CPAP Blog

There have been a few interesting stories involving Sleep Apnoea over the last couple of weeks, so here’s a quick round-up of what’s been going on.

Probably the most important news is the story we covered in our last blog entry; that of an Australian Sleep Clinic showing a direct link between weight and Sleep Apnoea. After studying 20 years of records, they found unquestionable correlation between increasing weight and more severe Sleep Apnoea. Although the link has long been made, it’s the first time that it has had some hard statistics to prove it.

On a similar note, there was a story in the Daily Mail last week about a girl who has been diagnosed with Sleep Apnoea and has vowed to lose 5 stones in the next year. Doctors had warned her that her condition could kill her – which may sound a little over the top as to many it just results in snoring and being tired during the day. It is very easy to forget that Sleep Apnoea itself can be fatal, and for a girl who weighs 16 stone at just 14 years of age that risk is very apparent.

A study by the Walter Reed Army Medical Centre in America, a respected hospital for ex-service people, has conducted a study which showed that weight-loss surgery does not eliminate Sleep Apnoea. 24 patients were from an average BMI of 52 down to an average of 32 but only 1 had their Sleep Apnoea “cured” after the gastric-band operation. It is worth noting that a BMI of 32 is still considered obese so it is perhaps not surprising that they still had OSA, but it is an interesting study nevertheless.

Although Sleep Apnoea itself can be fatal, as mentioned above, the major problem with it is that it can lead to other health problems. A recent study has shown that Sleep Apnoea sufferers are 58% more likely to develop heart disease. This is most likely due to the increased strain placed on the heart when an apnoea occurs. So your CPAP therapy is not only helping you sleep soundly, it could also be reducing your chances of developing heart disease – a win-win situation if ever there was one!

Those who drive while tired are risking their insurance policies according to a report. A study of 800 drivers conducted by Direct Line found that one in ten people admitted to driving while tired at least once a week, with 74% having done so at least once over the last year. Daytime tiredness is one of the main Sleep Apnoea symptoms, so if you feel tired all the time then it is worth getting it checked out – especially if you still feel tired after 8 hours sleep.

All of these news stories were broadcast via our Twitter account shortly after they first broke. If you follow us on Twitter, then you can be kept up to date with the latest Sleep Apnoea stories as soon as they happen. We’ll do a fortnightly round up on this blog so that we can keep all of you up to date with what’s happening in the world of Sleep Apnoea. If you come across an interesting news story that you’d like us to publicise, drop us a comment on our CPAP Blog or on our Intus SDB Twitter and we’ll spread the word!

A somewhat surreal question but it was actually asked in an online forum, this particular user wondered how a zero gravity environment would affect his CPAP machine. I don’t know whether he’s a mate of Richard Branson, about to have a space holiday, but it’s an interesting topic regardless of this person’s motives.

Others chime in and split the question in two. How does zero gravity or weightlessness affect OSA and how does it affect CPAP?

I’m not aware of any scientific research done to this effect (wrong, see below) but it doesn’t hurt theorizing about the possible outcome. As someone in that forum thread mentions, the lack of gravity could mean the airway wouldn’t collapse in the first place, avoiding apnoea events altogether. Oftentimes it is indeed the soft palate at the top of the throat collapsing down, blocking the airway so without gravity, perhaps this wouldn’t happen. But if this tissue still hangs about like something floating in space, not necessarily pulling down but perhaps left or right, it could still narrow the airpipe and cause hypopnea events, still causing trouble to the heart, blood and body in general.

As far as the CPAP is concerned, I don’t think much would differ. As long as you’re inside a spacecraft with air available for the machine to pump around, nothing changes. The humidifier chamber may need adjusting to keep water inside and I suspect the dreaded rain-out is a non-issue as water wouldn’t drop back down. But as far as the basic idea of pumping air is concerned, I can’t think of any gravitation dependent components. If you are going on a space trip, do remember to strap the CPAP to your back, or somewhere else secure. And make sure the mask fits inside the helmet.

Discover Magazine has some related tips in their article called 20 Things You Didn’t Know About Living in Space. Most importantly for CPAP users, they report that fluids move upwards so nasal congestion is a common issue for astronauts. For that reason, perhaps consider hanging upside down! At number 6, they also confirm snoring reduces when in space, referring to this journal about the effects of micro-gravity on sleep-disordered breathing. So there is research after all!

With 16 sunrises a day, you can also expect a seriously disrupted bio-rhythm. Bring some shades or use bright light therapy to combat jet lag. You can probably forget about your 9 hour lie-in. Not that you would, when on the Virgin Galactic!

In a related thread on another forum, a scuba diver asks about using CPAP in a hyperbaric chamber. One person replies saying in the documentation of his wife’s CPAP, he finds no mention of use of CPAP in high oxygen environments. If these machines aren’t tested in such settings, it is advisable to not use them there without confirming with the manufacturer.

No doubt, we’ll have more space travel tips for CPAP users later

On the day which sees ‘portable testing’ recommended officially in the United States, I will share with you my experiences of one night using the SleepStrip. Not every sleep blogger (Michael Rack: “It’s all over”) thinks in-home testing is a good thing, but in a market where hundreds of thousands of undiagnosed and needlessly suffering people struggle to get started with suitable treatment, I think in-home testing has its place in the process.

