Saturday, June 02, 2012
Sleep apnea -- the new fad?
There is a new buzz word out there... it's called sleep apnea and some employers are requiring employees to submit themselves to sleep apnea testing which may result in be required to use CPAP Machine or lose their jobs.
Think this won't happen to you?
There is a wide variety of "visible" conditions that may cause an employer to suspect that you may be suffering from sleep apnea even if you are not falling asleep at the job. Some of those conditions ranged from being overweight, having a thick neck to even have in a small jaw.
Once diagnosed with sleep apnea, you may be required to wear a CPAP machine for the rest of your life.
Refusal to comply [as these machines keep a record] may be grounds for termination.
In some states, if you get into an accident [both commercial and noncommercial driving] may cost you your license if you are not using your machine.
Personally, I think it's bull shit, and although I have not been diagnosed with sleep apnea... I've already made it very clear with my employer that they can take the job and shove it and I think more people should do the same because just like with any new "fad" this can be taken to the extreme.
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I suffered from sleep apnea for ten years and I can't believe the difference using the CPAP has made in my life. During the sleep study, I had a event every 45 seconds. That means I would start to sleep and every 45 seconds I would wake up. I didn't realize what was going on but I never got into a dream state. The normal number of events is under 5 per hour. I would sleep during movies, meetings, and even fell asleep at a Duck football game. Now I dream in color, can stay awake while watching TV, and my blood pressure has gone down and stabilized. Sleep apnea is really hard on a person's body and if they think they may have it, they should see their doctor for a referral to the sleep center at PeaceHealth at Riverbend.
Gary:
That's great Gary I'm glad that it helps you.
However, it should be a voluntary treatment and not a device that records your COMPLIANCE THE USE!
In other words, it should not be a life sentence.
In my investigations one of the questions that was asked is what about on your off time or weekends or if you are on vacation do you have to use your machine? The answer was, "yes. In order to remain in compliance."
It is way too easy to be diagnosed positive for sleep apnea and thereby be required for treatment.
The other thing that I do not hear talked about very often, is there are alternatives to the CPAP machine. Surgery for example has a 50-50 success rate while the mouthpiece similar to what football players use has an 80% success rate.
The other issue that is important, is that if you are a commercial driver and you test positive for sleep apnea and you think that you can just quit your job and walk away from it, you're dead wrong. It's now on your record.
What I recommend to people especially commercial drivers whose company wants to send them for sleep apnea testing is to refuse and especially do not quit your job. Let them fire you because currently it is not the law!
Additionally, even if you are not a commercial driver and you are tagged positive for sleep apnea you risk losing your license if you do not follow treatment or not in compliance of use.
That's why I say this is just one of those fads that is going to be taken to the extreme and people should stand up and challenge it [legally] now.
As a sleep tech, I see people that suffer from sleep apnea and have their lives changed for the better because of treatment. Myself included. You're percentages are incorrect. CPAP use has a greater than 95% success rate with the proper pressure and mask. The surgery can be up to 50% success, but, it usually fails after approximately 2 or 3 years. Technology is improving, but the current tech isn't there. The mouth guard has a success of about 30% or less. The biggest issue with them, is the doctors that sell them. Few people are good candidates for the oral deice but the doctors can make a mint on them.
With all that, the dangers of driving while sleepy are as bad or worse than driving drunk. CDL holders have a huge responsibility while on the road. Would you want someone with narcolepsy or seizures driving a truck untreated? Severe sleep apnea can be, and often is, worse.
I truly understand the threat to your job, but I encourage you to try to understand sleep apnea.
Sleep apnea is sleep deprivation and oxygen deprivation every time you sleep, and for many, it happens more times a night then not. Sleep apnea is directly related to heart failure, stroke, heart disease, amplifies every ailment you have and can cause medications to be useless. Failure to use treatment every night, means you are untreated that night. I do not sell equipment or work for a doctor that pushes them. As a person that has been treated for close to 8 years, I diagnose those with sleep apnea and try to help them find relief. Not everyone has it. Not everyone can tolerate treatment. But to risk the lives of every person that you share the road with, that's just irresponsible.
