Therapy Services
CPAP
Mandibular
Device
CBTI
CPAP therapy
Having OSA is not the end of the world, but it can make you so tired it feels like it sometimes. The good news is that OSA is a very treatable condition, and SleepDoctor will get you the treatment you need.
We won't just give you a diagnosis, we will give you the therapy you need to treat OSA, and allow you manage the condition and get back on track to feeling good again.
There are a number of therapies available, and we will discuss your options with you. We will guide you to the optimal solution, based on your clinical data and other relevant issues.
Getting Started on CPAP
Getting started on CPAP is a challenge for some people. There is no doubt that is feels a bit strange when staring therapy, but for the vast majority of people, settled therapy is achieved within a couple of months. The two key requirements to getting this right are:
1. Choosing the correct mask
2. Getting the correct support
The sleep consultants and the sleep physiologists at SleepDoctor are all experienced in helping you achieve this goal. We will actively support you when you start on therapy, and we will monitor your data to ensure your treatment remains effective. If we detect any issues, will will work proactively to resolve these issues, and ensure you are receiving the optimal benefit from your therapy. We will send you new consumables as they fall due, and we will be available to answer any questions you might have while on therapy.
CPAP is usually long-term treatment, and is effective only when used. We recognise the importance of ongoing support, and will always be available to help you.
CPAP equipment
PAP Device
Full Face Mask
Nasal Mask
Humidifier
The positive airway pressure (PAP) device provides a supportive pressure for your airways. This pressure prevents the airway closing while you sleep and prevents the occurance of OSA when used.
A nasal mask introduces the pressure only through the nose. This can be more comfortable as the mask is smaller and lighter. A comfortable mask is key to succcessful CPAP therapy, and is chosen with care.
A full face mask introduces the supportive pressure through both the mouth and the nose. A vent in the mask allows the air to escape while maintaing the pressure. Modern designs are very non-restrictive.
CPAP therapy can sometimes dry out the mouth and throat, leading to a degree of discomfort. A humidifier adds moisture to the system and can prevent or cure this dryness. Most people do not need a humidifier.
CPAP therapy with SleepDoctor
Continuous Positive Airway Pressure or CPAP therapy is used to treat Obstructive Sleep Apnoea. We provide equipment - CPAP devices and masks - from all major manufacturers. Our Sleep Support Team will contact you to arrange when and where you want your device delivered. It will come with all the instructions, and you will also have help from the Sleep Support Team with device set-up, and to help with ongoing use. It is very important that you are fully supported with CPAP, especially in the early days of treatment. Our experienced team will help you become fully established on therapy, and achieve the full benefit of CPAP.
CPAP is usually a long-term treatment, and we provide you with long-term support for your therapy. You will be able to monitor your own progress using an app on your smartphone, and we will monitor your therapy data regularly to ensure everything is working as it should.
Our subscription model includes all equipment, accessories, clinical support and review. Details available here.
How does CPAP work?
The patient wears a lightweight mask around their mouth and nose (or just the nose) that is attached to a CPAP device. This provides the necessary pressure to keep the airways open, thereby eliminating OSA.
The CPAP machine manages pressures automatically, and in response to your breathing pattern. It senses when your airway is becoming blocked and increases the pressure to splint the airway and keep it open. When you start on CPAP and are just getting used to therapy you will probably wake up to find the CPAP device is doing its job, and you will feel the higher pressures. This feels a bit strange to most people just starting on therapy, so when it happens you simply push the ramp - or reset - button and the pressure returns to the starting minimum pressure. Once you have got used to CPAP this won’t be an issue, and you won't even notice the pressure. It is important to have a good mask fit. A really good mask fit makes a big difference when getting started on CPAP, and one of the reasons support is so important.
CPAP therapy can result in a significant improvement in just days, although this differs from patient to patient. Generally, therapy becomes settled in around 2 - 4 weeks. A range of mask types are available to optimise comfort and help get you settled on therapy. Nasal mask – completely cushioned and covers just the nose, excellent if the patient moves around during their sleep. Full face mask – a triangular shaped mask which covers both the mouth and nose. This tends to be prescribed if a patient breathes through their mouth whilst asleep or has blockages in their nose, such as a cold or fever. Newer designs sit under the nose rather than acrosss the bridge of the nose and have improved comfort significantly. Nasal pillow mask – a mask which has a small cushion that sits in the nostril base, and can be very effective for people that have large amounts of facial hair.
