CleveMed Blogs

For most of us, when we think of carbon dioxide (CO2), we think of words like waste, danger, toxic, poison; but in reality CO₂ is not only a natural part of our existence but an essential one. We know we need to breathe oxygen to live. So many of us naturally assume that when we hold our breath, that it is the lack of oxygen that our body is reacting to and forcing us to breathe again. . . wrong. In reality, it is the accumulation of CO₂ that our body is reacting to and forcing us to breathe again, trying to reduce and remove the CO₂ from our lungs (You say: Ah ha, see, CO₂ is bad! Our body is fighting to get rid of it). Well, yes, too much of anything is a bad thing, even oxygen (Oxygen toxicity or oxygen poisoning, causes disorientation, breathing problems, and even seizures, but that’s not the point of this article). Back to CO₂, the needed concentrations of carbon dioxide we are talking about are well below the toxic levels, and most importantly without CO₂, you don’t have as much drive to breathe.

There are tens of millions of people with sleep apnea (that is, the failure to breathe while you sleep). Sleep apnea is typically further broken down into obstructive sleep apnea (OSA), where by the patient is trying to breath but air can’t get in due to an obstruction or collapse in the airway, and central sleep apnea (CSA), where by the patient just stops trying to breathe for short periods of time. The most prominent and successful treatment of OSA is using a constant positive airway pressure (CPAP) device or a variation there of. However some of these OSA patients do not get better, do not tolerate the CPAP, or even get worse. One reason is that a portion of the OSA population actually has a complex sleep apnea (CSA) condition that is masked by the OSA. In these cases the CPAP will prevent the obstructions, but then it becomes apparent that the patient is exhibiting CSA characteristics as well. The complex sleep apnea symptoms are unmasked or amplified because of a lack of respiratory drive due to insufficient levels of CO₂. Normally when we sleep, our CO₂ levels increase just slightly. Think about it, you are sleeping in a relatively stationary position creating a slight cloud of CO₂ around you. A CPAP device, however, reverses that effect since it is drawing air from an area a few feet away and pumping it into your airway. To add to that, the increased pressure and flow also acts to ‘blow off’ more of the CO₂ that is normally inside your lungs, so it is very conceivable that the CO₂ levels on CPAP can be even lower than normal (as opposed to slightly elevated in normal sleep). So this complex sleep apnea (CSA) population would appear to have a CO₂ ‘critical threshold’ right at that point between the CO₂ levels experienced with and without CPAP. There are multiple studies that have now shown that adding just a small amount of CO₂ actually treats these patients.

So yes, these patients do say, “give me CO₂ or give me bad sleep!”

Poor quality of sleep tends to accompany common illnesses, and life stressors (including family and social structure changes); patients tend to visit their primary care physician (PCP) who has knowledge of these factors that are related with their sleep problems. Symptoms and complaints associated with Obstructive Sleep Apnea are often expressed at a higher frequency in the primary care practice setting.

Patients often go to a sleep lab for OSA diagnosis & evaluation. On many instances, the primary care physician looses direct contact with his/her patient’s sleep condition and overall care path. An alternative to sending patients to a sleep lab test is to begin the diagnosis and management process within the primary care setting, by utilizing newer technology that makes sleep diagnosis portable and more readily accessible.

CleveMed’s sleep study network connects the primary care physician to sleep technologists, and board certified sleep physicians, so that the primary doc is able to be involved in the patient’s continuum of care. Here’s how:

This way, the PCP can maintain management of his/her patients’ sleep apnea and associated conditions.

We spend a third of our lives asleep –that can be a long time of fitful rest for someone who experiences sleep problems. Disruptions in this state of rest can lead to a decline in one’s overall quality of life. Most patients with sleep problems first seek medical help from their primary care physician.

Sleep in the Primary Care Setting:

Poor quality of sleep tends to accompany common illnesses, and life stressors (including family and social structure changes); thus, patients tend to visit their primary care physician who has a complete knowledge of the factors that are related with their sleep problems. Obstructive Sleep Apnea occurs at a high frequency in the primary care practice setting. An estimated 18 million Americans suffer from OSA; yet, despite the volume of sleep complaints to the primary care physicians, they often go unaddressed.

