Unlike most of our health problems, we can’t turn ourselves over to a doctor to prescribe a pill or an operation and assume that will solve the problem. After seeing our doctor for tests and prescriptions, we have to take care of our diabetes and our sleep apnea ourselves each day.
Since more people with diabetes also have sleep apnea than practically any other complication that I can think of except neuropathy, we need to know exactly how to advocate for our treatment. This is especially true because, as I wrote in the previous article here, most people with diabetes haven’t yet heard a doctor tell them that they have sleep apnea.
When we get that diagnosis – or better yet – even before that diagnosis, we need to know the choices that we have in the treatment of our sleep apnea. When a doctor diagnosed my sleep apnea about three years ago, I knew some of my options. And I have learned a few things since then that I wish I knew then.
By far the most common and effective treatment for sleep apnea is the CPAP or continuous positive airway pressure device. More sophisticated are the APAP or automatic positive airway pressure device and the bilevel device.
If your condition requires a bilevel device, you can count on your doctor to prescribe it. But it’s likely that no one will even mention that you could get an APAP.
I didn’t even know it existed until a couple of months ago, when I started using the ResMed S8 Autoset Vantage APAP. It works for me far better than my old Respironics REMstar Plus CPAP.
ResMed and Respironics are the two leading sleep apnea companies. They are close in market share. ResMed is the global leader. Respironics leads in the U.S.
ResMed, however, is the only company working on publicizing the relationship between diabetes and sleep apnea. ResMed resulted from the connection between Colin Sullivan, an Australian researcher who invented the first CPAP in 1981, and Dr. Peter Farrell, who founded the company.
An APAP has many advantages over a CPAP. An APAP monitors the state of our upper airway and adjusts pressure automatically throughout the night based on the severity of our breathing problems. Then it delivers the minimum pressure that we need to treat our sleep apnea. This is especially useful for people like me who have lost weight, but people on varying medications or seasonal allergies can also benefit from an APAP.
A CPAP, like my first device for sleep apnea, delivers a fixed pressure throughout the night. A sleep technician guessed how much pressure I needed, and there was only one way I could change it, short of seeing a sleep doctor. And since leaving California two and one-half years ago, I hadn’t found one here in Colorado.
My CPAP does have a setting for three different altitudes. It had begun to seem to me that the pressure setting was too high, because I would often exhale so much air through the mask that it seemed to bubble out of it. Setting the altitude to a lower level than the mile high setting appropriate to where I live in Boulder made it better.
Automatically adjusting to the right pressure is the main advantage of an APAP over a CPAP. But my new APAP is also smaller, quieter, and more attractive than my old CPAP. Furthermore, it comes with a much more attractive carrying case that just has room for my laptop computer when I travel.
The positive airway pressure device is the heart of the system. But two other parts of the system are equally important.
You can count on the sleep lab to offer you several masks. I certainly tried on several before picking a ResMed Mirage Vista mask that has served me well.
Most people prefer a nasal mask like that one. But there are two other main types of mask.
Full face masks are idea for people who breathe through their mouth. Some people prefer the so-called “nasal pillow,” which are less obtrusive. I have no idea if it would be better for me or not, because no one at the doctor’s office or sleep lab ever mentioned it to me.
The third part of the system is a heated humidifier. This was the only component that I was able to advocate for myself when I went to the sleep lab. It was a good thing too, because everyone there seemed reluctant to offer me one, probably because of the cost.
Without a heated humidifier, which I have on both my CPAP and APAP, I know that my mouth would be much drier at night and that the mask would be less comfortable and effective.
My guess is that cost was the reason why no one told me originally about APAP devices. The doctor and sleep lab will send you to a home care company to select the components of your system. In my case they sent me to Apria Healthcare, the largest provider of integrated home health care products and services in the country.
Apria seems to have a bias toward low-cost systems. That probably saved me a few bucks, although like most people, my insurance picked up almost all of the cost.
These are the most important considerations. But there are several excellent resources we can use to make us better advocates for sleep apnea treatment.
The best way to learn about the different sleep apnea choices is to check out Joe Guilford’s website. I can’t use my insurance there, so it is more expensive than going through Apria. But when my dog chewed up my mask, I needed one in a hurry. This website came through overnight.
Especially when we are new to some aspect of our health treatment, it’s useful to see what other people are doing about it. There’s where mailing lists come into play. The major one for sleep apnea is cpapusers.
Two websites offer a lot of valuable information. The National Sleep Foundation have just about everything that we need to know about sleep and the best way for us to get treatment for it.
After reviewing these resources, you will be an active advocate for sleep apnea treatment. The rest is breathing.