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Pain on Pinky Side of Wrist – Exploring Orthopedic Continuum of Care

A colleague of mine recently developed a wrist brace for ulnar-sided wrist pain — pain on the pinky side of the wrist.
In our discussions we learned what I often learn when discussing health care issues, the continuum of care is very similar, at least in the early stages, as the sleep apnea continuum. Ulnar-sided wrist pain is something that is best dealt with at the primary care level, but PCPs frequently don’t understand the issue which is usually due to TFCC (triangular fibrocartilage complex) tendonitis or how to treat it.
I think Jeff has a great product that will do very well, and I hope we get to explore building a care continuum program for joint pain!
Here is a link to an article that discusses pain on the pinky side of the wrist…
To learn more about this brace for ulnar-sided wrist pain / TFCC injuries, please visit the Bullseye Brace home page.

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Sleep Apnea Mask Problems and Solutions

Sleep Apnea Mask ProblemsSleep Apnea Mask Problems: #1 Dry Mouth

One of the first sleep apnea mask problems that I want to talk about is dry mouth.  If you wake with a dry mouth, chances are that you sleep with your mouth open – don’t worry, a lot of CPAP users do this. CPAP therapy can cause slight dry mouth on it’s own, but if you sleep with your mouth wide open, the problem can be seriously exacerbated.

There are only two primary solutions to dry mouth 1) use some method to keep your mouth closed at night and/or 2) use a full face mask with maximum humidity and other solutions to keep your mouth and tongue from drying out.

Keeping Your Mouth Closed During The Night

One solution that has worked for many CPAP users is to use surgical tape. Try 3″ 3M Micropore tape with one piece directly across your mouth and two more pieces from the jaw to the cheeks on either side of the mouth. The pieces on either side of your mouth help keep the tape over your mouth in place during the night.

You can also try using a chin strap – they work best with nasal masks, but can be made to work with full face masks as well, but if your mouth is not open at night, you do not need a mask that covers it.

We recommend the Philips Respironics Premium Universal Chin Strap

In some cases, dry mouth can be directly, or indirectly related to your pressure setting being too high, but hopefully your settings have already been optimized.

Humidification and Other Methods for Keeping Your Mouth and Tongue from Drying Out

Make sure you use as heated humidifier with your CPAP.  Most sleep doctors believe that everyone can benefit from heated humidification, especially those with mid to high range pressures, so hopefully you already have a heated humidifier.

You can also use Biotene products for dry mouth which include mouth sprays and gels, the gel seems to be most effective.   Some patients have reported success using Xylimelts tablets in their mouth prior to sleeping with their CPAP. Please check with your doctor first about using Xylimelts.


Sleep Apnea Mask Problems: #2 Mask Leak

Leaking or poor mask seal is the most common issue that CPAP users have to deal with.  Not only is mask leak annoying, but a heavy leak may exceed your CPAPs ability to maintain the prescribed pressure and have a negative impact on your therapy.

The silicone of a CPAP seal is very soft and it can crease if you over tighten it or when the mask moves around.  The first tendency for most people when presented with a leak is to tighten the straps more – this not only caused pain and discomfort, but also makes the problem worse. CPAP masks are designed to gently sit on your face without needing to be applied tightly.

Masks can be very durable, but they aren’t designed to last forever. Periodically check your cushions for tears, or changes in texture and flexibility which can cause increased leaking. Replace them when necessary.  Similarly, if your mask frame is worn or damaged, and/or your headgear is stretched out of shape, you will need to replace them.

maskmate for sleep apnea mask problemsMaskMate helps with a lot of sleep apnea mask problems.  You simply apply MaskMate to your mask to STOP air leaks, whether its facial hair, smile lines, skin wrinkles, or any other issue that is making your mask leak, this will stop the leaks.  It also helps to alleviate many of the other problems associated with your sleep apnea mask.

MaskMate Provides a Long List of Benefits:

  • Significantly Reduces Air Leaks
  • Stops Annoying CPAP Mask Noises
  • Improves Compliance and Increases CPAP Mask Comfort
  • Helps to Restore Smooth and Healthy Skin
  • Allows Users To Loosen Their Mask Headgear Without Compromising the Mask Seal
  • Comfortably Holds Mask in Place
  • Works Well With a Beard or Mustache
  • FDA Approved
  • Won’t Degrade Mask

Read More About MaskMate Here

Sleep Apnea Mask Problems: #3 Marks and Redness from the Mask

Getting a rash or redness from your mask? It could be you are wearing it too tight, not cleaning it well enough or it may be wearing out.

Even the very best mask out there may cause skin irritation when it’s getting close to the end of its life span. When you are wearing your mask every night, it will eventually wear out. Plus, when the cushion part of the mask degrades, its flexibility decreases, which increases the risk of leaks.

