Patient days are a great way of finding out more about OSA and CPAP from clinicians and fellow patients alike, as well as offering you a chance to see the latest CPAP equipment and accessories from the exhibitors on the day.

We at Intus try to attend as many of these days as we can throughout the year, and this Huddersfield show will be the first of many for us during 2012. It’ll be our first attendance at this particular day and we’re looking forward to meeting you and sharing our knowledge and experience with OSA patients in Huddersfield for the first time.

It should be a really good day all round and the full details about the timetable for the day and how to attend are here:

This National Children’s Centre is within easy access of Huddersfield railway station and the bus station. There are car parks near by. Click here to see on Google Maps.

The day will be held in a large meeting room on the ground floor and there will be tea, coffee and biscuits during the event. There will be no charge for refreshments.

Programme for the day:

It will be open from 11.00 and will close at about 3.00

St James’s Sleep Apnoea Support Group have invited representatives from the major equipment suppliers (including Intus Healthcare) so that you will be able to talk to them about CPAP machines and learn about the latest developments.

There will be a series of short talks and practical sessions during the day:

• Cleaning and maintaining your mask
• Humidification
• Getting the most out of your CPAP

Many of the group’s members also suffer from diabetes- there is a high correlation between the two conditions and we will have an illustrated talk on this subject from Dr Akshay Dwarakanath from St James’s Hospital.

Martin Latham will also give a talk on the history of CPAP. This is a very informative (and humorous) presentation.

There will be opportunities for you to meet and talk with other Apnoea patients, share experiences and listen to new ideas.

There will also be some fund-raising activities for the group.

The group will not be able to serve a lunch at this event, but you are welcome to bring a packed meal if you wish to.

If you would like to attend this event please let St James’s know by:

• Leaving a message on St James’s telephone (0845 4632087)
• Contacting St James’s by e-mail: stjamessasg@googlemail.com
• Using the “Contact us” link from the St James’s website

Please give your name, membership number (if applicable) and the number of places you need.

We look forward to meeting as many of you there as possible - come and say “Hi”!

Recently the inventors of the RemZzzs liners, Bob and Deb Rutan, were on the radio to discuss how they came up with the idea behind RemZzzs and the development that went into the number one CPAP comfort accessory.

It is an excellent listen - with a story that will no doubt resonate with many CPAP users. You can listen to the full interview here.

They discuss the desperate lengths they went to to solve Deb’s mask issues that were causing her to be unable to tolerate CPAP, and the moment of inspiration during the middle of the night that led to a t-shirt being cut up and the first RemZzzs prototype being produced on the spot.

For those unfamiliar with the RemZzzs CPAP Mask Liners, they are small pieces of fabric that sit between your mask and your face, helping to reduce leaks, improve comfort and reduce red marks and sores. They make CPAP much easier to tolerate and improve the quality of your therapy by solving many of the most common mask issues.

RemZzzs mask liners are available for most popular CPAP masks - you can find out more about the RemZzzs CPAP Mask Liners and pinpoint the correct ones for your mask by using the RemZzzs finder on EU-PAP.co.uk.

Although it may sound odd, it is based on some sound logic and has proven to be very popular. It is kept in place by a mouthpiece that attaches to the upper jaw.

The mask then uses nasal pillows, meaning there is no skin contact with the mask other than the perimeter of the nostrils. This is great for anyone suffering from red marks or skin irritation from their current mask.

Because the upper jaw is fixed to the nose, the position between the two never changes. So once the mask is in place, it cannot then be dislodged or change position – as a mask attached with headgear can.

As well as ensuring the mask does not move, it has the added benefit of greater comfort as you no longer need to worry about headgear, which for many is the biggest drawback of wearing a CPAP mask.

The high level of adjustability also means it will fit almost anyone. The nasal pillows do not even need to be aligned symmetrically and can be positioned at almost any length or angle required.

The CPAP Pro has been hugely popular in the USA and we are looking forward to it helping similarly large numbers of CPAP users in the UK.

The CPAP Pro will begin shipping in the UK and Europe in early September and you can pre-order yours now by clicking here.