CBTi Components
Therapy sessions can include the following aspects in an order to fit individual needs:
Sleep Hygiene
Quality of sleep has been impacted by the new normals of life - stressful jobs and the difficulty switching work off, 24/7 availability of information and advice, push messaging and targeted marketing, and enabling most of this is the smartphone. Fantastic devices that have opened up the world but they do come with a price.
From the efect of the screen itself on sleep quality, to the interruption of sleep by constant notifications, it has to be recognised that smartphone use has impacted sleep quality for many people. Many of the basics of sleep hygiene have got lost in the data driven age.
Try to remember some of the basics of sleep hygiene
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Stick to a routine
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Avoid the blue light of smart devices before bedtime
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Avoid unnecessary stimulation before bedtime
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Avoid caffeine after lunch
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Maintain daytime exposure to natural light
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Don't watch television in the bedroom
Consumer vs Medical Reports
There is a huge market for apps and devices that claim to track your sleep quality and quantity. The smart wristwatch is a prime example of a consumer product that has been 'upgraded' to a type of medical device. It is worth remembering how little data these devices record in relation to how much information they provide in their sleep reports. The simple truth is that if these devices could do what they claim, as accurately and simply as the marketing suggests, they would just be handed out by the NHS and there would not be any waiting lists for sleep testing. Using these devices can even cause harm to some people who become fixated by the numbers produced, with an overall worsening of sleep the outcome, rather than any of the claimed benefits.
Sleep restriction therapy
Sleep restriction therapy (SRT) – a somewhat misleading term as this component does not restrict the amount of sleep you already achieve, just the time in bed you have to achieve it. In other words, time in bed is restricted. This is worked out on an individual basis over the course of therapy. With the information you provide, together we work out the best way to increase your total sleep time (TST) and improve sleep efficiency (SE). Sleep restriction therapy is done by first reducing the time in bed to be equal to the average amount of time that you report currently sleeping based on sleep diary data (but never below what will be safe) and avoiding daytime naps.
Stimulus control
Stimulus control therapy (SCT) – sleep can be strongly associated with specific and learned behaviours. SCT deals with removing unhelpful habits and beliefs associated with sleep (perpetuating factors) and relearning useful behaviours. We determine the rules that work best for you and your current lifestyle or other considerations when implementing SCT. Stimulus control therapy reverses conditioned arousal by strengthening the bed as a cue for sleep. Patients are advised to use the bed and bedroom only for sleep and intimate relationships, and to wake up at the same time every morning, regardless of the amount or quality of sleep.
Cognitive therapies
CBTi includes strategies for helping patients reduce their worries and intrusive thoughts when in bed, since these are incompatible with sleep. Worries and other unpleasant thoughts that are experienced in bed also exacerbate insomnia, because they weaken the bed as a cue for sleep. Techniques include imagery or distraction, cognitive control techniques or restructuring approach. Some of these will work better for some people than for others and will be discussed with your therapist as you proceed through the course.
Relaxation techniques
There is no single relaxation method that is best for everyone. Progressive muscle relaxation, meditation, and diaphragmatic breathing can all help calm an active mind. Together, we can select a relaxation method that best fits you, and the therapist should recommned practice during the wind-down period. Playing white noise is also helpful for some people.
Mandibular Advancement Splint
One treatment option for snoring or mild obstructive sleep apnoea is a mandibular advancement splint. This hinged gum shield device holds the bottom jaw forward during sleep which aims to open up the airway at the back of the throat and nose. You will be referred to our orthodontic partner. Before attending your first appointment, please ensure you have seen a dentist recently to ensure your teeth and gums are healthy which is essential in order to use a splint.
Any treatment that is required must be completed before the appliance can be fitted and used. The orthodontist will examine your mouth and may also send you for an X-ray. They will let you know if you are suitable for the splint and when this can be made. A mould will be taken. The device will be made and you will return for first fitting. Drooling can be a problem early on. Occasionally temporomandibular joint problems can occur with use.
We work with Yorkshire Orthodontics to provide customised mandibular devices, and you can find out more here.
Providing the end to end service necessary to get back to a good night's sleep.