Who Should Use a Nasal CPAP?

Have you had a home sleep study? Has your primary care doctor diagnosed you with sleep apnea? Here is more information on CPAP from a specialist. - JR

CPAP stands for "continuous positive airway pressure." CPAP is a treatment that delivers slightly pressurized air during the breathing cycle.

This keeps the windpipe open during sleep and prevents episodes of blocked breathing in persons with obstructive sleep apnea and other breathing problems.

It is sometimes called nasal continuous positive airflow pressure (nCPAP).

Information

WHO SHOULD USE CPAP

Continuous positive airflow pressure (CPAP) is the best treatment for most people with obstructive sleep apnea. It is safe and effective in patients of all ages, including children. If you only have mild sleep apnea and do not feel very sleepy during the day, you may not need to use it.

After using CPAP regularly, many patients report the following:

• Better concentration and memory
• Feeling more alert and less sleepy during the day
• Improved sleep for the person's bed partners
• Improvements in work productivity
• Less anxiety and depression and a better mood
• Normal sleep patterns
• Improvement in heart and blood vessel problems, such as high blood pressure

A similar machine, called BiPAP (bilevel positive airway pressure) is used as an alternative to CPAP. With this machine, the pressure changes while a person breathes in and out.

These devices are useful for children and adults with collapsible airways, small lung volumes, or muscle weakness that makes it difficult to breathe, such as muscular dystrophy.

CPAP or BiPAP may also be used by people who have:

• Acute respiratory failure
• Central sleep apnea
• COPD
• Heart failure

HOW CPAP WORKS

CPAP works in the following way:

• The device is a machine weighing about 5 pounds that fits on a bedside table.
• A mask fits over the nose. A tube connects the mask to the CPAP device.
• The machine delivers a steady stream of air under slight pressure through this tube into the mask.

CPAP will be started while you are in the sleep center for the night. Sometimes, it can be started on the same night you have your sleep study.

The doctor, nurse, or therapist will help choose the mask that fits you best. They will also help adjust the settings on the machine while you are asleep. The settings on the CPAP machine depend on the severity of your sleep apnea.

If you are using the CPAP machine but your sleep apnea symptoms do not improve, the settings on the machine may need to be changed. Some patients can be taught to adjust the CPAP at home. Otherwise, you will need to make trips to the sleep center.

CPAP works by steadily increasing pressure in your airway. Newer devices, called autotitrating positive airway pressure (APAP) can respond to changes in pressure in your airway as they occur. This may be more comfortable, and it also can help you avoid overnight stays and other trips to the hospital.

GETTING USED TO THE DEVICE

It can take time to become used to a CPAP device. The first few nights of CPAP therapy are often the hardest. Some patients may sleep less or not sleep well at the start of treatment.

Patients who are having problems may tend not to use CPAP for the whole night, or even stop using the device. However, it is important to use the machine for the entire night or for as long as possible.

Common complaints include:

• A feeling of being closed in (claustrophobia)
• Chest muscle discomfort, which usually goes away after a while
• Eye irritation
• Irritation and sores over the bridge of the nose
• Nasal congestion and sore or dry mouth
• Noise that interferes with sleep (although most machines are quiet)
• Nosebleeds
• Upper respiratory infections

Many of these problems can be helped or prevented by the following methods:

• Ask your doctor or therapist about using a mask that is lightweight and cushioned. Some masks are used only around or inside the nostrils.
• Make sure the mask fits correctly. It should not be too tight or too loose, and it should not leak any air.
• Try nasal salt water sprays for a stuffed nose.
• Use a humidifier to help with dry skin or nasal passages.
• Keep your CPAP equipment clean.
• Place your CPAP machine underneath your bed.

Your doctor or therapist can lower the pressure on the CPAP machine and then increase it again at a slow pace. Some new machines can automatically adjust to the pressure that is needed.

Alternative Names

Continuous positive airway pressure; CPAP; Bilevel positive airway pressure; BiPAP; Autotitrating positive airway pressure; APAP; nCPAP

References

McArdle N, Singh B, Murphy M. Continuous positive airway pressure titration for obstructive sleep apnoea: automatic versus manual titration. Thorax. 2010;65:606-611.

Tomfohr LM, Ancoli-Israel S, Loredo JS, Dimsdale JE. Effects of continuous positive airway pressure on fatigue and sleepiness in patients with obstructive sleep apnea: data from a randomized controlled trial. Sleep. 2011;34:121-126.

Basner RC. Continuous positive airway pressure for obstructive sleep apnea. N Engl J Med. 2007;356:1751-1758.

Epstein LJ, Kristo D, Strollo PJ Jr., et al.; Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management, and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5:263-276.

