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Having a bedtime routine for adults has a positive impact on day-to-day activities and overall sleep health. Learn more about the ideal bedtime routine for adults to promote better sleep and a relaxed mind.

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A bedtime routine helps you keep a consistent schedule for healthier sleep. By going to bed at roughly the same time every night and by performing the same activities before bedtime every night, you are maintaining a bedtime routine. Bedtime routines help prepare your body and mind for sleep through conditioning. Erratic sleeping schedules can lead to sleep disorders and eventually health-related issues, so a bedtime routine is as important as diet and exercise for your well-being.

Why Is a Bedtime Routine Important for Adults?

When we think of bedtime routines when may think they apply mostly to children. But a bedtime routine is just as essential for adults. When adults of any age maintain a bedtime routine, they can maintain healthy sleep. Healthy sleep helps contribute to overall health including cardiovascular health. Healthy sleep through a bedtime routine also promotes mental health. Erratic sleep patterns can lead to daytime drowsiness due to sleep loss, poor memory, and concentration, which can affect work and life. Poor sleep can also lead to mental health issues such as anxiety or depression. So, a bedtime routine helps keep your mind and body in the best shape as an adult.

Examples of Bedtime Routines

Set A Specific Bedtime

Keeping a consistent bedtime helps your body and mind prepare for sleep every night. Try to establish a set time and stick to it. You may even find yourself getting sleepy as your set bedtime nears. It does not matter if you prefer to go to bed early or like to stay up late. As long as you maintain that sleep schedule every night, you can assist your body and mind to get ready for sleep.

Turn Your Electronic Devices Off

You may be tempted at bedtime to engage with your phone or computer or other devices, but this activity stimulates the mind and can affect healthy sleep. Blue light from these devices can trick the mind into thinking it is daytime, which arouses wakefulness instead of sleep. Set a time before you go to bed when you shut off your electronic devices. Stay away from your phone, computer, tablet, and even the TV if you can.

Listen to Calm and Relaxing Music

One way to prepare your mind for sleep every night is to set aside some time to listen to calming or relaxing music. As part of your bedtime routine, music can help lull you into a sleepy state. Be sure to listen to your sleep track before entering the bedroom. It is best not to conduct any activities in bed before sleep. Try to listen to your relaxing music track in another room for some time and then retire to the bedroom to sleep.

Eat Light Meals

Dinnertime can affect your sleep. Try not to eat anything several hours before bedtime as part of your routine. Food needs to be digested and the digestive process can keep you awake. Also, try to avoid heavy meals for your dinner. Consume all your calories at breakfast and lunch and select a lighter meal for dinner. This habit can reduce the digestive process by having less in your stomach at bedtime and allow for a more peaceful sleep.

Write Down Your Thoughts in Journal

One of the most useful pre-bedtime activities is writing in a journal. Journaling can help you organize your thoughts before bedtime. Often people will go to bed and experience racing thoughts or think about events that happened during the day, which can keep them up. Journaling helps vent those urgent thoughts. By getting them down on the page before bed, you are more likely to drift off to sleep and stay asleep with your mind at peace.

Create a To-Do List

While journaling can help you address the day's events, a to-do list can help you prepare for the next day. Often our busy lives can lead to anticipation of tomorrow's activities. These racing thoughts can keep us awake and may leave us too tired to complete those activities the next day. Writing down a to-do list before bed helps us prepare and organize the events that are coming up so we do not dwell on them while trying to sleep.

Take A Cold Shower to Destress

While a cold shower may sound like a shock to the system before bedtime, it actually has the opposite effect. A cold shower helps eliminate stress and reduce feelings of anxiety. If you have had a stressful day, that stress can carry over into bedtime and keep you awake with racing thoughts and worries. A cold shower breaks that stress and alleviates those urgent emotions. Climbing into a warm bed becomes a comfortable and inviting experience that promotes sleep.

Lower the Lights to Create a Soothing Atmosphere

Reducing the amount of light in your bedroom helps induce sleep. Even a nightlight, while helpful can create glare that keeps you awake. Just like the blue light of electronic devices, artificial light stimulates the mind into thinking it is daytime and time to wake up. Try to sleep in a room that is close to completely dark if you can. If you use a nightlight, try to place it so that it is very dim and does not shine a light on you while you are trying to go to sleep.

Practice Meditation

One of the proven ways to relax the mind is through meditation. Meditation, especially before bedtime, can help eliminate racing thoughts or anxious feelings that can keep you awake. Meditative practices help relax the body as well, which promotes relaxed sleep. Meditation is easy to learn and can be practiced without much training. There are many different ways to meditate, and you can explore some that take little time and can be an important part of your bedtime routine.

Relax with A Yoga Session

Another meditative practice that helps relax the mind and body is yoga. Yoga practices before bedtime help destress the muscles that may be taut from a day's worth of activities. There are many specific yoga routines designed specifically for healthy sleep. The practice also focuses on the mind much like meditation to get past anxious emotions or stressful thoughts that can lead to disrupted sleep. A yoga session before bedtime gets your mind and body ready for a restful sleep without exerting you physically.

Use Oils or Aromatherapy to Relax

The sense of smell plays an important role in healthy sleep. Disruptive, unpleasant, or harsh odors in the bedroom or odors that you experience before going to bed can keep you up. Use oils in aromatherapy that actually calm the mind. Scents like lavender are known to help soothe and relax. Fill your bedroom with these fragrances to help create a relaxing atmosphere before bedtime, so your mind and body are ready for peaceful sleep.

Prepare Your Bedroom

One of the most important aspects of maintaining a bedtime routine is that you should conduct most of your routine outside of the bedroom. Limit reading or watching TV or eating in your bedroom. Make your bedroom the sole place to sleep. As part of your bedtime routine, turn down your bed covers, plump your pillows and dim the lights to create an atmosphere that is inviting for restful sleep. Even as you perform other pre-bedtime activities such as meditation in other places in the home, your prepared bedroom is waiting for you to lie down and sleep.

What is The Ideal Time to Start a Bedtime Routine?

Your bedtime routine depends on when you decide you would like to go to sleep. You should start your bedtime routine roughly two to three hours before you decided on bedtime. But more time can be used preparing for sleep if needed. You can even establish a schedule that helps you stay on track. For example, if you go to bed at 10 pm you can follow this schedule.

Eat a light meal for dinner between 6 pm and 8 pm. Try to avoid snacking after 8 pm.

Conduct a meditation or yoga session for about an hour, around 8 pm to 9 pm.

Turn off electronic devices around 9 pm.

Complete your journaling or to-do list from 9 pm to 9:30 pm.

Prepare your bedroom and take a cold shower if you had a stressful day.

How Does Your Bedtime Routine Affect Your Chances of Developing Sleep Apnea?

While a bedtime routine is helpful for good sleep and can help with sleep apnea, it cannot prevent it. If you have sleep apnea, then you may have to include CPAP therapy as part of your bedtime routine. Staying CPAP compliant along with a healthy sleep schedule can both help reduce the instances of apneas throughout the night, so you sleep better.

Sleep apnea however is probably not the result of a poor sleep schedule. You need to follow the recommendations from a doctor to curb the symptoms and improve sleep. Only a doctor can help you determine the severity of your sleep apnea and provide proper treatment.

Where Can I Get Diagnosed for Sleep Apnea?

If you suspect that you have sleep apnea, the first step is to get an accurate diagnosis. You can do that through a home sleep apnea test from Sleep Care Online. Here is how it works:

Purchase a Complete Care package and fill out a health and sleep questionnaire.

We mail you a disposable HSAT, NightOwl-the world's smallest and most convenient home sleep apnea device. Get tested for sleep apnea at home, in the comfort of your bed. Data is ready to be analyzed the next morning.

Schedule a 15-minute virtual appointment with a board-certified sleep physician to review the test results, discuss therapy options, and write you a prescription.

Our sleep experts will reach out to provide customized recommendations and facilitate equipment purchase and setup.

Order a Home Sleep Test Today!

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A bedtime routine helps you keep a consistent schedule for healthier sleep. By going to bed at roughly the same time every night and by performing the same activities before bedtime every night, you are maintaining a bedtime routine. Bedtime routines help prepare your body and mind for sleep through conditioning.

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Aligned Medical Group, P.C. offers treatments that provide effective and immediate relief

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Medical weight loss is an effective way to control obesity without extensive exercise and diet management. Looking for medical weight loss solutions? Visit us today!

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Camping with CPAP is easy with these tips from CPAP Supply USA. Explore CPAP batteries for camping and portable CPAP machines to make your therapy simple.

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We all need a little escape from time to time, and camping is a great way to do that. There are plenty of benefits, from fresh air and sunshine to relieving stress and resetting your sleep cycle. But how can you go camping with sleep apnea? While it might seem like a challenge, camping with your CPAP is easier than it sounds. In this guide, we'll discuss the following:

1. How to Power a CPAP When Camping

2. Using a CPAP Battery for Camping

3. Using a Car Battery for Your CPAP

4. Choosing a CPAP Machine for Camping

5. Extra Tips and Reminders

How to Power a CPAP When Camping

Although it may be tempting to leave your CPAP at home for a few days, it's not recommended. Practicing consistency in your therapy is the best way to treat sleep apnea, so it's never a good idea to skip nights here and there. But in order to go camping with your CPAP, you'll need power, and which power source you use will depend on where you want to go. There are two choices:

Use a CPAP Battery for Camping

Stay at a Campsite with Electricity

Which direction you go is completely up to you, but rest assured that there are great options to power your CPAP machine either way.

Choosing a CPAP Battery for Camping

Using a battery is the best option if your trip takes you off the beaten path and the site you select doesn't have electricity. Disconnecting from the hustle and bustle is the obvious choice for outdoor enthusiasts looking for some peace and quiet, but it does require more preparation and planning. It's important to find the best battery to use for your CPAP while camping, and this comes down to a couple of options.

