The End of Sleep Medicine (Part 4)

 "You've come a long way baby" Virginia Slims cigarette tagline ~ circa 1968

Nearly five years since I have put pen to paper (so to speak) regarding the "end" or goal of sleep medicine. During that time I have, mostly quietly watched, the (r)evolution of the field.  I thought to provide some reflections on a field of medicine that was my professional life for 10 years. I would like also to thank again those who were my teachers and colleagues in the pursuit of helping those with the chronic health condition - #obstructive sleep apnea (OSA) - #sleep disordered breathing.

I recently had the occasion to visit a #CVS near me and found much to my surprise (though not really) the following displays

My earliest memories of serving as the executive director of the American Sleep Apnea Association was attending as an exhibitor at the #American Thoracic Society's 2004 International Conference in Orlando Florida. It was there I first met many of the men and women who would be my mentors. It was there I also met many of the reps of the device manufacturers #Resmed, #Respironics (now part of #Phillips Healthcare), #DeVilbiss, and #Fisher &Paykel.

While I was setting up the booth I had two encounters that have stayed with me. First was a woman working with the company setting up the exhibit hall. She saw the sign and stopped to tell me how her husband has #OSA. She lay beside him in the bed with her hand on his chest to make sure he was still breathing. This was my first encounter with sleep apnea - the first of what would be many during my tenure.

The second conversation I had was with a vice president for sales with #ResMed the number 1 or 2 in sales of #Positive Airway Pressure devices or CPAP.  I remember the conversation as if it was yesterday and these two images from CVS moved it to the front of my mind.  #Ron Richards said to me in five years you will be able to get these devices over the counter. If they work for you keep it (and use it) and if not bring it back. Like his boss, #Peter Farrell was fond of saying the only way one of these can hurt you is if it falls on your foot.

It took longer than five years and there are likely still a couple of hoops to jump through when it comes with the device, but at least when it comes to the supplies they are available when needed.

A second meaningful experience was the first time I provided testimony before a committee of  #Medicare regarding the use of #home sleeping testing (HST) for the diagnosis of #obstructive sleep apnea. This led to the publication of an open letter in the #Journal of Clinical Sleep Medicine.  It would be some years before the sleep medicine community would accept that #HST would not decrease the number of people seeking treatment for OSA and there would always be cases where the use of #HST would not be indicated. 

One of the many companies vying for a portion of the #HST market was a company using a different modality of measuring the incidence of pausing in breathing. #Itamar does not use the limitation of airflow into the lungs, something the pulmonary sleep medicine physicians were less inclined to accept as an accurate measure of disease. Without getting into the relative merits of the two modalities. #Itamar's technology  Here is an explanation of how this modality works.

Perhaps more important an alternate diagnostic modality was this technique engaged a medical community that heretofore had been reluctant to engage - cardiologists.  It is well known that untreated OSA has significant consequences on the cardiovascular system.  As far back as 2008 in the journal Circulation, there was the recognition that untreated sleep-disordered breathing is a driver of heart disease.  Perhaps the Itamar WatchPat technology spoke to cardiologists in a way ResMed Apnealink did not.   The important point here is cardiologists seem to be more engaged than previously.

Another memory - a well-respected sleep medicine physician would frequently say diagnosing sleep apnea as was so easy the janitor at the hospital where she practiced could tell just from looking a people in the waiting room whether they were positive for OSA.

The third and final meaningful experience happened at a medical conference where the ASAA was an exhibitor.  Our booth happened to catty-corner to that of the Board of Registered Polysomnographic Technologist (BRPST) and as it happened members of the American College of Chest Physicians happened to be passing by. The College had recently considered developing a certificate program for an allied health position for sleep, something akin to the Diabetes educator.  It was something subsequently they did not pursue.  But it was something I believed would be vital especially as #HST became more the norm than the exception.  I had always felt that successful treatment meaning being completely adherence to whatever therapy or treatment worked for the OSA patient was more important than how the diagnosis was arrived at. I knew both the representatives of ACCP and BRPST, and so I brought them together suggesting that BRPST take on the certificate program for what then call the sleep educator. It took some time and some hard work, but eventually, the CCSH program was born.

Perhaps it is fitting this blog post, the last in a series is published today on the 40th anniversary of the publication in the journal  The Lancet of Colin Sullivan's seminal research study 

Thank you to all my teachers, colleagues, and most importantly the patients who made this experience one I will always cherish.

Sleep, Sleep Apnea and the Ides of March.

The month of March has become, officially or unofficially, the month dedicated to sleep. It makes sense. For a long time and coincident with the vernal equinox we collectively (except for Arizona) adjust our clocks forward an hour to allow for an additional "hour" of daylight at the end of the work day. This adjustment occurs when we are, or should be, sleeping.

