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Newsletter Spring '09 Volume 6 No. 2

Newsletter Spring '09 Volume 6 No. 2

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Published by: Cardinal Sleep Disorder Centers of America on Jul 10, 2009
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Spring 2009 Vol. 6 No. 2
“The technician's patience and
attention was outstanding. Shewas extremely pleasant and help-
From the Cardinal’s Nest: What patients are saying…
Increasing Sleep Awareness in Cardinal Communities
The number of people reporting sleep disturbances has
increased according to the National Sleep Foundation’sSleep in America™ poll. The poll also states that while
64% of Americans report experiencing sleep problems at least a few nights a week within the past month, only32% of all adults have ever discussed sleep with ahealthcare professional. Significantly, in the group that has discussed sleep with a healthcare professional, al-most one-half (42%) have/had a sleep disorder.To raise awareness about under recognized and under-reported sleep disorders, Cardinal Sleep Disorder Cen-ters of America encourages both physicians and patientsto start talking about sleep. Cardinal Sleep has increasedsleep education efforts in all eight locations, and is urg-ing physicians to consider screening for sleep disordersif a patient is overweight and has high blood pressure,cardiovascular disease, and/or type 2 diabetes. Sleep dis-orders should also be considered in patients experienc-ing sexual dysfunction, nocturia, GERD, Iron deficiency,depression and mood disorders.
Morris Open House
Morris physicians now have the option to send patientsto the new Cardinal facility on W. US Route 6. The openhouse and ribbon cutting was held April 1st by theGrundy County Chamber of Commerce. The Morris facil-ity offers comfortable sleep studies performed by regis-tered technologists and in-depth analysis, diagnosis, andrecommendations provided by board-certified pulmo-nary and sleep physicians. Consultations and treatment options also are available through Kramer DME in anadjacent suite, therefore stream-lining the diagnosis and treat-ment process for the patient.
Registered PolysomnographicTechnologists at Cardinal Sleep
Nicole Steffes, RPSGT
Manager of Clinical & Educational Services
Polysomnographic (Sleep) Technologists are trained insleep medicine through formal programs and practicalwork experience. At Cardinal Sleep Centers, all eligiblestaff members have passed the rigorous requirements to become creden-tialed by the Board of Registered Polysomnographic Technologists, an inter-nationally recognized and accredited organization. This credential currentlyrepresents the highest standard in sleep technology, and is a symbol of quality, responsibility and credibility.
What it takes to be a Cardinal Sleep Technologist:Training:
All new sleep technicians must be enrolled in or have attendedan accredited sleep training program. They must demonstrate neces-sary clinical experience and maintain a high level of competence andexpertise in the field. Once eligible, they are required to obtain boardcertification by the BRPT.
Cardinal’s staff fosters ethical practices. Our credentialed
staff has made a commitment to professionalism, competence andethics by meeting the BRPT standards for certification.
High Standard of Care:
Our staff members take the time to understand
each individual patient and their needs….placing the well
-being of ourpatients first. Our technologists work as part of a team with a set of specialized skills to assist the physician in the education, evaluation,treatment and follow-up.
Continuing Education:
Cardinal staff members are required toobtain a minimum of 10 continuing credit hours per year. Technologists
attend monthly training and teaching conferences with Cardinal’s
 Medical Director and various sleep equipment companies to staycurrent on new sleep therapies, AASM standards, and techniques.
Cardinal Sleep Disorder Centers Expands Community Presence
Cardinal Chirp 
Complaint Free in 2008
Cardinal Sleep Centers was awarded
“Complaint Free” status for 2008, through the
Better Business Bureau. Cardinal has receivedthis award recognizing quality patient careand services for three consecutive years.
