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Melanie Cole (Host): You may have heard about sleep apnea and CPAP therapy. Maybe you had a friend that has had an experience using a CPAP. But what exactly is it and how doe sit work? My guest today is Gennie Anderson. She’s a respiratory care manager for Prism Healthcare Services, the Alden Network’s transitional care partner for home and durable medical equipment to increase independence in the home. Gennie, welcome to the show. What do you do in your role at Prism Healthcare Services?

Gennie Anderson (Guest): So, I oversee the clinical team of respiratory therapists there at Prism.

Melanie: Everyone experiences normal sleepiness from time to time so how do you know if it’s normal sleepiness versus something more serious?

Gennie: So, how you know it’s normal sleepiness versus excessive sleepiness is that it lasts more than a day or two. And it interrupts your day as far as you have mood changes, irritability, depression, you are having trouble concentrating, you are having trouble concentrating while driving and your partner is noticing that you are snoring and that you are having cessation of breathing during sleep. So, there’s other symptoms that are going on not just your normal tiredness.

Melanie: Well you bring up a great point about your partner noticing that you are snoring so first of all, Gennie, is it usually the partner that notices something like sleep apnea or excessive snoring and if you snore; does that mean that you have sleep apnea?

Gennie: So, if you snore, no it does not mean always that you have sleep apnea. But that’s a really key component in sleep apnea is that a lot of people that snore do have sleep apnea. But yes, the partner is the first line of identification a lot of times for identification of sleep apnea.

Melanie: So, tell us about sleep apnea. What is it and is it dangerous?

Gennie: So, I think to understand sleep apnea, you have to understand what the term apnea means itself. Apnea is the Greek word for cessation of breathing. So, that means that you have stopped breathing during sleep. So, sometimes you don’t necessarily have to stop breathing during sleep, but you can have that reduction or partial airway closing during sleep which is identified usually as a snore. So, that snore can be just as detrimental to your sleep as that apnea and a lot of people don’t realize that the snore can be just as detrimental as that complete cessation of breathing.

Melanie: How is it diagnosed? If your partner is telling you that you are snoring excessively, you’re tired during the day, just as you have described all of those symptoms; then what is the next step if you notice this in yourself or your partner notices it? Where do you go and what happens?

Gennie: the first thing I would do is see my primary care physician who may refer you to a neurologist or a pulmonologist who is a sleep specialist. That sleep specialist would then do a physical exam, a medical history and then refer you to a sleep study that can be done at a lab or a hospital lab or in your home.

Melanie: And what’s a sleep study like? Because people think oh well if I go I’m hooked up to all these things and I can’t get a good night’s sleep. What is it like for a patient?

Gennie: Well, having had one done myself, I used to do sleep studies and then I had one done myself I kind of dreaded it. It wasn’t as bad as what I thought it would be. So, what they do is they are able to see if you do have that cessation of breathing or a reduction in airflow and they are able to monitor your oxygen level and see if you have obstructive sleep apnea and how severe it is. And it’s a really key component in diagnosing obstructive sleep apnea so it’s a necessary test.

Melanie: So, now let’s talk about the treatments because people have heard this CPAP, they had heard it on commercials. Tell us what CPAP is and how does it work to help obstructive sleep apnea?

Gennie: So, CPAP stands for continuous positive airway pressure and what that does or the way I like to describe it to patients is that it extends or opens that airway by using – so CPAP has a flow generator in the device that pulls in room air and then gently pressurizes that air to deliver it through a tube to the patient. And that pressure is decided in that sleep study. So, that’s – or by the physician. So, it’s really important that they understand that the physician decides what the pressure is at and that varies from patient to patient. The pressure is delivered to the patient by a mask and there’s three masks that can deliver – three different types of mask that can deliver.

Melanie: Tell us about the three different masks. How do you know which one is right for you?

Gennie: Again, that varies with each patient and how they tolerate the mask. One type of mask is nasal pillows, they are the least obtrusive but the hardest to get used to. The next type is a nasal mask that just goes around the nose. The third and final one is a full-face mask that goes around the nose and mouth and that would be for somebody that’s a mouth breather.

