New version of Free Money, Come and Get It!!

I'm not going to comment on this just now. It made me too angry. It was done in 1992..updated in '98. What on earth are they waiting for?

Recommendation Six: An Educated America

The lack of awareness throughout America about the nature and impact of sleep disorders and sleep deprivation is a national emergency. Witnesses asked repeatedly, "How many preventable deaths are going to occur this year?" "Why don't we do something right now?" "Why don't we save as many lives as possible now ‹ not years or decades from now?" The Commission has concluded that the American public has been inappropriately denied the benefits of the research knowledge its tax dollars have supported. The Commission recommends that a major public awareness/education campaign about sleep and sleep disorders be undertaken immediately by the federal government.

http://www.stanford.edu/~dement/overview-ncsdr.html

Just to put that all in perspective, AIDS killed exactly 13,658 Americans in 2003, less than three times the number that died from cardiovascular disease directly attributable to sleep apnea (38,000).

From a public awareness perspective, how many people know about AIDS as compared to OSA? I almost hate to ask the question.

But now that between 50 and 65 million Americans are at "high risk" for sleep apnea maybe something will happen?

The Commission recommends that a major public awareness/education campaign about sleep and sleep disorders be undertaken immediately by the federal government.

I think that says it all, right there!

Den

Several have asked me to take a shot at putting the most recent studies and stats together in an article to be posted under Our Collective Wisdom. Here is a draft--I'd like to invite comments before submitting it. I'd be happy to provide references.

Are You Sleeping with the Enemy?

By SleepGuy

There’s much to be said about sleep apnea: It may well be the most significant, costly, easily treated, and least understood public health issue facing our nation. The most recent studies predict that over 50 million Americans (one third of all men and one fifth of all women) are at “high risk” for having sleep apnea. And very few of them have the slightest idea what sleep apnea is, much less that it may be affecting their lives in profound ways.

Apnea is the medical term for “stopping breathing.” Sleep apnea is the temporary cessation of breathing during sleep, often lasting for ten seconds or longer. At that point the body wakes up just enough to resume breathing and disrupt sleep, but usually not enough to awaken the individual. As a result, most people suffering from sleep apnea are not aware of their condition. The most common type, obstructive sleep apnea, occurs when the tongue and/or other soft tissues in the throat block the airway. Apneas can occur dozens or even hundreds of times every night. Common symptoms include loud snoring and a gasping or snorting sound, high levels of daytime fatigue, irritability, depression, and loss of judgment.

The Astounding Prevalence of Sleep Apnea in America
The numbers are shocking. The most recent studies have shown that one in four adults in the United States (31% of all men and 21% of all women over 18) is at “high risk” for OSA, based on analysis of the National Sleep Foundation’s 2005 Sleep in America survey. Another recent study showed that one third of adults who visit a primary care doctor are at “high risk” for sleep apnea. Based on the 2000 Census, that means that between 50 and 65 million Americans likely suffer from sleep apnea. This estimate far higher that previous estimates, which estimated that between 10 and 18 million Americans had sleep apnea. Increasing obesity rates and an aging U.S. population have been cited for the significant increase in OSA prevalence estimates.

The Surprising Human and Economic Toll
According to the National Commission of Sleep Disorders Research, 38,000 cardiovascular deaths a year in the United States are directly attributable to sleep apnea. On top of that, sleep apnea is associated with a large number of serious, co-morbid medical and psychological conditions Sleep apnea is also related to a large number of medical and psychological conditions, such as hypertension, abnormal heart rhythm, sleep deprivation, stroke, hearth disease, diabetes, depression, memory loss, poor judgment, and change in personality. As a result, undiagnosed and untreated sleep apnea victims are significant consumers of healthcare services.

In Canada, sleep apnea victims were shown to consume 23 to 50% more medical services in the five years prior to diagnosis than control subjects, with hypertension and cardiovascular disease accounting for the majority of increased costs. A recent study from Israel also showed that healthcare utilization was 1.7-fold higher by sleep apnea patients compared to the control group, with the upper 25% of the most costly sleep apnea patients accounting for 70% of the total healthcare expenditures. Other studies have demonstrated that successful sleep apnea treatment results in significant improvement in co-morbid conditions.

