The document discusses the importance of sleep and the consequences of sleep deprivation. It notes that lack of sleep can negatively impact physical and mental health, leading to issues like high blood pressure, heart disease, diabetes, obesity, memory problems and depression. It also discusses sleep disorders like sleep apnea, their costs to society, and symptoms. Diagnosis involves sleep tests of varying complexity to detect breathing issues during sleep. Positive airway pressure therapy using devices like CPAP and APAP machines is presented as the standard treatment for sleep apnea.

1. The importance of Sleep

2. Good Sleep is an Essential part of Life

3. • High blood pressure
• Heart disease
• Diabetes
• Obesity
Sleep deprivation adversely effects general health,
physical and mental performance.
Chronic (repeated) sleep
deprivation is serious, and
can contribute to many
problems including;
• Memory lapses
• Depression
• Increase in accidents
• Damaged relationships

5. Sleep Disorders are serious!
Source: Deloitte Access Economics, Wake Up Australia, 2011
The cost to the Australian economy has been estimated at $21.2 billion.
That figure included healthcare costs, lost productivity, road accidents
and work-related accidents.
Going 17 hours without sleep = Driving with blood alcohol 0.05%
Going 24 hours without sleep = Driving with blood alcohol 0.10%
Sleep deficiency can build up over several days
Being sleepy is like being drunk
Costs may be underestimated given the prevalence of people
experiencing symptoms is substantially higher than the proportion of
people who are diagnosed.

6. I snore loudly. Do I have Sleep Apnea?

7. Snoring – Do you snore loudly so it disturbs others or can be heard from another room ?
Tired – Do you often feel tired during the day, or fall asleep during the day ?
Stop Breathing – Has anyone observed you stop breathing during sleep or wake up
gasping for air ?
High Blood Pressure – Have you or are you being treated for high blood pressure ?
Obesity – Are you obese with a BMI (Body Mass Index) over 35 ?
Neck – Is your neck circumference over 40cm ?
Age – Is your age over 50 ?
Gender – Are you Male ?
Family – Has any member of your immediate family (father, mother, brother or sister) been
diagnosed with Sleep Apnea ?
There are a number of factors that need to be considered…

8. If the answer is YES to 3 or more of these questions, It is
recommended that the patient consults with their family doctor
who probably refer them for a sleep test.
A sleep test is the only way to find out for sure if the
patient has sleep apnea.

9. Sleep Testing

10. Parameter/Type Ⅰ Ⅱ Ⅲ Ⅳ
EEG (Brain activity) ＋ ＋ － －
EOG (Eye Movement) ＋ ＋ － －
ECG (Heart Activity) ＋ ＋ － －
EMG (Muscle Activity) ＋ ＋ － －
Air flow ＋ ＋ ＋ ＋
Snoring ＋ ＋ ＋ －
Respiration Effort ＋ ＋ ＋ －
SpO2 ＋ ＋ ＋ ＋
Body Position ＋ ＋ － －
Monitor ＋ － － －
There are four types of Sleep Test, based on AASM
Guidelines (American Academy of Sleep Medicine)
10

11. This test is conducted overnight in a sleep lab or hospital setting supervised by a
sleep technician. This is resource intensive, expensive and inconvenient.
Level I Sleep Test.
An overnight PSG (Polysomnogram) - Supervised
Sticky patches with sensors called electrodes are placed
on your scalp, face, chest, limbs, and a finger.
While you sleep, these sensors record your brain activity,
eye movements, heart rate and rhythm, blood pressure,
and the amount of oxygen in your blood.
Elastic belts are placed around your chest and abdomen.
They measure chest movements and the strength and
duration of inhaled and exhaled breaths.
Wires attached to the sensors transmit the data to a
computer in the next room. The wires are very thin and
flexible. They are bundled together so they don't restrict
movement, disrupt your sleep, or cause other discomfort.
During a Polysomnogram
Level II Sleep Test. An overnight PSG (Polysomnogram) - Unsupervised

12. This test is conducted at home after the patient has been given some simple
instructions on how to connect the sensors and recording device.
The patient returns to the sleep clinic the following day and the recorded data is
downloaded, analysed and reported.
Level III Sleep Test.
An overnight Home Sleep Test (HST)
Sensors are placed on your chest, on one finger and
under your nose.
While you sleep, these sensors record your heart rate,
the amount of oxygen in your blood and your breathing.
Elastic belts are placed around your chest or abdomen.
They measure movements and the strength and
duration of inhaled and exhaled breaths.
This type of test is becoming more popular, especially
when there is already a strong reason to suspect sleep
apnea without other associated risk factors.
During a HST
The BMC PolyWatch with respiratory band is categorised as
a level III sleep diagnostic device.

