About Sleep Apnoea
Sleep Apnoea is a sleeping disorder in which breathing is repeatedly interrupted during sleep.
When you sleep, your muscles start to relax, including the ones controlling the upper airway. When that happens, the airway collapses, causing you to stop breathing. The brain senses this and wakes you up, allowing the airway to reopen. Breathing usually resumes with a loud gasp, snort or a body jerk.
The severity of Sleep Apnoea can range from normal, mild, moderate to severe. The severity is measured by the Apnoea/Hypopnea Index (AHI). The higher the AHI, the more severe the disorder.
Some Sleep Apnoea patients may stop breathing up to 100 times in one night during sleep. This results in continuous sleep interruption that may lead to poor sleep quality and other serious health conditions such as cardiovascular disease and hypertension, to name a few.
Obstructive Sleep Apnoea (OSA) can occur in men, women and children of all age and sizes. A Sleep Apnoea sufferer may sometimes not be aware of their own symptoms so it is important for loved ones to look out for the following symptoms:
- Loud persistent snoring
- Excessive daytime sleepiness
- Dozing off while driving, reading or watching TV
- Choking or gasping for air during sleep
- Morning headaches
- Depression and irritability
- Restlessness during sleep
- Frequent night time visits to the bathroom
- Sexual dysfunction
If you suspect you or a loved one may be suffering from Sleep Apnoea, you should first consult your doctor and discuss your concerns. If your doctor establishes that you will require further investigation, your doctor can sign off on a referral form and you can make an appointment with us for a Sleep Study.
See more FAQ under Sleep Studies.
Obstructive Sleep Apnoea (OSA) can be successfully treated; the most effective treatment being CPAP Therapy. Alternative forms of treatments are available too. For milder cases of OSA, an oral appliance can be considered. Weight loss may also alleviate the degree of apnoeas. This is only intended as a general guide and there are other options, but your referring doctor or Sleep and Respiratory Physician will be able to advise you on the most suitable treatment for your condition.
See more FAQ under CPAP Therapy.
About Sleep Studies
A Sleep Study is a medical test done to diagnose Sleep Apnoea. It can be done in a hospital or in the comfort of your own home. There are different levels of studies available; and the two broad categories are Polysomnography (PSG) (Type One and Two) and Limited Channel Sleep Studies (Type Three and Four).
To simplify the explanation, PSG studies (Type One and Two) records a minimum of seven channels including EEG, EOG, chin EMG, ECG or heart rate, airflow, respiratory effort and oxygen saturation. This captures sleep staging and therefore calculation of an AHI.
Limited Channel Sleep Studies (Type Three and Four) have a more restricted number of parameters measured, and ranges from one to four channels only. In general, sleep staging is omitted and thus there is no calculation of AHI.
At CLM Sleep, we conduct a Type One PSG study at the Sleep Lab in North Eastern Community Hospital (SA), and a Type Two PSG study at patients’ homes. The key difference between the two is that the patient is monitored overnight in the hospital Sleep Lab, whereas the patient is not monitored overnight in their home.
Generally, this should be recommended by your doctor or Respiratory and Sleep Physician. For a relatively straightforward case of Sleep Apnoea investigation, a Type Two Home-based Sleep Study should suffice. However, if the doctor would like to investigate other Sleep Disorders such as Narcolepsy, Restless Legs Syndrome etc, or perhaps feel that the home environment is unsuitable due to lifestyle factors, the patient will likely be referred for a Hospital Sleep Study.
If you are uncomfortable with either studies, discuss it with your doctor.
We will require your doctor to sign off on a referral to conduct a Sleep Study. This is because you should discuss your concerns and symptoms with your doctor and do a quick screening to determine if you do need a Sleep Study. If your doctor thinks further investigation is warranted, we will then proceed to book you in for a Sleep Study.
Medicare will subsidise the Sleep Study if the pre-study requirements are met. For Home-Based Sleep Studies, patients will need a medical referral, and approved assessment tools need to be completed and indicate a high probability for moderate to severe OSA. The approved assessment tools are: either STOP-BANG or OSA-50 and an elevated Epworth Sleepiness Scale. Alternatively, a professional attendance (face-to-face or via telehealth) with a qualified adult sleep medicine practitioner or consultant respiratory physician to confirm the necessity of the test will be sufficient, irrespective of the approved assessment tools’ results.
Note that only 1 service per patient in a 12 month period will be subsidised by Medicare.