Testing is easy and getting easier with home testing. Sleep apnea treatment isn't a death sentence, but untreated sleep apnea is. Just as I want CDL operators tested, I also want surgeons tested. You have lives in your hands, be awake while doing your job. That goes for me too. You wouldn't want me running your test is I wasn't compliant with treatment. You also wouldn't want me on the road.
Cheezer - I understand that the treatment MAY work for some people however, you're totally missing my point.
My point is, unless you're actually having issues such as falling asleep at work then why should you be forced to go take the test against your will and have this on your personal record and with you the rest of your life?
Why are people being sent for testing simply because they may have a large neck?
Otherwise yes, I do agree that if your having problems staying awake, then you should find out why and do something about it.
And since you work at a sleep clinic... what are the percentages of people who come in for testing that actually tests positive?
I have asthma, and we are in the height of the hayfever season and lymph nodes are little bit swollen, do I run the risk of testing positive and being stuck with this damn machine for the rest of my life? Seriously, I really don't know the answer.
See, my biggest argument is that this will affect you outside of your job and when people go take the test, they're not told what are actually getting into.
[forget about the week long camping trip, or snuggling with your spouce]
It is currently not the law and not a pre-employment condition at my job and therefore, I should have a choice and my choice is that I'm currently not having any issues and I will NOT go do the test and they will have to fire me!
P.S. I got my data from U.S. Department of Health & Human Services on sleep apnea
Camping is still an option. There are battery powered unit, solar charger, etc.. If you have a camper or trailer, just plug it in. snuggling is doable as well, the mask isn't that bulky. Granted, there are things to over come. However, if you have the snoring that is common with apnea, your bed partner and camping friends would rather you were wearing the CPAP. I do not sleep in public because my snoring is so loud, I would likely be smothered by someone near by. It would be justifiable. It would be selfish of me to do that to them.
In my lab, I would guess that 75% of the people have apnea. But, by the time you get to our lab, you have been screened. You have to meet certain criteria before we accept you. You must have more than just snoring or a thick neck. If you enter here, you likely have several issues such as excessive day time sleepiness, snoring, hypertension, heart disease, diabetes, kidney failure, dementia, etc... We also get the CDL employees and police, fire and other emergency personnel.
If you have a narrow airway and you have swelling during the allergy season, you will likely exhibit mild apnea. You must have more than 5 apneas per hour average to be considered abnormal. Less than 5 per hour is normal. However, if your oxygen levels drop below 90% then you are at higher risk for other health concerns and treatment would be an improvement to your life. I can't tell you how many people I see that have their lives improved by treating apnea. Even mild. It is progressive and not always weight related. However, if you have apnea, it is almost always weight aggravated and weight loss should reduce the severity. Myself, I was diagnosed when I was within medically preferred BMI (in human eyes, I was under weight) now I am obese (by medical definition and average human opinion). So if I lose weight, my apnea will not be as severe, but I will never be cured. I am not a candidate for surgery or oral appliance.
I too have seasonally effected asthma, and when it is under moderate control, my apnea is less sever. Meaning, my pressure is lower. Asthma does not mean apnea. But again, can aggravate it.
As for employment, the employer needs to protect itself from harm and that includes insurance costs. If the cost of insurance drops because your drivers have been screened and or treated and the risk of accident has been reduce, then they have an obligation to do so. It could mean the difference between closing the doors or not. A serious accident can bankrupt a company. The cost of insurance can also push a company out of being able to bid jobs competitively. It is in their best interest to reduce costs to protect their employees, investors and the customers. May not be a popular decision, but it may be the right one. You do have the option to look for work elsewhere. I do not agree that an employer should be deterred from hiring a person diagnosed with apnea, but I do believe they would be in their right to check compliance as part of a pre-employment physical and health screening.
I know, not what you want to read. Just my opinion as a person with sleep apnea and one that sees people suffer with it daily. I am not a doctor or nurse, I am only a Technologist. I run studies and begin treatment as spelled out by a sleep specialist doctor that follows national guidelines. I also see people every shift, that are heavily medicated or in such poor health, that they should never be permitted in the front seat of a car as a passenger, let alone as a driver. Its a crazy world.
I agree with your last point... but then again there are people that are on the road that can't walk and chew gum at the same time but their job is not being threatened because of it.