It’s a good idea to replace your mask every six months. You also need to replace the headgear, tubing and humidifier chamber, as well as the air intake filter, which is the small sponge in the back of your CPAP machine. When this sponge becomes clogged with dust, it reduces the uptake of air into the CPAP machine, which in turn can cause you to feel a reduced airflow and may cause the unit to overheat.

This, of course, will also negatively impact the benefits of your CPAP therapy.  Most health insurances will allow for CPAP equipment to be replaced every six months, so do it. Be sure to ask your therapy provider if you are unsure.

MaskMate is also a great way to ease that irritation and help to seal the leaks.

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CPAP Problems and Solutions

CPAP problems are not unusual. Although the therapy is 100% effective for sleep apnea, it can also sometimes be challenging. This list of common CPAP problems and their solutions might help you get more out of your therapy.

The TotalCare Sleep Apnea disease management program is available free to any CPAP user and supported by qualified, professional, CPAP therapists. If you want help with your CPAP problems and help getting better sleep, click here to create your free account, complete an interactive CPAP therapy checkup, and to give us some details about your CPAP equipment.

CPAP Problem: Bloating, Burping & Gas

CPAP side effects bloating, burping and gas are some of the common side effects of CPAP therapy. The medical term for these side-effects is Aerophasia. Fortunately this CPAP problem can usually be managed with persistence and help from your CPAP therapist.

If your stomach feels bloated or you burp a lot after using your CPAP, you may be swallowing excess air during your sleep. Sometimes it’s simply a matter of getting accustomed to relaxed, regular breathing with your CPAP. This is especially true if you are new to CPAP therapy.

CPAP Problem: Vivid Dreaming During CPAP Use

Yes ‘CPAP Dreams’ are a normal and common ‘side effect’ of CPAP therapy. Quite often, untreated OSA disrupts sleep so severely that the dream stage is constantly interrupted or never reached at all. When the OSA is suddenly eliminated by CPAP, dreams will often be more intense , memorable, and frequent as sleep is restored.

Early in therapy, CPAP dreams may occupy much of your sleep time for the first week or so. After that, the dreams will taper off toward the levels seen in normal, healthy adults.

  • ‘CPAP dreams’ are a normal and common side effect
  • Untreated OSA disrupts sleep constantly interrupting the REM sleep stage
  • When OSA is eliminated by CPAP, dreams will become intense, memorable, and frequent
  • These dreams will eventually taper off and you will dream like a normal healthy adult

CPAP Problem: Claustrophobia

There is an adjustment period for most CPAP users as they get used to sleeping with any mask on the face. While your goal is to be able to sleep all night on CPAP, using it as long as you can tolerate it each night is better than nothing.

To reduce or eliminate feelings of claustrophobia, use your mask while you’re awake. Practice by first just holding the mask up to your face without any of the other parts attached. Once you’re comfortable with that, try wearing the mask with the straps and without the hose connected. Then attach the hose and turn your CPAP machine on at a low-pressure setting (with ramp feature turned on) and try holding the mask to your face and breathing without using the straps. And, finally, wear the mask with the straps and with the machine turned on.

CPAP Problem: Dry Mouth

If you wake with a dry mouth, chances are that you sleep with your mouth open – don’t worry, a lot of CPAP users do this. CPAP therapy can cause slight dry mouth on it’s own, but if you sleep with your mouth wide open, the problem can be seriously exacerbated. In this case, you might benefit from getting a chin strap if you use a nasal mask or nasal pillows mask. You can also use a full-face mask to accommodate mouth breathing.

CPAP Problem: Dry or Stuffy Nose

Having a dry or stuffy nose as a result of wearing a CPAP mask is never fun. Doctors recommend that you use the heated humidifier function on the CPAP machine to raise the humidity levels. If the humidity levels are too low, your mucous membranes react by becoming inflamed and swollen, which creates dryness and stuffiness. If using the heated humidifier doesn’t work, try using a saline spray right before you go to bed. If the dryness and stuffiness continues, you ask your doctor about using a steroid nasal spray.

CPAP Problem: Skin irritation, Sores and Bruises from Mask

No mask should cause pain nor discomfort if sized correctly and fitted properly. One of the most common mistakes CPAP users mask, is over tightening their CPAP mask, which leads to marks. Try loosening the straps and bit and let the mask form a seal when the air starts to flow. If you have to over tighten your mask to get a good CPAP Mask seal, your mask cushion may be worn out and need replacing. Or, you may need something to help with CPAP Mask Leaks

CPAP Problem: Bloody Nose

A bloody nose during CPAP use is a common problem, especially in the beginning of CPAP therapy. If you have a heated humidifier, try adjusting the level of humidity to make sure you are getting maximum humidity without creating condensation in your tubing or CPAP Mask. You might also try using a nasal saline spray or a ‘neti pot’ before bedtime to moisten your nasal airway. To maximize humidity in your airway without causing ‘rainout’ in your tube, upgrade to a heated tube. Talk to your doctor if you continue to experience a bloody nose during CPAP use.