The Type Two PSG Sleep Study diagnostic device has seven channels and provides a comprehensive study of your sleep and breathing patterns. In comparison to the Limited Channel Sleep Studies (Types Three and Four), the diagnostic device we use is more complex. It is therefore recommended that you do not set it up yourself. Our Sleep Technicians are trained to set up the devices accurately to maximise the effectiveness of the devices. Studies have shown that the rate of success is higher for diagnostic devices set up by trained professionals. We send our Sleep Technicians to your home (location-dependent) to set you up for your overnight Sleep Study so you don’t have to worry about setting it up yourself and we can minimise errors in the study.
A Sleep Study is an overnight study, so you sleep with the device set-up for about 8 hours. For a hospital study, you will be monitored overnight and you can wake up the next morning and go straight to work after washing up and having a light breakfast. For a home study, you can bag up the kit and return it to us the following morning.
Yes you can! Our Sleep Technician will set the device up on you, but you will be able to move around the house with the device on. So you can still continue with your nightly rituals whether it is watching TV, reading or just relaxing.
Yes you should definitely shower and wash up before the Sleep Technician arrives at your home. Once the device is set up on you, you will not be able to do so. Just wear something loose-fitting and comfortable that you can go to sleep in.
If you’re female, make sure you’re not wearing any acrylic nails, or remove your dark nail polish.
If you’re male, check with the Sleep Technician if you need to trim your facial hair in certain parts of your face. The electrodes need a smooth surface to adhere to as part of the study.
As previously mentioned, also make sure you’re showered and have changed into your sleepwear before the Sleep Technician arrives so the set-up can run smoothly.
When you get up the following morning, remove the device and the wires from your body. Dispose of the sticky patches that hold the electrodes. You can put everything into the bag provided to you and make sure you fill up the paperwork left behind with you by the Sleep Technician. Drop the kit off back to us the following morning and let us sort out the rest!
Troubleshooting guide for your Sleep Study
Before you go to sleep, ensure the Oximeter (the blue finger clip) is attached to the index finger of either hand. Use the medical tape provided to secure it to the finger. If it begins to cause any discomfort throughout the night, you can move the Oximeter between fingers. Just ensure the finger with the Oximeter does not have acrylic nails or dark nail polish on there.
If any electrodes appear to be losing their tackiness, you can replace them with the spare ones provided by our Sleep Technicians. If you are still having trouble with the electrodes, make sure your skin is clean and you don’t have moisturiser or make-up on as that can affect the stickiness.
You can also trim the electrodes slightly so it fits better on your skin if needed.
Our Sleep Technicians will have provided some medical tape in the kits for you to use if you need to secure the nasal cannulas. Cut out 2 small pieces of the tape and adhere it to your face to prevent movement throughout the night.
Our devices are set to turn on automatically and you can check that it is working properly by opening the device and looking at the display screen. Once the device is turned on, there will be a human figure displayed with a number of different sensors attached. This should tell you things are working fine. All you have to do is sleep!
If the orange light on the device is flashing, refer to the following steps to troubleshoot:
- Slide the latch at the top of the device to the right, and the device’s display should open.
- Look at the display, and take note of any sensors on the figure that are flashing.
- If the flashing sensors are located either on the hand or nose, ensure that both the blue finger clip and the nasal cannula are attached securely using medical tape.
- Any other flashing sensors will have a line that points to the corresponding wire on the side of the device. Ensure this wire is plugged into the device properly, and follow the wire back to the sensor to make sure it is also plugged in at the other end. Feel free to use the medical tape or wire ties provided to secure any wires that are causing problems.
- Once nothing is flashing on the display, the orange light at the top of the device should also stop flashing. This indicates that the device is now functioning properly, and the display can be shut again.
Remove the device from yourself by first unplugging one of the wire prongs on either side of the buckle. Then you can unclip the large black buckles on the blue belts around your chest and stomach.
Dispose of all sticky electrodes and medical tape from the wires, then place the device and all of their attached wires into the plastic bag provided. You do not have to unplug or pack anything away.
Ensure you have filled out the feedback form and sleep log form, then return the kit and forms to the office.
About CPAP Therapy
PAP (Positive Airway Pressure) commonly know as CPAP therapy is a safe and non-invasive treatment, consisting of 3 main parts – an air pump, a mask and a tube that connects the two.
