Do you snore?A guide to understanding sleep apnea,its risks and treatment solutions

NORFOLK: 801 Orapax St. • Norfolk, VA 23507

757-640-1709

PORTSMOUTH: 334 Effingham St. • Portsmouth, VA 23704

757-393-2273

www.tyconmedical.com

Sleep challenges call for timely and effective solutions.Did you know....

Loud snoring could be a sign of a serious sleep disorder?

Millions of adults are at high risk of developing heart disease and diabetes, and/or experiencing a stroke as a result of untreated sleep apnea?

Falling asleep while sitting, reading, watching TV, at work or driving is NOT the norm?

Your mental alertness and physical wellbeing can improve drastically with regular bedtime sleep treatment?

Follow These Steps..................4Finding solutions

Know the Risks .....................5-6Understanding Obstructive Sleep Apnea risks, signs and symptoms

Treatment Solutions............7-8A look at CPAPs and masks

Challenges and Solutions to CPAP/BiLevel Treatment............9Could you be suffering from OSA?This test will give you insight

Assess Your Needs............10-11A handy guide to finding a comfortable, effective mask solution

Maintain Your Sleep Health..12Get the most out of your treatment

Medicare, Insurance ............. 13A guide to understanding coverage

Record Keeping................14- 15Track your equipment usage and maintenance for better treatment results

Make an informed decision Sleep disorders affect the quality of daily living for millions of adults and children. Obstructive Sleep Apnea, or OSA, is by far the most common of sleep diseases and poses significant health risks if left untreated. According to the American Academy of Sleep Medicine, individuals with severe sleep apnea have three times the risk of dying due to any cause. The good news is that although it is a chronic disease, sleep apnea is very treatable and serious related health risks like heart disease, increased risk of stroke, high blood pressure and diabetes can be prevented with consistent treatment. Just as important, overall quality of life increases significantly with proper and ongoing treatment.

We invite you to use this guide to increase your awareness of the dangers associated with sleep apnea, help you identify signs and symptoms, assist you through the testing, diagnosis and treatment process, and help you understand the vital importance of following your treatment plan by making it a natural and comfortable part of your everyday life.

Our trained and credentialed staff is available to help you make informed decisions and provide you with the right equipment, training and service for your unique situation. We can also help you understand what is and is not covered by insurance.

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Do You Snore?A guide to understanding sleep apnea, its risks and treatment solutions

• Know signs and symptoms of OSA. Are you or your loved one experiencing one or more of them?

• Talk with your sleep partner about your sleep activities.

• Talk to your health care providers about a sleep test.

• Be informed. Know what to expect from a sleep test.

• A moderate to severe OSA diagnosis may require assistive equipment for treatment. Call us, your HME provider, to find out what equipment, assistive technology and services are available.

• Understand what your insurance plan and budget allow.

• Make a list of questions for the provider and know who to call to get answers.

• Try your sleep equipment with someone else present, and practice before bedtime.

• How is your equipment working? Are you using it regularly?

• Does it fit comfortably, or are there discomforts preventing proper and consistent use?

• Talk with us, your HME provider, about any challenges that arise from your treatment or equipment.

• Replace your mask and CPAP supplies regularly according to the suggested schedule provided by your respiratory therapist.

• Follow up regularly with your health care provider to make sure your treatment is having the desired results.

• Schedule a follow-up visit with us, your HME provider, in six months.

1 Be proactive about your

sleep health.

2OSA diagnosis?

What’s next?

3Use your

equipment.Prepare to feel better!

4Follow up!

Wake up! Obstructive Sleep Apnea poses grave risks to the health of your heart and puts you at greater risk of falling asleep while performing daily tasks like driving. We can help you successfully navigate your way to better sleep health and a refreshed outlook on life. Use the steps below to get you started on the process toward better sleep and improved overall health. We are here to help.

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Steps to better sleep health

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Understanding OSAObstructive Sleep Apnea is a chronic condition characterized by abnormal pauses in breathing that disrupt your sleep three or more nights a week, and cause excessive daytime sleepiness. It’s estimated that more than 12 million American adults have sleep apnea. More than half of the people who have this condition are overweight.

Health care practitioners diagnose sleep apnea based on your medical and family histories, a physical exam and results from sleep studies.

If you have sleep apnea, your airways can be blocked or narrowed during sleep because:

• Your throat muscles and tongue relax more than usual.