Melanie: So, tell us a little bit about how it feels on there and are people adhering to it because that seems to be one of the bigger problems with sleep apnea Gennie is that people don’t want to wear the CPAP so, they are not adhering, they are not being compliant to their prescription.

Gennie: I would totally agree with that. One of the things Prism does and I think it’s because we have a really strong clinical team is we are able to help them with compliance. Part of compliance that’s really important is that you put that CPAP on every day and I can tell you myself, that within a week or two of putting that on every day you don’t even feel the pressure. I have to sometimes pull it away – the mask away from myself to even know that it’s on now. And it’s hard to get people to understand at first that that’s going to happen. So, it’s just that consistent wearing every day that’s really important.

Melanie: Now what’s the process? Tell us if somebody does get a diagnosis of sleep apnea and they are going to use a CPAP, then they have got their prescription, they come to Prism to get the CPAP. Do they call you? Tell us the process.

Gennie: So, the process is that the doctor would send that order over and then there are notes that come with that along with the sleep study, that’s been verified with their insurance, Medicare or Medicaid which all of those are covered for the CPAP. And then that order goes through to a respiratory therapist who then sets that machine up and explains that to the patient.

Melanie: Now tell us about the myAir app, if they are a CPAP user. What is that and what are its benefits?

Gennie: So, the myAir app is used in conjunction with the ResMed machine which we use at Prism. That helps the patient comply with the CPAP and it gives them feedback on how they are doing with the CPAP and they can download that to their iPhone or their android device and it tells them a score up to 100 points and that score is divided into four categories. They get 70 points for how long they have worn it. They get 20 points for their mask and whether or not they have gotten a good seal on that mask. And then they get five points on whether they are still having events. So, events means apneas or the reduced airways, the snores. And then they get five points on whether they have taken that mask on and off too many times that night.

Melanie: Does this app work with all CPAPs or just certain ones and also when someone gets their CPAP from Prism, do they get to keep it?

Gennie: So, the app only works with the ResMed device and the ResMed device is considered the gold standard ResMed invented CPAP, so they were the first out there to develop the CPAP. And they do get to keep the CPAP only if they pass the compliance period. And the compliance period is the first 90 days. So, what happens is the first 90 days of them using the CPAP is a trial period. And during that trial period, they have to somewhere in that first 90 days do a 30-day consecutive period where they have worn it four hours minimum at least 70% of the time. That’s 21 out of those 30 days.

Melanie: Wrap it up for us Gennie. Give your best advice for good sleep hygiene as one thing and then for information about Prism Healthcare Services to help with CPAP therapy and what you would like the listeners to know about compliance and adherence if they are diagnosed with sleep apnea.

Gennie: So, good sleep hygiene is they go to bed at the same time every night and get up relatively the same time every morning. And a lot of people will stay up later on the weekends because it’s a weekend. But good sleep hygiene is that you go to bed relatively at the same time every night. No caffeine right before bed because you sleep better. And that you kind of keep that same routine all the time.

As far as Prism helping with it, we have a really – I think a really good team that – we do a really good setup. We spend a lot of time with the patient and then we are there to help with them to take them from the beginning – from the time we get that referral we have a clinical customer service team that works through the process of the intake of that order and then once it’s delivered to the respiratory team, we have a scheduler that takes them through the setup all the way through the respiratory therapist doing that set up. And then we work them through getting compliant.

Melanie: Thank you so much Gennie for being with us today and sharing your expertise and CPAP and since you’ve actually used one, you can really help patients to understand it and to understand that it’s not uncomfortable. Thank you so much for being with us today. You’re listening to the Alden Network podcast. For more information on any of our services please visit www.thealdennetwork.com or to hear more podcasts in this series please visit www.thealdennetwork.com/podcast, that’s www.thealdennetwork.com/podcast. This is Melanie Cole. Thanks so much for listening.