If you would like some more information about the mask, you can read the CPAP Pro’s product page on EU-PAP.co.uk, the CPAP Pro FAQ or some of the CPAP Pro Testimonials USA users have left.

It is currently being discussed in our CPAP Forums too - why not check out the ‘CPAP Pro “no mask” ?‘ to see what others are saying and share your views too?

It is with good reason that CPAP is the first choice treatment - it is 100% effective in treating OSA, a claim that few treatments can make for any health condition. However it is not without its drawbacks, and some simply do not get on with CPAP.

So is there an alternative? Well, for those with mild OSA yes, there is. A Mandibular Advancement Device is a clinically proven method of treating snoring and mild OSA, and has also had success in treating moderate OSA, too.

It uses an oral appliance that brings your lower jaw forward. It doing so, it opens up the airways in the throat, increasing airflow and decreasing the pressure that leads to snoring and apnoeas. Try it for yourself now if you like; move your lower jaw forward and you will notice that breathing becomes easier.

Mandibular Advancement Devices are generally considered to be far more tolerable than CPAP; after all they use a simple mouth splint rather than a mask, and are therefore becomming a popular choice. However it they are not for everyone, and the levels of success do vary from user to user.

If you are considering trying a Mandibular Advancement Device (MAD), then it may be worth using a trial device, such as a Somnolis which is available through Amazon.co.uk. This trial devices last for a few nights but will give you a good indication as to how effective Mandibular Advancement is for you.

Once you have tried that, you can look into a proper MAD. There are two main options. The first is a boil-and-bite MAD, such as the SomnoFit. These provide a customised mouth piece by biting into the mould, which then adapts to the shape of your teeth. The SomnoFit Mandibular Advancement Device retails for £89.95 and is available through Amazon.co.uk or EU-PAP.co.uk.

For those on a higher budget, you may wish to try a SomnoDent Mandibular Advancement Device, which uses a mouth piece made specially for you through a dentist’s indentation. Prices on these vary from dentist to dentist, but are usually in the region of around £1,000.

Mandibular Advancement, like CPAP, may not be for everyone. However if you are truly struggling with CPAP and your OSA is classed as mild, then a MAD will provide a true, clinically proven alternative to CPAP. Try a Somnolis, see how you get on, and go from there. You never know - you may be able to ditch the mask completely.

“As it is estimated around 75% of those with the condition are undiagnosed, it is excellent to see it being brought to the attention of the public and getting more people to get themselves tested for OSA themselves”. However it would appear that Mr Miliband’s operation was not a success which unfortunately comes as little surprise; as many as two thirds of operations to treat OSA are unsuccessful.

Obstructive Sleep Apnoea was also in the newspapers this week thanks to Dr Keith’s advice in The Sun on August 18. Dr Keith’s “excellent” advice to those with OSA was to lose weight, and then listed surgery as the first choice treatment – despite the success rate being as low as around 1 in 3 and CPAP being effective in all cases. It is not the first time Dr Keith has shared his views on OSA – back in 2008 he claimed that the way to treat OSA was simply “losing weight and ditching alcoholic nightcaps”.

A recent study also showed that OSA in older women significantly increases the chances of them developing cognitive impairment or dementia than those who sleep normally. OSA has long been linked with an increased risk of heart failure or stroke, and this study now further highlights the risk of leaving OSA untreated. The study was conducted by a team from the University of California led by Dr Kristine Yaffe, and comprised of 300 women with an average age of 82 who did not have dementia. The four year study showed that those diagnosed with OSA were 50% more likely to develop these further health conditions.

Another study at the University of Brescia this month suggested that wearing compression stockings can lower snoring and OSA by a third. There have been studies into the relationship between rostral fluid shift and sleep previously, so the result may not be as surprising as it first appears. However the study was comprised of just twelve patients, all of whom were attending a CVI Clinic rather than a Sleep Clinic which arguable skews the results further. Nonetheless, the findings are interesting and research of a larger, more “natural” sample would make for fascinating reading. A few members of the UK CPAP Forums are currently trialling this method and it will be intriguing to see how they get on.

