FAQ

Insomnia 

• Up to two-thirds of adults periodically experience some form of insomnia 

Obstructive Sleep Apnea  

• OSA affects at least 30 million Americans, but many cases go undiagnosed. 

Narcolepsy  

• Narcolepsy affects roughly 1 in 2,000 people in the United States. 

Restless Leg Syndrome 

• Up to 15% of people have RLS, but only around 2% to 3% experience significant symptoms. 

– Stats provided by https://www.sleepfoundation.org/sleep-disorders 

It is an ongoing difficulty to initiate or maintain sleep despite wanting and having the time to sleep. Insomnia can be caused by many factors such as aging, stress, poor sleep habits, medications, medical conditions, social habits, and gender.

Insomnia classifications:

Acute (short-term) insomnia can last for a few days or weeks, but usually resolves and does not persist longer than three months. Acute insomnia can often be traced to stress, or environmental factors.

Chronic insomnia – is ongoing insomnia symptoms persisting longer than three months, with episodes occurring 3 or more days a week.
Insomnia symptoms may include:
• Difficulty falling asleep at night.
• Waking up during the night.
• Waking up too early.
• Not feeling well-rested after a night’s sleep.
• Daytime tiredness or sleepiness.
• Irritability, depression, or anxiety.
• Difficulty paying attention, focusing on tasks, or remembering.
• Increased errors or accidents.
• Ongoing worries about sleep.

Narcolepsy disrupts your sleep-wake cycle, resulting in excessive daytime sleepiness (including episodes of irresistible sleepiness), making it hard to stay awake for extended periods of time. This is due to the disorder causing REM sleep to be irregular in your sleep cycle. Those with this disorder will typically have their first REM cycle within minutes of falling asleep when normally the first cycle occurs within 90-120 minutes of sleep initiation. This inability to properly regulate the sleep cycle causes serious problems for day-to-day activities. Episodes of narcolepsy have been described as “sleep attacks” and may occur in unusual circumstances, such as walking and other forms of physical activity.

Causes and Types 

Research is still being done on what causes the underlying nature of this disorder but the causes and risk factors for each type are not fully understood. Head trauma, multiple sclerosis and other diseases affecting the brain can play a role in causing this disorder.

• Type 1 (NT1)- Is associated with the symptom known as cataplexy which is a sudden loss of muscle tone but not every case of NT1 will have cataplexy. It can be better described as the loss of 90% or more of the neurons in the brain responsible for making hypocretin (a chemical that helps regulate wakefulness and sleep). Autoimmune triggers and genetic predisposition can lead to this loss of neurons, but it is not always the case.
• Type 2 (NT2)- Will not have cataplexy or low levels of hypocretin but will have other symptoms related to narcolepsy. Other sleep disorders have similar symptoms so it can make it hard to diagnosis. If a person with NT2 develops lower levels of hypocretin or cataplexy they will be reclassified as NT1. Little is known about the risk factors for NT2.

Symptoms 

The symptoms of narcolepsy may get worse during the first few years of the disorder. Then they continue for life. They include:

• Excessive Daytime Sleepiness
• “Sleep Attacks”
• Automatic Behaviors
• Disrupted Nighttime Sleep
• Sleep Paralysis
• Sleep-related Hallucinations
• Cataplexy
• Changes in REM Sleep.

People with narcolepsy may have other sleep disorders such as REM sleep behavior disorder, Insomnia, or OSA.

RLS or Willis Ekbom disease causes uncomfortable sensations in the legs (or arms which is less common) such as itching, crawling, pulling, or prickling. They usually happen on both sides of the body and these sensations create an overwhelming urge to move the affected extremities. These sensations tend to be worse when inactive, lying down, or relaxing, which can result in disruptions to a person’s sleep cycle. Walking, stretching, shaking, or pacing can at times provide relief.

Causes 

RLS can be associated with iron deficiency, diabetes, kidney problems, medications, other sleep disorders, and neurological conditions. It can also temporarily occur during pregnancy, but the underlying cause is unknown.

 Symptoms 

• The chief symptom is an urge to move the legs with symptoms being worse in the evening.

The sensations, which occur within the limb rather than on the skin, can be described as:

• Crawling
• Creeping
• Pulling
• Throbbing
• Aching
• Itching
• Electric
• Twitching
• Uncomfortable or Restless
• The feeling of needing to stretch or move

Its common for symptoms to fluctuate in severity. Sometimes, symptoms disappear for periods of time, then come back.

Obstructive sleep apnea is a sleep-related breathing disorder. It is described as a blockage of the airway, either partially or fully, causing reductions or pauses in breathing. These lapses are followed by either a full, or partial awakening from sleep to clear the airway.

Symptoms of OSA

• Excessive daytime sleepiness
• Loud snoring which can at times change into gasping or choking sounds
• Restless sleep and or frequent awakenings
• Increased need to get up to use the bathroom
• Headaches upon or shortly after waking up
• Dry mouth upon awakening
• Some people may describe feeling irritable, frustrated, fatigued, or drained. They can also have difficulties focusing during the day.

OSA has a range of causes and risk factors such as medical conditions, certain drug use, weight, age, head and neck anatomy, or gender. OSA does not resolve on its own and a reduction in weight, in most cases, will not lead to a cessation of the disorder. Therefore, if you’re experiencing these symptoms, it is best to consult further with a doctor to be screened for OSA. Common screening tools are the STOP BANG questionnaire and the Epworth sleepiness scale.