1. Using a CPAP Battery: Bringing a on your trip is the best way to keep your machine powered up and ready to go. CPAP batteries are great for camping since most are fairly small and lightweight. Most are also FAA-approved, so you won't have to worry about transporting them if you're flying to your camping destination. Keep in mind, however, that an average battery will only last for one or two nights, so we recommend bringing multiple batteries if you plan on taking a longer trip. As you choose a battery, it's also important to remember that not all batteries are compatible with every machine. Some batteries use a DC input, while others might require an inverter, so it's best to purchase a battery that is compatible with your CPAP out of the box. If you have questions about your machine's specific power needs, contact our support team and we'll help you find what you need.

2. Using a Car Battery: Using a car battery for your CPAP is an alternative to a traditional CPAP battery that might be appealing depending on your situation. The biggest advantage is how long a car battery will power a CPAP machine - usually, 2-3 days compared to 1-2 for a CPAP battery thanks to a larger capacity cell. However, there are tradeoffs to using your car battery. You will most likely need to use a DC adapter cable, which is clipped onto the positive and negative terminals on the battery and allows you to plug your machine into a standard car auxiliary outlet (cigarette lighter). Depending on your machine, you may also need an inverter to convert the power from DC to AC. Finally, car batteries are not FAA-approved, so you will need to make sure you're driving to your destination if you plan to bring one along.

Ultimately, it's up to you to choose the best battery to use for your CPAP on your camping trip. There are positives and negatives to both options, but either one can help you plan the trip you want.

Find a Campsite with Electricity

Of course, the easiest option is just to stay at a campsite that provides power. If you're looking for a camping experience with a side of air conditioning and Wi-Fi, this is the way to go. There are plenty of great choices, from to , that offer power hookups. Access to power makes it a lot easier to go camping with your CPAP, especially if you use a humidifier. While helpful, using a humidifier will drain your battery a lot faster, so it's recommended to have a source of electricity or to bring extra batteries if you plan to use your humidifier on your trip. Powered campsites are also more likely to have bathrooms and showers available, but they may be more crowded and feel less like a true camping experience, so keep all of this in mind as you're deciding where you want to go.

Choosing a CPAP Machine for Camping

While it's perfectly fine to use your current CPAP machine for camping, you may also want to consider investing in a travel CPAP machine for long trips. Using a more portable CPAP for camping and other traveling offers a few advantages:

Smaller and lighter weight, making it easier to carry on long hikes.

Simpler to use in confined spaces such as a car, plane, or tent.

You don't have to disturb your home setup every time you travel.

In addition, travel CPAP machines often have advanced features that allow you to track sleep trends and gain further insight into your sleep quality. These are great for anyone that struggles with sleep more when they're on the road.

Extra Tips and Reminders

As you're preparing to go camping with your CPAP, deciding where to stay, and figuring out how many and what type of batteries you need, don't forget the rest of your essentials.

Make sure to bring your mask, tubing, and other accessories such as filters and cleaning supplies that you may need during your trip.

Remember to pack everything carefully to avoid damaging your equipment.

Consider bringing something to protect your CPAP from the rain, since the weather can be unpredictable.

Above all else, have fun! Camping with sleep apnea doesn't have to feel any different than normal camping. Make sure you're prepared, then all you'll have to worry about is the standard stuff like mosquitoes, poison ivy, and bears...Sweet dreams and happy camping!

Sources

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We all need a little escape from time to time, and camping is a great way to do that. There are plenty of benefits, from fresh air and sunshine to relieving stress and resetting your sleep cycle. But how can you go camping with sleep apnea?

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One of the biggest challenges in travel and camping is maintaining proper sleep hygiene. This is especially true with people who may already have sleeping issues. Luckily we have some CPAP travel tips for when you're camping or traveling away from home.

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Next time you sleep under the stars, make sure you, and those around you, follow these simple tips to get the quality sleep you’ve become so accustomed to, now that you’ve been using CPAP.

1. Use CPAP when you’re camping

Always use CPAP whenever and wherever you sleep. Travel bags make it easy to bring CPAP with you. There are also travel CPAP machines that are completely portable. You’ll also be glad you got a good night’s sleep in order to get the most out of your camping trip.

2. Know how to power your CPAP outside

If you have an external CPAP battery, refer to its user guide on how to charge it. If you don’t have access to wall socket power during your camping trip, and your machine’s manufacturer doesn’t make a battery for it, you should consider getting a marine battery to power your CPAP machine. Talk to your equipment provider about what you need and where you can get it. If you own a ResMed CPAP machine, you should consider getting the RPSII - a portable battery especially designed for S9 and AirSense 10 CPAP Machines. Philips Respironics also have a universal portable battery pack available. So there are plenty of portable power options to help you go off the grid.

Is this the CPAP system for camping?

When it comes to camping, portability and power consumption can be major considerations, especially in remote places where every kilogram in the backpack matters, and where options for power are limited.

The ResMed AirMini may be the answer you are looking for. This compact and complete package will impress, whether you are looking for a portable travel CPAP machine or a primary device for your sleep apnea treatment.

3. Know how many hours of power you have

Humidification and CPAP pressure can both affect how much power your battery can provide. For instance, ResMed’s RPS II packs up to 13 hours of power. But with humidification on, it can be much less. If you are unsure, come in to one of our locations and ask us:

How much power your CPAP battery can provide

Whether you can run two batteries at once to double your power (you can with the RPS II)

Whether you can get by without using humidification outside (depending on the weather forecast)

4. Change your filter when you get home

Your filter will be likely to pick up far more allergens and dust particles outside than it does in your bedroom. Be sure to order some extra CPAP machine filters before you go camping, and swap them the day you get home.

Taking your CPAP camping isn’t always possible with non-travel ready CPAP machines. If you’re looking to upgrade or purchase your first, new CPAP machine, check out our full range of CPAP Machines.

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One of the biggest challenges in travel and camping is maintaining proper sleep hygiene. This is especially true with people who may already have sleeping issues. Luckily we have some CPAP travel tips for when you’re camping or traveling away from home.

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Can you go camping on CPAP Therapy? Does your CPAP Machine support portability and how do you manage the adversities of camping with CPAP. Read this detailed article to learn
more.

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As the weather warms, it's time to start spending more time outdoors. Spring is a great time for camping. Our extensive line of Travel CPAP equipment makes it easy to enjoy a night under the stars. Here are some tips to make camping with CPAP hassle-free.

What CPAP Machine Should I Pick When Camping with CPAP?

Whether it is your first time or you are a seasoned pro, camping requires a lot of gear! In addition to your personal necessities, you may need a tent, sleeping bags, bedding, tarps, chairs, firewood, and cooking utensils, at a minimum. The last thing you want is to pack another heavy, cumbersome machine. Don't worry, we have you covered.

Our new line of travel CPAP machines is compact and lightweight-weighing as little as 2 lbs! These mini machines include all the conveniences of your home unit. Plus, they can operate on battery power and even include heated humidification options.

Our customer favorites include:

Philips Respironics DreamStation Go Auto Travel CPAP Machine

At half the size of the at-home DreamStation, the DreamStation Go Auto delivers all the same powerful therapy on-the-go. Features include a color touch screen, automatic pressure adjustments, flex pressure relief during exhalation, a whisper-quiet motor, and Bluetooth connectivity. Additionally, the new 12mm microtubing is the smallest diameter tubing available, making it lightweight and flexible.

The innovative design features a built-in power block to eliminate bulk and take up minimal space. Either plug the machine directly into an outlet or purchase an optional battery to use off-grid or as a back-up in case the power goes out. Conveniently, the color screen shows the current battery pack charge status so you are never left guessing. And even with the optional battery, the DreamStation Go Auto still weighs in at less than 3 lbs!

But what really makes the DreamStation Go Auto stand out against its competitors is the addition of the new optional heated humidifier. Heated humidification adds moisture to your delivered air to improve comfort during therapy. With the DreamStation Go Auto, the heated humidifier seamlessly connects to the unit. Additionally, it can be operated with tap, bottled, or distilled water.

Purchase Now

ResMed AirMini Auto Travel CPAP Machine

The world's smallest CPAP machine, the ResMed AirMini Auto fits in the palm of your hand. It weighs only 10.6 ounces. However, size is only a number when it comes to delivering powerful therapy. The AirMini offers many of the same features as the standard AirSense 10 Auto device, including auto ramp, expiratory pressure relief, Bluetooth connectivity, and SmartStart.

While portability was the driving factor in the ResMed AirMini's design, it also features many new, innovative technologies including a waterless humidification system. Named HumidX, the small, 30-day replaceable, waterless humidifier features bands of material embedded in a pod that sit in the mask tubing. Instead of water, the machine delivers humidification through vented air.

The ResMed AirMini is compatible with only three masks: AirFit P10 Nasal Pillow, AirFit N20 Nasal Mask, and the AirFit F20 Full Face Mask.

HDM Z2 Auto Travel CPAP Machine

Building on the form of the Z1, the new Z2 Auto CPAP features a quieter motor, auto start/stop, auto-adjusting pressure, and exhalation pressure relief. Weighing at 10.5 oz, the machine is lightweight, compact, and portable. And, it is compatible with any mask!

The Z2 comes with a small, portable humidification cartridge. It is inserted between the hose and the mask to capture the moisture in the exhaled breath and release it on the inhaled breath without any electricity or additional water.

When camping with CPAP in areas with limited power or off-grid, the Z2 has an optional PowerShell fully integrated battery option to provide a full night's sleep on one charge.

How Do You Power Your CPAP Machine While Camping?

When it comes to running your CPAP machine through the night, you have a few options. The first is, of course, plugging your machine into an outlet. Most campgrounds have campsites with electricity. If that is an option, you can easily plug your machine into the electricity post outside your tent and enjoy the comforts of home while camping with CPAP.
Integrated Batteries
However, for areas with limited power or when you choose to go completely off-grid, many of our travel CPAP machines come with the option to purchase integrated batteries. These batteries are unique to the machine and seamlessly connect the base to minimize bulk and maximize space. They are available for purchase with the DreamStation Go Auto and the HDM Z2.
Battery Packs
We also carry stand-alone battery packs (remember to buy the corresponding cables!) that can work with nearly any machine. These include the Medistrom Pilot-24 Lite CPAP Battery Backup Power Supply (for ResMed), the Medistrom Pilot-12 Lite CPAP Battery Backup Power Supply (for Respironics), and the lithium ion Freedom Travel CPAP Battery. Charge times vary depending on the amount of direct sunlight available. These work particularly well with the ResMed AirMini.