• Your tongue and tonsils (tissue masses at the back of your mouth) are large compared to the opening into your windpipe.

• You’re overweight. The extra soft fat tissue can thicken the wall of your windpipe. This causes the inside opening to narrow and makes it harder to keep open. • The shape of your head and neck (bony structure) may cause a smaller airway size in the mouth and throat area.

• The aging process limits the brain’s ability to keep your throat muscles stiff during sleep.

Do you snore? Not enough air flows into your lungs when your airways are fully or partly

blocked during sleep. This can cause loud snoring and a drop in blood oxygen levels.

When the oxygen drops to dangerous levels, it triggers your brain to disturb your sleep. This helps tighten the upper airway muscles and open your windpipe. Normal breaths start again, often with a loud snort or choking sound.

Frequent drops in oxygen levels and reducedsleep quality trigger the release of stress hormones. These compounds raise your heart rate and increase your risk for high blood pressure, heart attack, stroke and irregular heartbeats. The hormones also raise the risk for, or worsen heart failure.

Untreated sleep apnea can also lead to changes in how your body uses energy. These changes increase your risk for obesity and diabetes.

We can help assess your sleepiness and recommend effective solutions.

Why should I be concerned?

Know the Risks

Normal breathingAirway is open.Air flows freely to the lungs.

Obstructive Sleep ApneaAirway collapses.Air flow is blocked.

CPAP TherapyAirway is kept open with air pressure. Air flows freely to the lungs.

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Know the Risks

Loud and chronic snoring. Pauses may occur in the snoring, and choking or gasping may follow the pauses.

The snoring usually is loudest when you sleep on your back; it may be less noisy when you turn on your side. Snoring may not happen every night. Over time, the snoring may happen more often and get louder.

You’re asleep when the snoring or gasping occurs. You will likely not know that you’re having problems breathing or be able to judge how severe the problem is. Your bed partner or family members will often notice these problems before you do.

Not everyone who snores has sleep apnea; however, it is considered a strong indication you may suffer from this all-too-common sleep disorder.

Daytime Sleepiness. Another common sign of sleep apnea is fighting sleepiness during the day, at work, or while driving. You may find yourself rapidly falling asleep during the quiet moments of the day when you’re not active.

Morning Headaches, memory and learning problems and the inability to concentrate can also be signs your sleep is being interrupted.

Irritability, feeling depressed, mood swings and personality changes can be caused by the inability to sleep soundly and uninterrupted.

Other physical signs are frequent nighttime urination and dry throat upon waking.

If the sleep apnea is mild, there are some lifestyle changes that can help.

• Avoid alcohol and medicines that make you sleepy. They make it harder for your throat to stay open while you sleep. • Lose weight. Even a little loss can improve your symptoms.

• To keep your throat open, sleep on your side instead of your back.

• If needed, talk to your doctor about nose sprays or allergy medicines that might help keep your nasal passages open at night. • Stop smoking.

Moderate to severe sleep apnea can be successfully treated with a breathing device called a CPAP. We can help you find the machine and mask to fit your needs. Ask us. We are here to help.

Signs and symptoms of OSA

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Did you know that a CPAP user’s feeling of well being is directly related to how often they use their equipment? Supplemental humidity can help mitigate the nasal irritation and dryness that some individuals experience.

Chin straps help keep your mouth closed when you’re sleeping. During the deep sleep stage, people lose muscle tone temporarily, which means their mouths may come open. A chin strap will not keep high CPAP pressures from blowing through and forcing your mouth open. Air will just pass through your lips. It also will not stop you from voluntarily opening your mouth.

CPAP

Treatment SolutionsCPAPs

Continuous positive airway pressure (CPAP) is the most common treatment for moderate to severe sleep apnea. A CPAP machine has a mask that fits over your mouth and nose, or just over your nose. The machine gently blows air into your throat.

The air pressure is adjusted so that it’s just enough to stop the airways from becoming narrowed or blocked during sleep.

A respiratory therapist/sleep technologist will set up the machine and adjust it based on your doctor’s orders. If you have trouble with your CPAP,

work with your sleep specialist so steps can be taken to reduce side effects. There are many different types of machines and masks.

People who have severe sleep apnea generally feel much better when they start treatment.

It takes time and patience to get used to CPAP treatment. It is vital to your health that you stick with treatment. This is called compliance. We can help you have a comfortable experience.