In the United States, total healthcare costs associated with cardiovascular disease is estimated to be $40.4 billion annually, causing over 685,000 fatalities in 2003. Hypertension healthcare costs in the United States are approximately $19 billion. It is not known what percentage of all cardiovascular and hypertension healthcare costs are attributable to untreated sleep apnea but in light of the fact that between 50 and 65 million Americans are at high risk for the disease, it stands to reason that undiagnosed and untreated sleep apnea account for hundreds of millions—perhaps billions—of healthcare dollars spent treating conditions that could be more effectively and far more economically treated as a sleep disorder.

Collateral Impacts
Collateral impacts arising from 50 to 65 million clinically sleep-deprived people in the United States are almost incalculable. One report focusing on highway safety impacts from sleep apnea concluded that more than 800,000 sleep-apnea related highway accidents occurred in 2000, resulting in 1,400 fatalities and costing nearly $16 billion. If the same analysis were performed today using the new, much higher sleep apnea prevalence rates, the highway safety impacts would probably be twofold higher. Sleep apnea-related losses due to worker productivity, industrial accidents, clerical mistakes, sick leave, and so forth would be almost impossible to calculate but given the numbers no doubt amount to the billions of dollars annually. On top of this, the personal quality of life impacts—depression, personality changes, lack of judgment, irritability, etc.—cannot possibly be measured in economic terms.

Simple, Economic Treatment
The best news in sleep apnea is that it is a condition that is easily and economically treated. Continuous positive airway pressure (CPAP) therapy is the treatment of choice for obstructive sleep apnea and has been proven to be highly effective in treating sleep apnea and improving a number of co-morbid conditions. CPAP therapy consists of a ventilatory device that applies positive airway pressure at a constant, continuous pressure to help keep the airway open, allowing the patient to breathe normally during sleep.

Where to Go from Here
The biggest problem facing sleep apnea is public awareness. Unfortunately, a large number of doctors are still not very familiar with sleep apnea or its treatment. An excellent place to start is for an individual who suspects he or she may be suffering from sleep apnea to fill out a one-page, ten question survey called the “Berlin Questionnaire” that is widely available on the Internet. This questionnaire is simple, fast, and is highly predictive of sleep apnea—the positive predictive value of the survey for people scoring as “high risk” is 89%. A number of overnight screening assessment tools are also available. A formal sleep study is necessary, however, to diagnose sleep apnea and obtain CPAP treatment.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): news, CPAP

I think that says it all, right there!

Den

Den...you may be absolutely correct.

The Commission specifically stated:

The Commission has concluded that the American public has been inappropriately denied the benefits of the research knowledge its tax dollars have supported.

And since that was included, I am adding my elected officials to my mailing list. May not do any good, but I will have tried.

Well, we know what it takes to get things accomplished at ANY level of government.....$$$$$$ (with lots of zeros). And, that's just for campaign contributions just to get their attention (he said, cynically). I don't know if things have changed much (or not) since the Abramhoff scandal got a bunch of them run out of office.....but we've got some new money-grubbers in there now.

Let the GRIDLOCK continue.....!!!

Den

I'm damn mad and I for one am not going to take it anymore. You guys inspire me so much. SleepGuy, your actions will pay off, I promise you. We're not needing to belt a grand slam, but we for sure need to start consistently hitting singles and doubles.

Hats off to you and others who "do something, even if it is only a little."
And your contributions here are not "only a little"

Thanks for helping lead the charge.

Hi Everybody, I am new to the board and registered with the name 'Auricula,' which was accepted at the time. When I try to post I am told the username has been taken. For the moment I will try to post under 'XXX.'

