All articles by Talk About Sleep

The Talk About Sleep Mission: to be a world leader in the sleep field by providing quality information, support and resources to sleep disorder patients, their family, friends and healthcare professionals.

What Are Circadian Rhythm Sleep Disorders?

Life has changed.

Life used to be simpler. Just a few decades ago, we would get up and wind down with the sun. And we spent much more time outdoors than we do now. This was important for our health, because we each have an internal body clock that depends on sunlight to tell us when to be active and energetic, and when to sleep.

Now with our hectic lifestyles, we often miss these critical signals from the sun, and our body clocks suffer. Without proper morning light, our body clocks don’t produce the hormones we need to wake up and feel active. When we miss daytime light, we slump and become less productive. At night, we usually stay up hours after dark, causing sleep and mood problems. In fact, how we sleep, how active we are and how we feel are all regulated by our body clock.

What are Circadian Rhythms?

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Air Leaking Through the Mouth During Nocturnal Nasal Ventilation: Effect on Sleep Quality

Thomas J. Meyer, Mark R. Pressman, Joshua Benditt, Francis D. McCool, Richard P. Millman, Ranjini Natarajan and Nicholas S. Hill
Divisions of Pulmonary and Critical Care Medicine, The Lankenau Hospital (Wynnewood, PA), University of Washington (Seattle, WA), and Brown University (Providence, RI)
Published in Sleep, Vol. 20, No. 7, pp561-569, 1997


BiPAP is used not only for people with sleep apnea but also for those with respiratory failure from other causes, such as neuromuscular disease. These patients often complain of air leakage through the mouth, just as do sleep apneics. The authors studied the effects of this phenomenon on sleep in six such patients, with two nights of overnight polysomnography, which included audio/videotaping of the face to monitor air leakage around the mask and through the mouth, also identifiable by measurement of mask pressure and estimated airflow into the mask. Four patients, partially sleep-deprived the night before, were also monitored during daytime naps.

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Gastroesophageal Reflux Disease (GERD) Fact Sheet

What is GERD?

Gastroesophageal Reflux Disease, or GERD, occurs when stomach acid moves in the wrong direction, flowing back, or refluxing, up the esophagus (the tube that carries food from your throat to your stomach), and causing discomfort.[1]

What is erosive GERD?

Over time, reflux of acid erodes (burns away) the lining of the esophagus, leading to inflammation and ulcers, a condition called erosive GERD.[2]

When erosive GERD is not treated, it can lead to more serious problems, such as:

  • Bleeding from the lining of the esophagus
  • Esophageal stricture (a narrowing of the esophagus)
  • Barrett’s esophagus (a precancerous change in the lining of the esophagus)[3]

What are the symptoms of GERD and erosive GERD?

Heartburn is the most frequent symptom of GERD and erosive GERD.[4] GERD sufferers also may experience regurgitation, the appearance of refluxed liquid in the mouth[5] that may cause a bitter or sour taste of acid in the back of their throat, as well as other symptoms such as belching, bloating or early satiety (feel excessively full after meals).

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American Academy of Sleep Medicine (AASM)

The American Academy of Sleep Medicine (formerly known as the American Sleep Disorders Association) is the non-profit professional organization for persons practicing Sleep Disorders Medicine. It is based in Rochester, Minnesota. In conjunction with the Sleep Research Society, it co-sponsors the annual scientific meeting of the Associated Professional Sleep Societies, which brings together a number of professional organizations working within the field of sleep medicine, including clinicians, researchers, technologists, and sleep dentists; along with the members of the sleep products and services industry.

The AASM is also the organization that maintains the standards for accrediting sleep centers and sleep laboratories.

The Mission of the AASM

The American Academy of Sleep Medicine has been organized to promote and advance the mutual interests of its members engaged in sleep disorders medicine specifically:

  • To establish, update, and maintain standards for the evaluation and treatment of human sleep disorders and sleep related disorders.
  • To establish and continue to review a standard diagnostic classification of such disorders.
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The Talk About Sleep advocacy mission is to increase sleep disorder awareness in both the public and medical professional communities. This will be achieved by coordinating efforts to “get the word” out through mass media vehicles. Advocacy Services is a highly focused group whose goal is to create global awareness of sleep disorders as a life issue. In general, the Talk About Sleep Advocate is a friend of sleep who disseminates information, motivates groups and influences individuals regarding a wide variety of sleep related issues with the goal of forwarding sleep awareness.

What Is Sleep Advocacy?

National Sleep Foundation/Centers for Disease Control Funding Request

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What is Sleep Advocacy?