If you use a humidifier with your CPAP machine, then you will have come across condensation build-up in the tube, also known as rainout. As the warm air leaves the humidifier, it loses heat all the way to the mask. In the process, the humidity turns to condensation, and water builds up in the CPAP hose. This can cause discomfort, gargling noises and affect the accuracy of the CPAP pressure being provided. In short; it is a big problem.

Previous solutions have tried to minimise the air temperature difference, with the most common choice being a hose fleece, which helps to insulate the tubing. Members of our CPAP forums will no doubt recall some rather novel attempts at tackling the issue over the years – with mixed results to say the least! However, most solutions are designed to minimise rainout rather than tackle it completely. That is where the Hybernite Rainout Control System differs – it is designed to prevent the cause of rainout in your CPAP setup, rather than just reduce it.

It is very simple - the Hybernite Rainout Control System uses a heated hose, which heats up inside. This prevent the air from cooling between the humidifier and your CPAP mask, meaning it does not form condesation, or rainout. This leaves you free to enjoy the benefits that humidification brings without having to worry about the annoying and unpleasant side-effects. It combines with almost any CPAP humidifier to form the complete humidification solution. No more rainout!

The Hybernite Rainout Control System uses a heated hose that simply replaces the regular hosing of your CPAP humidifier. It uses its own power supply, allowing it to be used with any existing humidifier that uses the standard 22mm connection. Whether you are using a ResMed, Philips Respironics, DeVilbiss or almost any other CPAP machine, you can now enjoy the full benefits of your humidification.

What are the advantages? Other than the obvious in reducing rainout, it can also help prevent your CPAP humidifier’s water chamber from running out overnight. Many have their humidifier set to maximum to compensate for heat loss, but with the Hybernite the air is kept warm so there is less need to crank it up. Lower setting = less water being used. Conversely, those who have their setting lower than they would like to prevent rainout can also enjoy warmer temperatures without that fear.

The complete Hybernite Rainout Control System is available now for £59.95, including both the power supply and the heated hose. If the heated hose needed replacing, as all hoses do after a while, then that can be replaced separately for £32.95 – only slightly more than a regular hose. For a product that helps eliminate rainout, improve comfort and enhance the quality of your CPAP therapy, we’d say that isn’t a bad deal at all!

The Hybernite Rainout Control System is available through www.EU-PAP.co.uk – get yours now!

What’s lurking inside your CPAP?

Aside from changing the filters, there’s little you can do to keep the inside of your CPAP machine clean and hygienic. Over time, they begin to accumulate dust and others small particles, which is turn become a breeding ground for bacteria. As the pictures on this page show, the inside of a CPAP machine can become very dirty. It is inevitable as a result of what they do – they suck in air, and therefore also anything that is lingering in the air will come with it. While a filter will keep out the majority, it cannot keep out 100% of particles.

The easiest comparison to make would be to a computer. If you open it up for the first time in a while, you’ll find many of the components will be covered in dust sucked in my the fans. A CPAP machine is no different and similarly have a circuit board inside, which is a magnet for dust. In this dust bacteria can lurk and breed. Consequently, some will then find their way into your airflow, the tubing, the mask, and your lungs.

Simple steps towards solving the problem

If the introduction to this post sounds alarmist, that’s because it is. We want all CPAP users to be aware that dust and bacteria will build up inside their machines over time and therefore be vigilant about preventing it and dealing with it regularly. The first step is obvious, but often overlooked: clean and change the filters.

Almost all manufacturers recommend cleaning and changing your filters regularly. As an example, Respironics recommend cleaning the coarse filter every two weeks, and replacing it with a new one every six months. It is very important to do so, as dirty or worn filters will not be effective at blocking particles and bacteria from entering the system.

CPAP Guardian – sterilize your CPAP machine safely and effectively

The second step to take is to sterilize your CPAP machine. Because you are not allowed to open it up to clean is properly, the next best step is simply to sterilize it. Most CPAP users will regularly clean their mask and hosing, which is highly recommended, but this job is then undermined by blowing dirty air from the machine straight back into them.

