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Medicare ABN Form
Advanced Beneficiary Notice of Noncoverage (ABN), a required form for any new, returning, or newly turned Medicare patient who wishes to use our services.
What is Obstructive Sleep Apnea (OSA)?
Obstructive Sleep Apnea occurs when the throat completely or partially collapses causing interrupted sleep. Snoring occurs when the throat is partially closed and the air passing through causes the throat to vibrate.
When you sleep and experience a complete collapse of the upper airway caused by relaxation of the muscles controlling the soft palate and tongue you have an apnea or a total cessation of air flow in the throat.
When you sleep and experience a partial collapse of the upper airway you have a hypopnea causing upper airway tissue vibration also known as snoring.
OSA is classified as being mild, moderate or severe based upon the number of apneas or hypopneas per hour of sleep. 5 to 14 per hour is considered mild, 15-30 is considered moderate and 30 or more per hour is considered severe.
Closed Airway During an Apnea Normal Open Airway
Common Signs & Symptoms Of OSA:
Irregular Breathing during Sleep
Nighttime Gasping, Choking or Coughing
Frequent Nighttime Urination
Disruption of bed partner’s sleep
Excessive Daytime Sleepiness
Lack of Energy
Common Conditions Associated With OSA:
Approximately 76% of congestive heart failure patients have OSA
49% of atrial fibrillation patients have OSA
Anywhere from 30 to 83% of patients with hypertension have OSA
48% of type 2 diabetes sufferers have OSA which may have a causal role in the development of type 2 diabetes
86% of obese type 2 diabetes patients have OSA
65% of stroke patients have OSA. Moderate to severe sleep apnea triples stroke risk in men.
If I snore or snort, does this mean I have OSA?
While snoring or snorting during the night can indicate the presence of OSA. You will need to have a diagnostic sleep study to confirm the diagnosis.
At what age can you develop OSA?
OSA can happen to anyone (male or female) of any age. Small infants can have narrow airways which can cause snoring and sleep apnea. A diagnostic sleep study may be required by some insurance providers prior to have tonsils and/or adenoids removed.
Can fit and thin people get OSA?
OSA does not discriminate, it can occur in anyone of any size or shape. While having some excess weight may increase your chances of developing OSA, body type and weight are not the only determining factors. If you suspect you may have OSA, please discuss this with your primary physician or call Associates in Sleep Medicine at 708.364.0495 to schedule an appointment with one of our sleep physicians.
What is a Polysomnogram (Sleep Study)?
A polysomnogram is a study that measures the quality of your sleep. A typical polysomnogram includes the following measures:
Brain waves (electrodes placed on the scalp)
Eye movement (electrodes placed on the face, by the eyes)
Chin muscle tone (electrodes placed on or near the chin)
Heart rate (electrodes placed on the chest)
Leg movements (electrodes placed on the legs)
Breathing (breathing sensor placed near the nose and mouth)
Breathing effort (two small elastic belts placed around chest and abdomen)
Oxygen level (small sensor attached to the finger)
Audio and video recording
Why is it necessary to record the above functions?
During sleep, the body functions differently than while awake. Disturbed sleep, such as irregular breathing or lack of sleep consolidation, can interfere with daytime activities, cause daytime sleepiness, and cause serious health problems.
How can I sleep with all of the electrodes?
Most people sleep reasonably well. We are looking to obtain a sample of your sleep pattern. The body sensors are applied so that you can move during sleep and change positions during the night. The sleep rooms are set up as comfortable bedrooms, and our staff makes the environment as restful as possible.
Will the sensors hurt?
No. This is a painless and non-invasive (no needles) testing procedure. Paste is applied to your skin and scalp to keep the electrodes in place, but it is easily removed with soap and warm water.
What is a Multiple Sleep Latency Test (MSLT)?
Some people also participate in daytime testing. This test consists of a series of 20-minute naps. Sensors and electrodes are used to record information similar to the polysomnogram test. 20-minute naps are taken every two hours throughout the day. Please bring something
to read or work on during the day to help keep you occupied in between naps. A DVD player is available. The MSLT test is usually completed by 6:00 p.m.
What is AHI? How is it calculated?