Our colleagues at the National Sleep Foundation designated the week before the time change National Sleep Awareness Week(r) and use that time to release an annual poll regarding a sleep issue.

This year, unlike previous years, there were several other important information releases during the month that bear mentioning.

On March 1st, the American Thoracic Society released a long awaited report on research priorities for ambulatory management of adults with obstructive sleep apnea. What is significant is that collaborating on the report are three of the principal medical societies responsibility for diagnosis and treatment of sleep apnea, plus the European Respiratory Society. Having everyone rowing in the same direction can only help improve the care of those with sleep apnea - here in the United States and Europe.

On March 7th, the Centers for Disease Control and Prevention published in their Morbidity and Mortality Week Report the analysis of data collected as a part of the "sleep module" from 12 states in their Behavioral Risk Factor Surveillance System (BRFSS). The addition of this set of questions to the BRFSS was due in large measure to lobbying the U.S. Congress to pay attention to sleep.  A portion of the funding granted by Congress was used to pay the expenses of the National Sleep Awareness Roundtable. 2009 was the first time the module was included and as the graphic above indicates that those getting less than 7 hours of sleep a night have a higher likelihood of snoring, unintentionally falling asleep and nodding off (!) while driving.

The watershed event of the month occurred on March 15th, when the Institute of Medicine released their report on the leading health indicators for Healthy People 2020. The IOM, at the request of the US Department of Health and Human Services distilled the nearly 600 objectives included in Healthy People 2020 down to the 24 most important. Included among the 24 was one of the four from the Sleep Health topic -  Increase the proportion of adults who get sufficient sleep. It was already significant that sleep now had its own "topic" under Healthy People. On top of that, to be included as one of the leading health indicator is a great leap forward in awareness.

March is about sleep and this year the needle moved on the importance of sleep. Now our job is not to let them forget about it the rest of the year.

Sleep Apnea on World Sleep Day March 19th

Sleep Apnea Awareness Day 2010 was pretty quiet this year, this notwithstanding that the ASAA celebrates its 20th anniversary.

A lot of our attention is focused on the upcoming sleep apnea and trucking conference scheduled for May 11-12. If you aren't familiar with what we are planning, check it out.

We have other activities planned to celebrate the beginning of our 20th year of service to the public as the leading patient organization for education, support and advocacy for sleep apnea. Stay tuned.

I want to call people's attention to World Sleep Day this coming week - March 19th. Organized by the World Association for Sleep Medicine, it is a global effort to call attention to the importance of sleep and recognizing there are there are a number of disorders that interfere with it. Their catchphrase this year - SLEEP WELL, STAY HEALTHY. The organizers have simplified the rules for good sleep hygiene into a list of ten "commandments."

Another reason why I want to call your attention to March 19th is that World Sleep Day is part of a yearlong, worldwide recognition of lung health - The Year of the Lung. Most of the respiratory medical professional and patient organizations from all over the world are partnering to focus on the many issues that affect lung health and sleep apnea is one of those issues.

Our colleagues at the American Thoracic Society, founding partners for the Year of the Lung have taken as one of their charges promoting World Sleep Day.

We join with them to share the following declaration for March 19, 2010 - World Sleep Day:

Whereas, sleepiness and sleeplessness constitute a global epidemic that threatens health and quality of life,

Whereas, much can be done to prevent and treat sleepiness and sleeplessness,

Whereas, professional and public awareness are the firsts steps to action,

We hereby DECLARE that the disorders of sleep are preventable and treatable medical conditions in every country of the world.

Take time this week to think about how you and other members of your family sleep (particularly your children and grandchildren) . Share the ten commandments with those who would benefit from a change in their sleeping habits.

Remember - Sleeping well is a key to staying healthy.

Preparing for Sleep Apnea Awareness Day 2008

I started working for the ASAA in May of 2004. I realized soon after I got there that what needed to addressed sooner than later was updating the educational video the association had released in 1994!

It took some time and some doing, but it is almost finished. The completed video, which will be available on DVD will run 10 minutes and is shot in high definition. The video will have a prologue and an epilogue that can be used as PSA for television.

Currently the prologue is available on Youtube.

Our plan is to hold an event in Washington, DC during National Sleep Awareness Week, to premiere the video and then to take it to Minneapolis to where the largest A.W.A.K.E. group will be holding an all day event on March 6 - Sleep Apnea Awareness Day.

The video will feature prominently in the RSVP campaign which will be unveiled in the spring.

2008 is already shaping up to be a big year for the ASAA. Check back for more news on SAAD 2008!