In cases of spotty coverage, the battery will serve as a back-up to guarantee an uninterrupted night of sleep. Battery power time will vary from 10 hours to 40 hours depending on your individual pressure settings. You can easily recharge your battery by purchasing cables to connect to a deep cycle marine battery or a cigarette lighter. However, if you are in a remote area with no access to recharging, consider buying multiple batteries to cover the length of your stay.

While it is tempting to skip a night of therapy, remember that pausing therapy has many negative mental and physical health risks. Even one night of missed therapy can result in depleted energy, headaches or migraines, and trouble focusing. Don't miss out on the fun!

The Trouble with Inverters

In some cases, if you are using an older CPAP machine, an inverter may be necessary to connect the machine to a battery. In these cases, the CPAP machine plugs into the inverter and the inverter plugs into the battery. Both the inverter and the machine pull their power from the battery, so this can drain the battery power twice as fast. Therefore, the best solution is to buy a battery that is specifically designed for your machine or consider upgrading to a travel machine with a built-in battery for the most efficient delivery.

Pro-Tip! To maximize your CPAP battery life, turn the heated humidifier off. It can continue to add humidity but just not heated.

- Jose Acosta, CRT, respiratory therapist at The CPAP Shop

The CPAP Shop's knowledgeable team is here to answer any questions you may have. We can help you decide which products best suit your travel needs. Give us a call at 866-414-9700!

Have you taken your CPAP therapy on the road? Please share your experiences with us below. Our readers greatly appreciate the insight as they make their own buying decisions.

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As the weather warms, it's time to start spending more time outdoors. Spring is a great time for camping. Our extensive line of Travel CPAP equipment makes it easy to enjoy a night under the stars. Here are some tips to make camping with CPAP hassle-free.

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Regular Marijuana Use and Obstructive Sleep Apnea: A Recipe for Disaster During Sedation

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Regular Marijuana Use and Obstructive Sleep Apnea: A Recipe for Disaster During Sedation

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Some people use marijuana as a sleep aid to help them feel drowsier and experience its relaxing and sedative-like effect.

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Regular Marijuana Use and Obstructive Sleep Apnea: A Recipe for Disaster During Sedation
Published on Jan 11, 2021
Regular Marijuana Use Increases Sedation and Anesthesia Medication Needs
In a retrospective study published in the Journal of the American Osteopathic Association (2019; 119:307-311), researchers concluded that more sedation medications may very well be required during procedures for patients that regularly use marijuana. The differences translated to an additional 14% of fentanyl, an additional 19.6% of midazolam, and a whopping 220.5% more propofol during sedation needed for cannabis users. This increased dose may put the patient at a higher risk for respiratory depression which could lead to complications during and after surgery.

Some people use marijuana as a sleep aid to help them feel drowsier and experience its relaxing and sedative-like effect. The reality is that its use actually inhibits REM sleep, the rapid eye movement stage of sleep, a very important phase of sleep and is very important for the restorative part of our sleep cycle. When REM sleep is disrupted for even one night, the body will fail to follow its normal circadian sleep cycle ("inner clock") progression and instead, people will slip directly into REM sleep as a result of not getting the right amount of sleep the night before. Marijuana users will also go through extended periods of REM sleep until they "catch up" on this stage of sleep. Marijuana not only has a sedative and relaxing effect on the brain, but it also relaxes the skeletal muscles of the body that control movement and patency of the upper airway. The muscles of the upper airway (wind pipe), a region that extends from behind the nose, past the mouth (including the tongue and muscles that control movement of the lower jaw), and down to the vocal cords, controls how much air goes into the lungs and when those muscles relax, it results in the narrowing of the upper airway, restricting the amount of airflow into the lungs. For a patient with an undiagnosed or untreated obstructive sleep apnea (OSA) or upper airway resistance syndrome (UARS) undergoing sedation, it is a recipe for disaster.

Sleep apnea affects over 70 million people in the U.S. alone and a billion people worldwide, equating to 1 out of 4 adults, and 80% of them are not even aware they suffer from it.

OSA occurs during sleep when muscles and soft tissue in the upper airway including those that control the tongue, throat and lower jaw relax and block the airway and stop breathing for 10 seconds or more. OSA is often an undiagnosed disorder and this prolonged duration of not breathing causes the brain to wake the person up momentarily, choking and gasping for air repeatedly, sometimes hundreds of times during the night. Such repeated pauses in sleep leads to not only a restless and disturbed sleep, the decreased sleep quality and quantity resulting in unrestored sleep which can lead to experiencing, headaches in the morning upon waking up, sore or dry throat upon waking up, daytime irritability, drowsiness, fatigue. Decreased quality of daytime function and can adversely affect your overall health and day-to-day activities. OSA occurs during sleep when muscles and soft tissues in the upper airway relax, including those that control the tongue, throat and lower jaw.

Snoring is often a symptom of OSA, where the soft tissues of the soft palate vibrate (air turbulence) as the air passes through the mouth squeezing between the low draping soft palate and the back of the tongue. This continual restriction can progress to an obstruction and cause a complete collapse of the airway causing the person to stop breathing for 10 seconds or longer and air doesn't go into the lungs and that results in a decreased amount of oxygen circulating not only to the brain, heart and other vital organs, but also to the rest of the body. The longer the obstruction or collapse continues, the more the body goes deprived of oxygen, and this continual and chronic oxygen deprivation over long term can take a terrible toll on one's overall physical, mental and social well-being.

Other symptoms of untreated OSA include:

Restless Sleep

Interrupted Sleep

Witnessed Apneas (stopping of breathing during sleep followed by gasping of breath)

Excessive Daytime Sleepiness

Impaired Daytime Alertness and Function

High Blood Pressure

Unexplained Weight Gain

Impaired Immune System

Teeth Grinding during Sleep (Bruxism)

TMJ - Jaw Pain

Morning Headaches

Difficulty Breathing from Nose

Mouth Breathing

Dry Mouth Upon Awakening

Impaired Memory Consolidation

Impaired Physical Performance

Depression

Severe Anxiety

Impaired Executive and Cognitive Functioning

Attention Deficit and Hyperactivity Disorder (ADD, ADHD)

Short Term Memory Loss

Intellectual and Cognitive Deterioration

Mood Changes

Shortened Lifespan

Temperamental Behavior

Poor Job Performance

Decreased Sex Drive

Impotence

People with undiagnosed or untreated sleep apnea have a higher incidence of obesity, heart conditions, erectile dysfunction, diabetes, high cholesterol, stroke and snoring etc.

According to the "Practice Guidelines for the Perioperative Management of Patients with Obstructive Sleep Apnea" published in the May 2006 issue of the journal Anesthesiology, "both pediatric and adult patients with OSA ... present special challenges that must be systematically addressed ... to improve [their] care and reduce the risk of adverse outcomes,".

The recommendations are that for a surgical patient, OSA status needs to be established early on, by means of medical histories, screening tools, and physical examinations that take into account such risk factors as large neck circumference, and airway and palate anomalies. Patients with OSA have significantly more collapsible airway and are especially susceptible to the effects of inhaled anesthetics, sedatives and opioids and have more sedation related complications than patients who do not suffer from OSA.

One of the sound advices I received and continue to practice was from Dr. Charles Jackson, an anesthesia attending, who taught me, "Don't treat a stranger", and "Screen every patient for OSA". Knowing a patient's medical history is not enough, it is also important to interview them for their sleep history, social history and know their recreation alcohol and amount of drug use. During the pre-sedation workup, patients may admit to alcohol and drug use easier than reporting if they suffer from OSA. On average 80% of patients with OSA do not know they suffer from it and about 60% do not report experiencing excessive daytime sleepiness (EDS), a common symptom associated with OSA, disruptive sleep and sleep deprivation.

Conclusion:

Regular use of marijuana, especially before sedation or anesthesia, not only increases medication threshold for desired sedation effect, it also suppresses the patients central and skeletal muscle response to respiratory depression leading to a faster onset, deeper and longer period of oxygen desaturation. Add to that a highly collapsible airway and decreased lung volume of an OSA patient, during sedation which is an artificially induced state of sleep, the sedated patient can desaturate and experience cardiorespiratory distress much faster than a patient without OSA.

To avoid intra-operative complications with patients who use marijuana regularly and/or OSA during in-office surgery the depth of sedation may have to be adjusted to allow for maintenance of protective reflexes by the patient. Such adjustments which can result in intraoperative awareness or accidental awareness during sedation, where patients regain varying levels of consciousness during their surgical procedures. General anesthesia may have to be induced for the procedure to continue comfortably for both the surgeon and the patient.

Having sedated hundreds of patients with OSA, and correlating pre-treatment symptoms with diagnostic sleep studies of thousands of patients successfully treated with oral appliances (OAT), to mitigate intra-operative complications to determine the appropriate level of sedation as part of informed consent, we have developed simple and easy to use screening questionnaires to be used during evaluation of not only the surgical patient and for all patients in our practice.

Dr. Pankaj P. Singh

Chief Scientific Officer: APP-NEA, LLC

Co-Founder & Faculty: Foundation for Surgical Excellence

Attending: Lenox Hill Hospital - Department of Otolaryngology

Faculty: The New York Head & Neck Institute and Center for Facial Reconstruction

Editor: Journal of Oral Implantology

Editor: Journal ACTA Neurology

Contributing Writer: Huffington Post

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Regular Marijuana Use and Obstructive Sleep Apnea: A Recipe for Disaster During Sedation | APP-NEA

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Some people use marijuana as a sleep aid to help them feel drowsier and experience its relaxing and sedative-like effect.The reality is that its use actually inhibits REM sleep, the rapid eye movement stage of sleep, a very important phase of sleep and is very important for the restorative part of our sleep cycle.

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Marijuana as Treatment for Sleep Apnea? 

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Marijuana as Treatment for Sleep Apnea? 