Experts Claim ADHD Is Over-Diagnosed

What experts and the public have already long suspected is now supported by representative data collected by researchers at Ruhr-Universität Bochum (RUB) and University of Basel: ADHD, attention deficit hyperactivity disorder, is over-diagnosed. The study showed that child and adolescent psychotherapists and psychiatrists tend to give a diagnosis based on heuristics, unclear rules of thumb, rather than adhering to recognized diagnostic criteria. Boys in particular are substantially more often misdiagnosed compared to girls.

These are the most important results of a study conducted by Prof. Dr. Silvia Schneider and Prof. Dr. Jürgen Margraf (both from RUB) and Dr. Katrin Bruchmüller (University of Basel) as reported in the periodicalJournal of Consulting and Clinical Psychology.

Daniel has ADHD, Danielle doesn't

The researchers surveyed altogether 1,000 child and adolescent psychotherapists and psychiatrists across Germany. 473 participated in the study. They received one of four available case vignettes, and were asked to give a diagnoses and a recommendation for therapy. In three out of the four case vignettes, the described symptoms and circumstances did not fulfil ADHD criteria. Only one of the cases fulfilled ADHD criteria based strictly on the valid diagnostic criteria. In addition, the gender of the child was included as a variable resulting in eight different case vignettes. As the result, when comparing two identical cases with a different gender, the difference was clear: Leon has ADHD, Lea doesn't.

Male and conspicuous: the "prototype" makes the difference

Many child and adolescent psychotherapists and psychiatrists seem to proceed heuristically and base their decisions on prototypical symptoms. The prototype is male and shows symptoms such as motoric restlessness, lack of concentration and impulsiveness. In connection with the gender of the patient, these symptoms lead to different diagnoses. A boy with such symptoms, even he does not fulfil the complete set of diagnostic criteria, will receive a diagnosis for ADHD, whereas a girl will not. Also the therapist's gender plays a role in the diagnostic: male therapists give substantially more frequently a diagnosis for ADHD than their female counterparts.

Diagnostic inflation, more medication, higher daily doses

In the past decades the diagnoses ADHD have become almost inflationary. Between 1989 and 2001, the number of diagnoses in German clinical practise increased by 381 percent. The costs for ADHD medication, such as for the performance-enhancer Methylphenidate, have grown 9 times between 1993 and 2003. The German health insurance company, Techniker, reports an increase of 30 percent in Methylphenidate prescriptions for its clients between the ages of 6 and 18. Similarly, the daily dosage has increased by 10 percent on average.

Remarkable lack of research

Considering these statistics, there is a remarkable lack of research in the diagnostic of ADHD. "In spite of the strong public interest, only very few empirical studies have addressed this issue," Prof. Schneider and Dr. Bruchmüller point out. While in the 70s and 80s a "certain upswing" of studies on the frequency and reasons for misdiagnoses could be observed, current research hardly examines the phenomena. The current study shows that in order to avoid a misdiagnosis of ADHD and premature treatment, it is crucial for therapists not to rely on their intuition, instead to strictly adhere to defined, established diagnostic criteria. This is best possible with the help of standardized diagnostic instruments, such as diagnostic interviews.

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Autism More Common Than Previously Thought: CDC Report Shows One in 54 Boys Identified

The U.S. Centers for Disease Control and Prevention estimates that 1 in 88 children in the United States has been identified as having an autism spectrum disorder (ASD), according to a new study released March 29 that looked at data from 14 communities. Autism spectrum disorders are almost five times more common among boys than girls -- with 1 in 54 boys identified.

The number of children identified with ASDs ranged from 1 in 210 children in Alabama to 1 in 47 children in Utah. The largest increases were among Hispanic and black children.

The report, Prevalence of Autism Spectrum Disorders -- Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, 2008, provides autism prevalence estimates from 14 areas. It was just published in the Morbidity and Mortality Weekly Report.

"This information paints a picture of the magnitude of the condition across our country and helps us understand how communities identify children with autism," said Health and Human Services (HHS) Secretary Kathleen Sebelius. "That is why HHS and our entire administration has been working hard to improve the lives of people living with autism spectrum disorders and their families by improving research, support, and services."

"One thing the data tells us with certainty -- there are more children and families that need help," said CDC Director Thomas Frieden, M.D., M.P.H. "We must continue to track autism spectrum disorders because this is the information communities need to guide improvements in services to help children."

Zachary Warren, Ph.D., director of the Vanderbilt Kennedy Center's Treatment and Research Institute for Autism Spectrum Disorders at Vanderbilt University, says effective early identification and treatment of autism is a public health emergency.

"The new CDC data is the best evidence we have to date that autism is a very common disorder. While recent estimates have varied, we have always known the individual, familial, educational and societal costs that go along with autism are tremendous," Warren said. "We are now seeing autism in more than 1 percent of the population, which highlights how challenging it will be for systems of care to meet service needs."

