the year 2012.  Most dental practices simply do not get involved with treating OSA.  But take my word for it:  this will change in the next 10 years.  And it’s going to change in a major way. Why?  There is too much money to be made by simply being a dentist who’s sitting on the sidelines.

Since I work in the field of sleep apnea, I know exactly how rare a dental practice treating sleep apnea actually is.  Anybody in the United States could walk over to a dental office building, and after going into 10 offices, you’d realize the exact same thing.  All you would really have to do is ask the receptionist, “Do you offer oral appliance therapy to patients to treat sleep apnea?”  If one out of those ten offices you inquire with answers with a, “YES”, that is pretty good.  But sadly, you very well might have to approach thirty or forty dental offices before you find a match.

It’s not the dentists who are the problem.  It’s really not.  The truth is that by and large, most dental schools teach absolutely zero in terms of recognizing and treating sleep apnea.  And, if your dentist graduated from dental school thirty years ago, there’s a pretty good chance he/she doesn’t even know oral appliances exist.  Sad, but true.

But there’s more to the reason for why dentists are completely missing the boat in terms of helping to treat OSA.  It has to do with insurance companies and HMO groups.  Most of the large carriers and insurance payors simply do not pay very much money on the reimbursement side of things for oral appliances.  Medicare pays for oral appliances, but only $500-600 on average, and that is only if the doctor performing the installation is certified and qualified to work with Medicare.  Private insurance companies are very hit or miss at the moment with how they cover this type of “durable medical equipment”.

So what is left for the patient, very few options.  As a general rule, the average overall cost the few existing dentist charge for this type of therapy is about $2000-2500 on average for the full oral appliance fees.  Yikes, that’s alot of money.  You’re damn right it is.  But before you start jumping the gun and thinking your dentist is ripping you off with such a high dollar figure, take a look at what is necessary to get you feeling and sleeping better.

The full oral appliance therapy from a dentist usually includes:

  1. An initial consultation and exam of the patients mouth
  2. Full impressions are needed to mold the oral appliance mouthpiece
  3. First visit fitting the appliance
  4. Follow up visits titrating or re-fitting the appliance

With all of the office visits, and with lab fees and the time needed for dental offices to obtain authorizations and payment from insurance companies, it sure is lots of work just to pull one of these off.  And when the dental office is only doing 1 or two per month, they are almost re-inventing the wheel each time.  This is one of the main reasons why so few dental practices have decided to get involved with providing appliances to patients.

In conclusion, the current landscape for getting all squared away with your sleep apnea from your dentist is pretty bleak.  But, as more and more dentists get involved, and as more and more insurance companies realize the benefit of this type of therapy, positive changes will soon follow.  More dentists should mean lower prices as the supply of providers offering this sleep therapy increases.  And, with more patients receiving this therapy, more competition among the actual devices should increase as well also bringing down prices.

Here is a list of some of the current providers of Oral Appliances:

  1. TAP – Thornton Adjustable Positioner:
  2. Respire Medical :
  3. SUAD Device by Strong Dental:
  4. Somnodent device by Somnomed:


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Apnea Hypopnea Index of 5 or Less – Sleep Apnea?

Figuring Out If You Really Have Sleep Apnea

A very common outcome after getting a sleep study is to come back with diagnostic results that are in the very mild range.  This might be numbers such as an AHI (Apnea Hypopnea Indes) of 5 or less or maybe even an AHI of 1 or two.  There is often another set of numbers or actually another index that you might notice on your test results which stands for RDI (respiratory disturbance index) and this number is always going to be the same or higher than the AHI.  The reason being, the RDI takes into account both apneas, hypopneas, and also upper airway resistance syndrome events per hour.  So, compared to the AHI which only calculated the Apnea plus Hypopneas per hour, this new index takes into account more events.  But still, everyone wants to know what is something to be concerned about, and what are test results that you don’t need to worry about.

