In starting the Fast Asleep newsletter, I seek to provide a lot of practical knowledge combined with a great deal of unconventional wisdom on how to resolve your sleep problems, one night at a time.
To kick things off, I want to answer a question routinely brought up in work with clients through my Sleep Health coaching services at www.barrykrakowmd.com.
How do I find the right sleep center in my area or perhaps in my state?
While people of all stripes seek help at sleep centers for numerous reasons and various sleep disorders, it is a reasonable assumption the largest majority will undergo an evaluation for sleep breathing disorders. On this basis, there are four fundamentals that will help steer you in the right direction. In many instances you might be able to sort out these factors by simply phoning to various centers until you hit on the one you like best.
1. Foremost, you want to know that the center is highly focused on fixing sleep quality problems. Why the use of the word, “quality?” Because nowadays too many facilities are caught up in counting hours of sleep while using a CPAP machine, all because of insurance rules imposed on clinical sleep medicine. If a patient doesn’t use the device at least 4 hours per night for 5 nights in a week, then insurance may refuse to provide coverage. This arbitrary rule has steered thousands of sleep health professionals to pay too much attention to this “compliance” or “adherence” metric instead of asking the PAP user how well they are responding to treatment. So ask, “how do you track improvement in sleep quality?”
2. In 2005, we stopped prescribing CPAP or its more recent variant auto-CPAP. These devices in our clinical experience are outmoded and obsolete. Sometimes they are traumatizing to individuals who suffer from the anxiety. The problem with CPAP, which stands for continuous positive airway pressure is the setting is always the same whether you are breathing in or breathing out. In 2005, we started prescribing only bilevel devices that offer two settings, a higher pressure level to breathe in and a lower one to breathe out. This combination yields greater comfort. In the past decade auto-adjusting bilevel type devices have been invented, which in our experience have proven far superior to any other devices on the market. So ask, “do you prescribe advanced modes, like bilevel?”
3. Piggybacking onto item #2, ask the sleep center whether or not they score the 3rd major breathing event that goes by various names such as flow limitation, RERAs (respiratory effort-related arousals) or upper airway resistance syndrome (UARS). Unfortunately, most centers are only attending to apneas and hypopneas to yield what is known as the apnea-hypopnea index or AHI. This metric is also outdated and obsolete except that insurance companies still force sleep centers to use it in diagnosing sleep breathing disorders. A center that measures, scores and treats the 3rd type of breathing event is likely to provide more advanced care than one that sticks only with the AHI. Ask, “do you score and treat flow limitation events?”
4. Last, the weakest leak in all of sleep medical care for sleep breathing disorders is the role of the durable medical equipment (DME) companies. Some of these business enterprises are very good at helping patients adapt to their use of the PAP machine, but many DMEs provide mediocre service or worse. Therefore, you want to ask the sleep center whether or not they provide their own hands-on services to help a patient learn to use a PAP device (hopefully, the bilevel variety). Ask, “what hands-on services do you provide to help with PAP adaptation?”
As you might imagine, we will explore all these elements in greater depth and will do so in future posts. For now, how a sleep center manages these 4 factors tells you a lot about whether they are running an average operation or one that is a cut above.