CPAP Guardian bags provides back with a built-in Ozone Sterilizer. You simply put your machine in the bag, and the CPAP Guardian fills it with Ozone – a gas which kills all living organisms. However, after about 30 minutes the Ozone particles disintegrate into regular oxygen, leaving no harmful gasses or residues, but one completely sterile CPAP machine. You can use it to disinfect your entire system in one go, including your mask and tubing.

Keep your CPAP machine off the floor

Many people choose to keep their CPAP on the floor; either to reduce noise, reduce condensation in the mask or there’s simply not enough room on a bedside cabinet. However, if you CPAP is on the floor it is inevitably going to suck in more dust and dirt; whether your floor is wood, laminate or carpet it will harbour more dust and bacteria than a table. If you CPAP machine has to be low, see if you can find a stand to raise it a few inches off of the floor. After all, the first CPAP prototype was made with a vacuum cleaner motor, so they have some serious suction and will pull in any microbes in the surrounding area.

Keep your machine clean, keep yourself healthy

Keeping your CPAP as clean as possible is vital for preventing health problems caused by it. Try to keep your CPAP off of the floor to minimise the amount of dust it sucks it, and ensure you clean and replace the filters in your machine as recommended by your manufacturer. By following these two simple steps you will greatly reduce the amount of microbes entering your system in the first time.

However, over time it is inevitable some will accumulate however careful you are. We would therefore recommend getting your machine sterilized to ensure that it is not harbouring any bacteria. The CPAP Guardian bags provide the most effective and safe method of doing so currently, and they have the added bonus of making a great travel bag for your system as well. Overall, do whatever you can to ensure your air supply remains clean and safe, and ensure you stay as healthy as possible in the process.

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!

There has long been a link between sleep apnoea and being overweight, but it is interesting to find a study that shows the link between the two so directly. On average men put on 10kg and women 12kg from when they first visited the clinic, but while no specific reason was named for why they put on the weight, the increase in the severity of their sleep apnoea was a clear consequence.

Weight and Sleep Apnoea are closely linked

“As body weight goes up, Sleep Apnoea gets worse”

Dr Jeffry Pretto, who did the analysis of the clinic’s data, said: “How many times each hour people actually stop breathing, or slow their breathing down significantly - that marker is very much linked to body mass index. As people’s body weight goes up, the severity of their sleep apnoea gets worse. The other interesting finding is the instance of severe obesity - that is if they have a body mass index of over 40. Back in 1987, only 3 per cent of people that were referred to us for sleep studies we’d classify as having morbid obesity. In 2007, that went up to 15 per cent. It’s gone up by a factor of five.”

Without successful treatment for sleep apnoea it can become a vicious cycle. Sleep apnoea makes you tired during the day, giving you less energy to be active and do exercise. This leads to you gaining weight, increasing the severity of your apnoea, making you even more lethargic. The cycle goes on and on. Some people also blame increase carbohydrate cravings on tiredness, which leads to weight increase.

To break the cycle, you first need to get treatment for your sleep apnoea. CPAP therapy, the most successful and widely-adopted treatment for sleep apnoea, will alleviate or greatly reduce the frequency of apnoeas, giving you the energy and enthusiasm during the day to allow you to be more active and to exercise.

From there, the circle repeats itself in the opposite direction, more energy, more exercise, lose weight, fewer apnoeas, more energy, etc. It takes determination, will power and patience, but by losing weight you can reduce the severity of your sleep apnoea and, in some cases, alleviate it completely.

Lifestyle changes are difficult - but not impossible

While easier said then done, if you are suffering from sleep apnoea then it is important to try to at least maintain your current body weight if possible, and ideally look to gradually lose weight. One of the major problems with sleep apnoea is that it usually gets diagnosed very late, on average after around seven years of suffering, by which time most people are over 40 and a change of lifestyle becomes very difficult to implement.

One of our forum members, scourserpaul, has just started using the Atkins Diet to reduce his weight. You can follow his progress in his Sleep Apnea And Dieting thread.