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Last year we wrote a post on-that's right-marijuana as a potential treatment for sleep apnea. Since then, midterm elections have brought a new wave of legalization to the West Coast: Alaska and Oregon both decriminalized recreational use of the drug. So we thought it was worthwhile to take a second look at whether pot, scientifically or politically, could become a valid treatment for sleep apnea.

The Science behind Smoking

Obstructive sleep apnea (OSA) is a breathing disorder that occurs when the back of the throat relaxes during sleep, blocking off the airway. This causes gasping, choking, and oxygen deprivation to the brain, preventing the subject from ever reaching a deep sleep and resulting in serious long-term health consequences.

Several studies have supported the hypothesis that cannabis can alleviate the symptoms of this sleep disorder. A study conducted in 2002 by researchers at the University of Illinois found that THC and oleanide, both types of medical marijuana, improved breathing patterns in rats with the condition in all stages of sleep. In fact, apnea episodes decreased by 42 to 58 percent. The higher the dosage of the drugs, it was discovered, the greater the improvement.

In 2013, the head researcher from the 2002 examination, Doctor David Carley, oversaw another study that was the first to investigate the connection between marijuana and sleep apnea in people. After administering a THC-containing pill to test subjects for three weeks just before bedtime, he observed a 32% decrease in apnea events in humans.

Dr. Carley has been granted $5 million from the National Institute of Health to further investigate the findings, and he hopes to develop a commercially available pill.

But on the other hand, several studies such as this one have linked pot use to decreased sleep quality. Experts maintain that pot is not a valid solution to issues like stress or insomnia. This throws some doubt on the utility of pot to aid in sound sleep.

How does this potential treatment compare to CPAP therapy?

In comparison to existing remedies, the benefits of marijuana are modest. CPAP (Continuous Positive Airway Pressure) therapy, which involves pumping pressurized air through the airway to keep it open, has a nearly 100% success rate and can completely alleviate sleep apnea symptoms. Plus, it is legal, accessible, and even covered by insurance.

However, one of the disadvantages of CPAP machines is lack of compliance on the part of patients. Hypothetically, patients might find it easier to pop a pill than wear a mask. But this route still has to be tested and developed.

The Situation in the States

Right now, four states-Colorado, Washington, Alaska, and Oregon-have legalized recreational marijuana. 19 more, plus the District of Colombia, permit medical marijuana.

Where does that leave California? The Golden State was in fact the first to embrace medical marijuana. We're surrounded by states that have legalized the drug. But in 2010 Californians struck down by a large margin a measure to open it to non-medical use.

That doesn't mean that eventual legalization is out of the question. In the 2012 midterms, voters agreed to reclassify drug possession from a felony to a misdemeanor, which indicates at least some disillusionment with strict drug sentencing. And it's very likely that legalizing cannabis could be back on the ballot in 2016 thanks to the work of organizations like the Marijuana Policy Project.

So where does that leave us?

Pot as a sleep apnea treatment-in both political and scientific terms-is still in very preliminary stages. Much research still has to be done to determine its effectiveness in curing apneas. Increased legalization across the United States could open the door for more in-depth studies of marijuana's effects. But until then, the best option for treating the sleep disorder is still a CPAP machine, or, in a serious case, surgery.
Shop CPAP and supplies online Sources: Other posts you may find intersting:
Photo Credit: Chuck Coker

Julia Rodriguez

Julia joined Advanced Sleep Medicine Services, Inc. in 2011 with a background in sales, marketing and customer service. She is currently the vice president of marketing and operations and enjoys the opportunity to educate and interact with those looking to improve their health through better sleep.

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Marijuana as Treatment for Sleep Apnea? California is one step closer

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Last year we wrote a post on-that's right-marijuana as a potential treatment for sleep apnea. Since then, midterm elections have brought a new wave of legalization to the West Coast: Alaska and Oregon both decriminalized recreational use of the drug. So we thought it was worthwhile to take a second

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Marijuana is used for sleep apnea but its effectiveness is not scientifically proven. Does marijuana help or deteriorate sleep disorders? Read this article to know more.

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Marijuana is the dried flowers, leaves, stems, and also seeds of the cannabis plant. The dried elements contain compounds that can elevate a person's mood but can also impair cognitive abilities and decision-making. Marijuana is often a treatment for many medical conditions including glaucoma and depression. Its effects on healthy sleep are not completely known, yet many researchers suggest that the sedative attributes may help people with sleep disorders, including obstructive sleep apnea.

Relation Between Marijuana and Sleep Apnea

While research is still ongoing, some studies show that some strains of marijuana may contribute to sounder sleep. If considering the use of marijuana to help with sleep apnea, make sure you know the laws where you live regarding the drug. Also, it's important to select a strain that offers sedative effects. Some strains can be more stimulating and may not help with sleep. Also, be aware of any side effects of marijuana use.

Does Marijuana Help or Deteriorate Your Sleep Quality?

The legal marijuana industry has become more sophisticated. Cultivation has allowed growers to develop varied strains of cannabis for different needs among users. Some strains may cause stimulation, which can reduce sleep. Others offer a more sedative effect which may help with sleep. One study found that a synthetic version of cannabis helps the brain to exert better control of the airway muscles during sleep and can reduce the shallow and temporarily interrupted breathing of sleep apnea.

Marijuana For Sleep Apnea

While CPAP therapy is the most proven effective treatment for obstructive sleep apnea, moderate marijuana use may be a helpful supportive sleep aid. If you choose to supplement your CPAP treatment with cannabis, be sure you make sure the drug is not a health risk to you. Speak to your doctor and know the side effects. Also, be sure you understand the varied strains available and select one that best fits your needs.

Can Smoking Marijuana Regularly Lead to Sleep Apnea?

There is no evidence that marijuana use will promote sleep apnea. While some strains may stimulate the senses, which may not be beneficial for sleep, there is no link between marijuana and sleep apnea. However, smoking marijuana, much like smoking cigarettes can aggravate the symptoms of sleep apnea. Inhaling smoke can inflame the airway. If smoking marijuana, try to use the drug many hours before scheduled sleep or choose edible versions of cannabis to avoid smoking.

How Does Marijuana Affect Obstructive Sleep Apnea?

Many lifestyle choices can help reduce obstructive sleep apnea symptoms. However, marijuana use may or may not be a good option, depending on your health. What to know:

Speak to your doctor about marijuana use with sleep apnea

Use marijuana in moderation

Be careful what strain of marijuana you select

Be wary of side effects such as grogginess from marijuana use

Continue CPAP therapy while still using marijuana to ensure compliance

Take A Free Risk Assessment to Find If You Have Sleep Apnea

If you are not sure if you have obstructive sleep apnea you can always take a free risk assessment to see if you need to follow up with additional testing. Home tests are one of the easiest ways to receive a sleep apnea diagnosis.

Board-certified sleep physicians will evaluate your risk assessment to determine if you require a home sleep apnea test. Complete the quick and easy questionnaire to begin a sleep apnea evaluation. Take the free risk assessment.

Obstructive Sleep Apnea(OSA) And Medical Cannabis

In some instances, patients already diagnosed with obstructive sleep apnea may also be prescribed medical cannabis to treat unrelated medical conditions. Medical cannabis may be prescribed for a variety of medical issues from depression and anxiety to pain and specific medical conditions such as glaucoma or cancer management. Speak to your doctor about balancing your medical cannabis prescription with your CPAP therapy prescription. Make sure both treatments are beneficial to get better sleep and overall health.

Position Statement From AASM: Avoid Using Medical Marijuana to Treat Sleep Apnea - Why?

The American Academy of Sleep Medicine has recommended not prescribing medical marijuana for sleep apnea treatment.

The AASM has concluded that sleep apnea should be excluded from the list of chronic medical conditions for state medical cannabis programs due to unreliable delivery methods and insufficient evidence of treatment effectiveness, tolerability, and safety.

The use of medical marijuana as a remedy for sleep apnea is up to the discretion of the patient and their doctor.

Where Can I Get an At-Home Sleep Test?

You can find at-home sleep tests from Sleep Care Online. Home sleep tests are easier than lab tests as they can be completed in the comfort of your own home. The FDA-approved all-inclusive kit provides unlimited support for your sleep apnea diagnosis. For more information, give our knowledgeable staff a call at 866-465-4478.

Order a Home Sleep Test Today!

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Marijuana is the dried flowers, leaves, stems, and also seeds of the cannabis plant. The dried elements contain compounds that can elevate a person's mood but can also impair cognitive abilities and decision-making. Marijuana is often a treatment for many medical conditions including glaucoma and depression.

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From a minor cut to sciatica, pain is an unwelcomed, yet underappreciated visitor, who comes bearing an important warning that something's wrong with your body. Without this important messenger, we may forego critical medical treatment or continue with activities that may worsen the situation.

Sometimes pain overstays its welcome and outlives its original purpose. Long after the initial injury or condition that may have triggered the pain heals, pain continues to linger as pain signals continue going off throughout the nervous system - tormenting the sufferer, who frantically searches for a moment's relief and, sometimes, must come to grips with the ever-fading hope for some semblance of normalcy.

They have joined a group that no one wants to belong to - a community of people whose pain has persisted longer than three months, which becomes classified as chronic pain.

Americans have become all too familiar with this dilemma. According to the Centers for Disease Control and Prevention, 20.4% of adults have experienced chronic pain, with 7.4% of adults experiencing what is known as high-impact chronic pain, which has frequently limited their lives and work activities.

What are chronic pain conditions?

Many of the leading causes of disability, including musculoskeletal disorders, back pain and osteoarthritis, also involve long-term, debilitating chronic pain - also known as chronic secondary pain because the pain is a symptom of another condition. Chronic primary pain conditions include syndromes, such as fibromyalgia and chronic regional pain syndrome, nonspecific neck and low back pain, and chronic migraine - conditions that cannot be attributed to another pain-causing complaint.

Other examples of conditions that can cause chronic pain include:

Arthritis of the spine

Failed back surgery

Headaches

Neuropathic pain

Neuropathy (nerve pain - diabetic and peripheral)

Radiculopathy (from when a nerve is pinched, damaged or inflamed)

Sciatica

Shoulder, knee and hip pain

Can chronic pain be all in your head?