For the overwhelming majority of people who come back with test results in the range of 5 or less for the AHI, nothing is usually done further.  However, if a patient has a very low diagnostic score from the sleep study, and that same patient is very symptomatic of the common sleeping related breathing problems, something still needs to be figured out.  What is the reason that the patient is so fatigued during the day for example.  Why does the patient continuously complain of waking up in the middle of the night with headaches?  These are still signs of sleep apnea, and need to be investigated if they are present.

The overall goal of any diagnostic test is to help patients feel better and live longer.  The same is true for doctors who are trying to help patients by diagnosing sleep apnea.  But, not everyone is a cut and dry OSA case.  Some patients might be very mild with symptoms and with test results, and even though its so easy to do nothing, some positive changes will only help.

A great way to move your health forward if you are diagnosed with very mild sleep apnea is to think about your daily routine.  If you are constantly tired in the early afternoon, or even all day for that matter, maybe some changes can be made.  And maybe these changes are for your sleep?  If you are one of those very common people who decides to watch the TV right before you go to sleep, that might not be the best move to be making every night.  Studies show that people who watch TV before falling asleep are much more likely to have awful nights sleep on a much more regular basis.  And the worst part is, that missed sleep due to having your mind racing is time you will never get back again.  You actually need to catch up on your normal sleep to get back to normal now.

Talk with your pulmonologist or sleep doctor if you are a mild OSA patient.  There are some creative solutions that you might find very helpful that do not involve surgery or other “minimally invasive procedures”.

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Does Sleep Apnea Help Or Hurt The Medical System?

After being heavily involved with sleep medicine and specifically obstructive sleep apnea for quite some time now, I still find myself wondering what costs and benefits does this little niche in medical care really add/subtract?

It’s a very loaded question, that is for sure, and it’s also one where you would probably find much disagreement between doctors, patients, and especially between insurance companies.  So, I’ll try to break down some of the main issues that I see with sleep apnea and how it folds it’s way into the medical world.


There are a two main questions that exist with the testing of sleep apnea.

1) Is testing necessary to diagnose obstructive sleep apnea?

2) What is the best method for testing sleep apnea?

To try and tackle the first question of the necessity of the actual sleep study test, it’s not as easy to answer as one might think.  First of all, primary care doctors who make the most initial referrals to outside sleep testing facilities are usually correct with their early suspicion that a particular patient might have obstructive sleep apnea.  In-fact, over 85% of referrals to sleep testing labs come back positive for OSA according to reports from the previous decades.  That’s actually great news, because that means that non “sleep doctors” are very good at picking up the signs and symptoms of when patients might have this sleeping disorder.  On the other hand, without have a sleep study, nobody is going to know right away how severe he patient’s sleep related breathing disorders actually are.  For example, you might have a patient who suffers from OSA but who is very mild in symptoms.  This easily can compare to a patient who suffers from extreme sleep apnea who might end up having a heart attack in just a few days due to the disorder.  Doctors are very good at picking up sleep apnea, however, it is very difficult to guess the severity of someone’s breathing without a full test.

As for deciding on what form of testing is appropriate, that’s a much easier decision.  Between the current possibilities for formally diagnosing a patient with obstructive sleep apnea, the home testing sleep study is by far the best choice in almost every case and scenario.  The simple reason being the costs are so much less compared with in-lab full Polysomnography testing.  And, the results are virtually identical, even though the doctors who own the full sleep labs would like to argue otherwise.  That is simply not the case.


The biggest questions that I have with treatment actually relates to the testing of sleep apnea.  And here is my question:  if doctors are so good at suspecting that patients have sleep apnea, why not skip the diagnostic tests, and send a patient off for treatment right away.  Almost like what happens with patients when they go to the doctor to get treated for a common cold or the flu.  In those cases, the doctor prescribes some medication or treatment, and the patients go right over to the pharmacy and get squared away.

OK OK, this is not apples to apples, yes, I know that, but there is much more to the story.  Here is the deal, many patients have sleep apnea, and they know it.  But many patients don’t actually want to get tested for the disorder.  Instead, they would rather continue living their lives with OSA, and just hack through the symptoms instead of getting the dreaded sleep study.  It’s horrible.  Imagine that, you’d rather subject yourself to a potential heart attack, compared to getting tested and treated and probably having a much better life.  What’s with that?  How can a diagnostic test be so awful that patients are literally scared to death to get it completed?  Very simple, patients don’t like long drawn out diagnostic tests where they have to spend the night in the hospital, especially when it may cost them over $2,000.  That’s the idea here, people don’t like that type of equation, even if it may save their life.