• Humidifier• Chin strap• Facial liners• Nose bridge cushion• Rechargeable battery pack• Replacement filters • DC power adapter• Carry bag• CPAP wipes • Hose holder• Replacement tubing• Pulse oximeter

Medicare and insurance may not cover all accessories. Ask us. We are here to help.

Accessories to assist you

Treatment Solutions

CPAPs and Masks

CPAP machines have evolved to include advanced technology that has resulted in smaller, lighter units that provide gradual air pressure adjustments, heated humidity and a quieter treatment experience. We can help assess your needs and provide the appropriate machine.

When choosing a CPAP mask, patients can choose from three basic categories: the nasal mask, the full face mask and nasal pillows.

Prescribed CPAP pressure, facial structure and size, individual breathing and sleep styles, and personal characteristics like facial hair, or whether or not you wear eyeglasses or suffer from a condition like arthritis or TMJ (jaw disorder), are all factors that influence comfortable and effective mask fit. Our sleep specialists will work with you to give your treatment the best possibility of success.

Obstructive sleep apnea is a chronic disease that can be extremely dangerous if left untreated. It is vital that your CPAP treatment is comfortable, effective and ongoing.

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Sore or dry eyes

Redness/skin irritation where mask contacts skin

Runny nose

Cold nose

Dryness or burning sensation in throat or nose.

Nasal, sinus or ear pain

Discomfort from the sensation of too much pressure

Pressure delivered seems lower or higher than normal

Air seems too warm

Unit seems loud

Unit stops and starts

No air comes out of unit when power is connected

Mask not positioned correctly/headgear adjusted improperly;Inappropriate mask size

May be allergic to mask material

Nasal reaction to airflow

Room air temperature is too cold. Air cools while traveling through tubing.

Air is too dry. The relative humidity is less than 50 percent.

Sinus or middle ear infection.

Pressures above 13.0 cmH2O may cause feelings of discomfort, but are necessary to treat sleep apnea.

This will be present during ramp period. If present after ramp time is up, there may be a unit malfunction.

The filter may be obstructed by debris. The entrainment port may be blocked. The room temperature may be too warm.

Patient not yet used to unit.

Power cord not completely connected to grounded outlet. Smart Stop or Auto On/Off feature may be enabled.

Possible internal problem.

Re-apply mask and re-adjust headgear.Contact Sleep Remedies to obtain proper mask size.

Most masks are made of silicone, not latex. Use a barrier between your skin and the mask, such as a Comfort Gel pad, 3M’s Micropore tape or Duoderm. Contact Sleep Remediesif problem persists.

You may need to increase the humidity on your unit or request a humidifier.

Request heated tubing or reposition tubing so it runs under the bed covers to reduce heat loss.

Increase the humidifier setting; Ask you physician about nasal sprays or gels; Make sure you are breathing through your nose and not your mouth. A chin strap could be helpful.

Stop using the unit and contact your health care provider.

It may take up to six weeks to adjust to your PAP system. Try to relax when using the unit. It is important to establish your own rate and rhythm and rate of breathing through your nose.

Contact Sleep Remedies.

Replace or clean the filter; Move the unit to unblock port; Turn room temperature down.

Air leaks can occur at the mask, however most of the time the mask can be adjusted to stop the leak.

Verify proper connection. Refer to machine manual for specs on Smart Stop or Auto On/Off.

Contact Sleep Remedies.

Challenge Probable Cause Solution

Important note about CPAP intolerance: If, after an appropriate trial with a CPAP device, you do not feel better or cannot tolerate usage, it is important to talk to your health care provider. Many times these challenges can be remedied with other medical technology. Please let us know if you have questions about this. We are here to help.

Common Challenges and Solutions to CPAP/BiLevel Therapy

Are you comfortable with the feel of a mask over your mouth and nose?

Assess Your Needs

START

YES

YES

YES

NO

NO

NO

OK

NO

Which mask will fit your unique needs?Once you have been prescribed CPAP therapy, you will be fitted for a mask, tubing and headgear (interface) necessary for the delivery of the pressurized air that prevents apneas from occurring. Mask size and overall fit are vital to a successful CPAP treatment. Use this guide to become educated about mask options that might be right for you. We are here to help you through the process.

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NOHas your doctor prescribed CPAP therapy for your OSA?

Do you have a nasal obstruction or congestion that prevents you from breathing through your nose or do you sleep with your mouth open?

Assistive equipment may not be necessary or appropriate. There are dental devices and lifestyle changes to help alleviate mild sleep apnea.