I am very enthusiastic about the ideas posted in this thread so far and could best help with making editorial suggestions. I was trained as a technical editor at a medical publishing company and worked in the field for over 20 years. I was diagnosed with severe obstructive sleep apnea last spring at age 65 but feel I had symptoms dating to childhood, so I am very interested in making this condition better known to the public. Had my internist recognized the signs that were there 10 years ago perhaps my condition could have been arrested at the mild or moderate stage.

Following is a cut-and-pasted version of the original draft with some suggestions based on just a quick reading. If you would like me to do a careful editing of a final draft it would be my pleasure.

The title is great and will catch the reader's attention. The quality of the writing is quite professional.

Are You Sleeping with the Enemy?

By SleepGuy

There’s much to be said about sleep apnea: It may well be the most significant, costly, easily treated, and least understood public health issue facing our nation. The most recent studies predict that over 50 million Americans (one third of all men and one fifth of all women) are at “high risk” for having sleep apnea. And very few of them have the slightest idea what sleep apnea is, much less that it may be affecting their lives in profound ways.

Apnea is the medical term for “stopping breathing.” Sleep apnea is the temporary cessation of breathing during sleep, often lasting for ten seconds or longer. At that point the body wakes up just enough to resume breathing and disrupt sleep, but usually not enough to awaken the individual. As a result, most people suffering from sleep apnea are not aware of their condition. The most common type, obstructive sleep apnea [ADD '(OSA)' SINCE YOU USE ACRONYM LATER?], occurs when the tongue and/or other soft tissues in the throat block the airway. Apneas can occur dozens or even hundreds of times every night. Common symptoms include loud snoring and a gasping or snorting sound, high levels of daytime fatigue, irritability, [ADD 'MALAISE AND'?] depression, and loss of judgment. [ADD 'IMPAIRMENT OF SHORT-TERM MEMORY'?] [ADD SOMETHING RELATING TO FAMILY OR INTERPERSONAL RELATIONSHIP PROBLEMS?] [ADD LOSS OF PRODUCTIVITY/PERFORMANCE IN THE WORKPLACE?] [DISCUSS THE REPERCUSSIONS TO THE BRAIN WHICH IS STARVED FOR OXYGEN?]

The Astounding Prevalence of Sleep Apnea in America
The numbers are shocking. The most recent studies have shown that one in four adults in the United States (31% of all men and 21% of all women over 18) [SOMEHOW THE PREVIEW SCREEN IS SHOWING A SMILEY FACE INSTEAD OF THE '8)' HERE] [AGAIN THERE IS A FACE INSTEAD OF AN EIGHT AND PARENTHSIS; WHY IS A MYSTERY TO ME'] is at “high risk” for OSA, based on analysis of the National Sleep Foundation’s 2005 Sleep in America survey. Another recent study showed that one third of adults who visit a primary care doctor are at “high risk” for sleep apnea. Based on the 2000 Census, that means that between 50 and 65 million Americans likely suffer from sleep apnea. This estimate far higher that previous estimates, which estimated that [SUGGESTED REVISION TO AVOID USING ESTIMATE 3X -- 'THIS IS FAR HIGHER THAN PREVIOUS ESTIMATES, WHICH PROJECTED'] between 10 and 18 million Americans had [HAVE] sleep apnea. Increasing obesity rates and an aging U.S. population have been cited for the significant increase in OSA prevalence estimates.

The Surprising Human and Economic Toll
According to the National Commission of Sleep Disorders Research, 38,000 cardiovascular deaths a year in the United States are directly attributable to sleep apnea. On top of that, sleep apnea is associated with a large number of serious, co-morbid medical and psychological conditions Sleep apnea is also related to a large number of medical and psychological conditions, such as hypertension, abnormal heart rhythm, sleep deprivation, stroke, hearth disease, diabetes, depression, memory loss, poor judgment, and change in personality. As a result, undiagnosed and untreated sleep apnea victims are significant consumers of healthcare services.