Sort of, but not in the way some people think; chronic pain isn't imaginary. It's a real phenomenon that is hard to quantify. One person's pain scale rating for an arthritic knee may be at a 3, while it feels like an 8 to someone else. It's all about what constant pain does to the nervous system.

"What we've found is that when patients have chronic pain, in general, there starts to be this kind of rewiring that happens within the brain and the spinal canal," said Dr. Sagar Chokshi, a pain medicine specialist with Houston Methodist Department of Neurosurgery.

"As these pain signals get propagated, there becomes a feedback loop that doesn't necessarily come from an original injury. And, as it gets ingrained in the brain, it becomes really hard to break that feedback loop."

How do you manage chronic pain?

Pain will make even the most reluctant of us eager to go to the doctor or the ER to find relief. Pain and pain-causing conditions are among the most common reasons people go to the doctor. But, when pain persists for too long, sufferers may benefit from consulting a pain management specialist.

"If you are experiencing chronic pain, it's never too early to talk to a specialist. Treatment can go off course if you wait too long, causing the pain to last longer. Also, patients who don't want to have surgery will often consult with a pain specialist to find out if there are nonsurgical options for treating their pain," explains Dr.Chokshi.

"If pain develops, get evaluated by your primary care doctor or in the emergency room. The basic treatments for injury usually involve rest, ice and heat, and some low-dose medications, perhaps even a steroid. If whatever you're doing is not significantly helping and you've gone a couple of times to the primary care doctor or even had an emergency room visit, I think it's appropriate to consider an evaluation with the pain management specialist."

What are treatment options for chronic pain?

Since there are so many conditions that can cause chronic pain, treatment primarily focuses on addressing the underlying cause.

"When the body has rewired itself to constantly think about pain and creates a feedback loop that doesn't necessarily directly involve an injured area, the pain signals continue to go from the brain to the spinal cord and back to the brain. Unfortunately, it's very difficult to treat this type of chronic pain, because these signals continue to persist within the central nervous system," admits Dr. Chokshi.

Along with nonopioid medications, doctors may prescribe physical therapy or surgery as well as recommend therapies, such as acupuncture and massage, the use of a deep-brain stimulation device, or even an anti-inflammatory diet.

"Often, we strongly recommend physical therapy, injections, biofeedback and relaxation strategies with cognitive behavioral therapy because learning different strategies can be very helpful," says Dr. Chokshi.

Opioids aren't the solution for chronic pain

It may feel like doctors are holding out on the "good stuff" that will knock out the pain, but there are good reasons why the medical community now frowns on prescribing opioids - narcotics made from the opium poppy plant, which includes potentially highly addictive prescription medications, such as hydrocodone, fentanyl and oxycodone, used for treating pain.

With time, patients taking these medications build up a tolerance and possibly dependence on opioids - meaning patients require higher and higher doses of the medication, so they become less effective in treating chronic pain.

Opioids are medications that block pain signals in the brain. For an acute injury, such as a fracture or a surgery, there's a reasonable time to be taking these types of medicines. After this time, if you're continuing to take a medicine, it's a temporary fix for a bigger issue," says Dr. Chokshi.

"Patients develop a tolerance to these medications, meaning that the same dose isn't as effective as the first time you took it. Then you keep taking more and more medication. That's when we start to see a lot more of the side effects. Also, taking oral opioids interferes with the body's natural endogenous opioid production, causing hyperalgesia, meaning that things that shouldn't hurt become painful because the body has completely shut that system down in your brain."

Opioids come with a high risk of dependence and addiction as well - with approximately 2.1 million prescription opioids users in the U.S. developing opioid use disorder.

Tips for coping with chronic pain

Get some support. Some chronic pain sufferers face stigma because family and friends think they are exaggerating or simply seeking attention. And, because of the opioid crisis, some patients fear that the medical community will lump them in with those who are drug-seekers. This is especially true for those who are suffering from pain caused by an unknown origin. Consider talking to a therapist to develop strategies to cope with the pain.

Be open to trying various treatments. It may seem counterintuitive to ask someone in a lot of pain to go to physical therapy or exercise, but if you don't move it, you may lose it. Maintaining or improving mobility, which includes exercising and stretching, may improve your pain or keep it from getting worse. It is important to consult your doctor or a physical therapist about which exercises are appropriate for you because you don't want to make your pain worse. Ask if activities like walking, swimming and water exercise, yoga, or tai chi are okay for you to try.

Before trying alternative therapies or natural remedies, discuss them with your doctor first. If the advertisement claims to "cure" your condition or eliminate pain, you should treat it with a healthy dose of skepticism and get the okay from your doctor before trying it. Even natural remedies can cause harm and interact with your other medications.

Practice self-care. Living with chronic pain robs you of enjoying life fully. It takes a physical, mental and emotional toll on those living with it. Develop a plan to take care of yourself. When your pain is more intense, it may be helpful to think about the things that have been helpful in the past, such as taking certain as-needed prescription or over-the-counter medications, applying ice or heat to a painful area, stretching or using self-massage. If laughter is a good distraction for you, have your favorite comedies on standby. Most importantly, be kind to yourself because being in pain means you may not be able to do what you used to do. If the house doesn't get cleaned as often or if you miss a few activities with family and friends, so be it. Just take care of yourself.

You may also need to adjust your expectations. Depending on the cause of your chronic pain, you may have to come to terms with a new normal. That doesn't mean that there isn't any hope. Work with your doctor on exploring treatment options and keep yourself educated on new treatments being developed. It's important for you be your own health care advocate.

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From a minor cut to sciatica, pain is an unwelcomed, yet underappreciated visitor, who comes bearing an important warning that something's wrong with your body. Without this important messenger, we may forego critical medical treatment or continue with activities that may worsen the situation. Sometimes pain overstays its welcome and outlives its original purpose.

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A revolutionary approach to dealing with chronic pain.

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A revolutionary approach to dealing with chronic pain

From arthritis and back pain to fibromylgia, chronic pain afflicts some one hundred million Americans. With more than twelve years' experience treating its sufferers and seeing the nation's health-care system come up short, Dr. Peter Abaci developed innovative treatments that have helped thousands better their lives in dramatic ways―techniques he now offers in this book for the first time.

In Take Charge of Your Chronic Pain, Dr. Abaci sets forth a comprehensive approach to chronic pain, one rooted in cutting edge research and case studies. He empowers readers by teaching them how they can take control of their pain by pairing traditional medicine with unconventional treatments―such as meditation, tai chi, art therapy, diet, supplements, acupuncture, and yoga. Writing in a reassuring tone throughout, he also reveals groundbreaking new information about how functional MRIs can now measure pain for the first time before and after treatments, as well as startling information about the pharmaceutical industry and the surprising new discovery that narcotic pain medications can actually worsen the pain.

Take Charge of Your Chronic Pain educates readers on the various aspects of chronic pain management, such as:

Eliminating negative emotions and thoughts

Making lifestyle changes

Using art to process inner conflicts

Living free from addictions

Managing stress

Recognizing myths about medications and surgeries

Knowing what to eat

I found Take Charge of Your Chronic Pain to be very comprehensive, easy to read, and a great handbook for patients with chronic pain. Dr. Abaci's approach wonderfully includes both traditional and nontraditional methods, which can not only relieve pain but provide overall wellness. I would recommend this book to my patients and to our doctors training to become pain specialists.
-Carol A. Warfield, MD, Lowenstein Professor of Anesthesia, Harvard Medical School

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From arthritis and back pain to fibromylgia, chronic pain afflicts some one hundred million Americans. With more than twelve years' experience treating its sufferers and seeing the nation's health-care system come up short, Dr. Peter Abaci developed innovative treatments that have helped thousands better their lives in dramatic ways―techniques he now offers in this book for the first time.

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Taking Charge of Chronic Pain: A Positive Approach

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Taking Charge of Chronic Pain: A Positive Approach

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When it comes to managing chronic pain, it is strongly recommended to consider a positive and individualized approach.

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Chronic Pain is a problem that affects over 100 million American citizens and 1.5 million individuals worldwide according to the American Academy of Pain Medicine.

This problem is more prevalent than diabetes (25.8 million people in U.S.), heart disease (16.3 million people) and stroke (7million people) according to both the American Diabetes Association and the American Heart Association. Chronic pain can affect anyone, including men and women, young and old. It is a debilitating illness that can alter the life of both the sufferer and their loved ones.

The sufferer often feels isolated from others and may experience hopelessness due to ongoing pain and lack of understanding from others. One pain sufferer stated that, "people can understand if you are suffering from a broken leg but not from a pain that can't be visibly seen."

In today's world of accelerated technological innovations and state-of-the-art medical treatments, the treatment of chronic pain is still in its infant phase. This problem, which has existed since the beginning of written history, is in great need of new treatments, including enhancement of traditional approaches and greater research funding to develop new approaches.

Chronic pain may be the result of an ongoing or acute illness or an injury, or may occur in the absence of a precipitating event. Individuals may experience physical symptoms, including headaches, backaches, neurological symptoms, or joint pain. Emotional pain often manifests in the form of depression, anxiety, and other mood changes. At the same time, many studies continue to report the significant cost that chronic pain treatment and management contributes to our society, an estimated $560-$635 billion annually according to a recent Institute of Medicine report "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research." Despite the staggering costs and ongoing research, the question remains about how to best manage the debilitating symptoms of chronic pain.
When it comes to managing chronic pain, it is strongly recommended to consider a positive and individualized approach.

There are new ways to treat and manage chronic pain which reinforce the use of an integrated multidisciplinary approach which focuses on the physical, emotional and social aspects. An essential part of this is viewing the individual, not as a passive sufferer, but as an active participant in managing their pain. Some options include:

1. Participation in exercise programs are often encouraged and may include gentle yoga, Pilates, swimming or tai chi classes. These programs may be helpful because they reinforce skills that may improve balance and strengthen and support core muscles.