Read more about mask problems at this post – Sleep Apnea Mask Problems and Solutions


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solve your sleep problems

Diet and Lifestyle Recommendations to Solve Your Sleep Problems

In case you’re not already familiar with the statistics, roughly one in three Americans aren’t getting enough sleep. Many who are sleep deprived point to common problems as the cause of their insomnia. citing issues such as snoring, nightmares and acid reflux as reasons for their restlessness. But how do you put an end to these seemingly small, yet stifling, sleep problems?

The answer could be your daily diet. “Food provides the nutrients needed for the production of neurotransmitters that regulate sleep,” says Dr. Ana Krieger, director of the Center for Sleep Medicine at NewYork-Presbyterian and Weill-Cornell Medicine.

Listed are the six easy dietary do’s that will help solve your sleep problems:

1. Balance your plate to avoid nightmares.

Consuming a balanced meal of proteins, fats and carbs will help stabilize blood sugar levels ahead of bedtime, says Maya Bach, a licensed dietitian nutritionist, and owner at River North Nutrition in Chicago. This stability will help prevent spikes and crashes in blood sugar that can disrupt your energy levels and mood. A dip in blood sugar at night can cause nightmares and other odd bedtime behavior, like crying out in your sleep.

2. Pair protein with carbs to fall asleep faster.

Proteins like turkey, roasted soybeans and milk are high in levels of an essential amino acid called tryptophan. Tryptophan is a key component of serotonin, a chemical that promotes relaxation when it’s released in the brain.

Pairing proteins high in tryptophan with a starchy carb or whole grain may help prime the body for sleep, Bach says “The surge in your blood sugar after eating carbs stimulates tryptophan’s sleep-inducing properties in the brain,” she says.

3. Curb snoring by staying hydrated.

Snoring affects a whopping 90 million American adults. In some cases, dehydration may be the culprit behind snoring, according to Georgia Giannopoulos, dietitian and manager of Be Healthy, an employee-focused health program at NewYork-Presbyterian Hospital. To help prevent this, she recommends being mindful of your hydration throughout the day (try downloading an app to help). You can also keep a glass of water at your bedside as a reminder to start hydrating when you wake up in the morning.

4. Skip the booze to sleep soundly.

Drinking alcohol may make you feel drowsy at first, but research suggests you may end up with lower quality sleep overall. “In some cultures, alcoholic drinks are commonly used to facilitate sleep,” says Dr. Krieger. “[But] alcohol intake close to bedtime has several downsides; it acts as a muscle relaxant that worsens snoring and may trigger sleep apnea, and also leads to a chemical disruption of sleep.”

5. Eat a light dinner to avoid acid reflux.

Try paring down for your final meal of the day, Bach says. “Consuming less food later in the day may help reduce bloating, discomfort and possible acid reflux some of us experience when we consume too much food at one meal,” she says. Avoid spicy, acidic foods and instead opt for low-acidic foods before bedtime, like lean proteins such as baked chicken and poached fish, and green veggies like broccoli and asparagus.

6. Keep a food diary to find hidden offenders.

Because not all bellies are created equal — what works for the majority may not work for you — tracking what you eat could solve your food/sleep related mysteries. “If someone has a pattern of difficulty sleeping, keeping a food and sleep diary may be beneficial in helping spot if certain foods are affecting sleep,” Giannopoulos says. Hint: This includes caffeine!

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Diet and Lifestyle Recommendations to Solve Your Sleep Problems

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resmed new record

ResMed New Record: One Billion Nights of Sleep Data Monitored

ResMed new record in digital connected care: One billion nights of sleep data have been downloaded using ResMed’s remote patient monitoring platform, AirView.

“One billion isn’t just a big number,” says Atul Malhotra, MD, chief of the Division of Pulmonary and Critical Care Medicine and director of Sleep Medicine at UC San Diego Health, in a release. “It’s a major milestone that holds great promise for future research and the treatment of sleep apnea and other respiratory conditions through connected health tools.”

“We are about to enter a new phase of sleep research and sleep understanding,” says Malhotra, also immediate past president of the American Thoracic Society, “using big data to improve patients’ well-being.”

Mick Farrell, ResMed CEO, says, “This unprecedented amount of data enables predictive analytics to help physicians and providers better manage patients’ sleep apnea and COPD therapy, and ultimately improve their overall health. Reaching one billion nights is about more than just big data; it’s a testament to how the adoption and meaningful use of technology benefits patients, physicians, and providers everywhere, and we couldn’t be more pleased to start 2017 with this exciting news—this is just the beginning!”

More than 3 million patients being monitored by AirView, more than 200,000 diagnostic tests processed in ResMed’s cloud, and more than 1,000 patients per day signing up for myAir to track their own therapy use on ResMed Air10 devices.

Sleep centers are also excited about ResMed’s milestone and the general advancement of remote monitoring.

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ResMed New Record: One Billion Nights of Sleep Data Monitored

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