After Train Crash, Transit Regulators Targeting Sleep Apnea – ABC News

Federal regulators are urging railroads across the country to test train operators for obstructive sleep apnea after the engineer in September’s deadly New Jersey commuter train crash was found to have the fatigue-inducing disorder.

The Federal Railroad Administration will issue a safety advisory this week stressing the importance of sleep apnea screening and treatment, Administrator Sarah Feinberg told The Associated Press. One railroad that already tests its engineers, Metro-North in the New York City suburbs, found that 1 in 9 suffers from sleep apnea.

The advisory, akin to a strong recommendation, is a stopgap measure while regulators draft rules that would require all railroads to screen engineers for sleep apnea. That process could take years, and Feinberg said railroads shouldn’t wait for the government to force action.

“At this point, it’s unacceptable to wait any longer,” Feinberg said.

Sleep apnea patients are repeatedly awakened and robbed of rest as their airway closes and their breathing stops, leading to dangerous daytime drowsiness.

“You end up with an engineer who is so fatigued they’re dosing off, they’re falling asleep in these micro bursts and they often have no memory of it, and they’re operating a locomotive at the time, so they’re putting hundreds of people in danger,” Feinberg said.

To read more, click here: After Train Crash, Transit Regulators Targeting Sleep Apnea – ABC News

CPAP Apnea Devices Help Control Blood Sugar in Diabetics

The study, published in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine, tracked 50 patients with both OSA and uncontrolled Type 2 diabetes. Some were asked to use CPAP masks, while the others were not.

After six months, the researchers found CPAP users had lower levels of insulin resistance and hemoglobin (HbA1c) levels — key markers of diabetes — than nonusers. In addition, the CPAP group had fewer inflammatory proteins and other biomarkers associated with Type 2 diabetes blood sugar control.

Read more: CPAP Apnea Devices Help Control Blood Sugar in Diabetics

Why Change Liners for Your CPAP Mask?

Why Change Mask Liners?.

“Don’t fix it if ain’t broken!” A patient reluctantly shared with me when I asked him about CPAP supplies renewal.

Supplies renewal recommendations from the manufacturers and DME companies appeared to me to be motivated by personal gain. Now, I have become more and more religious about advocating and even insisting that all my patients change them as recommended.

To make my point, I just saw an Amish patient in his 50s on CPAP. He felt better, but not all the way. His pretreatment apnea hypopnea index was 43/hr. On his CPAP compliance report, it was 13.5/hr, which is abnormal. We like it less than 5/hr and preferably close to 0/hr!

Why was he having residual apnea? At least, in part it was the air leak from not changing his mask liner! Take a look at the following compliance report in the right half of the image.


So, get your supplies refilled in a timely manner.

Sleep Well, Live Well.

Sleep 7+ Hours to Live a Long, Healthy, & Happy Life


Consensus Statement (published in June 2015 issue) from American Academy of Sleep Medicine and Sleep Research Society recommends 7 or more hours of sleep every night.

1. Sleeping less than 7 hours per night on a regular basis is associated with adverse health outcomes, including weight gain and obesity, diabetes, hypertension, heart disease and stroke, depression, and increased risk of death. Sleeping less than 7 hours per night is also associated with impaired immune function, increased pain, impaired performance, increased errors, and greater risk of accidents.

2. Sleeping more than 9 hours per night on a regular basis may be appropriate for young adults, individuals recovering from sleep debt, and individuals with illnesses. For others, it is uncertain whether sleeping more than 9 hours per night is associated with health risk.
3. People concerned they are sleeping too little or too much should consult their healthcare provider.

Sweet Dreams! God Bless!

– Yatin J. Patel

Can CPAP Improve my Sexual Function?


“I don’t have any sleep problem. My wife forced me to come here,” a young man in his forties vented out his irritation. I explain that the treatment of sleep apnea does reduce the risk of stroke, heart attack, and early death. Now, he got even more irritated, “I am not going to wear that CPAP.” I continued to make my case, “Studies have shown that the CPAP also improves intimacy and sexual function.” All of a sudden his eyes became big, he straightened up in the chair and asked hurriedly, “How soon Can I get that CPAP machine, Doc?”