2. Breathing exercises and various forms of relaxation, including mindfulness and meditation are suggested.

3. Weight loss counseling may be helpful since pain may be exacerbated by extra weight.

4. Cognitive Behavioral Therapy (CBT) is often suggested to aid with chronic pain management. The principles of CBT emphasize challenging negative beliefs while substituting them with positive affirmations and actions.

5. Pharmacological treatments are considered the mainstay in pain management programs. Great controversy and ongoing regulations continue to exist concerning the use of opioids to control pain. Always follow your doctor's instructions on how to properly take any prescription medication.

6. Alternative treatments, including acupuncture, massage and chiropractic care, may provide relief.

7. Many states have legalized the use of cannabis products to manage pain through the use of ointments, patches and inhalants.

There is an overwhelming need for new approaches to pain management.
The goal is to set realistic goals with the purpose of not removing the individual from living their lives. This may involve developing alternative ways to participate in previously enjoyed activities. Medication may continue to be a component of the treatment plan in addition to incorporating other alternative approaches.

The goal for individuals dealing with chronic pain is not to feel like "silent sufferers."

Chronic pain is not an imagined but a real illness that causes the sufferer and their loved ones both physical and emotional pain. The hope is that the individual will find ways to participate in life and find ways to manage their pain. Also, hopelessness must be replaced with hope. The mantra for chronic pain sufferers and their loved ones should be the old adage, "never give up."

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Taking Charge of Chronic Pain: A Positive Approach - Full Spectrum LLC

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Chronic Pain is a problem that affects over 100 million American citizens and 1.5 million individuals worldwide according to the American Academy of Pain Medicine. This problem is more prevalent than diabetes (25.8 million people in U.S.), heart disease (16.3 million people) and stroke (7million people) according to both the American Diabetes Association and the American Heart Association.

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Salt, sleep apnea linked to excessive night urination

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Salt, sleep apnea linked to excessive night urination

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Salt consumption and sleep apnea may be associated with nocturia, according to findings from two studies presented at the European Association of Urology.

Salt consumption

Tomohiro Matsuo, MD, from the department of urology at Nagasaki University School of Medicine, Japan, and colleagues provided 321 participants in Japan with written instructions on how to reduce salt intake. Participants' urinary frequency and voided volume was also recorded before decreasing their salt intake and 12 weeks after initiation of decreased salt intake.

After 12 weeks, 223 participants lowered their mean salt intake from 10.7 g to 8 g ( P< .001) per day. Their nocturnal polyuria index improved from 30.2% to 27.7% ( P <.001) and nighttime frequency improved from 2.3 times to 1.4 times ( P <.001). In addition, Core Lower Urinary Tract Symptom scores for urgency changed from 1 to 0.9 ( P= .001), nocturia improved from 1.9 to 1.3 ( P < .001), frequency during the day improved from 0.8 to 0.4 ( P < .001), and the quality of life parameter improved from 3.6 to 2.7 ( P < .001).

"This work holds out the possibility that a simply dietary modification might significantly improve the quality of life for many people," Matsuo said in a press release.

Among the other 98 participants, the mean salt intake increased from 9.6 g to 11 g ( P < .001) per day. Matsuo and colleagues found that among these participants, nighttime frequency increased from 2.3 times to 2.7 times ( P < .001); nocturnal polyuria remained unchanged during the study period.

"Research generally focuses on reducing the amount of water a patient drinks, and the salt intake is generally not considered," Marcus Drake, BM, BCh, MA, DM, FRCS, working group lead of the European Association of Urology Guidelines Office Initiative on Nocturia, said in the release. "Here we have a useful study showing how we need to consider all influences to get the best chance of improving the symptom."

Sleep apnea

Sajjad Rahnama'i, MD, PhD, from Maastricht University in the Netherlands, and colleagues asked 256 patients being treated for obstructive apnea with continuous positive airway pressure, or CPAP, a series of questions about their nocturia incidents, medical history, and medications. Before beginning CPAP treatment, 69% of the patients had reported nocturia.

Researchers found that after the patients started to use the CPAP, nocturia was reduced in 65% of patients In addition, of the 77 patients who had indicated two episodes per night, 32 went the whole night without waking up.

"This is the first study to show the true incidence of nocturia ... in patients who suffer from obstructive sleep apnea," Rahnama'i said in a separate release. "It's also the first study to show the size of the effect of positive pressure mask treatment in patients with obstructive sleep apnea on their nocturia symptoms."

Drake said that although the link between breathing problems and nocturia may be surprising, it is a very real problem.

"To have a study showing the link, and the potential benefits of therapy, may help establish the treatment into routine clinical practice," he said in the release. - by Janel Miller

Degalliers S, et al. Abstract 566. Presented at: European Association of Urology Annual Meeting; March 24-28, 2017; London.

Matsuo, T, et al. Abstract 399. Presented at: European Association of Urology Annual Meeting; March 24-28, 2017; London.

Disclosure: Healio Family Medicine was unable to confirm the researchers' relevant financial disclosures prior to publication.

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Salt, sleep apnea linked to excessive night urination

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Salt consumption and sleep apnea may be associated with nocturia, according to findings from two studies presented at the European Association of Urology. Salt consumption Tomohiro Matsuo, MD, from the department of urology at Nagasaki University School of Medicine, Japan, and colleagues provided 321 participants in Japan with written instructions on how to reduce salt intake.

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Could a High-Salt Diet Be Contributing to Your Sleep Apnea?

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Could a High-Salt Diet Be Contributing to Your Sleep Apnea?

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A new study aims to find the connection between higher than usual sodium contributing to sleep apnea. Here is the details.

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There are many reasons why the rate of sleep apnea in this country is increasing. Partly, it’s weight gain. As the obesity levels in this country rise, it makes sense that obstructive sleep apnea rates would as well. However, a new study begun by Brazilian researchers, seeks to determine whether a diet high in salt, also common in the US, could contribute to sleep apnea.

How High Salt Could Contribute to Sleep Apnea

A diet high in salt causes your body to retain fluid. It retains fluid in all your tissues as the salt creates an ionic imbalance that prevents water from flowing out of the cells and toward the kidneys, which regulate fluid levels in the body.

When you lie down to sleep, the fluid retained in the tissues of your neck increase the weight of your airway. When you fall asleep, this increased weight pushes down on your airway and either narrows it or forces it to close completely. The effect is similar to the way that excess fat in the neck area contributes to sleep apnea.

How Much Salt Do You Eat?

Chronic salt overintake is common in the US, partly because many of the processed foods we eat include high levels of sodium. According to the Centers for Disease Control, the body only needs about 180-500 mg of salt per day. The recommended amount is about 1500 mg. The upper limit that we can eat without suffering ill health effects is about 2300 mg. However, on average an American consumes about 3400 mg every day!

Even without the sleep apnea connection, eating this much sodium contributes to high blood pressure and other heart problems.

Testing the Connection

The Brazilian researchers trying to determine whether salt is partly responsible for sleep apnea will divide 54 volunteers who have severe sleep apnea into three groups. One group will take a diuretic pill, which will reduce salt in the body by increasing the amount that the kidney excretes in urine. Another group will be switched to a low-salt diet, which reduces bodily salt by decreasing intake. A control group will have no treatment. All groups will undergo constant sleep studies to determine the effect of salt level changes on sleep apnea.

Reducing Your Salt & Treating Your Apnea

Reducing your salt intake is a good step to take for your health anyway and is recommended for most people. Here are three quick steps for reducing your sodium intake:

Eat fewer processed foods–these foods often use an excessive amount of salt as their primary flavoring. This includes eating out, where you do not know the amount of salt being added to dishes.

Don’t salt food twice–either add salt to the recipe or add it at the table. Try not to do both.

Avoid high-sodium condiments–even when you’re cooking at home, you may not know that the ingredients you’re using have an excessive amount of salt. For example, one tablespoon of soy sauce contains about 1000 mg of sodium. If you can’t give it up, try to switch to low-sodium versions if possible.

Use more spices rather than salt to flavor your foods.

Read the labels of foods you by and opt for ones that contain lower sodium content.

However, if you want to learn more about treating sleep apnea, please call (303) 691-0267 at the TMJ Therapy & Sleep Center of Colorado in Denver.

Share This Story, Choose Your Platform!

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Could a High Salt Diet Be Contributing to Your Sleep Apnea?

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A new study aims to find the connection between higher than usual sodium contributing to sleep apnea. Here’s the details.

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The Relationship Between Salt and Sleep Apnea

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The Relationship Between Salt and Sleep Apnea

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Find out the relation between salt and sleep apnea and how salt therapy can help a person with sleep apnea. Compare it to various sleep apnea treatments.

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Sleep apnea patients have always relied on CPAP therapy as their primary form of treatment. But other lifestyle changes from diet to quitting habits like smoking can all reduce the severity of sleep apnea. Now a new salt therapy is gaining popularity as a non-invasive and natural treatment for sleep disorders.

What Is Sleep Apnea?

Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. If you snore loudly and feel tired even after a full night's sleep, you might have sleep apnea. There are three types of sleep apnea: obstructive sleep apnea, central sleep apnea and complex sleep apnea syndrome.

What Is Obstructive Sleep Apnea?

Obstructive sleep apnea (OSA) is the most common form of the sleep disorder. It occurs when the throat muscles relax during sleep causing the airway to close up momentarily, causing brief loss of air called "apneas". People with OSA wake up throughout the night frequently gasping for air, which eventually leads to chronic sleep deprivation.

What Is Central Sleep Apnea?

Central sleep apnea starts in the brain. When the brain fails to send the proper signals to the muscles that control breathing, periodic loss of air occurs throughout the night. People suffering from central sleep apnea experience episodic gasping at night, which leads to sleep deprivation much like OSA patients.

What Is Complex Sleep Apnea?

Complex sleep apnea syndrome occurs when a patient experiences both aspects of obstructive apnea and central sleep apnea, resulting in a more complex syndrome. Both the muscle relaxation of the throat and failed brain signals lead to frequent episodic periods of gasping throughout the night, which leads to chronic sleep deprivation.