NASAL MASKSThere are many options in the nasal mask family for patients who breathe through their nose during sleep, or who desire or require lessmask-to-face contact.Does this sound like you?

Do you breathe through your mouth despite a month of trying a nasal mask and chin strap? Let us help you find

a full face mask that fits all your needs.

YES

FULL FACE MASK

A full face mask is a good choice for mouth breathers. There are masks in this family to

fit all facial sizes and styles to accommodate most sleep styles. If a full face mask is a good fit, we can help determine insurance coverage.

YES

NASAL PILLOWSThere are options available for patients who require minimal contact. There are masks to fit the needs of patients who can’t seem to find the right nasal or full face mask. Does this sound like you?

Assess Your Needs

YES

AND/OR

NO

NO

YES

AND/OR

AND/OR

YES

YES

Has your doctor prescribed a high pressure airflow setting?

Do you wear eyeglasses or are you bothered by a mask that limits your field of vision?

Are you claustrophobic?

Do you sleep on your side or on your abdomen?

Are you sensitive to pressure on the back of your head and neck?

Are you experiencing a sore nose from a nasal mask? Do you move around a lot

when you sleep or have the tendency to dislodge your mask in the night?

NASAL MASKwith silicone cushions

NASAL MASK FAMILY

NASAL PILLOWSNASAL MASKwith gel cushions

YESYES

YES

AND/OR

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TRADITIONAL NASAL MASK

NASAL PILLOWSMINIMAL CONTACTNASAL MASK

The cushions on these masks are typically removable and are a good choice for patients

with high pressure requirements and who are active sleepers. There are many options available within this mask family. We can help assess your needs.

Minimal contact masks have been referred to as rescue masks.

Patients who do not require high pressure settings, who cannot tolerate anything on their face, side or tummy sleepers or who have sore noses from other masks may find pillows to be a good alternative.

Minimal contact nasal masks are a good choice for patients who toss and turn, have

divots from eyeglasses, or who are comfortable with a smaller interface. This mask provides more freedom of movement with minimal face contact, while still providing the secure fit and comfort of a cushioned mask.

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Maintain Your Sleep Health

Maintain your sleep health

It is important to follow up with your health care provider regularly to make sure your OSA treatment is working...

• Tell him or her if the treatment is causing side effects you can’t handle. This is especially important if you’re getting CPAP treatment. It takes awhile to adjust.

• If you’re not comfortable with your CPAP or it doesn’t seem to be working, tell us, your HME provider. You may need to switch to a different machine or mask. Or, you may need treatment to relieve CPAP side effects.

• Try not to gain weight. Excess weight can worsen sleep apnea and require adjustments to your CPAP device. Weight loss may relieve your sleep apnea or reduce the pressure needed to treat it.

• Until your apnea is properly treated, know the dangers of driving or operating heavy machinery when you’re sleepy.

• If you’re having surgery that requires medicine to put you to sleep, let your surgeon and doctors know you have sleep apnea. They might have to take extra steps to make sure your airway stays open during the surgery.

Note: It is important to your health to replace your CPAP mask, tubing and filters on a regular basis. Replacement masks and supplies may be covered by your insurance plan and Medicare.

Daily Cleaning ProceduresTo lengthen the life of your equipment and supplies it is important to inspect and clean all elements on a regular schedule. The mask, tubing and headgear should last anywhere from 3-12 months, but the actual life of the equipment can vary greatly. Daily cleaning is recommended for CPAP masks, other supplies should be cleaned as necessary. Always follow the manufacturer’s recommendations.

Step 1: Wash your hands with soap and water for at least 30 seconds.

Step 2: Remove the headgear from the mask or nasal pillow shell. Disconnect the mask or shell, swivel connector and tubing.

Step 3: With a soft cloth, gently wash the mask or pillows with a solution of warm water and a mild clear liquid detergent.

DO NOT USE STRONGLY SCENTED SOAPS.

Step 4: Rinse thoroughly and let air dry. Recommended to clean equipment in the morning allowing ample dry time.

DO NOT PLACE SUPPLIES IN THE DRYER.

Same steps can be used for water chamber/standard tubing, however this can also be cleaned weekly with white vinegar and tap water (1:5 Ratio). Let soak for 15 minutes, then rinse and let air dry.

Note: Heated tube should be cleaned weekly with mild clear liquid detergent.