Losing weight when you have sleep apnoea is far from easy, but it gets easier as you go along as the positive cycle mentioned earlier begins to take effect. The health benefits are not only confined to reduced sleep apnoea, so it is certainly worth making a concerted effort towards.

Symptoms

According to the NHS³, the symptoms of Sleep Apnoea include:

1. feeling very sleepy during the day
2. waking up with a sore or dry throat
3. poor memory and concentration
4. headaches (particularly in the morning)
5. irritability and a short temper
6. anxiety
7. depression
8. lack of interest in sex
9. in men, impotence (inability to get or maintain an erection)

Additional symptoms include snoring, non-refreshed sleep, restless sleep, gasping or choking during the night, reduced ability to handle stress, frequent toilet visits during the night and high blood pressure⁴.

What can contribute?

1. Increasing age
2. Being overweight *
3. Being male
4. Small lower jaw
5. Large collar size *
6. Existing diabetic *
7. Smoking
8. Alcohol
9. Use of sedatives

* - key risks⁴

What it means for you

The effects of sleep apnoea are wide ranging. As well as the tiredness and increased risk of heart disease, as mentioned above, it also leads to a lack of concentration, higher risk of accidents at work and while driving, anxiety, short temper, as well as leading to problems in your personal life due to depression, irritability and a lack of sex drive.

What can I do about it?

If you think you may have sleep apnoea, there are three main routes to follow – either getting diagnosed and treated by the NHS, privately, or at home. It all depends on how long you are prepared to wait, and on the expense.

You can be diagnosed and treated for sleep apnoea by the NHS. While this is free, the time frame can be quite drawn out. In June this year there were 4,461 people on the NHS waiting list for a Sleep Study, 16% of which had been waiting for over a month already5. Once you actually receive a Sleep Study, you then have to wait for your results, a consultation, and then there is another waiting list to actually get the equipment you need. It is not uncommon for the process to take several months from seeing your doctor initially to being given your CPAP equipment. Please be aware that once you are diagnosed with sleep apnoea, you will not be able to drive until you are shown as being compliant with your therapy. Failing to report a diagnosis to the DVLA can result in a £1,000 fine. Therefore if you drive, the waiting time between getting diagnosed and getting treatment on the NHS can simply be too long, so you may want to consider one of the other, much faster, alternatives.

Alternatively, you can go to a private sleep clinic. There they will assess you, give you a sleep study, and provide you with the appropriate equipment. Prices vary from clinic to clinic, but expect to pay between £1,000 to £2,000 for everything. The difference in waiting time is stark – it is often less than a month from consultation to therapy. The price may put people off, but it is a considerably faster yet more comprehensive solution. For those looking for a similar level of speed but with a much lower cost, then the third option may be the solution.

Your third choice is to simply rent a Sleep Study for use at home. You can rent one for as little as £99, and you get the results within a fortnight, and often within a week. With those results you can then go to the NHS to join the equipment waiting list, or you can order the equipment online and begin your therapy almost immediately. With machines starting at £450 and masks at £54, the whole process costs as little as £600 and you can be getting therapy within three weeks. There is not the same level of consultation or advice as you would get from a Sleep Clinic, but if you’re prepared to do your own research and use your initiative, it can be a much better value alternative.

Stop snoring, start sleeping, start living

Whatever you do, if you have any of the symptoms of sleep apnoea, we strongly recommend that you get tested, as the effects of untreated sleep apnoea can be very serious. The important thing to remember is that diagnosis and treatment can be very quick and incredibly effective, so you could be enjoying a better quality of life within a month.

2 - http://pagingdrgupta.blogs.cnn.com/2010/07/13/sleep-apnea-linked-to-heart-disease-risk/

3 - http://www.nhs.uk/Conditions/Sleep-apnoea/Pages/Symptoms.aspx

4 - http://www.sleep-study.co.uk

5 - http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/@sta/@perf/documents/digitalasset/dh_118346.xls accessed via http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performancedataandstatistics/HospitalWaitingTimesandListStatistics/Diagnostics/index.htm