Because the costs and whole set of actions that needs to be taken to get diagnosed with sleep apnea is so cumbersome, patients would rather for go everything altogether.  That’s not idea. And when patients go undiagnosed for sleep apnea, and untreated, they end up costing the healthcare system tens of millions of dollars each year, actually the number is probably in the billions of dollars.  That is awful.

What may end up being a much better idea, and not only in terms of overall health, but also in terms of saving millions of dollars and helping out the healthcare system, would be to simply put all suspected sleep apnea patients directly on CPAP therapy right away, and see how they feel afterwards.  If patients feel much better, then that would be a win.  If they do not see any particular gains, then different approaches could be taken to reduce the symptoms that the doctor noticed in the first place.

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Treating Sleep Apnea with Weight Loss

Sleep Apnea & Weight Loss

Doctors can be pretty funny sometimes, especially when it comes to the varying weighs that different doctors practice medicine.  I recently was meeting with a doctor in San Francisco who works specifically with patients who are overweight.  That’s right, in order to make it into this doctor’s office, you must be overweight.  There is nothing unusual so far, but when I started to learn more about how this doctor practices medicine, it became clear that some differences from the normal doctor exist.

Take for example the common issue of sleep apnea for overweight patients.  Sleep apnea affects all sets and subsets of the population, and this particular doctor claims to have dealt with a good amount of these patients.

When I asked how the doctor diagnoses and treat the sleep apnea symptoms, that’s when things got interesting.  The doctor described that sleep apnea is treated with diet and diet alone!

“Wow”, I thought.  That sounds pretty cool.  The doctor went ahead and explained to me that by reducing the excess mass and tissue underneath the neck, it allowed for many more people to evacuate and escape.  This doctor did not believe in the sleep testing of the patients, felt that was just a waste of money all together.  So, for this practice, the best way to lose your sleep apnea is to lose weight.

What’s great news is that sleep apnea and obesity go hand in hand, so if you can strike out one problem, you might be able to fix other ones.

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Sleep Doctors and Sleep Labs – Hard Times Ahead

The news is not out yet, but the signs that the medical world in the United States are changing are become more and more clear each day that passes by.  What is pretty interesting to observe is how the physicians are all trying to change course to adjust to potential change from the government forces that are getting tighter and tighter.  The once bustling business of becoming a sleep doctor, and having your board certification from the American Academy of Sleep Medicine is caught up in this uncertain time just like the rest of the other specialists out there as well.

When meeting with several sleep doctors over the past few weeks, it was very interesting to see and feel the amount of frustration that this particular group of doctors is living through.  What seems to be the biggest concern across the board was the worry that local sleep labs are going to be the thing of the past in just a couple more years.  That’s right, those places that many people have to spend an entire night at, “sleep labs” may be no more once and for all.  There are a whole bunch of reasons for these types of potential changes, and specifically, it appears that technology has caught up and passed these old school sleep labs, and pretty much left them in the dust.

If you have ever had the chance to visit a sleep lab, the chances are you were not the happiest person to be put up for the night in the environment that existed.  Most sleep labs are described as cold, dark, and awfully uncomfortable places.  After speaking with over 15 sleep lab patients who recently had a sleep apnea study, every single patient told me they would never go back to the awful environment in the future.  Some of the patients complained that they were constantly being woken up by the staff of the sleep lab, others complained that they had to wear all sorts of polysomnography equipment throughout the night, and couldn’t fall asleep at all.  The complaints were numerous, and as unfortunate as it is, the worst part is that nearly every single one of these patients did not need to go to their sleep lab in the first place.  Sounds crazy right?  Unfortunately it is the truth.

Why Do we No Longer Need Sleep Labs?