The results of CDC's study highlight the importance of the Obama administration's efforts to address the needs of people with ASDs, including the work of the Interagency Autism Coordinating Committee (IACC) at the U.S. Department of Health and Human Services. The IACC's charge is to facilitate ASD research, screening, intervention, and education. As part of this effort, the National Institutes of Health has invested in research to identify possible risk factors and effective therapies for people with ASDs.

Study results from the 2008 surveillance year show 11.3 per 1,000 8-year-old children have been identified as having an ASD. This marks a 23 percent increase since the last report in 2009. Some of this increase is due to the way children are identified, diagnosed and served in their communities, although exactly how much is due to these factors is unknown. "To understand more, we need to keep accelerating our research into risk factors and causes of autism spectrum disorders," said Coleen Boyle, Ph.D., M.S.Hyg., director of CDC's National Center on Birth Defects and Developmental Disabilities.

The study also shows more children are being diagnosed by age 3, an increase from 12 percent for children born in 1994 to 18 percent for children born in 2000. "Unfortunately, 40 percent of the children in this study aren't getting a diagnosis until after age 4. We are working hard to change that," said Boyle.

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Ful study here

Is Too Much or Too Little Sleep Bad for the Heart?: Study

When it comes to what's best for their hearts, people walk a fine line between getting too much and too little sleep, a new study suggests.

Adults who get fewer than six hours or more than eight hours of sleep a night are at greater risk for a variety of heart conditions, according to research led by Dr. Rohit Arora, chairman of cardiology at the Chicago Medical School.

Sleeping too little puts people at significantly higher risk of stroke, heart attack and congestive heart failure, the researchers found. On the other hand, people who sleep too much have a higher prevalence of chest pain (angina) and coronary artery disease, a narrowing of the blood vessels that supply the heart with blood and oxygen.

The findings are scheduled for presentation Sunday at the American College of Cardiology annual meeting in Chicago.

The researchers analyzed data from more than 3,000 patients over age 45 who participated in the U.S. National Health and Nutrition Examination Survey, making theirs the first nationally representative sample to show the association between sleep duration and heart health.

The study showed that people who got too little sleep were twice as likely to have a stroke or heart attack and 1.6 times more likely to have congestive heart failure. People who slept more than eight hours a night were twice as likely to have angina and 1.1 times more likely to have coronary artery disease.

The findings remained significant even after the researchers accounted for heart risk factors such as age, blood cholesterol levels, smoking and obesity, as well as for sleep apnea and other sleep problems.

Previous studies have shown that insufficient sleep is linked to a hyperactive nervous system, glucose intolerance, diabetes, inflammation and a rise in stress hormones, blood pressure and resting heart rate, the researchers noted.

The reasons too much sleep can lead to heart problems are unclear, however, and further research will be needed.

For now, Arora said, health-care providers need to talk about sleep with their patients.

"Clinicians need to start asking patients about sleep, especially those who are already at greater risk of heart disease," he said. "It's really a simple thing to assess as part of a physical exam; it doesn't cost anything and it may help patients to adopt better sleep habits."

Although the new study uncovered an association between sleep issues and heart trouble, it did not prove a cause-and-effect relationship.

Research presented at medical meetings should be viewed as preliminary until it is published in a peer-reviewed medical journal.

SOURCE: American College of Cardiology, news release, March 25, 2012

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Study: Sleep Disturbances May Cause Memory Problems

Brief disturbances of sleep may interfere with the normal process of solidifying the memories we form during the day.

In a new study, healthy people performed better on a task they had learned the day before after getting a good night's sleep. By contrast, participants with mild sleep apnea, which causes sleep disturbances, showed virtually no improvement on the task the next day.

The finding adds to a growing body of research showing sleep aids in memory consolidation and canimprove the ability to perform certain memory tasks, particularly those that require motor memory, such as riding a bike. But the study also shows "it's not just the amount of sleep, it's really having restful sleep that’s not interrupted that is important," said study researcher Dr. Ina Djonlagic, a physician in the division of sleep medicine at Brigham and Women's Hospital in Boston.

...

Sleep and memory

Scientists divide the memory process into three main stages: encoding, consolidating and retrieving. The consolidation of memories includes stabilizing and storing them for the long term.

...

After a night's rest, and with no additional training, the healthy participants showed a 14 percent improvement in their task accuracy and speed. However, the sleep apnea patients showed almost no improvement, and some did worse than the day before, Djonlagic said.

Alertness was not an issue: Both groups performed equally well on a reaction task in the morning testing their alertness, Djonlagic said.

No relationship was found between participants' performance on the morning task and the amount of oxygen deprivation they experienced at night. However, there was a link between task performance and the number of times participants were roused from sleep: The worst performances appeared related to the greatest number of disturbances.