CPAP is the acronym for Continuous Positive Airway pressure and is used as a treatment for OSA. Airway pressure is delivered by a mask that is connected to a CPAP device. The mask is worn during sleep to stent the airway keeping It open. Airway pressure therapy is 99% effective in treating OSA making It the gold standard treatment.

Common side effects of this therapy include 

• Aerophagia
• Discomfort
• Skin irritation
• Claustrophobia
• Respiratory infections
• Nasal Congestion
• Dry Nose, eyes, or Mouth

Cleaning your equipment regularly and trialing of different masks can reduce or prevent these side effects. Make sure you talk with your doctor if these side effects are occurring after starting therapy.

An Oral appliance is a device that is custom fitted by a dentist and is like a mouth guard or orthodontic retainer in fit. It is a removable device worn only at night and goes on both the top and bottom teeth. An over-the-counter mouth guard or device will not work for treatment of snoring and sleep apnea as it must be custom made. It supports the jaw in a forward position to keep the airway open.  It is a secondary form of therapy for treatment for OSA as it is not as effective as CPAP therapy. Some people prefer the oral appliance as it is small and easy to use, but the Oral appliance is most helpful for those who cannot tolerate CPAP therapy and have mild to moderate sleep apnea.

Oral appliance therapy may have minor side effects such as: 

• Excessive salivation
• Dry mouth
• Tooth and jaw discomfort
• Temporary bite changes

Some patients experience potential complications such as:

• Jaw pain
• Permanent changes to your bite
• TMJ symptoms

The main parts of the equipment should be cleaned weekly. Since it is a respiratory therapy no heavy cleansers, degreasers, lotions, aloe, or chemicals should be used.

Ivory dish detergent or baby shampoo are good options to use for cleaning. Use warm water only. Cold and especially boiling water should not be used. Below will list out a recommended cleaning regimen.

Daily: (Recommended – especially for those who suffer from chronic sinus infections)

• Wipe off any part of the mask/cushion/pillow that touches your face (can hand wash or use hypoallergenic non-alcohol-based wipes)
• Change water in your chamber. Dump out any water left from the previous night (Distilled water only unless emergency)

Weekly: (Required for good hygiene and respiratory health)

• Washing the Mask frame, cushion/pillow, and headgear (lay headgear flat do not hang it)
• Tubing- do not try to scrub the tube with a wire brush, it may cause tears or holes over time.
• Water chamber/reservoir

Monthly (4-6 weeks): (Required for extended motor life and respiratory health)

• Dispose the current filter in the machine and replace with a new clean disposable filter

Odors

If your equipment has an odor, you can use one-part white vinegar and two parts water to create a solution for the equipment to soak in for 30 minutes. After the soak rinse and clean the equipment. This should remove any strong odors from the equipment.

Cleaning DONTS

• Do not put anything in the dishwasher, washing machine, or dryer
• Do not use a blow dryer to dry your equipment
• Do not use Lysol, Bleach, or any chemical-based cleaner
• Do not use alcohol-based wipes to wipe down cushions
• Do not use Hot/Boiling water to clean

Before bed

• Brush your teeth before wearing your appliance- plaque and bacteria can grow on the appliance, putting you at risk for cavities and infection, as well as causing bad breath.

• Rinse and dry your appliance before use, rinsing will help remove food particles and bacteria that could have been missed from the last cleaning.

When you wake up

• ALWAYS brush your appliance in the morning – use a soft-bristled toothbrush and clean the device gently. Cleaning agents such as clear anti-bacterial soap, or mild dish soap can be used.

• Once cleaned let the appliance air dry. Avoid leaving the appliance in direct sunlight. It is also recommended to avoid storing the appliance in damp, or dark closed off spaces.

• Store your device in its storage container when not in use. A storage container is included for convenience. Proper storage of the device is specific to the device being used. Make sure to check with your dentist on how to properly store your specific appliance.

Once a week

• Clean the appliance using a denture tablet/cleaner (can be found at your local drug store). Let the appliance soak for no longer than 15 minutes. This will help provide a deep clean that your day-to-day cleaning cannot achieve.

Cleaning Don’ts

• Do not use HOT or BOILING water for cleaning. Room temperature or warm water is best.
• Avoid cleaning with toothpaste- Most brands have abrasives that can scratch or damage the device.
• Do not leave the device in areas that can be exposed to extreme heat or cold such as your vehicle.

Below is a table listing the equipment items and the standard replacement schedule for them. Insurance will only cover equipment replacements if it meets their requirements for purchase. (The insurance schedule is listed in the last column of the table –most insurances follow this schedule for purchase of items but that is not always the case.)

The requirements for insurance coverage of supplies are based on three major factors.

• When the item was last dispensed. Each item has a different time interval for dispensing set by insurance. If equipment is picked up outside of these time frames the insurance company will not pay.

The time frame is based on the last pick up of the item.

• The quantity of the items must match the allowed amounts set by the insurance. If additional quantities are wanted, then they will need to be purchased out of pocket.

• Lastly Prior authorization may be needed to dispense supplies. This requires compliant use of therapy for the insurance to cover replacements. If the insurance plan requires prior authorization but compliance is not met, then the equipment will not be covered.

Do you accept my insurance?

4 Better Sleep Centers accepts most of the recognized Insurance companies.

If this is not your case, or if you have no insurance coverage then you will be expected to pay the bill in cash or credit card at the end of consultation.

An estimate of appointment fees and equipment costs are available on request.

In case of inclement weather in the DFW area, 4 Better Sleep Centers follows the Dallas ISD school closing policy and will reopen for normal business as soon as the weather permits. Please contact our offices with any questions.