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Treatment Follow-Up
The optimal management of patients with sleep disorders involves follow-up of symptoms, testing results, and treatment outcomes. Sleep Medicine Associates is committed to providing follow-up care to meet the highest standards of patient care and satisfaction. Patients are seen by Dr. Cocanower, and Lindsay Lang, nurse practitioner, at intervals appropriate to the evaluation and management of their sleep problems. The majority of follow-up care for patients is provided by the nurse practitioner who has been trained to care for the broad range of problems encountered in patients with sleep disorders. Typically, patients are seen more frequently early in their care, with yearly appointments the norm once symptoms and sleep problems have been controlled. Patients are encouraged to return to the office for care if problems develop between scheduled visits.
What should I expect of treatment?
Most people who have sleep apnea experience sleepiness and fatigue. These are common symptoms of sleep apnea and result from the fragmentation of sleep that is caused by interruptions in breathing and the resulting arousals. You should notice a difference in your fatigue, sleepiness and energy levels soon after you begin treatment with CPAP/BIPAP, although this varies with individuals. Research shows that a maximum effect from CPAP/BIPAP is achieved in about two weeks. For unknown reasons, some individuals whose sleep apnea is effectively treated with CPAP/BIPAP may still experience sleepiness. Some patients take longer to acclimate to CPAP/BIPAP, extending the period of time on the therapy in which symptom improvement has yet to occur, Consult with your sleep medicine specialist if your sleepiness is not improving. Keep in mind that using CPAP will not make up for an insufficient amount of sleep.
I have questions about my CPAP / BIPAP equipment
If you have questions about the use or functioning of your CPAP or BIPAP equipment, contact the durable medical equipment (DME) company that provided your equipment. They will assist you in making sure that the equipment is working properly and that your mask is fitting well and not leaking. If the DME company is not able to help or needs to make adjustments to your equipment, they will typically contact your sleep specialist for instructions.
I have questions about my surgery results
If you have questions about the results or effectiveness of any surgical procedures done for the treatment of sleep apnea, consult with the surgeon who did the surgery. He or she will be able to discuss the results and outcome of the surgical procedure with you. If you continue to have problems with fatigue and excessive sleepiness, the surgeon may refer you back to the sleep specialist for evaluation of you symptoms.
I have questions about my oral appliance
If you have questions about the use or the effectiveness of your oral appliance for the treatment of sleep apnea, consult the dentist who fitted the device. He or she will be able to make sure that the device is fitted and working properly. If you continue to have problems with fatigue and excessive sleepiness, the dentist will typically ask that you return to the sleep specialist for evaluation of your symptoms.
I am having nasal problems
If you are having nasal problems that make using your CPAP/BIPAP uncomfortable or prevent you from using your equipment, contact your sleep specialist.
I can’t breathe through my nose
It is stuffy: If your nose is congested as a result of a cold or sinus infection, consult your physician for treatment. Though having nasal congestion due to an upper respiratory infection is not an absolute contraindication for using your CPAP/BIPAP equipment, sinus pain, or coughing may as a practical matter necessitate discontinuing your device for a short period of time. During these periods when you are not using the device, you may find it more comfortable to sleep in a more upright position in a recliner. Nasal stuffiness can also be caused by a reaction to allergens in the air (allergies). Interventions to address these allergies (avoidance strategies, medication, etc.) can be discussed with your physician, or reviewed with the sleep specialist during your visits. Most patients using CPAP/BIPAP equipped with heated humidification will typically experience baseline nasal congestion relief.
It runs: If your nose runs (rhinorrhea) when you try to use your CPAP equipment, changes to the humidification of your CPAP equipment will often help. Although it may seem that turning the humidifier settings down (less heat) is the proper action, adjusting the heater settings higher has been shown to be an effective strategy to address rhinorrhea, and in some patients may require that the heater settings be turned up as high as the device allows. Drier air passing over the nasal passages will result in the nose increasing moisture available to humidify the air, with resulting congestion.
It was broken in the past: If your nose has been broken in the past, an obstruction may be present that can make CPAP usage difficult and uncomfortable. In some cases, using a different type of CPAP mask, such as a full-face mask, that covers both the nose and mouth, may help. If significant nasal obstruction is present, a surgical evaluation may be recommended to you.
I have nosebleeds: If you experience nosebleeds as a result of your CPAP treatment, adjustments to your heated humidifier, and/or the use of nasal saline spray in the nose, will likely help. Nosebleeds should be reported to your physician, or sleep specialist, so that the proper interventions, or evaluation can be initiated.
I still snore
When CPAP/BIPAP pressures have been optimized, you should not snore. Air escaping from the mouth while using CPAP/BIPAP (mouthleak) may sometimes be mistakenly referred to as snoring by a bedpartner. If snoring remains while using CPAP/BIPAP, insufficient pressure settings, or an improper fit of your mask, may be the cause. This issue should be reviewed with your physician, or sleep medicine specialist. Your DME provider can help with mask fit questions. Mouth leak should be addressed, as this can result in a suboptimal response to the CPAP/BIPAP treatment.
I am still tired/sleepy
Residual symptoms of tiredness, or sleepiness may be due to various reasons. 1) The entirety of your sleepiness/tiredness complaint may not be due to sleep apnea. It will require consistent use of the CPAP/BIPAP equipment throughout the night (studies document improvement in symptoms the longer the device is used up to your regular sleep hour amount) to help determine if non-sleep apnea factors are contributing to your residual symptoms. These factors include not getting enough sleep, the presence of another sleep disorder (ie. periodic limb movements, idiopathic hypersomnia), medication effect, and mood dysfunction (ie. depression) 2) Your settings may not be optimal, or the equipment may not be performing optimally (including mask fit). 3) sequela of previously untreated obstructive sleep apnea. Though poorly understood, it is well recognized that some patients with obstructive sleep apnea have residual sleepiness in spite of what appears to be optimal therapy. These individuals will typically benefit from alerting medications that will improve the sleepiness symptoms.
Does my treatment need adjustment if I gain / lose weight?
Weight gain is often associated with an increase in soft tissue that accumulates around your throat. This will increase the tendency for airway collapse and obstruction during sleep, including while on CPAP/BIPAP, and may require an upward pressure adjustment made to your machine. Conversely, weight loss may result in a reduction of soft tissue around the throat, and may necessitate lowering of device pressures to avoid discomfort from excessive air pressure associated with mouth leak, and air in the stomach (aerophagia). A change of 10% of your body weight has been shown to change the tendency for sleep apnea.
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