To fully understand why the sleep lab enviornment is becoming extinct, you have to begin to look at sleep medicine like a business.  (After all, nearly every single sleep lab medical facility is owned by a sleep doctor, or group of sleep doctorsor pulmonologist, or sometimes even neurologists for that matter.)

If you can wrap your head around the idea of a doctor owning a sleep lab, then you will be able to understand why most of the country’s sleep labs will soon be out of business.  First, with very minimal investigations, you can be 100% certain the the overwhelming majority of sleep labs diagnose and test for one thing:  obstructive sleep apnea.  That’s right, the world’s most common sleeping disorder.  This is so common that many sleep labs report over 95% of patients are referred to a sleep doctor for this one specific reason.  Sleep apnea is so common, that it virtually overtakes the entire world of sleep medicine, and the forecasters predict that sleep apnea will only continue to grow across the population as time moves forward.

As horrible as sleep apnea can be, and as painful as it might be to family members of a sleep apnea patient, there is some good news.  The good news has to do with technology.  When sleep apnea was first discovered, diagnosed and treated many years ago, Dr. William Dement invented a polysomnography device to test for sleep apnea.  This diagnostic test, became known as a “sleep study” and was tested in a place called a “sleep lab”.  Well, that was 1971.  ALOT has changed since then, and that’s the good news.

For years and years, millions of patients around the world were required to attend an overnight PSG test to check for sleep apnea.  And whether the patient liked it or not, the test had to be performed in a bed at either the hospital or a private sleep lab facility.  The test has always been a very expensive diagnostic test, sleep studies are also very time consuming, and the most unfortunate part is that they often fail.  By fail, that means that a valid amount of sleep time was not recorded, so the patient either fails the study or must re-take the exact same sleep study once again.  When you sit back and look at it, it’s no wonder why patients absolutely dread visiting sleep labs.

But like everything else, times are changing and sleep labs better be prepared.  Technology has taken over, and this is a 100% FOR SURE win for both patients, families, and especially the bank account.  Technology has allowed for patients who are being tested for sleep apnea to complete a full nights sleep study in the comfort of the patient’s home.  Pretty amazing!  Actually, it’s a no-brainer.

There are several different companies who have spent millions of dollars developing diagnostic testing equipment which will allow for every patient to receive a fully valid, very inexpensive, and much more comfortable sleep study from home.  It is that simple.

To give you an idea of what a HUGE SAVINGS this will have, look no farther than your local sleep lab.  The average price for a sleep study at a local sleep lab can run anywhere from $1600 to well over $5000.  As incredible as that sounds, there are actually some sleep labs who have charged their patients well over those amounts.  But the good news is that sleep studies which are used to diagnose obstructive sleep apnea can be performed in the comfort of the home for as little as $250 per sleep study.  That is virtually free compared to the hundreds and thousands of dollars that have been charged by local sleep lab doctors for so many years.

In this modern world where we rely on technology so much, advances in sleep medicine technology are leading the way, and will eventually save everyone thousands and thousands of dollars.

Of course if you are a sleep doctor, this might not be the best news for you, considering how much of your paycheck comes from the bills you mail out for the in-lab overnight sleep studies.  But that is just life, things will continue to move forward, doctors will adjust, and hopefully nobody will lose any sleep over this.

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What Sleep Apnea Sounds Like

It is not very difficult to determine if someone is struggling through their sleep with obstructive sleep apnea(OSA).  Actually, it is quite simple.  All you need to do is take a good listen to the sounds that are being made, and there’s a great chance you will be able to recognize the tell tale signs of his sleeping disorder.  In this video, you can hear the common sounds of moderate snoring, but you can also hear the sounds of airway obstructions if you listen a bit more closely.

What might surprise you is that sleep apnea is not something that is reserved for men or women.  It is found in both sexes and the current trend is that more and more females are being diagnosed as the years are moving forward.  One thing that everyone should pay attention to is directly related to sleep.  If you are feeling tired and fatigued during the day, try to record your sleep one night with a simple video camera.  It is very possible that you are making sleep apnea related sounds just like you can hear in this video.  All snoring is not sleep apnea, but quite a bit of it is.

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