Salt Therapy

Salt therapy is a holistic spa-style treatment that involves sitting in a room aerated with natural sea salt. Patients relax in the room for periods of up to 45 minutes breathing the salt-enriched air. The salt air is believed to alleviate inflammation in the respiratory system and open up air passages in the throat and nose.

About Sleep Apnea Treatment

Salt therapy may help sleep apnea patients by reducing throat muscle inflammation. Salt therapy is just one of the common treatments for sleep apnea. Mostly patients will turn to CPAP therapy which uses a CPAP machine to blow pressurized air through a mask to keep airways open at night. More complex cases may involve surgery to correct irregular throat muscles.

How Are Salt and Sleep Apnea Related?

Salt plays an important role in reducing inflammation in the respiratory system which relate to sleep apnea. Often the throat muscles can become swollen and tense in sleep apnea patients. Salt therapy acts to alleviate that inflammation. Frequent visits to a salt therapy spa can open up the air passages in a sleep apnea patient so they can breathe more easily.

How Salt Therapy Can Help in Fighting Sleep Apnea?

Many patients with sleep apnea may find the use of CPAP machines difficult. Breathing pressurized air nightly and using a CPAP mask are adaptations that many patients with sleep apnea have a hard time acclimating too. Salt therapy is one option that may supplement CPAP therapy or possibly replace it for some patients. Sleep apnea patients should always consult with their doctor before seeking out salt therapy as a treatment.

Key Takeaways

Sleep apnea patients should explore all potential treatments. But they should also consult with their doctor about those treatments to ensure they are safe and the best option for their sleep apnea.

CPAP therapy continues to be the most common treatment which requires a prescription.

Lifestyle changes such as losing weight or quitting smoking can help some mild cases of sleep apnea without additional treatment.

Salt therapy is also an option that can help some sleep apnea patients get relief from inflammatory issues that might be aggravating their sleep apnea.

If you're wondering if you have sleep apnea, Sleep Care Online, a simple, safe and affordable way to get tested for sleep disorders from the comfort of your home, offers a free risk assessment to help you get started. Take it today, and reach out with any questions by calling 866-465-4478.

Take a Free Risk Assessment!

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The Relationship Between Salt and Sleep Apnea

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Sleep apnea patients have always relied on CPAP therapy as their primary form of treatment. But other lifestyle changes from diet to quitting habits like smoking can all reduce the severity of sleep apnea. Now a new salt therapy is gaining popularity as a non-invasive and natural treatment for sleep disorders.

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Music has the power to awaken the mind. With the Music & Memory program at Living Branches, residents are brought closer to loved ones. Hear about some more of the positive effects from the director of dementia care strategy, Kathleen Roberts, and the history of the organization.

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Music has the power to awaken the mind. With the Music & Memory program at Living Branches, residents are brought closer to loved ones. Hear about some more of the positive effects from the director of dementia care strategy, Kathleen Roberts, and the history of the organization.

Dementia Care Strategy: Music & Memory at Living Branches

"My name is Kathleen Roberts; I'm the director of dementia care strategy at Living Branches. We have an opportunity to really shape how dementia looks, feels and what it is for our residents at Living Branches. One of the programs that we've initiated because of how effective it is, is the program called Music & Memory. Music & Memory was started by a gentleman who was trained as a social worker but he spent his whole career in IT and now he's at the end of his career and he recognized that when he goes to a nursing home, he wants his favorite music and he didn't want to compromise that. And lo and behold, when he looked and saw these things called iPods and he figured out that he could put his playlist on his iPod and listen to that forever. So he did that. Put it on for himself, but then he decided to try that for other adults. He went to a nursing home in New York, near him, and started videotaping what that did for the residents of this nursing home. It was phenomenal and because of that he's now turned that into a whole nonprofit effort. But it really does make a difference seeing individuals impacted by music and what a favorite song can do."

"Do you like that?", staff. "That's similar, let's go to the hop hop hop hop hop," resident.

"Do you enjoy listening to music?", Olga's family member. "Sure. Wow," resident Olga Bliss. "Do you know who that is making the big sound? That's Dad. You just listened to Dad because we were just playing the music. Yeah enjoy it! Enjoy doing that!", Olga's family member.

Maureen McShea - Life Enrichment Coordinator

"Hello my name is Maureen McShea. I'm the life enrichment coordinator here at Personal Care so I do Oakwood Court and Harmony House Memory Care unit. So the first time we put Dot's headphones on; when we put them on, it was her son's music which is really powerful. But when she turned and looked in the mirror and saw these big clunky things on her ears, she just started laughing so I grabbed them like, sorry, like,I didn't want to upset her. So when I went to pull it off she grabbed it and put them right back on, which I knew was a sign that this is going to be very powerful."

"That you're doing something that's very important to yourself and that's really great," Harry Moore. "Well we we take everything out and I still there," Dot Moore. "Anything that keeps her on the music of the soul will be helpful to her," Harry.

"This is all about meeting the needs of our residents but our community as well. That's who we are at Living Branches. We see it as, this is a bigger calling than just a job. We want to do something that makes a difference."

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Dementia Care Strategy - Music & Memory - Living Branches

# data[].attributes.attachment_link.description
Music has the power to awaken the mind. With the Music & Memory program at Living Branches, residents are brought closer to loved ones. Hear about some more of the positive effects from the director of dementia care strategy, Kathleen Roberts, and the history of the organization.

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Music Therapy in the Treatment of Dementia

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Music Therapy in the Treatment of Dementia

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Dementia is a neurological condition characterized by deterioration in cognitive, behavioral, social, and emotional functions. Pharmacological interventions are available but have limited effect in treating many of the disease's features.

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Abstract

Background: Dementia is a neurological condition characterized by deterioration in cognitive, behavioral, social, and emotional functions. Pharmacological interventions are available but have limited effect in treating many of the disease's features. Several studies have proposed therapy with music as a possible strategy to slow down cognitive decline and behavioral changes associated with aging in combination with the pharmacological therapy.

Objective: We performed a systematic review and subsequent meta-analysis to check whether the application of music therapy in people living with dementia has an effect on cognitive function, quality of life, and/or depressive state.

Methods: The databases used were Medline, PubMed Central, Embase, PsycINFO, and the Cochrane Library. The search was made up of all the literature until present. For the search, key terms, such as "music," "brain," "dementia," or "clinical trial," were used.

Results: Finally, a total of eight studies were included. All the studies have an acceptable quality based on the score on the Physiotherapy Evidence Database (PEDro) and Critical Appraisal Skills Program (CASP) scales. After meta-analysis, it was shown that the intervention with music improves cognitive function in people living with dementia, as well as quality of life after the intervention and long-term depression. Nevertheless, no evidence was shown of improvement of quality of life in long-term and short-term depression.

Conclusion: Based on our results, music could be a powerful treatment strategy. However, it is necessary to develop clinical trials aimed to design standardized protocols depending on the nature or stage of dementia so that they can be applied together with current cognitive-behavioral and pharmacological therapies.

Keywords: systematic review, meta-analysis, dementia, music therapy, cognitive function, quality of life, depressive state

Key Points

Music therapy is used as a treatment for the improvement of cognitive function in people with dementia.

The intervention based on listening to music presents the greatest effect on patients with dementia followed by singing.

Music therapy improved the quality of life of people with dementia.

Music has a long-term effect on depression symptoms associated with dementia.

Introduction

Approximately 50 million people worldwide have dementia, and it is projected to almost triple by 2050 ( 1). Dementia is an overall term for diseases and conditions characterized by progressive affectation of cognitive alterations, such as memory and language, as well as behavioral alterations including depression and anxiety ( 2, 3). In order to ameliorate the symptoms of dementia, different intervention approaches, both pharmacological and non-pharmacological, have been trialed. Pharmacological interventions, such as acetylcholinesterase inhibitors, are mainly aimed to treat cognitive symptoms but without avoiding the course of the disease. Unfortunately, these therapies have limited effect on alleviating behavioral and psychological symptoms of dementia ( 2, 4). On the other hand, non-pharmacological interventions can provide complementary therapy, offering versatile approaches to improve outcomes for people living with dementia and minimize behavioral occurrences as well as to improve or sustain quality of life ( 2, 5- 9). There are many types of non-pharmacological approaches, such as psychosocial and educational therapies (either with individuals or in groups) and physical or sensorial activities (music, therapeutic touch, and multisensory stimuli) ( 7, 10- 12). In particular, music therapy is thoroughly used in daily clinical practice in case of dementia ( 13, 14). Many authors emphasize the positive effects of music on the brain. In this sense, several studies showed that people with dementia enjoy music, and their ability to respond to it is preserved even when verbal communication is no longer possible. These studies claimed that interventions based on musical activities have positive effects on behavior, emotion and cognition ( 2, 15, 16). Therefore, studying and playing music alter brain function and can improve cognitive areas, such as the neural mechanisms for speech ( 17), learning, attention ( 18), and memory ( 19). Music can also activate subcortical circuits, the limbic system, and the emotional reward system, provoking sensations of welfare and pleasure ( 14). In this regard, long-term musical training and learning of associated skills can be a strong stimulus for neuroplastic changes, in both the developing brain and the adult brain. These findings suggest the great capacity of music to enhance cerebral plasticity ( 13, 16, 20). Contrariwise, there are studies that question the specific effect of music therapy on people with dementia ( 21). With this background, the aim of this study is to analyze from an unbiased approach the effect of music therapy on the cognitive function, quality of life, and/or depressive state in people living with dementia.

Methods

Search Strategy and Selection Criteria

A systematic review was conducted following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) ( Figure 1 and Searching procedure of Supplementary Data) ( 22). An independent literature search was conducted across Medline, PubMed Central, Embase, PsycINFO, and Cochrane library databases. We carried out the systematic review of the literature following a series of criteria as detailed below.

Initially, the search began with the terms "brain" and "music." Later, "dementia" was added, and finally, "clinical trial" was included. The search period used was from 1990 to present. Next, a more in-depth study of selected trials was carried out. Duplicate studies were removed. All studies that compared any form and method of musical intervention with an intervention without music were evaluated. Lastly, those studies that were systematic analysis, reviews, and study protocols and those which do not evaluate cognitive function were excluded. All the trials chosen were designed as randomized controlled trials (RCTs).