Forty million Americans suffer with debilitating sleep disorders, and surveys show that an additional sixty million people experience sleep difficulties more than once per week. The cost to society is lost productivity, wasted medical resources, and a greatly reduced quality of life.

Even more distressing is the fragmented healthcare market which has had great difficulty in channeling resources back into the medical system to help identify and facilitate the management of the primary sleep problem. The paradigm needs to change. Sleep is not a cost center, but an unrecognized medical illness that, in the case of sleep apnea, will result in twice the consumption of medical resources when compared to a similar person without the sleep disorder.

The statistics are graphic. One hundred deaths per night are contributed to by sleep apnea alone. Three out of four people with Narcolepsy remain undiagnosed. The cost of sleep related traffic accidents exceed $64 billion per year.

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The following information is provided by Fisher & Paykel Healthcare

  1. Hayes M J; Continuous nasal positive airway pressure with a mouth leak: effect on nasal mucosal blood flux and nasal geometry, Thorax 1995; 50:(1179-1182)
  2. Richards, G N; Mouth Leak with Nasal Continuous Positive Airway Pressure Increases Nasal Airway Resistance, Critical Care, July 1996,Vol 154 No.1, (182-186)
  3. Massie, C.A., et al., Effects of humidification on nasal symptoms and compliance in sleep apnea patients using continuous positive airway pressure [see comments]. Chest, 1999. 116(2): p. 403-8.
  4. Kline, L R et al., NCPAP Acceptance and Compliance is altered by Humidification. Sleep 1999 (abstract)
  5. Kribbs, N.B., et al., Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea [see comments]. Am Rev Respir Dis, 1993. 147(4): p. 887-95.
  6. Hoy, C.J., et al., Can intensive support improve continuous positive airway pressure use in patients with the sleep apnea/hypopnea syndrome? Am J Respir Crit Care Med, 1999.
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Frequently Asked Questions

The following information is provided by Fisher & Paykel Healthcare

Q. Is it possible for a patient to catch an infection from a humidifier?
A. The environment in the heated humidifier chamber under most operating conditions is such that the majority of pathogens are rapidly killed.

Even if pathogens were able to exist in the humidification chamber, they would not be able to be transported to the patient. The humidity travels from the chamber in vapor form, which is too small for a bacteria or virus to travel in.

BacteriaVirusWater Vapor
Relative Cell Sizes of Bacteria, Virus, and Water Molecules

Q. Will treatment with nasal steroids prevent nasal symptoms from occurring?
A. Nasal steroids assist in the prevention of allergy induced histamine reactions in the nasal airway.

They do not alter the clinical nasal response to cold dry air (10). Heated humidifiers heat and humidify the air so that airways can be maintained under optimum conditions and are not adversely affected by the increased flows of CPAP therapy.

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Compliance with CPAP Therapy

The following information is provided by Fisher & Paykel Healthcare

Nasal CPAP is the treatment of choice for obstructive sleep apnea (OSA) and as with all treatments, its effectiveness is dependent upon the compliance of the user. Initially it was thought that patient compliance was very high. It was reported that approximately 80% of people who started on CPAP were using it seven days a week for the duration of their sleep time.

However, more recently it has been demonstrated that patients significantly overestimate the use of CPAP. In reality fewer than 50% could be considered regular users 3,5.

Several studies have looked at factors that may influence whether or not patients persevere with CPAP treatment. The severity of OSA determined by polysomnography, may or may not influence CPAP compliance. Regardless of actual improvement in the apnea/hypopnoea index (AHI) it is the patients perception of their improvement that increases compliance. If the patient feels that CPAP is beneficial for them they are more likely to comply with the treatment.

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Increase in Nasal Resistance

The following information is provided by Fisher & Paykel Healthcare

In 1995, the American Thoracic Society published a paper by Richards et al entitled Mouth Leak With Nasal Continuous Positive Airway Pressure Increases Nasal Airway Resistance (2). This paper revealed some significant facts:

  • Mouth leaks cause unidirectional (1-way) airflow past the nasal membranes, which causes an increase in nasal airway resistance (NAR).
  • Heated humidification reduces NAR by supplying the required humidity to the air that the nose is unable to supply.

Humidification 1

Patients were using nasal CPAP at 12cm H 2 O with a calibrated mouth leak* of 50 L/min for 10 mins. This graph compares NAR after the mouth leak has taken place. Every subject included in the study exhibited an increase in NAR following mouth leak.

*= Mouth leak was simulated by mouth breathing

Humidification 2

A mouth leak was simulated while the patient was on CPAP with room air, cold passover humidification and heated humidification.

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