The SleepStrip is one such product which can help ease the burden on the traditional screening and diagnosis pipeline. The NHS uses the SleepStrip to pre-screen suspected sleep apnoea sufferers. This way they know that someone booked in for a PSG or other form of clinical testing definitely experiences interrupted breathing patterns. For this purpose, the SleepStrip was found to be an inexpensive yet very useful tool for screening many patients in a very short time. This filtering role makes perfect sense and can speed up the process whilst bringing clarity to patients in terms of cause and effects.

The SleepStrip (see intro video on our video blog) is a one channel screening device worn between the nose and mouth during one night. It has a built-in battery and a tiny computer which analyzes the data gathered throughout the night. The SleepStrip has three respiratory flow sensors; two below the nostrils and one hanging over the upper lip. This way, no matter whether you breathe through nose or mouth, the SleepStrip will detect when you exhale.

The kit comes in an envelope sized package with the actual device packed in an airtight seal. There is use by date printed on the box, presumably because of the battery and glue used to stick to the face. Clear instructions are included in English.

The SleepStrip turns on automatically when you remove the stickers protecting the glue. A built-in red LED illuminates shortly and when it detects airflow via its sensors. This light will only come on during the first few minutes, but even if it lasted all night, it’s too weak to keep you awake anyway. It’s just to show you it’s working as expected. You then bend the nasal sensors so they are in the airflow’s path. Then it’s ready to put on. The glue, which is already on there, keeps the two outer ends firmly attached to your cheeks so the sensors sit snugly between your upper lip and nose.

The first 15 minutes or so this device sticking to your face obviously feels a bit foreign but I was surprised to find the glue-like attachment method to be easy on the skin. It didn’t burn or itch at all. I only remember waking ever so slightly just once, wondering what was touching my face but i quickly dozed off again. In the morning I woke up pleasantly surprised about the experience and curious about the outcome.

By detecting each time you stop breathing, the SleepStrip figures out an Apnoea Index ranging from 0 to 3. Zero means fewer than 15 breathing lapses per hour detected, scaling up to three meaning 40 apnoea events or more per hour. Based on that scale you could say: 0 - no sleep apnoea; 1 - mild sleep apnoea; 2 - moderate sleep apnoea and 3 - severe sleep apnoea.

The score is available an hour after you peel it off your skin and shows permanently on a display on the strip. As someone already on CPAP (but not that night, for testing purposes) the outcome was 2 (25-39 stops an hour), which shows my holistic efforts must have paid off over recent years as the original sleep clinic test showed over 100 apnoea events many moons ago.

The idea of the SleepStrip with the way it’s packaged is that you can send it back to where you purchased it or to your doctor/consultant who can read out the score along with your answers to a short questionnaire (ala Epworth Sleepiness Score). Together you can then decide how to proceed.

As the SleepStrip only records one channel, its findings alone is currently not accepted as a full diagnosis so it won’t get you a referral for CPAP immediately. If a doctor finds the results confirm their suspicion of sleep apnoea they may use this as the only means but it’s unlikely at this stage. They will probably use it to refer you to a clinic if it shows moderate to severe sleep apnoea, or to a dentist in the case of mild sleep apnoea.

Interesting to note, however, is the fact that the majority of NHS testing in the UK is done via a single channel device already. As we found earlier this year, two thirds of all UK sleep studies are oximetry alone. That means, you get a small device plugged on the end of one of your fingers which monitors blood oxygen saturation. These studies don’t look at breathing patterns at all. If those sleep studies detect blood oxygen drops and your symptoms point to OSA, that’s enough for the NHS to get you prescribed CPAP.

Based on those traditional and wide-spread methods of performing a sleep study, it seems odd that something like the SleepStrip does not (yet) qualify as a definitive yes or no for sleep apnoea. I guess the doctor’s involvement is key here. But at least the SleepStrip can help individuals find out for themselves whether what they experience is indeed related to breathing disruptions during their sleep. This knowledge can go a long way to determining what to do next. The SleepStrip can eliminate or confirm sleep apnoea so you know exactly what is and what isn’t happening during the night.

Finding out such an important answer to a potentially life threatening question with the SleepStrip is a lot faster than joining the waiting lists for an NHS test too. You can buy the SleepStrip without a prescription for around £50 and get it delivered the next day. If this had been around when I first got involved with Sleep Apnoea, I would have happily paid that £50 to ease my worries and take away my doubts. Even nowadays many GPs still don’t recognize OSA as a real health problem; a product like the SleepStrip will make it hard for them to ignore your pleading. If anything, this clever product can speed things up for you, a lot.

With the scarcity of diagnostics equipped hospital beds here in the UK (just 1 such bed per 330,000 people) I welcome this type of innovation in home-based sleep apnoea screening. With its clinically proven track record and scientifically sound methods, products like the SleepStrip can offer a much needed alternative to traditional testing methods.

More information about the SleepStrip:

• S.L.P. Ltd - SleepStrip manufacturers
• Talk About Sleep - about the SleepStrip
• Clinical Info
• FDA Approves “Sleep Mustache”
• High Cost of Undiagnosed Sleep Apnea
• Medical Design Excellence Award - SleepStrip wins in 2002
• SleepStrip Compares Favourably To Other Methods (PDF)
• PSG Compared to SleepStrip
• Buy the SleepStrip (UK/E.U.)
• Buy the SleepStrip (US)