13. This test is conducted at home after the patient has been given some simple
instructions on how to connect the sensors and watch style recording device.
The patient returns to the sleep clinic the following day and the recorded data is
downloaded, analysed and reported.
Level IV Sleep Test.
An overnight Sleep Screening Test (SST)
Sensors are placed on one finger and under
your nose.
While you sleep, these sensors record your
pulse rate, the amount of oxygen in your blood
and your breathing.
This is a cost effective sleep screening test
used when there is already a strong reason to
suspect sleep apnea without other associated
risk factors.
During a SST
The BMC SleepView is categorised as a level IV sleep diagnostic device.

14. Sleep Apnea

15. Sleep Apnea (Apnoea)
Apnea is the Latin name for absence of breath.
Obstructive Sleep Apnea (often just called sleep apnea, or sometimes OSA) occurs
when the airway collapses during sleep and the person stops breathing. This is
usually because a narrow airway collapses or becomes blocked when muscles relax
during sleep.
The person with sleep apnea may have hundreds of these episodes throughout the
night, disrupting their sleep and starving the body of vital oxygen.
Sleep apnea affects between 5 and 12% of the population with estimates of up to 75%
being undiagnosed.
The ratio of male to female is around 3:1 and the highest prevalence is in the 40 to 65
year old age group.
Central Sleep Apnea (CSA or CA) is much less common. Central sleep apnea occurs
because the brain doesn't send proper signals to the muscles that control breathing.

16. People with obstructive sleep apnea usually snore loudly and have restless sleep.
Often these symptoms are not noticed by the person with sleep apnea, but by their
partner or work colleague, who may also notice frequent pauses in breathing and
snoring, lasting between 10 seconds and a minute or even longer.
Each pause ends with a deep gasping noise and brief awakening as the person
struggles to breathe, although the person doesn’t usually remember awakening.
As a result of the problems during sleep, the person with sleep apnea is usually very
tired during the day, and as the day progresses, they may struggle to stay awake.
The tiredness can affect the person’s ability to concentrate and to function well at
work, and it can be extremely dangerous if they become sleepy while driving or
operating heavy machinery.
Other symptoms which occur in untreated sleep apnea include depression, irritability,
personality changes, impotence, memory impairment and increased frequency of
urination at night.
Symptoms of Sleep Apnea

17. • Sleep apnea can occur at any age.
• In childhood, it is commonly the result of enlarged tonsils or adenoids or of
some cranio-facial abnormality.
• In adulthood, it occurs more often in middle age, and is more common in men
than in women. (Approx 3 to 1 ratio)
• It is often associated with being overweight, particular with excess fatty tissue
around the neck.
• In people not overweight, it is likely that they have been born with a narrow
airway, or a facial structure which leads to narrowing.
• Almost everyone who has obstructive sleep apnea will snore, as snoring is
also the result of narrow or floppy upper airways.
Who Gets Sleep Apnea?

18. How is Obstructive
Sleep Apnea Treated?

19. Positive Airway Pressure (PAP) Therapy
is the “gold standard” for treating Obstructive Sleep Apnea.
Treatment therapy is delivered by an air pump, hose and Mask.
Treatment Compliance is generally considered as;
• Using for at least 4 hours per night
• Using for 70% of the time. Eg: 21day out of the last 30 days
• AHI under 5, and the lower the better

20. CPAP
Constant Positive Airway Pressure (CPAP) machines treat Obstructive Sleep Apnea. They are
set to the treatment pressure the patient's body requires .
This is usually based on a sleep study and doctor's prescription or a previous machine setting.
This treatment pressure is the pressure required to keep the patient's airway open during sleep.
Even if the patient is still awake, the machine will still put out this constant pressure.
If you do not know your prescribed treatment pressure, usually a CPAP machine cannot be
supplied as we don't know what to set it to.

21. APAP (Auto or Auto PAP)
The Automatic Positive Airway Pressure (APAP) machines are set up with a minimum and
maximum setting.
The auto machine adjusts up and down between this range throughout the sleep period to
treat Obstructive Sleep Apnea (OSA).
During sleep, the auto machine will increase and reduce the pressure as required.
Typically the pressure is higher when the patient is sleeping on their back and less when on
their side. The pressure will also vary depending on the different sleep stages, The auto
machine will cope with all these changes by varying the pressure automatically as required.
In the future, the treatment pressure may change due to weight gain or weight loss, ageing,
loss of muscle tone in the throat, etc. The auto machine will keep adjusting automatically to
the correct pressure, often without the need for another sleep study.

22. "In my personal opinion, this is more comfortable and smarter way
of providing the required therapy for OSA patients."
Which type of machine is best for me?
This is a very common question, and simply answered by referring to the table below;

23. Questions ??