MaimonidesSweetDreams3-28-16

The Patient Process

from

ABCs

to

ZZZs

6739 Academy Rd NE, Suite 380, Albuquerque, NM, 87109

505-998-7200

Maimonides Patient Care:
Steps at a Glance

Diagnostic Sleep
Study

Discuss Results
Over Phone

In Lab PAP-NAP Other Pathways Other
Titration PSG* Alternative Sleep
SDB* Disorders
Discuss Therapy Treatment
Results Insomnia
Over Phone NDS*,
Script OAT*, ENT*
to DME*
PAP* Device Nightmares
Set Up
at Home Leg
Follow Up Movements
Appointment
Retitration
PSG* and
Follow-up
Appointment

I’m tired of being tired!

* See pages 14 - 15 for “Terms to Know”

2

Getting Good Sleep
for the Rest of Your Life

The following pages will take you through the patient process at
Maimonides Sleep Center. If you have any questions, please feel free to
reach out to our key contacts:

General ������������������������������������������������������� 505-998-7200
Reception/Scheduling �����������������������505-998-7208
Billing Coordinator �������������������������������505-998-7216
Results Coordinator ���������������������������505-998-7209
Follow-up Coordinator �����������������������505-998-7217
Sleep Lab ������������������������������������������������� 505-998-7210
Clinical Manager ���������������������������������505-998-7219
Medical Records �����������������������������������505-998-7213
Fax Number ��������������������������������������������� 505-998-7220

Use your login to submit support tickets at
www.sleeptreatment.com

“Isn’t it time to put your sleep
problems to rest?”

3

What to Expect Following Your
Diagnostic Sleep Study

Diagnostic
Sleep Study

Discuss Results
Over the Phone

Titration PAP-NAP Alternate Non-SDB
Sleep Study SDB Therapy Treatment

• Our Results Coordinator will contact you to discuss Dr.
Krakow’s Interpretation and Recommendations.

• If you are hesitant about moving forward with PAP therapy to treat
your SDB, you may consider a PAP-NAP. See page 9 to learn about
this special desensitization procedure.

• Want to explore your options? See page 12 for alternatives to PAP
therapy.

• Ready to start treatment? Schedule a titration sleep study to test
PAP masks, modes and pressure settings.

Titration Sleep Study Date:__________________

4

What to Expect Following Your
Titration Sleep Study

Discuss Titration
Results Over the

Phone

Prescription Sent to
DME Company

PAP Device Set Up
with

DME Company

• Our Results Coordinator will contact you to discuss Dr. Krakow’s
Interpretation of the study and Recommendations.

• If leg jerks are present, Serum Ferritin, Vitamin D and Magnesium
blood test may be ordered to rule out deficiencies as the cause of
RLS/PLMD.

• A prescription for your PAP device will be sent to a DME company
contracted with your insurance.

• A DME company will provide your PAP device, mask, tubing and
other necessary supplies; they will also help you to learn how to use
your PAP device at home.

• A follow-up appointment at our sleep center will be scheduled to
assess progress with PAP therapy.

Follow-up Appointment Date:_______________

5

The Role of DME Providers

Durable Medical Equipment (DME) providers are assigned to you by
your insurance company. Most insurance companies have contracts
with at least 2 DME providers.
We strongly encourage you to reach out to your DME company if you
are experiencing any of the following issues during treatment as it
may expedite care:

1. Mask fit – if you are having difficulty with mask leaks or want
to try other types of masks, you can make an appointment with
your DME company to see a Respiratory Therapist.

2. Device Malfunction – if your device is no longer functioning
properly, contact your DME company. If it is still under
warranty, they will repair or replace your device.

3. Resupply of PAP Therapy Product – See page 7 for more
information on resupply.

4. Billing issues related to your PAP device/supplies.

Your DME company should provide you with the
best care possible; however, occasionally they
may provide substandard care, and you may
become frustrated or dissatisfied with their
service. Our staff is happy to advocate on
your behalf for a DME issue, or to help
you switch to another DME company. If at
anytime during your treatment you become
dissatisfied with your DME company’s service,
please contact our facility as soon as possible.

6

PAP Supply
Replenishment Program

Most insurance companies follow Medicare guidelines for renewal of
PAP supplies. Below is a summary.