Common OSA facts and its associated health risks

• OSA is more common in men, and those over the age of 40.
• Snoring (Sleep Disordered Breathing) can be a sign of sleep apnea.
• Adult OSA has a long-standing and unambiguous correlation with obesity and daytime sleepiness. The National Sleep Foundation Sleep in America poll found that 77% of obese adults report having sleep problems. ¹ Sleep specialists say that weight gain, especially in the trunk and neck area, increases the risk of sleep-disordered breathing due to compromised respiratory function.¹ Research shows that sleep problems, like sleep apnea, also result in weight gain which can lead to additional health problems.¹
• Epidemiologic studies have linked sleep apnea with potential, long-term cardiovascular risk.
• Other studies have noted the consistent and strong association between OSA and hypertension.

Diagnosis and Management of OSA

Patients normally go to a sleep lab for OSA diagnosis & evaluation. Often, this causes the primary care physician to loose direct view of his/her patient’s sleep condition. An alternative to sending patients to a sleep lab test is to begin the diagnosis and management process within the primary care setting, by utilizing newer technology that makes sleep diagnosis portable and more readily accessible. Today, diagnosis and therapy of OSA should be considered as part of the health plan to manage diabetes, hypertension, and congestive heart failure — which are all core aspects of primary care medicine.

In conclusion, with training in sleep and an understanding of appropriate testing procedures, primary care physicians can use current evidence based information in the field to provide high-quality sleep medicine in the primary care setting.

About Sleep Apnea:

According to the National Institutes of Health, 50 to 70 million Americans are affected by chronic sleep disorders which can significantly diminish health, alertness and safety. An estimated 18 million Americans have sleep apnea, one of the most common sleep disorders. Yet, many sufferers are undiagnosed. Untreated sleep disorders can lead to hypertension, heart disease, stroke, depression, diabetes and other chronic disorders. In order for sleep apnea to be diagnosed, a patient normally undergoes a polysomnography (PSG), which is a noninvasive, pain-free procedure that usually requires spending a night in a sleep lab. During a PSG study, a sleep technologist records multiple biological functions during sleep, such as brain wave activity, eye movement, muscle tone, heart rhythm and breathing using electrodes and monitors placed on the head, chest and legs.

About DreamPort:

CleveMed recently introduced DreamPort™, an accessory to CleveMed’s Sapphire PSG™ (full PSG wireless system). Using broadband technology and built-in camera, DreamPort is a gateway to transmit full PSG data from the patient’s location to a sleep lab, thus, allowing remote attendance for patients who may be anxious or incapable of attending a sleep lab. With this new emerging medical device technology, diagnosing and treating sleep disorders has become timelier.

Why DreamPort is Suitable for Clinical Trials:

DreamPort is suitable for clinical trials as it allows for cost effective research studies to be conducted nearly anywhere. According to Cutting Edge Information, the average drug company spends about 37% of their overall R&D budgets on clinical trials. The average per-patient cost of clinical trials ranges roughly from $5,500 $7,600¹. Typical clinical trials follow a set of rules called a protocol and are managed by doctors. The studies are commonly run by nurses or other health care professionals². Now, DreamPort gives clinicians and researchers greater flexibility to conduct clinical trials where the patient is. Researchers and clinicians are able to obtain new types of research, like location specific research -home, hotel, hospital or lab; which can lead to support and establish a wider patient base.

The cost of home testing is a fraction of the cost of in-lab testing and can be less than the cost of using personnel for a full night sleep study. The average in-lab sleep studies cost range between $1,000-$5,000 a night. The cost of home studies range 35% to 88% lower than in-lab studies. The lower cost of home sleep studies makes DreamPort a practicable screening tool to collect meaningful research for patients with suspected sleep disorders, like Obstructive Sleep Apnea (OSA).³

This post draws on the experience of CleveMed professionals and professionals in the Sleep Disorder industry.