Apnea Hypopnea Index is the number of apneas plus the number of hypopneas per hour while sleeping. This number is used to determine the severity of a patient’s obstructive sleep apnea.
To determine your AHI add the total number of apnea and hypopnea events, divide by the total number of minutes of actual sleep time, then multiply that number by 60.
Apnea + Hypopnea multiplied by 60, then divided by actual total sleep time
100 Apneas, 100 Hypopnea (200 Total Events)
360 Minutes Actual Sleep time (6 hours x 60 minutes)
Multiply 200 x 60 =12000 / 360 = 33 AHI (Severe OSA)
The Severity of OSAHS as defined by the American Academy of Sleep Medicine Task Force (1999) is:
<5 per hour = Normal
5 - 15 per hour = Mild
15 - 30 per hour = Moderate
> 30 per hour = Severe
How Sleep Apnea is Treated
Continuous Positive Airway Pressure (CPAP)
Continuous positive airway pressure (CPAP) is the frontline treatment for obstructive sleep apnea. CPAP keeps your airway open during the night by gently providing a constant stream of air through a mask you wear while you sleep. This will eliminate the breathing pauses caused by OSA, so you will no longer snore or make choking noises in your sleep. You will be able to sleep through the night without your body waking up from lack of oxygen. When you use CPAP, you will feel more alert during the daytime. Your mood will improve and you will have a better memory. CPAP prevents or even reverses serious health problems associated with sleep apnea such as heart disease and stroke. Your partner may even sleep better because you will stop snoring. Research shows treatment of OSA using CPAP therapy improves daytime blood pressure, heart rate and reduces blood glucose levels.
Oral Appliance Therapy
Oral Appliance Therapy involves the selection, fitting and use of a specially designed oral appliance that maintains an open, unobstructed airway when worn during sleep. Oral appliances reposition and maintain the lower jaw in a protruded position during sleep. This opens the airway by indirectly pulling the tongue and soft tissue behind the tongue forward.
Weight changes can significantly affect the severity of sleep apnea, perhaps even leading to a reassessment of the degree of OSA and CPAP requirements.
Avoiding Certain Medications
Benzodiazepines, narcotics, and alcohol reduce upper airway muscle tone and should be avoided. No medications are associated with improvement of OSA.
Sometimes sleep apnea is much worse when lying on your back compared to sleeping on your side. In such instances the use of a “bumper belt” which forces you to sleep on your side may be a sufficient remedy for OSA.
Some patients with sleep disordered breathing may be candidates for a surgical intervention. A surgeon board certified in sleep medicine should be contacted to evaluate anyone interested in exploring a surgical option.
Important! If you are suffering from any of these symptoms, see a doctor right away do not try to diagnose yourself. There are other more serious conditions which share the same symptoms.
How does a CPAP machine work?
The purpose of a CPAP machine is to keep your airway open. The machine filters air through a mask that funnels a constant stream of air into your airway. This constant stream of air creates enough pressure to maintain open airway and maintain proper oxygen levels. You can then sleep without waking up, choking or snoring.
There are many CPAP machine models that help you breathe. All consist of an air pump unit, a mask, and flexible tubing that connects the two and delivers pressurized air to the lungs. The tubing is long enough so that you can comfortably move around in bed, and the unit is quiet enough that it will not disturb you or a partner.
There are several types of PAP therapy machines that deliver air in a different manner:
APAP or auto-titrating positive airway pressure therapy. This machine raises or lowers your air pressure automatically during the night as needed.
BiPAP or bilevel positive airway pressure. This machine alternates pressure as you breathe in and out.
CPAP or continuous positive airway pressure. This machine keeps constant airway pressure.
PAP therapy masks vary; so choose the mask that is most comfortable for you. Here are some examples:
A nasal mask, the most common type of CPAP mask, covers only the nose.
A full-face mask covers both the mouth and nose. This mask works well if you breathe through your mouth when you sleep.
Nasal pillows are soft silicone and pillow-like inserts that slip gently into your nostrils to deliver the air along with a full-face mask. They can eliminate further air leaks.
The type of mask you use depends on your preference and your condition. Your Patient Care Coordinator and Sleep Physician will work with you to help you determine the best mask for you, as well as the right amount of air pressure you need.