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New Positional Obstructive Sleep Apnea Therapy

By Jerrold Kram, MD, FCCP

A recently published study found that over 70% of those diagnosed obstructive sleep apnea and having an apnea-hypopnea index less than 60 are at least twice as severe when sleeping on their back as compared to other (non-supine) position.

This condition is referred to as “positional obstructive sleep apnea” (POSA). The most commonly recommended approach for treating POSA is to sew tennis balls into a night shirt. Several manufacturers (REMatee and Zzoma) developed commercial adaptations of the tennis-ball approach using cushions held in place by a waist belt or shoulder harness to restrict back-sleeping.

I recently read very promising study results using a novel position therapy device called the Night Shift. Worn on the back of the neck, Night Shift begins to vibrate when users start to sleep on their back and slowly increases in intensity until a position change occurs. For patients with POSA, 90% responded to Night Shift therapy and had a median apnea-hypopnea severity reduction of 79%!  

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United States: House Passes Bill Requiring Formal Rulemaking Before Implementing Pilot Sleep Apnea Policy

Article by Ilyse W. Schuman

 The House of Representatives overwhelming approved a bill (H.R. 3578) that would require the Federal Aviation Administration (FAA) to use the formal rulemaking process to adopt any new or revised requirement providing for the screening, testing, or treatment of pilots for a sleep disorder.  By the same token, the FAA could institute such a policy for air traffic controllers only if it meets its obligations pursuant to chapter 71 of title 5 of the U.S. Code.

This bill was introduced a day after the FAA announced a new planned policy that would require aviation medical examiners (AMEs) to calculate the Body Mass Index (BMI) – a method for identifying obesity and a measurement that is related to risk of sleep apnea – for every pilot.  Under the terms of the planned policy, pilots with a BMI of 40 or more would need to be evaluated by a physician who is a board-certified sleep specialist, and, if diagnosed with obstructive sleep apnea, treated before they could be medically certified.

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The end of insomnia? Scientists discover the ‘switch’ that tells the brain to go sleep


  • Switch works by regulating neurons in the brain when the body is tired
  • They demonstrated the theory on fruit flies, creating insomniac insects
  • Scientists believe there is a similar group of neurons in the human brain
  • Researchers are now trying to find out how to activate the sleep switch

Scientists think they have discovered the switch in the brain that tells our bodies when to go to sleep.

The discovery, made by neurologists at Oxford University, could pave the way for a treatment to combat sleep disorders such as insomnia.

The scientists think the switch works by regulating neurons, or nerve cells, in the brain. 

Described as a ‘homeostat’ which can tell when someone has been awake for too many hours, the mechanism fires when the body is tired.

Scientists think they have discovered the switch in the brain that tells our bodies when to go to sleep

Scientists think they have discovered the switch in the brain that tells our bodies when to go to sleep

Professor Gero Miesenböck, whose team conducted the research, said: ‘When you’re tired, these neurons in the brain shout loud and they send you to sleep.’

The researchers demonstrated the theory on fruit flies, removing the switch to create insomniac insects.

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Study proposes novel treatment for narcolepsy

Published In Medical News

October 10, 2013

Lancet Neurology, a prestigious journal in its domain, publishes in its last issue, an article entitled “Pitolisant versus placebo and modafinil in patients with narcolepsy: a double-blind randomised trial” authored by Y. Dauvilliers and others from the HARMONY I study group which proposes a novel treatment for this orphan disease. It is accompanied by a Commentary entitled “A need for new treatments in narcolepsy”.

Narcolepsy is a rare disabling disorder mainly characterised by Excessive Daytime Sleepiness (EDS) and cataplexy, a sudden loss of muscular tone following various emotions. Present treatments comprise psychostimulants, like modafinil or amphetamine-like compounds, to fight EDS and sodium oxybate or antidepressants against cataplexy attacks. However these treatments are not fully satisfactory in terms of efficacy, tolerance or administration.

Pitolisant is the first representant of a new class of drugs to be introduced in the clinics, the histamine H3-receptor antagonists; it was designed in 3 European academic laboratories and developed by Bioprojet, a small independent French pharmaceutical company.

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Abstract: Effects of a Heated Tube on Sleep Quality, With Active Heated Humidification During CPAP Therapy In a Cool Sleeping Environment

Printed with permission from Fisher&Paykel Healthcare

Poster Session: Advances in Obstructive Sleep Apnea
Nilius, Georg, Domanski, Ulrike, Franke, Karl-Josef, Ruhle, Kral-Heinz
Chest 2005 128: 232S-a


To compare the effect of conventional humidification with ThermoSmart™ heated breathing tube humidification on sleep quality and patient symptoms.


  • 19 OSA patients, prospectively recruited.
  • Patients underwent two full nights of polysomnography (PSG), in a cool room, whilst on CPAP at their pre-determined therapeutic pressure. Their first night was randomized to either conventional heated humidification or ThermoSmart™ heated breathing tube humidification. Patients crossed over to the alternative treatment arm on their second night.
  • PSG parameters were analyzed to determine objective quality of sleep and subjective questionnaires were administered to determine patient symptoms/side effects of therapy.


results graph

results graph


If condensation forms in the CPAP tubing system sleep quality is considerably reduced. When using CPAP therapy in a cool room, the use of a heated humidifier with a heated breathing tube improves sleep quality and subjective symptom scores.

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