Bi-Flex® and Positive Airway Pressure ComplianceKramer DME Enhances Follow-up Protocol
2009 Sleep in America™ Poll Findings
From the Medical Director’s Desk:
Bi-Flex® and Positive Airway Pressure Compliance
Robert Aronson MD, ABSM
Medical Director, Cardinal Sleep Disorder Centers of America
Obstructive sleep apnea is an independent risk factor for motor vehicle crashes and cardiovascu-lar morbidity and mortality. Use of nasal continuous positive airway pressure (CPAP) therapy hasbeen shown to improve crash risk and cardiovascular sequelae. Optimization of compliance isthus crucial. However, in the absence of aggressive measures to facilitate therapy, long termcompliance is estimate to approximate only 50%. At Cardinal, we constantly strive to optimizethose factors that limit CPAP compliance in your patients.Ballard et.al. (J. Clin. Sleep Med., 2007;3(7):706-712) assessed the effectiveness of Bi-Flex
, apositive airway pressure (PAP) mode superimposing a late inspiratory/early expiratory pressurerelease onto Bi-level (BiPAP
) therapy. OSA patients noncompliant with CPAP were entered first into a regimen of standard CPAP salvage strategies, including mask refitting, heated humidity,nasal rinses or steroids, and education. 24% of these previously noncompliant patientsbecame compliant with such interventions. Of the remaining noncompliant patients, 67%agreed to proceed to a second phase in which a new polysomnography assessed Bi-Flex
settings. These patients were then randomized to continued CPAP vs. Bi-Flex
. 49% on Bi-Flex
became compliant, as opposed to only 28% of those continuing CPAP. The lattershows that continued attempts to achieve CPAP compliance may at times be successful, howeverBi-Flex
appears to have additional effectiveness in salvaging positive airway pressure therapy.Overall, between the 2 phases of the study, 44% of previously noncompliant patients ultimatelybecame compliant, a significant finding in light of the PAP therapy benefits noted above.Given that earlier studies have not proven benefit of C-Flex (early expiratory release applied tostraight CPAP) or of standard Bi-level therapy in salvaging CPAP, the combination of earlyexpiratory release to BiPAP
may provide benefit through yet to be clarified mechanisms.Other PAP salvage strategies deserve mention. In patients with nasal obstruction from factorssuch as septal deviation, polyps, or turbinate hypertrophy not responsive to medical therapy,nasal surgical intervention, while often not curing OSA, may salvage CPAP compliance. Inaddition, the combined use of mandibular advancement devices and CPAP is being explored insituations where the dental device alone is ineffective but the required CPAP pressures are not tolerated.In situations of CPAP noncompliance despite conventional salvage measures, assessment of Bi-Flex
may be a therapeutic option.
REFERENCES:"Interventions to Improve Compliance in Sleep Apnea Patients Previously Non-Compliant with Continuous
Positive Airway Pressure” from Journal of Clinical Sleep Medicine 2007; Volume 3 No. 7; 706
Page 2
For more information on this article please contact Community Relations atinfo@cardinalsleep.com or (815) 773-9090 ext. 300.
In no way are the suggestions in this newsletter to be taken as medical advice, please seek proper medical attention from a medical professional.
The National Sleep Foundation’s 2009
Sleep in America™ 
Poll finds that:
Almost one-third (27%) of Americans say their sleep has been disturbed at least afew nights a week in the past month due to personal financial concerns (16%),the U.S. economy (15%), and/or employment concerns (10%).Surprisingly, other national and global issues are affecting their sleep to a muchlesser extent: healthcare costs (8%), the war in Iraq or Afghanistan (6%), globalwarming/environment (3%), and/or the threat of terrorism (3%).More than half of people (54%) losing sleep over economic concerns also haddifficulty with their feelings at least a few days a week in the last month.
Discussing Sleep with a Healthcare Professional:
More than one-half of adults (54%) reported that they have driven at least once whiledrowsy in the past year, with almost a third (28%) reporting that they do so at leastonce per month.
Cardinal Sleep Disorder Centers is a National Sleep Foundation Sleep Care Center Member.
Committed to quality sleep-related care, Kramer DME has expanded areas of service to include Cook, DuPage,Grundy, Kankakee, Kendall, LaSalle and Will counties. Both home and office setups are available, with emergencycoverage provided 24 hours a day, 7 days a week. To accommodate this growth and continue to provide bettersleep solutions, Kramer DME has updated their protocol for patient follow-up and compliance.
Kramer DME provides:Thorough set-up
Specially designed for each individual patient with a treatment plan explained to them by aRegistered Polysmnographic Technologist or Sleep Equipment Specialist. Education on sleep disordered breath-ing. Review of sleep study results. Instruction on equipment use and care. Custom fitting of the mask. All ques-tions answered.
 Continuous follow-up
- Calls are made to patients on an ongoing basis to answer questions, assess equipmentand provide reminders regarding equipment care.
Reporting to Physician
Setup confirmation is sent to the physician’s office with information on the patient’s
equipment, pressure, mask, and initial follow-up on patient compliance to therapy during the first 3 days of use.
In addition, Kramer DME provides an extensive report on the patient’s follow
-up and use of their equipmentthroughout the course of treatment. Reports include but are not limited to: date of initial setup, machine type,mask type, pressure, average number of nights they are using therapy, how often they are waking up throughoutthe night, if they are still snoring, how they are caring for their machine, and an Epworth Sleepiness Scale to as-sess their current daytime sleepiness.
Educational support group meetings
Kramer DME hosts a monthly support group meeting for CPAP/Bi-levelusers that fosters improved patient compliance with prescribed therapy. Patients reach a better understanding of 
their diagnosis through monthly presentations on topics including: “the Heart and Sleep Apnea,” “Diabetes andSleep,” and “What the Sleep Technician Sees.” An annual Equipment Fair and Machine Check also is held to
showcase the latest advances in sleep technology.
- Offered for potential Kramer DME patients. In the instance of a failed titration study, this accli-mation process prepares the patient for a successful study and increases patient compliance and understandingof therapy when received.
Kramer DME’s treatment protocol has proven to increase patient compliance to over 85 percent.
What’s New in OSA?
Marsha Cronkrite, R. PSG. T. Clinical Administrator
Snooze News:
Sleep in America
Poll, Highlights & Key Findings
Page 3
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