Item Quantity/Frequency

Full Face Mask 1 per 3 months
Nasal Mask 1 per 3 months
Nasal Pillow Mask 1 per 3 months
Full Face Cushion 1 per month
Nasal Cushion 2 per month
Nasal Pillow Cushion 2 per month
Heated Tubing 1 per 3 months
Heated Tubing with Oxygen Port 1 per 3 months
Slim Line Tubing 1 per 3 months
Humidifier Tub 1 per 6 months
Filter, Disposable 2 per month
Headgear 1 per 6 months
Chinstrap 1 per 6 months

7

Getting a Good Response
to PAP Means

Awaken Decreased
More Nightime
Awakenings
Refreshed

Decreased Better Decreased
Daytime Sleep Nocturia
Quality
Sleepiness
and Fatigue

Enhanced Using
Physical PAP
All Night
and
Mental
Health

Other signs of an optimal response include:

• Enhanced brain power • More dreaming

• Feeling better in the morning • Reduced or Eliminated:
• Increased energy level throughout - Headaches
(especially in the AM)
the day - Snoring
• Enhanced concentration, memory - Restlessness
- Dry Mouth
and attention span - Trips to the Bathroom
• RLS/PLMD symptoms resolved

A Retitration in The Sleep Lab often
optimizes your results.

8

Follow-up
and Other Appointments

PAP-NAP*

A PAP-NAP is a 3 to 4 hour
procedure to gradually introduce
PAP therapy; it may be conducted
during the day or at night. This
procedure is recommended when
there are any initial barriers to
PAP therapy such as reluctance,
claustrophobia, or if you are
hesitant to return for a full night
titration. It is less invasive than
our titration study as it requires
very few sensors.

The PAP-NAP during the daytime
is a one-on-one procedure typically
involving extensive coaching, mask
fitting, and pressure desensitization.
This procedure may occur any time
after setup with your PAP device if
you have difficulty acclimating to
the therapy.

* The PAP-NAP was invented by
Maimonides sleep center staff and
is now widely used across the USA.

9

Follow-up
and Other Appointments

(continued)

PMA

A PAP Management Appointment (PMA) is a daytime appointment
with a licensed sleep professional to discuss progress with PAP
therapy. Some PMAs are mandated by insurance.
Types of PMAs

1. Follow-up: Scheduled 30-90 days after you have been setup
with your device to evaluate your progress with sleep and
daytime symptons. Focuses on acclimation and at-home use of
your PAP device.

2. Mask Fit: Discuss mask related problems. This appointment
may include troubleshooting with your current mask, trying
different masks, or learning about mask accessories such as
mask liners.

3. Sleep Tech & Physician: Discuss more complex PAP related
issues with a sleep tech and Dr. Krakow.

Clinic Appointment:

A clinic appointment with Dr. Krakow, may be scheduled at any time
to discuss PAP therapy, barriers, medications, insomnia, nightmares,
or other sleep related problems. Dr. Krakow recommends that you
start reading Sound Sleep, Sound Mind prior to coming in for a clinic
appointment to help facilitate understanding of terms and strategies
that will be further discussed during your appointment.

10

About Barry Krakow, MD

Barry Krakow, MD is a board certified internist
and sleep disorders specialist, who has nearly
40 years in practice in the fields of internal,
emergency, addiction, and sleep medicine.
Dr. Krakow started in sleep research in 1988
and helped pioneer innovative therapies for
chronic nightmare patients. Since 1995, he
has practiced sleep medicine full-time and
specializes in the treatment of sleep disorders
such as insomnia and sleep apnea in mental health patients. He is
also principal investigator of the Sleep & Human Health Institute,
a non-profit research center focusing on the complex interplay
between physiological and psychological sleep disorders. Dr. Krakow’s
groundbreaking book, Sound Sleep, Sound Mind (2007) describes in
depth the Sleep Dynamic Therapy™ model of clinical sleep medicine.
The book aids patients and sleep professionals to recognize the critical
value of concurrent assessments and treatments for both the mental and
physical components rooted within the vast majority of sleep disorders.
Insomnia appointments centered around the Sound Sleep, Sound Mind
book may be scheduled with Dr. Krakow and his Clinical Manager &
Lead Sleep Technologist, Michelle Sturgess, RPSGT, at anytime during
treatment. These appointments focus on treatment of insomnia and
using the SDT™ framework.
You can find blog posts on PAP therapy from Dr. Krakow at:

classicsleepcare.com
sleepdynamictherapy.com

11

Alternative SDB Treatments

Although PAP therapy is the standard for treating sleep-

disordered breathing, it may not be the best option for all patients.