Again, I'm not arguing the effectiveness of the treatment... what I am arguing is the fact that you have to make the decision to lose your job for something that you are showing no signs or symptoms of.
Even answering a question wrong on the survey [which everybody has to take] can send you to the sleep apnea clinic.
My other point is, if the treatments work so good... then why are you not given a choice of the treatment?
Once diagnosed positive with sleep apnea, your ONLY choice is a CPAP machine and that is because they can monitor you for compliance.
Again, if it works so damn well... why is it necessary to monitor you for compliance. I would think you would want to use it to feel better.
The other issues that are related to, is it is just like if your company requires you to have the Company logo tattooed on your left arm or be fired?
How does that relate as an example?
Simple... both are permanent and affect you outside of your job.
Secondly, if your job is your job is requiring it then you should be paid for your time and reimbursed for the equipment.
We'll be talking about this in an upcoming radio program and I would like to invite you to participate if you're interested.
Sorry I dropped off the face of the planet.
I appreciate your offer to have me on radio, but I am horrible in those situations. You would lose listeners from the dead air and um, um, um , uhuh... Also, I work nights and it appears your show is on mid afternoon.
To answer "Again, if it works so damn well... why is it necessary to monitor you for compliance. I would think you would want to use it to feel better."
There are many reasons for failure to be compliant. The biggest issue is failure to be properly fitted with a mask and failure of the patient to follow up. We are all shaped differently. One mask does not fit everyone.
CPAP should be snug, but never painful. A proper fitting is crucial and unfortunately not always done. The patient needs to pay attention and be involved and educate themselves. I repeat this to every patient I know is going to be getting CPAP at least 3 times before they leave in the morning.
I have also had people that are so vain, they won't wear it because "it's not sexy." I actually have heard that from people. Guess what? You only wear it to sleep. You don't take it on a date or wear it at dinner.
Then there are people that are claustrophobic or have anxiety disorders. Some people just can't get over having it on their face. I have had active marines freak out after only a few minutes, while a sweet 85 year old lady in the next room sleeps peacefully. We all have different experiences that trigger different responses.
But the biggest issue of noncompliance stems from poor fitting when receiving equipment and poor understanding of how the system works. Education is critical, being willing to accept that education is also critical. The patient must be willing to understand how the system works, how to make adjustments and why it is important. They must also be willing to try to get over their fears and vanity. They must also be their own advocate and demand that the mask fit correctly. If you're unable to wear CPAP for the minimum 4 hours per night, why? Explain the issue and find a solution ASAP. You have to explain what you're feeling physically. And some people have to explain how they're feeling emotionally. But clearly communicate.
"If your job is your job is requiring it then you should be paid for your time and reimbursed for the equipment."
If you are having diabetic attacks from failure to properly control your blood sugars, should your employer be responsible for that equipment and prescription as well? Some diabetic attacks appear to be DUII. Both CPAP and diabetic meds are for your health. Sleep apnea treatment will also help treat diabetes. why are we expecting our employers to pay for and maintain our health? They offer health insurance (most of them) isn't that their encouragement for you to maintain your health?
While there are many sleep apnea health difficulties, coronary arteries disease and heart attack are the most serious if you are obese and you suffer from some kind of sleep disordered breathing, like sleep apnea.
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Every person I know who has visited a doctor, at the clinics that are part of our local hospital system, is scheduled for sleep apnea testing, EVERY ONE! It is a real health issue but also the most over diagnosed health issue today. Doctors are brainwashed by the companies that make the crap machines and in some cases run the clinics. The machines sell for about $500, if you can get one, but the companies that make them charge almost $200 a month to lease the machines to you. This is an multi billion dollar industry.
I don't snore, stop breathing or have a large neck but because I am overweight every time I visit a clinic, the last visit was for a sore knee, they suggest I get a sleep study done to check for sleep apnea because "you probably have it". It costs about $4500 locally for the sleep tests. I tell them I think it is to expensive and I don't have any symptoms and they respond with "why do you care your insurance will pay for most of it".