Memory problems

"This highlights the fact that the arousals that are associated with sleep apnea truly can have an impact on someone's memory," sleep expert Dr. David Neubauer, who was not involved in the study, said of the findings. The impact may be especially pronounced in people with more severe sleep apnea, said Neubauer, who is at Johns Hopkins University School of Medicine.

...

The study is published today (March 28) in the journal PLoS ONE.

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Children's Sleep Problems Signal Later Emotional Troubles

A milestone in child development, at least for many parents, is when the kid finally sleeps through the night. But a recent study suggests that it’s a good idea for parents to monitor how the wee ones are sleeping as well as how long.

Published in the journal Pediatrics, the study shows that children who have problems breathing while they sleep are more likely to experience behavioral problems such as hyperactivity and aggressiveness when they get older. They’re also more likely to have emotional issues such as difficult peer relationships.

Researchers from the University of Michigan and the Albert Einstein College of Medicine at Yeshiva University followed the sleeping patterns of more than 11,000 children for six years. They found that kids who snored, breathed heavily through their mouths and experienced apnea—long pauses between breaths during sleep—were at risk.

Collectively known as sleep-disordered breathing (SDB), the problem peaks when children are between 2 and 6 years old, but can occur when they are younger. Approximately 1 in 10 children snores regularly and 2 to 4 in 100 have sleep apnea, according to the American Academy of Otolaryngology–Health and Neck Surgery (AAO-HNS). Common causes of SDB are enlarged tonsils or adenoids, but be wary of the “quick-fix” of tonsillectomy—as we have reported, that surgical procedure is often unnecessary, and to conclude that tonsils contribute to sleep disorders requires careful diagnosis.

Quite simply, the study’s authors said, “Parents and pediatricians alike should be paying closer attention to sleep-disordered breathing in young children, perhaps as early as the first year of life.”

Although earlier studies indicated sleep problems could signal later difficulties, they involved only small numbers of patients, short follow-up of a single symptom or limited control of individual traits such as low birth weight that could be responsible for some symptoms.

In the new, more substantial study, children whose symptoms peaked between the ages of six and 18 months were much more likely to experience behavioral problems when they were 7 compared with children who breathe normally during sleep. Children whose SDB symptoms persisted throughout the evaluation period, and were most severe at 30 months, expressed the most severe behavioral problems.

Researchers theorize that SDB might be responsible for behavioral problems because of its effect on the brain. Decreased oxygen levels and increased carbon dioxide interrupts the restorative process of sleep and disrupts various chemical systems. Such malfunctions can impair one’s ability to pay attention, plan ahead and organize. They also impede one’s ability to regulate emotions.

To learn more about SDB and treatment options, consult the AAO-HNS fact sheet.

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Top 6 Sleep Myths & Facts: Age, Amount, Weight, Naps, & Mood

When it comes to sleep, the easiest consensus to arrive at for most people is that we could all use more of it.
What else should we know? Globalnews.ca turned to two experts to help us demystify the science around this precious commodity most of us take for granted.

1. Sleep quality gets worse as we get older: False.

According to Michael Decker, PhD., associate professor at Georgia State University and spokesperson for the American Academy of Sleep Medicine, this is simply not true. He says if you’re not feeling refreshed, you most likely have a sleeping disorder, as most people don’t recognize they a have a sleeping disorder. Eighty per cent of all sleeping disorders are yet to be diagnosed, says Decker.

2. Eight hours of sleep is what most people should get each night: It depends.

According to Peter Backx, professor of Physiology and Medicine at the University of Toronto, clearly insufficient sleep creates health risks but the number of hours that constitutes "insufficient" is dependent on many factors. Dr. Decker also says total sleep time is genetically determined. According to Blackx, many health professionals and those that study sleep believe that the adult body needs a minimum of eight hours of sleep.


3. Sleep deprivation can lead to weight issues: True.

Decker says there is real science behind the studies that show a lack of sleep leads to insulin resistance, which is one of the first steps to becoming diabetic.

4. Napping is bad: True.

Decker says naps can disrupt the next night of sleep as we build-up a drive for sleep. He says if you take a nap in the early afternoon or late at night, you release some of that drive for sleep. In general, if allowed, the body will take the sleep it requires, says Blackx.

5. Contiguous sleep is better than interrupted sleep. Not sure.

Decker says there is a critical period of five hours of sleep that our brain needs. The amount of sleep we need is based on prior sleep history and genetics. According to Blackx, many health professionals and those that study sleep would say that the adult body needs a minimum of eight hours of sleep.

6. Depression and sleep are linked: True.
Abnormalities in REM are frequently observed in patients with depression. Disturbances of sleep are typical for most depressed patients and belong to the core symptoms of the disorder. Depression is associated with requiring more hours of sleep, says Blackx.

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