1. Nasal Hygiene and Nasal Dilator Strips: Nightly use of nasal
saline irrigation rinses and nasal dilator strips can open your
nasal airway, which prove very useful for mild cases of UARS
without oxygen desaturations.

2. Allergy Assessments and treatment: Learning more about your
nasal congestion is a very important step in the treatment of
SDB. Seeing an allergist may be necessary. Some patients benefit
considerably by use of prescription nasal sprays such as nasal
steroids or nasal antihistamines.

3. ENT Evaluation: An appointment with an Ear, Nose, and Throat
specialist to assess your airway for anatomical abnormalities.
Surgical intervention may be recommended particularly for
nasal blockages or enlarged tonsils.

4. Oral Appliance Therapy (OAT): A device designed specifically
for you by an experienced and certified dentist to hold your
lower jaw forward to expand the airway. OAT may be suitable
for mild-moderate OSA without oxygen desaturations.

12

Notes

13

ABPAP: Terms to Know

ASV/ASVAuto: Auto Bi-level has 3 pressures settings. Similar to
BPAP with different settings for inhalation and
BPAP: exhalation, but also includes a third setting that
allows for variability depending on sleep stage or
Central Apnea: body position.
Chinstrap: An advanced device for patients who cannot tolerate
Comorbidity: standard forms of PAP therapy, have central or
CPAP: complex sleep apnea. This mode of therapy includes
DME: variable settings and monitors the volume of each
ENT: breath to adjust pressures while you sleep.
Hypopnea: Bi-level PAP device has two pressure settings. A
Mask Leak: higher pressure for inhalation and a lower for
Nasal Hygiene: exhalation is more comfortable than CPAP and is
often used in patients who cannot tolerate CPAP.
NDS: Occurs when your brain does not send a signal to
your respiratory system to breathe even though your
airway remains open.
A strap that wraps around the head that prevents the
jaw from dropping open and thus eliminates mouth
breathing.
The presence of one or more additional disorders co-
occurring with a primary disorder.
Continuous Positive Airway Pressure. This mode
of PAP therapy provides the same pressure for
inhalation and exhalation.
Durable Medical Equipment provider that will
supply all necessary PAP equipment.
Ear Nose and Throat Doctor

A 30-50% reduction of the air flow during sleep.

Excess air escaping from the PAP mask, beyond the
normal amount to expel CO2.
Use of saline sprays and rinses to cleanse the nasal
passages and remove debris such as allergens that
cause congestion.

Nasal Dilator Strips

14

Terms to Know (continued)

Nocturia: Waking up to urinate.
OAT: Oral Appliance Therapy
OSA: Obstructive Sleep Apnea
Pad-A-Cheek liner: Microfiber mask liner that wraps around your mask
to absorb sweat, prevent skin irritation and mask leak.
PAP: Positive Airway Pressure
PAP-NAP: A gradual introduction and desensitization to PAP
therapy modes, pressures and masks.
Periodic Limb Repetitive limb movements that occur during sleep.
Movement
Disorder (PLMD): PAP Management Appointment
PMA: A sleep study.
PSG
(Polysomnogram): Typically associated with dreaming. A restorative sleep
REM Sleep: that helps improve mood, memory, and energy.
Hypoallergenic cotton liners that can be used to create
REMZzzsTM Liner: a barrier between the face and PAP mask to prevent
skin irritation, mask leak or to absorb sweat.
Respiratory A 10 - 25% reduction in airflow causing an arousal from
Effort-Related sleep; this term applies to the UARS breathing event.
Arousal (RERA):

Restless Legs Uncomfortable, tingling, itching or aching sensations
Syndrome (RLS): in the legs typically occurring in the evening.
Serum Ferritin:
The amount of iron in the blood directly related to
Sleep Disordered iron storage. Values less than 50 mg/mL have been
Breathing: linked to RLS/PLMD.
Titration: Repetitive episodes of abnormal breathing during
sleep.
Upper Airway A sleep study where PAP therapy is tested to stabilize
Resistance the airway and set pressures.
Syndrome (UARS): Abnormal breathing more subtle than Apneas or
Hypopneas but which still results in sleep fragmentation.

15

6739 Academy Rd NE, Suite 380
Albuquerque, NM, 87109

Ph: 505-998-7200 Fax: 505-998-7220
E-mail: [email protected]
www.sleeptreatment.com

Sweet Dreams