In Canada, sleep apnea victims were shown to consume 23 to 50% more medical services in the five years prior to diagnosis than control subjects, with hypertension and cardiovascular disease accounting for the majority of increased costs. A recent study from Israel also showed that healthcare utilization was 1.7-fold higher by sleep apnea patients compared to the control group, with the upper 25% of the most costly sleep apnea patients [UPPER 25% OF THE SLEEP APNEA PATIENTS WHO CONSUMED THE MOST RESOURCES] accounting for 70% of the total healthcare expenditures. Other studies have demonstrated that successful sleep apnea treatment results in significant improvement in co-morbid conditions.

In the United States, total healthcare costs associated with cardiovascular disease is [ARE] estimated to be $40.4 billion annually, [REVISION NEEDED HERE -- THE COSTS DID NOT CAUSE THE FATALITIES; PERHAPS MAKE A NEW SENTENCE AND CLARIFY THE FOLLOWING PHRASE] causing over 685,000 fatalities in 2003. Hypertension healthcare costs in the United States are approximately $19 billion. It is not known what percentage of all cardiovascular and hypertension healthcare costs are [IS] attributable to untreated sleep apnea but in light of the fact that between 50 and 65 million Americans are at high risk for the disease, it stands to reason that undiagnosed and untreated sleep apnea account for hundreds of millions—perhaps billions—of healthcare dollars spent treating conditions that could be more effectively and far more economically treated as a sleep disorder. [SOMETHING COULD BE SAID HERE ABOUT IMMENSE SAVINGS IN PHYSICAL PAIN AND MENTAL ANGUISH THAT COULD BE AVOIDED FOR PATIENTS WHO WILL NOT NEED INVASIVE HEART TESTS, PROCEDURES, AND SURGERIES, TO SAY NOTHING OF SAVINGS OF LIVES OF THOSE WHOSE DISEASE WILL NOT PROGRESS TO DIRE STAGES AND DEATH.]

Collateral Impacts
Collateral impacts arising from 50 to 65 million clinically sleep-deprived people in the United States are almost incalculable. One report focusing on highway safety impacts from sleep apnea concluded that more than 800,000 sleep-apnea related highway accidents occurred in 2000, resulting in 1,400 fatalities and costing nearly $16 billion. If the same analysis were performed today using the new, much higher sleep apnea prevalence rates, the highway safety impacts would probably be twofold higher. Sleep apnea-related losses due to worker productivity, industrial accidents, clerical mistakes, sick leave, and so forth would be almost impossible to calculate but given the numbers no doubt amount to the billions of dollars annually. On top of this, the personal quality of life impacts—depression, personality changes, lack of judgment, irritability, etc.—cannot possibly be measured in economic terms.

Simple, Economic Treatment
The best news in sleep apnea is that it is a condition that is easily and economically treated. Continuous positive airway pressure (CPAP) therapy is the treatment of choice for obstructive sleep apnea and has been proven to be highly effective in treating sleep apnea and improving a number of co-morbid conditions. CPAP therapy consists of a ventilatory device that applies positive airway pressure at a constant, continuous pressure to help keep the airway open, allowing the patient to breathe normally during sleep.

Where to Go from Here
The biggest problem facing sleep apnea is public awareness. Unfortunately, a large number of doctors are still not very familiar with sleep apnea or its treatment. An excellent place to start is for an individual who suspects he or she may be suffering from sleep apnea to fill out a one-page, ten question survey called the “Berlin Questionnaire” that is widely available on the Internet. This questionnaire is simple, fast, and is highly predictive of sleep apnea—the positive predictive value of the survey for people scoring as “high risk” is 89%. A number of overnight screening assessment tools are also available. A formal sleep study is necessary, however, to diagnose sleep apnea and obtain CPAP treatment.

POSSIBLE ADDITIONS
Mention treatment alternatives to CPAP, e.g. dental devices and ENT surgery?
State that most insurance plans, including Medicare, will pay for testing and therapy.
Give an actual link to the Berlin Questionnaire?

Just getting home from a "hard day at the office", and I have neither the energy nor intellect currently to say anything more than BRAVO.

