Sleep Equity Project
Sleep Apnea Awareness
You will learn the following in this section:
Symptoms and Signs
Nontraditional Symptoms and Signs
Gender Differences in Sleep Apnea Symptoms and Signs
Racial Inequity In Recognizing Sleep Apnea
Screening and Diagnosis Pathways
Treatment Options (STILL UNDER CONSTRUCTION)
Chronic Health Conditions Seen with Sleep Apnea (STILL UNDER CONSTRUCTION)
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Just the Basics
What is the difference between signs and symptoms?
Signs are what other people notice
Symptoms are what a person may notice
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Learn more here about what are traditional signs and symptoms for sleep apnea. No sign or symptom is seen across every single person. Each person may notice or experience different signs and symptoms. That's what makes this sleep breathing conditions so complex and hard to be self aware or even comprehend what a bed partner or loved one observes.
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Sleep apnea also has various degrees of severity. Mild Sleep Apnea can be very impactful. Moderate sleep apnea can be ok to one person and debilitating to another. Some people can live with Severe Sleep Apnea for decades untreated and life a long life with few chronic health conations. Some people don't snore and still have Sleep Apnea.
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Its difficult to become aware, get diagnosed and adjust to treatment in a short period of time.
Signs
Something a bed partner or relative notices
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Gasping or choking while asleep
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Pause in breathing during sleep (Apnea)
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Loud snoring
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Tossing and turning at night
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Physically there but not mentally present
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Drowsy Driving
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In Children
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Bedwetting
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Hyperactive/Inattentive (can look like ADHD)
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Poor school performance
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Attention Issues
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Frequent movement while asleep
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Sleeping in an unusual position with neck extended
Symptoms
Something a Person May Experience
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Sleepy all the time despite getting a full night's rest
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Poor concentration
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Morning headache
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Dry mouth
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Poor memory
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Irritable
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Difficulty staying asleep
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Reflux or heartburn
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Issues with mood such as depression or anxiety
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Issues with comprehension
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In Children
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Can be same as above
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BUT children may not be able to describe these symptoms
Nontraditional Signs and Symptoms
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Frequent trips to the bathroom at night
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Teeth grinding
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Clumsy
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Taking a long time to process information
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Can't remember dreams
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Can't connect the dots between all these symptoms
Gender Differences in How Women Describe Sleep Apnea
Why Women Are Underdiagnosed With Sleep Apnea
Women with OSA report of symptoms such as insomnia, restless legs, depression, nightmares, palpitations, and hallucinations whereas men are more likely to report snoring and apneic episodes.
Wimms A, Woehrle H, Ketheeswaran S, Ramanan D, Armitstead J. Obstructive Sleep Apnea in Women: Specific Issues and Interventions. Biomed Res Int. 2016;2016:1764837.
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This contributes to women being grossly underdiagnosed with sleep apnea
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Also the myth of being an overweight man as the only type of person who could have sleep apnea impacts women being underdiagnosed
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Multiple factors combine to lower the total number of events (how many times the airway closes for 10 seconds in an hour) counted by sleep studies with regard to women
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The stages of sleep are made up of Rapid Eye Movement (REM) and Non-REM. 20% is REM and 80% is NONREM. Women have been found to have more events during REM. This results in less events being counted during the sleep study which lowers the total events
REFERENCE: Forbes Magazine-Sleep Apnea in Women: Risk Factors and More https://shorturl.at/anOS9
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Women tend to have Hypopneas (partial Airway Closure) which may not get counted as events during a sleep study which then lowers their total events
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The lack of recognition by primary care physicians of differing ways women report symptoms of sleep apnea translate to less women being referred to sleep physician
Racial Inequity in Recognizing Sleep Apnea
Various factors lead to less minorities being diagnosed with sleep apnea
Recognized need by Primary Care of Signs and Symptoms
Lack of Access to Health Care
24/7 Support
Barrier faced by all
Signs and symptoms often go unnoticed by individuals. This same issue is widespread among society and various medical professionals. This leads to a lack of referral by primary care physicians to sleep medicine.
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Some medical specialties are doing better at recognizing when someone may have sleep apnea. Cardiologists have added sleep as their 8th lifestyle habit for a healthy heart. Some cardiologists are even board certified in sleep medicine and treat both conditions.
Minority Representation in Primary Care and Sleep Medicine Workforce
Race of Physician Impacts Mortality and Health Outcomes
Various studies have shown that when minorities have a physician who matches their race, they have better outcomes. There are studies which show that that concordance in the race of both physician and patient leads to longer life expectancy and reduced mortality.
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REFERENCES
Snyder JE, Upton RD, Hassett TC, Lee H, Nouri Z, Dill M. Black Representation in the Primary Care Physician Workforce and Its Association With Population Life Expectancy and Mortality Rates in the US. JAMA Netw Open. 2023;6(4):e236687. doi:10.1001/jamanetworkopen.2023.6687
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Minorities More Likely to Receive Lower-Quality Health Care, Regardless of Income and Insurance Coverage
News Release | March 20, 2002; National Academy of Medicine Statement
A large body of research has shown that compared with the White population, racial and ethnic minority groups experience disparities in access to care and healthcare quality, including effectiveness of treatment, timeliness, patient safety, and preventive screening.