Indeed, the studies have shown that up to 68% of men with Obstructive Sleep Apnea report sexual dysfunction and loss of interest in sex.

In a study published in Journal of Clinical Sleep Medicine, Judith L. Reishtein, Ph.D. and colleagues evaluated the sexual function of 176 patients with sleep apnea before and after the treatment with CPAP for 3 months.

Intimate and sexual relationships were assessed using the Intimate and Sexual Relationships subscale of the Functional Outcomes of Sleep Questionnaire (FOSQ). This disease-specific, self-administered instrument contains 30 questions and 5 stand-alone subscales.

As shown in the following table, difficulty with sexual desire, arousal, and orgasm decreased remarkably after 3 months of treatment with CPAP.




How does CPAP improve sexual function?

Those who are sleepier, as the researcher found, may be less interested and more impaired in sexual activity. Indeed, Barnes and colleagues also found among a group of 98 men with OSA, those with Erectile Dysfunction were significantly sleepier in the daytime than those without ED.

Margel and colleagues reported that morning tiredness was predictive of sexual satisfaction and the ability to have a morning erection.

In addition to excessive sleepiness, other potential mechanisms have been considered, including hormone levels as well as hypoxic-induced neural dysfunction affecting the erectile process. Comparing 10 men who had OSA with 5 healthy controls, Luboshitzky and others found that the OSA patients had lower mean luteinizing hormone (LH) and testosterone levels, secreting less LH and testosterone during sleep.

In a study of 1312 men, Barrett-Connor and colleagues found that men with the lowest testosterone levels had more severe apnea than those with normal levels. They also spent more of their sleep time with oxygen saturation less than 90%.

Soukhova-O’Hare found that chronically low oxygen level in rodents decreased levels of the endothelial nitric oxide, which mediates penile erection. This team also documented that chronic intermittent hypoxemia produced a 55% decrease in the number of daily spontaneous erections that were reversed after 6 weeks of recovery in normoxia. They also found reduced sexual drive and mating activity.

Thus, the findings from these studies suggest that the effect of OSA on intimate and sexual behaviors may be multifactorial.

How Quickly Sexual Function can Improve?

Bradshaw and associates demonstrated a significant increase in the Intimate and Sexual Relationships score in participants who received just 2 weeks of CPAP treatment.

Goncalves and colleagues reported Erectile Dysfunction resolved in 13 of 17 OSA patients treated for one month with CPAP.

Akashiba and colleagues reported that in patients with severe OSA, following 6 weeks CPAP treatment, Intimacy and Sexual Relationships scores improved 2.59 points.

In conclusion, treatment of sleep apnea with CPAP improves intimacy and sexual function besides reducing your risk of stroke, heart attack, high blood pressure, high blood sugar, and drowsy driving. So, listen to your spouse and talk to us.

God Bless You.

Sleep Well, Live Well.




A CPAP Patient is Happy

Call us for a home sleep test if you snore and have one these; tiredness, excessive sleepiness, high blood pressure, heart condition.

Untreated sleep apnea increases the risk of stroke, high BP, heart attack, and congestive heart failure. It also increases the risk of drowsy driving.

Sleep Well. Live Well.


FDA Approves a Novel Sleep Apnea Treatment


Photo Credit: Filip Schneider

Photo Credit: Filip Schneider


The US Food and Drug Administration (FDA) has approved the first fully implantable neurostimulator to treat obstructive sleep apnea (OSA), but only as a second-line therapy.

The device, called Inspire Upper Airway Stimulation therapy, is manufactured by Inspire Medical Systems, which announced the FDA’s decision today.

The implant helps keep a patient’s airway open by stimulating the hypoglossal nerve during sleep in tandem with a patient’s inspiration. The stimulation contracts upper airway muscles to pull the base of the tongue forward.

The FDA has approved Inspire Upper Airway Stimulation therapy specifically for patients with moderate to severe OSA who cannot use continuous positive airway pressure.

Adverse events reported in a clinical trial of the device included tongue weakness, dry mouth, pain, and numbness. The device is incompatible with having a magnetic resonance imaging scan.