I get tested for regularly for INR as I had a clotting issue 8 years ago so they have had me on coumadin for the last 8 years. They never looked for the cause of the clots just said you will need to take coumadin the rest of your life and get tested monthly for your INR reading to make sure the coumadin is being taken at the right level. Yesterday I told the main doctor he would prescribe a home testing meter for INR, I would do my own testing and send him the results so you could contine prescribing coumadin. He refused so I fired him and went to another clinic in the same building. They agreed. They were charging me $136 for each bllod draw and the lab to test it to get the INR reading the at home unit is around $700 for the device and $18 per test so after the initial purchase, which is covered by my insurance it would cost me 15% or the $18 test fee instead of 15% of the $136 lab fee for the bolld draw and analysis. Thats quite a difference out of my pocket.
My advice is if you think you have a sleep problem because you have the symptoms then get it tested if you don't then tell them to pound sand. I find it very suspicous that nothing is ever cured anymore and everything requires life long treatment. Never accept what your doctor tells you without further checking if it incudes weekly, monthly or what ever interval treatments.
Thankyou Robin for being a lone voice in the wilderness crying out to be heard. I have been searching the internet for days until I found you. I live in Australia and my husband has recently discovered that after going to a sleep clinic for help with his snoring, he is now married to an APAP machine for life if he wants to continue to operate a heavy duty forklift. I am outraged at this and am trying to do some research in order legally challenge the whole issue. I've been researching articles in various journals and have discovered exactly what you say, it's a new fad without long term, objective results. I would love to talk to you on the phone. Someone has to challenge this outrageous example of the medical profession running over peoples rights. We don't screen new parents for sleepiness, shift workers or sex addicts or recreational drug users and various other people who miss out on sleep so why should someone who goes for voluntary treatment suddenly find out they are on what amounts to a Legally enforceable Community Treatment Order which takes away their legal right to refuse treatment and why is the power all in the hands of the Dr who is set to profit from the patients so called compliance measured by a machine. In the beginning the problem was a stated problem measured by a subjective account of tiredness and daytime sleepiness volunteered by the patient. So why is it then that the effectiveness of treatment in not also a subjectively stated statement by the patient "I feel much better now that I use my CPAP machine (when and how I choose!!!) End of story. I am a nurse and am well aware of some of the Medical related laws. Here in Australia only two Psychiatrists can do that and then its only for 28 days followed by repeated court appearances for 3 month stints. Are you able to recommend any reading material that may help my in this quest or point me to any legal precedents in the US which have tested the validity of this absurd new fad. Thankyou so much for starting this blog and I hope we can chat some time, I am not going to let go of this bone until I have won and set a precedent here in Australia.
Juliette
Juliette - sorry for taking so long to respond. - Yes, I do have some information on this and the two other sleep apnea alternatives.
http://sleepapnea.org/diagnosis-and-treatment/treatment-options.html
this website has a lot of information on sleep apnea however, a lot of companies prefer the CPAP machine ONLY because it can be monitored.
Like in America, a commercial truck driver even if diagnosed with sleep apnea is only required to get treatment. It is currently NOT the law that the treatments must be a CPAP machine.
It is typically the companies that require it mostly for insurance reasons.
And that's the catch 22.
You might talk to your husbands company and see if they would allow an alternative treatment if not, then it becomes an issue of how much do you really like your job.
best sleep apnea machine are of two kinds- Cpap and Bipap. Choose the ones which suit you best. You should consult a doctor before you start using a breathing apparatus.
I'm a sleep tech. compliance is only for certain insurances like medicare, where they do not pay for their machine and they require a contract where they don't have to pay, but have to use the device, or someone else who is more compliant will get the device instead. i own my cpap device outright through my insurance company, and most others will too.
CPAP stands for continuous positive airway pressure. It treats breathing problems like sleep apnea with mild air pressure, keeping the airways always open. CPAP machines are also used to cure infant lungs which are not fully developed.
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CPAP machine in Darwin is the best treatment for obstructive sleep apnea, which is the common disorder causing slow, shallow or painful breathing while the patient is sleeping.
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CPAP stands for continuous positive airway pressure. It treats breathing problems like sleep apnea with mild air pressure, keeping the airways always open. CPAP machines are also used to cure infant lungs which are not fully developed.
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