You guys ROCK!

Just one other thing:

driving home, I was thinking of all the wonderful things that have been accomplished by Activism.

A child of the people power revolution, I laid down on railroad tracks (with many others) to protest the movement of a train load of munitions headed for Viet Nam back in the early 70's. I don't say it to brag, but man, those days were exhilirating because people power was in full bloom.

Power to the people, right on - John Lennon, right?

You heard of be-in's ,sit-in's, etc. but who could forget John (and Yoko) and their tremendously powerful Bed-in?

Between March 25 and March 31, John and Yoko spent their honeymoon at the Amsterdam Hilton staging their famous "Bed-In" for peace. John Lennon stated, "We're staying in bed for a week, to register our protest against all the suffering and violence in the world."

"How do You Sleep?" was released on John's second solo album, "Imagine", on September 9, 1971. The title track of this album has become one of the most popular songs of all time, and more importantly, remains as powerful today as it was decades ago.

http://www.mobovivo.com/program-bedin.html

I'm starting to get some realllllly crazy ideas about how to bring our cause in to the public eye on March 8, National Sleep Apnea Awareness Day. Think creatively. I don't know what it would take for people to have a Sleep-in across the United States (in prominent places, of course), but we gotta dream big (pun intended).

Or if you don't dream big, maybe you can recall another song that John wrote: Imagine.


Lyrics for: How Do You Sleep?

So Sgt. Pepper took you by surprise
You better see right through that mother's eyes
Those freaks was right when they said you was dead
The one mistake you made was in your head

Oh how do you sleep?
Oh how do you sleep at night?


I say "sic 'em" ':twisted:'

Hello everybody! Drbandage's message is vital. Nobody is going to advocate for us or the millions who don't yet know they are in the same boat. We have to be the advocates. I talk about my own experiences with sleep apnea every chance I get. It helps me find the people who should be getting tested. And I give them all the info I can. Tonight something happened that brought it home to me more than ever. My three year old is visiting from Florida with his Mom. He laid down on his blanket to take a nap and immediately began to snore. It was cute to everyone else more than to me. My sister said he does it all the time. I asked if he snores when he sleeps on his side. Later I noticed that he did not. I warned my sister that apnea can show up even in kids. She thanked me for giving her something new to worry about. I suggested she get him a sleep study instead of worrying. I don't know what else to do, but I promise to come up with something. The sleep in sounds like one idea. I say we hit the problem from a bunch of angles.

Hiya, Folks.

I note that apart from the previous post, all the good chat and work on this thread seems to have stopped a year ago.

Has anything happened, or did all of you great people die in a plane crash?

I know I've been trawling the net for information (of course, after I was ripped off by my Aussie version of a DME), and I've been banging on on other threads about this very issue because I've not been able to EASILY find information.

My search eventually brought me to this forum, and its Collective Wisdom. There is some brilliant information on that, BUT there is also a great slew of equally brilliant information buried in the pages of the forum. Unless you have endless hours (retired or whatever) you don't have the time to trawl through the THOUSANDS of webpages brought up in some searches. The information needs to be easily accessible to time short people.

If only someone would set up an authoritative INDEPENDENT website, with all this great information hanging off it, the ONLY information any doctor would need to do is refer the patient to the site, so that they're armed with information before getting a sleep test, before being ripped off by DMEs, insurers, equipment suppliers.

I don't have the time, sadly, nor do I have the necessary range of skills. But surely there's someone out there in apnea land who does.

Advertisements and the kind would not need to include great swags of information about apnea, it would only need to refer a person to the one website. When searching, hopefully that website would come up at the head of the list of items found.

Come on, guys, surely there's someone out there. Please!!!!!??????

Regards,

Hopeful GrizzlyBear

GrizzlyBear wrote:If only someone would set up an authoritative INDEPENDENT website, with all this great information hanging off it, the ONLY information any doctor would need to do is refer the patient to the site, so that they're armed with information before getting a sleep test, before being ripped off by DMEs, insurers, equipment suppliers.