Insurance Guide

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Most insurances and Medicare cover CPAP supplies including masks, headgear, tubing, filters, humidifiers, and replacement pillows and cushions. Regular supply replacement (every month, three months or six months) is recommended and allowed under Medicare and most other insurances.

Your insurance company has guidelines for beneficiary receipt of CPAPs and sleep apnea-related equipment, giving you the opportunity to replenish your equipment regularly through us, your HME provider. There are guidelines specific to your insurance concerning CPAP.

Important Information for Medicare Beneficiaries

Medicare covers a single-level CPAP device, for initial coverage, if the patient, during sleep, temporarily stops breathing (Obstructive Sleep Apnea). This diagnosis may be documented by a facility-based or home-based sleep study.

Medicare covers the use of the CPAP for up to three (3) months. If a patient requires the CPAP beyond three months, between the 31st and 91st day after beginning use of the CPAP, the patient must be re-evaluated by their physician, who will coordinate continued need with the supplier.

Medicare covers accessories used with the CPAP if the CPAP is covered by Medicare.

An order (prescription) must be on file with the supplier. It must be signed and dated by the treating doctor.

We can help you determine coverage. Please feel free to discuss your situation with us.

Medicare will continue to cover your CPAP and supplies past the initial 90 days. However, it is necessary that you revisit your doctor between the 31st day and the 91st day after initiation of your CPAP therapy, so your physician can conduct a re-evaluation. This is to ensure you are receiving benefit from your CPAP therapy. Ask us. We are here to help.

Insurance & Medicare GuideInsurance & Medicare Guide

If your coverage comes from Medicare...

Obstructive Sleep Apnea is a chronic disease that can be extremely dangerous if left untreated. It is vital that your CPAP treatment is comfortable, effective and ongoing. As you become familiar with your

treatment and equipment, it is helpful to keep track of usage, your state of wellness and any problems that arise that could impede your progress toward better sleep health and improved overall wellness.

CPAP Usage RecordWeek

NumberNights of usage per week

On a scale of 1(not at all rested) to 10 (very rested) how rested do I feel?

Issues or obstacles with CPAP or mask (discomfort, skin irritation, mask leak , dislodge mask in sleep, etc.)

1

2

3

4

5

6

7

8

9

10

11

12

13

Keeping Track: Your Health, Your Equipment

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What is your prescribed CPAP pressure (PAPRX)?

Where did you get your CPAP machine? Provider: Tycon Medical Phone: 757.640.1709

Who is the manufacturer?

What is the make and model? Make Model

Name of referring physician Name Phone

Vital CPAP Information

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Other Helpful Contact Information

Replacement Information Suggested replacement frequency Equipment/supplies

Every one to three months Cushions, pillows, filters

Every three months Mask/interface, tubing

Every six months Chin strap, headgear, humidifier chamber

Every six months Inspection of CPAP machine

Every five years CPAP machine

Most supplies associated with sleep therapy are designed to last three to six months, and using them longer than intended can inhibit the quality and progress of your CPAP therapy. Keep track of your equipment maintenance and replacement

below. With coverage from most insurances and Medicare, most supplies can be replaced on a regular basis, such as every three or six months; some can be replaced more often.

Record of Mask and Supply Replacement Date Mask/Interface Headgear/Chin Strap Tubing/Hose Filters Pillows/Cushions Humidifier Chamber

Doctor Name Phone

Doctor Name Phone

Sleep Doctor Name Phone

HME Provider Name Phone

Respiratory Therapist Name Phone

Dentist Name Phone

Be sure to schedule a follow-up visit with your physician by / / (date).

It is also very important to schedule a follow-up visit with us in six months. / / (date)

Keeping Track: Your Health, Your Equipment

Tyc o n M e d i c a l 7 5 7 . 6 4 0 . 1 7 0 9

A guide to the information you need to make educated decisions about your sleep health.

• Understanding Sleep Apnea

• Treatment Solutions

• CPAP/BiLevel Therapy: Solutions to common challenges

• Mask Assessment

• How to Maintain your Sleep Health

• Medicare/Insurance guide

• Helpful Resources

• Record Keeping

When you or a loved one has special needs, our caring staff is here to help you through the process. Customer wellness and satisfaction are our top priorities. We are here to help.

Wake up refreshed......

Do you snore?

NORFOLK: 801 Orapax St. • Norfolk, VA 23507

757-640-1709

PORTSMOUTH: 334 Effingham St. • Portsmouth, VA 23704

757-393-2273

www.tyconmedical.com