How PAP therapy works is that the air pump provides air pressure via the tube and mask into the throat, keeping the airways open while you sleep. Receiving enough airflow during your sleep means your brain will not jolt your body awake to breathe, and you will not experience disruptions through the night when you sleep.
PAP therapy is an ongoing treatment and is designed to work straight away. The best way to get an effective therapy with PAP therapy is to persist at using it every night when you sleep. If you stop PAP therapy, the symptoms you used to experience will also start coming back very quickly.
Technically, all CPAP devices regardless of the brand are designed to work the same way. However, as technology improves with new devices, there might be algorithm differences or slight technological differences. The noise volume for different devices of different brands may also differ. We only work with reputable brands with sound technology that will provide optimum results for the patient. So the best way to determine which brand’s device would work best for you, is to do a CPAP Trial. The device most suitable for you would be dependent on your sleep data download.
Finding the right mask and the right fit is vital to your CPAP therapy. There are many types of masks available for use with your CPAP device – they fall into three broad categories of pillow masks, nasal masks and full-face masks. There is no “one-size-fits-all” mask. The most suitable mask for you will be dependent on many factors such as your breathing needs, sleep habits and comfort levels. Other factors that could affect your mask selection could be having facial hair, and your facial structure, amongst other things.
The best way to find the right fit for you is therefore to come in and have a mask trial. In the mask trial, we will select from a few masks based on your habits and needs, and let you try those on. It is also a good idea to take it home and try it when you go to sleep – sometimes a mask that feels most comfortable for you when you’re awake might be prone to shifting if you’re an active sleeper, reducing the effectiveness of your CPAP therapy. At the end of your mask trial, we should be able to find you the right mask for you.
CPAP therapy is a treatment for Obstructive Sleep Apnoea (OSA) but not a cure. This means that CPAP therapy should continue as long as a patient is suffering from OSA. That said, there are patients who have been able to go off CPAP therapy after making some lifestyle changes such as exercising more and losing weight. If applicable, they can do another Sleep Study to investigate if they are still suffering from OSA. If they are not, they can stop CPAP therapy.
There are more complications to OSA than just losing weight. Your best advice can come from your Respiratory and Sleep Specialist.
If your machine is a genuine product, it should technically operate the same way regardless of where you purchase from. However, the warranty that comes with your machine may be void or not applicable. This is where you have to be very careful. The 5 year warranty for your CPAP machine only applies to devices that are TGA-approved for Australia.
We have taken an excerpt from one of our working partners Philips Respironics:
Philips products are sold globally but only products sold by Philips Australia’s authorized distribution partners are registered with the Australian regulatory body (TGA) and available for the DreamStation 5-year warranty by Philips Australia (terms and conditions are available here).
So if you are looking to purchase a machine from overseas, your warranty may only be applicable in the country where you have purchased it from, meaning you will not be eligible for servicing or replacements of parts as required in Australia. You may have to cover your shipping fees to get it serviced overseas, or travel overseas to get the support you need. So you will have to decide if the costs and hassle are worth it, if and when you run into issues with your machine.
If you are considering purchasing your machine online, we’ve asked one of our working partners Philips Respironics for some tips on how to better inform your decision and considerations.
- Only products sold by Philips Australia’s authorized distribution partners are registered with the Australian regulatory body (TGA) and available for the DreamStation 5-year warranty by Philips Australia (terms and conditions are available here). In short, the warranty only applies to devices that are TGA-approved for Australia. Otherwise your warranty may be void or not applicable.
- How will your therapy be setup according to your individual needs? PAP devices should have therapy pressures and/or preference settings entered into them, and masks should be fitted to your individual anatomy and personal preferences.
- Who will review information from the device to ensure that it is being used correctly? How will information be provided to your physician when you have your next physician visit? Keeping your care team (typically comprised of you, your physician, and your homecare provider) informed over the course of your treatment is important to ensuring that you get quality care in the near- and long-term.
- What support is available in-person, on the phone, and/or online? What are the hours of this support? While everyone’s learning process is different, we have found that almost everyone has questions about his/her CPAP treatment and equipment in the near- and long-term. Choosing a company that can match your learning style today and in the future is an important step to giving you the best chance for your treatment success.
- If there is a problem with the device, what is the repairs / returns process? How long does this typically take? Where you purchase a device will have implications for how you will be able to receive support.
With this in mind, do consider very carefully all your needs and how you can be continually supported through the duration of your therapy. Speak to us if you’d like to find out more.