I don't have the time, sadly, nor do I have the necessary range of skills. But surely there's someone out there in apnea land who does.]

Someone did.

Her nickname on this message board is Mile High Sleeper.

http://www.smart-sleep-apnea.blogspot.com/

The trick, however, is getting doctors aware enough about OSA in the first place, so that they'll inquire about their patients' sleep when the patient has a doctor's appointment for ANY reason.

The simple 8 question Epworth test should be handed to EVERY patient sitting in the waiting room...to fill out right then and there. And be given to the doctor BEFORE the doctor enters the exam room. Don't just stick it in the patient's file. Have it out on top of the clipboard so the doctor sees it first.
http://www.stanford.edu/~dement/epworth.html


If religiously handing out that simple questionnaire is too much to expect of doctors' offices, then the doctor should at least ALWAYS ask this question in the exam room no matter why the patient has come in.

"Has anyone ever said they heard you snore...even once?"

Don't ask, "Do you snore?" Not many people have ever heard themselves -- 'cause they are ASLEEP, for pete's sake. Also, some women would be embarrassed to admit they snore. So unladylike. Make it less personal. Ask, "Has anyone ever said they heard you snore?"

If the answer is "Yes", the doctor should immediately order an overnight recording pulse oximeter test for that person to do at home.

If the answer is "No", but the person is overweight, the doctor should still order the overnight pulse oxi test. Yeah, I know, I know...thin people can have OSA too. But I'm talking about something that even the busiest doctor could notice -- the patient right there in front of him being overweight.

Those simple things done in EVERY doctor's office across the country could lead millions of undiagnosed sleep apnea sufferers to diagnosis and treatment.

Talk about cutting down on heart attack, stroke, diabetes, fatal car accidents.... wow!

So simple.

But do family doctors routinely ask or notice? Or even know what to ask, or what to notice?

In my opinion:

1. Every cardiologist should send every single one of their patients for a PSG sleep study.

2. Every doctor who has a patient who has ever had a heart attack or stroke at any time in the past should send that patient for a PSG sleep study.

3. Every doctor who is treating someone for GERD (acid reflux) should send that patient for a PSG sleep study.

4. Every doctor who is treating someone who is obese should send that patient for a PSG sleep study.

5. Every doctor who is treating someone for high blood pressure should send that patient for a PSG sleep study.

Did I say millions of people with undiagnosed sleep apnea?

It's the doctors who are dropping the ball -- not understanding we're not just talking about "getting sleep." Sleep Apnea is about suffocation. It's about trying to breathe through an airway that literally slams shut when the person is not awake.

Doctors who don't understand that it's about getting oxygen TO the brain and heart, not just about "getting a good night's sleep" will never take "sleep apnea" seriously. Even the ones who do understand it fairly well probably are still not routinely screening for it right there in their own offices.

They'll routinely take a person's blood pressure and check their temperature. But do they ever routinely ask about snoring? Do they ever administer the Epworth Sleepiness Scale test? Do they ever order an overnight pulse oxi test for their overweight patients?

Well said RG ... as usual

Hiya,

It's true that GPs need to be better informed about asking about sleep - and that is undoubtedly one track of information/education that needs to be promoted.

However, it is also true that we need to get good quality educational information out to people who have been (or perhaps more to the point, are about to be) diagnosed with OSA.

It has taken me WEEKS to find out about Mile High Sleeper Gal's blog - and on my so far brief examination, it looks wonderful. But why has it taken me so long to find it????

We still need more easily accessible information. I know all you people are wonderful, and I'm VERY grateful, but why was I not told of the blog after my first entry into this forum? Why did not my GP or my sleep clinic not inform me? Well, I know why the latter didn't - but the former probably didn't, because he's never heard of it. He will know very shortly, however, because I will tell him.

I will also be writing to our GPs' organisations to try and get them to better inform their members.

Regards,

GrizzlyBear