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Reference: Agency For Healthcare Research and Quality
accessed January 10, 2024
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Minority Americans Have Lower Rates of Insurance Coverage and Less Access to Care Lack of health insurance is linked to less access to care and more negative care experiences for all Americans. Hispanics and African Americans are most at risk of being uninsured.
Reference: Minority American Lag Behind Whites on Nearly Every Measure of Healthcare Quality, Many have Communication and Financial Barriers to Care, and Lack Trust in Doctors: A Press Release by The Commonwealth Fund March 2002 accessed January 10, 2024
Diagnosis and Screening Pathways
There are different ways a person can be diagnosed with sleep apnea. First there are screening tools used by sleep medicine to get an idea that a person may need a more extensive test.
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The primary screening tool used by sleep medicine is the Epworth Sleepiness Scale. This tool asks questions about drowsiness.
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The STOP-BANG is a tool a patient can take independently and see where they score.
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Screening Tools
Sleep Studies
Treatment Options
In this section we will give you basic information about:
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What options are available
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How effective each option is
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What are some barriers to adopting the treatment
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Average cost of treatment option
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THIS SECTION IS STILL UNDER CONSTRUCTION
Frequently Asked Questions
-Are sleep doctors just trying to sell CPAP machines?
ANSWER: No, they are highly trained to diagnose a sleep breathing disorder that is impossible for humans to observe themselves. We are asleep and can't gather the ton of information (heart rate, respiration, leg movements, body position, sleep cycles, etc.) a sleep physician gathers and interprets during a in office and at home sleep study.
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-How do I clean my CPAP Machine?
ANSWER: Various sleep technicians have different methods they share. 1. Use white vinegar and rinse thoroughly; 2. soap and water and rinse well.
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-What’s the difference between a CPAP and a BI-PAP?
ANSWER: CPAP has one continuous pressure. Most in use today are Automatic Pressure Range CPAP. Bi-Pap uses two pressures (one for when you breath in and one for when you breath out)
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-Can I make changes to my machine to make me more comfortable?
ANSWER: Yes, but only adjust the comfort setting. DO NOT change your pressure. Your sleep physician should be consulted to discuss your pressure settings (AKA The prescription)
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-Do I really need to add DISTILLED water daily?
ANSWER: YES, use of tap water will leave sediments in your humidification chamber.
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-If I’m not overweight can I still have sleep apnea?
ANSWER: YES, you can be very thin and also have severe sleep apnea. We know patients who are thin and have severe sleep apnea. That goes for BOTH men and women.
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-What’s this INSPIRE Commercial about?
ANSWER: Inspire is a medical device approved by the FDA to be implanted in the chest of a patient who either has moderate or severe sleep apnea.
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-Why do I have sleep apnea?
ANSWER: Basically there are three possible reasons. Weight, jaw set back, overgrown back of the throat.
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-Why is Sleep Apnea the #2 sleep disorder in the world?
1 Billion people estimated to have but 80% Undiagnosed!!!
ANSWER: Research studies indicate that one of the factors is the increase in obesity in the United States. Other studies highlight that the other causes (jaw set back, overgrown back of throat) are rarely recognized.
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-Does Medicare or Medicaid pay for sleep study and CPAP?
ANSWER: Yes
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-Can I travel on an airplane with my CPAP?
ANSWER: Yes and it is a good idea to carry it on with you. It is a medical device and not considered baggage.
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-Where do I get a sleep study?
ANSWER: You can get a sleep study in a sleep doctors sleep clinic or a home sleep study.
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-You can get a sleep study at HOME!!!
ANSWER: YES, there are numerous home sleep studies devices and the sleep physician can diagnose if you have sleep apnea from that data. They are small and don't come with a bunch of wires.
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-What if I DON’T want a CPAP or want to return it?
ANSWER: You can of course return your CPAP. Research shows that it may take 6 moths to a year to see significant improvement in signs and symptoms. Some people see an improvement quickly (the first month). Some continue to be sleepy for months or even years. Please don't give up and seek support from PEERS. See our peer support group sign up.
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-My bedpartner won’t wear their CPAP and I can’t sleep?
ANSWER: Show you loved one grace. For some they are unable to picture how bad the signs (those that others see) are. Society has normalized fatigue and exhaustion as necessary for gaining wealth (sleep is for Losers -We don't believe that of course)
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-What is Sleep Equity Project?
ANSWER-We are a patient led nonprofit that started in January 2023 to address the needs of minorities who are underdiagnosed, underserved and have worse chronic conditions as a result of untreated or undiagnosed sleep disorders! We are here to provide empowerment, support, education and information