(From Medscape)

7 Tips to Eliminate Dry Mouth during CPAP Use

Courtesy: Periowave Dental Services

Courtesy: Periowave Dental Services


My patients often complain that the CPAP is making their mouth dry, sometimes to a severe degree such that they can not keep the CPAP on all-night long. These are the suggestions I have given to them over last 20 years of my practice.

1. Treat nasal congestion. Dry mouth occurs when you breathe through the mouth as your nose gets plugged up at night because of dust, mold, pets, or food allergies. Get checked out and treated for these allergies.

2. Check the side effects of your medications. Nasal decongestants, several types of blood pressure medicines, and antidepressants can cause dry mouth. Talk to your pharmacist and doctor to see if you can switch these medications or at least take them in the morning.

3.  Use the humidifier attachment of CPAP. Dial up the setting on the humidifier of your CPAP machine. If you still suffer from dryness, you can also place an extra humidifier next to the bed.

4. Try nasal pillows. Patients sometimes can reduce this dryness by using nasal pillows instead of a full face mask. You can add a chin strap if you are a mouth-breather.

5.  Use nasal saline spray frequently. This is an over-the-counter product without any medicine in it, but is of great use as it not only moisturizes the nasal lining but also washes away the allergens and irritants. Keep the spray always on the nightstand. Use a couple of sprays in each nostril at bedtime and in the morning. You can use it when you wake up at night to use the restroom.

6. Consult an ENT specialist. This can help if you suffer from nasal obstruction because of a deviated septum or nasal polyps. Nasal obstruction will make you a mouth-breather, which in turn would make your mouth dry.

7. Stay hydrated. Drink water generously especially towards the evening to maintain good hydration.

If you follow these tips as applicable to your situation, dryness of mouth should abate. If it still continues to be a problem, talk to your doctor about other options.

Remember that an untreated sleep apnea increases your risk of uncontrolled blood pressure, elevated blood sugars, stroke, heart attack, and death. Please use CPAP every night.

Sleep Well, Live Well. God Bless You.


Persistent Depression Despite CPAP? Treat Daytime Sleepiness. CHEST Journal | January Article

Photo Credit: Andrew Richards

Photo Credit: Andrew Richards

Untreated sleep apnea is associated with depression symptoms. The treatment with CPAP (Continuous Positive Airway Pressure) improves these symptoms in most, but not all patients. 

In this multicenter prospective cohort study published in January 2014 CHEST journal, researchers evaluated 300 patients with OSAHS and depressive symptoms.

After an average of 529 days of CPAP therapy, the mean depression score decreased from 9.2 to 5.4 (p<0.0001), but 125 (41.7%) patients presented persistent depressive symptoms. The persistence of depressive symptoms was independently associated with persistent excessive daytime sleepiness (EDS), comorbid cardiovascular disease, and female gender.

Persistent depressive symptoms are strongly associated with Excessive Daytime Sleepiness. Active monitoring of depressive symptoms is needed in CPAP-treated OSAHS patients.

A New Sleep Apnea Treatment Could Help Millions | CBS News

In Thursday’s New England Journal of Medicine, researchers unveiled a new treatment that utilizes a sensor to stimulate nerves, allowing the body to breathe when otherwise it would not.

“I am so excited about this new device,” Dr. Ash told the co-hosts of “CBS This Morning.” She said the device, known as a “pulse generator” is surgically implanted, requiring a two hour procedure.

“It senses your effort to breathe. So it senses that you’re trying to take a breath,” she said. “It sends a pulse stimulation to the hypoglossal nerve — the nerve in your neck that controls those muscles that keep the airway open, and stimulates them, so the airway doesn’t collapse.”

Current standard treatment for sleep apnea is a device called a CPAP. It is a machine that applies air pressure through a mask, which, if worn while sleeping, keeps the airway open. Many people find the masks bulky and uncomfortable, choosing instead to leave their apnea untreated.

“For people that cannot use (the CPAP), that cannot tolerate it, it will make all the difference,” Ash said about the new device.

The new device is still in preliminary stages awaiting FDA approval, but Dr. Ash says she looks forward to the day when it is available to the general public. 

Please click on the link to watch a video clip on CBS News http://www.cbsnews.com/video/new-sleep-apnea-treatment-uses-nerve-stimulation