ED

Sleep Apnea Awareness Day 2007 - wrap up

The 3rd annual Sleep Apnea Awareness Day lecture was held... here is the link to the page on the ASAA web site with the link to the lecture - www.sleepapnea.org/saad2007.html.

The speakers at the event were excellent. And while the attendance at the event was less than it might have been, we do have it video recorded and available to anyone with access to the Internet.

I must say though, it is a lot of work putting this together and the spent on this was time taken away from other equally important activities. But this was important and now it is done.

There was some serendipity this year that made SAAD 2007 special. I had the pleasure of sharing parts of it with members of the ASAA Board. I got to know Terry Young, noted researcher in the field of sleep apnea.

We were able to participate with the National Sleep Foundation in visits to Capital Hill in support of additional funding for CDC for sleep and sleep disorder surveillance... which will do more with in our legislatative action center.

On top of everything that occurred during Sleep Awareness Day - our newest Board member Nancy Rothstein did a read-a-loud at a local elementary school. It was a treat.

Big things are on the horizon... I will be back to report on these doings, soon.

The road to Sleep Apnea Awareness Day 2007

Readers of this journal know there are many interesting aspects of my work as an executive director... but planning an event like the Sleep Apnea Awareness Day (SAAD) lecture is the most challenging.

After last year's less than spectacular event, I did not retreat. I rethought, and with the benefit of the collective wisdom of our Board of Directors, redirected the focus of the lecture.

Perhaps the biggest problem for "us" in the sleep community is "translating" the incredible research done by the sleep researchers into content that is accessible to the layperson. What good are the findings of the studies if they remain locked up in a prestigous, but inscrutable medical journal.

The idea of bringing what is known from sleep research to the general public is what the lecture should be all about. In Washington, DC, where we make our home... the public can include policy folks from trade and professional associations as well as members of Congress, their staff and members of Federal agencies.

Dr. Terri Weaver's presentation on snoring and sleep apnea: the effects on the family will do that on Wednesday. Words will never fully express my gratitude for her willingness to share what she has learned with those will assemble this coming week.

That adjustment alone will be a guarantee of a successful lecture. But this year we will stretch and add another dimension to the proceedings, personal experiences.

We have the good fortune to have a new member of our Board of Directors Nancy Rothstein, who, has in the past year, become very active in raising public awareness about the negative effects of snoring and sleep apnea. Her experiences are captured and elegantly depicted in a children's book My Daddy Snores. She will provide the introduction.

We also have the good fortune to know Ashley Keenan, a young woman who willing to share her experience with sleep apnea.

I think it is fitting there are three women speaking at the SAAD lecture, in light of the National Sleep Foundation's National Sleep Awareness Week (r) theme of Women and Sleep.

I hope those of you can attend the event on Wednesday March 7th will, and those of who can't will take the time to view the proceedings when the webcast link (funded by a generous donation from the American College of Chest Physicians - Sleep Institute) is established.

I'll be back with a report on how it went... don't touch that dial, er, mouse.

Sleep Apnea Awareness Day(s) 2007

There are less than 30 days until March 8, Sleep Apnea Awareness Day during National Sleep Awareness Week. Of course, every day should be sleep apnea awareness day... we take the opportunity during the week before the time change when we "spring forward" an hour to focus attention on sleep apnea.


I am pleased to announce there will be a Sleep Apnea Awareness Day lecture. This year it will be held on March 7. I am especially pleased to announce that Dr. Terri Weaver nationally recognized researcher on sleep disorders will be speaking on snoring and sleep apnea the effect on the family.

Dr. Weaver's lecture will be preceeded by introductory comments from Nancy Rothstein, ASAA Board member and committee chair for the SAAD 2007 event. Mrs. Rothstein is the author of a recently published children's book and accompanying web site My Daddy Snores .

A new feature of this year's lecture will be comments offered from the patient's perspective. In keeping with the National Sleep Foundation's theme of women and sleep, speaking will be a young woman who does not fit the profile of an apnea patient. Not fitting the profile led to misdiagnosis and incorrect treatment. Fortunately she found a physician who prescribed a sleep study and with the introduction of CPAP therapy turned her life around.

The lecture will be in Washington, DC and we hope to offer it to a wider audience by means of a webcast. If we are successful there will be a link from the main ASAA web site.

Other scheduled activities for Sleep Apnea Awareness Day 2007 in Washington as well as elsewhere in the United States conducted by members of the A.W.A.K.E. Network of support groups are listed in special notice on the main site.

I hope you can join us, in person or spirit. Please use the occasion of Sleep Apnea Awareness Day to raise awareness about a very serious and very treatable medical condition.