Data Collection, Extraction, and Quality Assessment

Two authors (CMM and PMM) independently assessed publications for eligibility. Discrepancies or difficulties were discussed with a third review author (CP). Data were collected independently using a standardized data extraction form in order to summarize the characteristics of the studies and outcome data ( 23).

From each individual study, we extracted baseline information: publication and year, study design, participants (number, age, and sex ratio), Mini-Mental Status Examination (MMSE) score, and Clinical Dementia Rating (CDR) (clinical evaluation of dementia) when possible, as well as the design of each individual study (intervention method, frequency, duration, and time of evaluation of the results) ( Table 1 ).

Table 1

SUBJECTS

DESIGN

Participants
(age, sex & percentage
of women)

CDR

Särkämö et al. ( 24)

RCT

N = 89
SG: 27 → 59.3%
78.5 ± 10.4
MLG: 29 → 89.6%
79.4 ± 10.1
CG:28 → 64.3%
78.4 ± 11.6

People living with mild to moderate dementia, without serious psychiatric illness or substance abuse

SG: 19.08 ± 2.5
MLG: 15.7 ± 2.26
CG: 18.57± 2.64

SG: 1.0 ± 0.6
MLG: 1.6 ± 0.5
CG: 1.1 ± 0.5

Active: sing
Passive: listen to music
Control group
No significant differences in clinical medication between groups

90 min once a week for 10 weeks

Improvement of mood, orientation and memory Soft effect on attention, executive function, and general cognition.

Särkämö et al. ( 25)

RCT

N = 89

People living with mild to moderate dementia

SG
F1: 22.9 ± 3.4
F2: 21.0 ± 4.8
MLG
F1: 21.0 ± 4.6
F2: 18.8 ± 4.5
CG
F1: 21.5 ± 4.8
F2: 19.6 ± 6.3

-

Active: sing
Passive: listen to music
Control group
No significant differences in clinical medication between groups

90 min once a week for 10 weeks

MLG had benefits in the behavioral alterations of depression, while the SG showed specific benefits in physical signs of depression.

Doi et al. ( 26)

RCT

N = 201
Average age 76.0, 52% women
DG: 67 → 50.7%
75.7 ± 4.1
IMG: 67 → 58.2%
76.2 ± 4.6
CG: 67 46.3%
76.0 ± 4.9

Older adults living with mild cognitive impairment

DG: 26.29 ± 2.6
IMG: 26.36 ± 2.1
CG: 25.4 ± 2.3

-

Interactive, two cognitive programs of leisure activities:
(1) Dance
(2) Musical instruments

60 min per week for 40 weeks

Long-term cognitive leisure activities involving dance or playing musical instruments improved memory and general cognitive function

Han et al. ( 27)

RCT

N = 64
Age = 76.22 ± 5.84 62.5% women
MG: 32
75.63 ± 6.3
68.8%
CG: 32
76.81 ± 5.36
56.3%

Older people living with mild cognitive impairment or mild dementia

MG: 23.45 ± 4.76
CG: 22.87 ± 4.68

Patients presenting 0.5 of CDR:
47 (73.4%)

MG: Multimodal cognitive improvement therapy (MCET)
CG: Mock Therapy
No significant differences in clinical medication between groups

2 treatment phases of 8 weeks separated by a period of 4 weeks.
Total: 20 weeks

MCET improves cognition, behavior and quality of life

Ceccato et al. ( 28)

RCT

N = 51
MLG: 27 → 77.8%
85.5 ± 5.9
CG: 23 → 82.6%
87.2 ± 7.1

Elderly people living with mild and moderate dementia

MLG:16.93 ± 3.66
CG:16.39 ± 3.90

-

Sound Training for Attention and Memory STAM-Dem (listening)

Two weekly session of 45 min for 12 weeks

General improvement in the results of the experimental group

Lyu et al. ( 29)

RCT

N = 192
SG: 97 → 58.7%
68.9 ± 7.1
CG:95 → 58.9% 69.9 ± 7.9

People living with mild, moderate or severe Alzheimer- type dementia

SG:13.45 ± 3.66
CG: 13.22 ± 4.01

-

Sing vs usual care

Music therapy practiced in groups.
twice daily.
30-40 min per session for 3 months (12 weeks)

Effectiveness in enhancing cognitive function and mental well being

Chu et al. ( 30)

RCT

N = 100
MG:49
CG:51
53%
82 ± 6.80

People living with Moderate (62%),
mild (17%) and severe (21%) dementia

MG12.80 ± 6.15
CG: 13.76 ± 5.36

-

Playing an instrument, Sing and listening to music

12 sessions of group music therapy (two 30-min sessions
per week for 6 weeks)

Music intervention appeared to reduce depression and delayed the deterioration of cognitive
functions, particularly short-term recall function.

Guétin et al. ( 31)

RCT

N = 30
MLG:15 → 86.7%
CG:15 → 60%
75-90

People living with mild to moderate Alzheimer- type dementia

MLG:19.8 ± 4.4
CG: 20.7 ± 3.4

-

Listening to music

Session once a week for 16 weeks

No significant differences between MLG and CG

In addition, at the beginning of the study, we assessed the quality of meta-analysis-included studies using the Physiotherapy Evidence Database (PEDro) scale and the Critical Appraisal Skills Program (CASP) scale ( Supplementary Tables 1, 2 of the Supplementary Data) ( 23, 32, 33).

Outcome Measures

The primary outcome defined to be compared was cognitive function evaluated through MMSE ( 34), Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-Cog) ( 35), Revised Memory and Behavior Problems Checklist (RMBPC) ( 36), or Immediate and Deferred Prose Memory test (MPI and MPD, respectively) ( 37). Other comparative results, named as secondary outcomes, were quality of life, assessed through Quality of Life in Alzheimer's Disease (QOL-AD) ( 38), and depression, evaluated through Cornell-Brown Scale for Quality of Life in Dementia (CBS) and Geriatric Depression Scale (GDS) ( 39, 40).

Statistical Analysis: Meta-Analysis

First, a comparison was made using the random-effects model. All outcomes were continuous variables [mean ± standard deviation (SD) of the change in the score before and after the therapy in the different diagnostic tests], and the standardized mean difference (SMD) was analyzed. All the analyses were carried out considering a confidence interval (CI) of 95%. Statistical heterogeneity was also tested by I ². I ² <25% was identified as low heterogeneity ( 41, 42). Finally, the publication bias was evaluated using funnel plot graphs ( 43, 44). To further investigate the heterogeneity, meta-regression and subgroup analyses were performed to assess the primary outcome data and associations according to the method of intervention (interactive and passive), trial period, number of sessions per week, and effect of evaluation method used. The P values in the meta-regression revealed the overall significance of the influence factors.

Meta-analysis, heterogeneity study, and graphical representations were performed using R with the Metafor package ( 44). To digitize graphics and obtain numerical data from those trials that did not provide them, the GetData Graph Digitizer program ( Getdata-graph-digitizer.com) was used.

Results

Baseline Characteristics

Results of initial search and exclusions are shown in Figure 1 . A thorough reading of each article was carried out, and a summary of each of them is shown in Table 1 . Therefore, we finally stayed for the systematic review and meta-analysis with eight articles. The size of the studies was between 30 and 201 subjects, with a total of 816 subjects with mild to severe dementia, assigned randomly to both the intervention and control groups. All the people in the trials stayed in nursing homes or hospitals. Särkämö et al. divided the participants into three groups, an active group that sang, a passive group that listened to music, and a control group ( 24, 25). On the other hand, Doi et al. evaluated two cognitive programs of leisure activities: dancing and playing musical instruments ( 26). Furthermore, Han et al. tested a multimodal cognitive improvement therapy (MCET) consisting of cognitive training, cognitive stimulation, reality orientation, physical, reminiscence, and music therapy against a sham therapy without music ( 27). In this line, Ceccato et al. tried the program Sound Training for Attention and Memory in Dementia (STAM-Dem), a manualized music-based protocol designed to be used in the rehabilitation of cognitive functions in people with dementia. Those in the control group continued with the normal "standard care" provided ( 28). While Lyu et al. compared the effect of singing on cognitive function and mood, Chu et al. assessed a protocol that includes playing an instrument, dancing, and listening to music. The effect size of all those studies reveals a general improvement in the results of the experimental group ( 29, 30). Finally, Guétin et al. did not find a significant difference between the experimental and control groups when evaluating the cognitive function after an 18-month therapy based on listening to music ( 31).

All the studies had an acceptable quality as confirmed after applying the PEDro and CASP scales ( Supplementary Tables 1, 2, respectively, of the Supplementary Data).

In case of medication (dementia, antipsychotic, and antidepressant medication and sedative or sleeping medication), it must have been stable prior to the trial. Since participants were randomized, there were no significant differences between the control and music-treated groups with regard to medication. Likewise, there were no significant differences between groups in the dementia severity and/or demographic variables.

Efficacy of Musical Intervention in Cognitive Function

Figure 2 summarizes the relevant results of the quantitative synthesis of the effect of music therapy for people living with dementia. First, we evaluated the effect of music therapy on cognitive function by analyzing eight studies (816 cases) ( Figure 2A ). In the random-effects model, SMD was −0.23 (95% CI: −0.44, −0.02), which suggested that musical intervention could be beneficial to improve cognitive function in people living with dementia. However, the trials showed very high heterogeneity [ I ² value = 72% ( P < 0.0001)].

Subgroup analyses and meta-regression were used to further explore this source of heterogeneity ( Table 2 ). Two significant sources of heterogeneity were detected: the trial period and the intervention method (coefficient = 7.43, P = 0.006 and coefficient = 3.981; P = 0.046, respectively). Interestingly, we observed that shorter intervention periods (<20 weeks) and passive interventions methods (listening to music) had greater effect on people living with dementia than longer intervention periods or interactive interventions, such as singing and dancing ( Figure 2A ; Table 2 ). On the other hand, to play an instrument does not seem to have a positive effect on cognitive function. Nevertheless, it appears to be effective when it is combined with singing and listening to music, without improving the effect of just listening to music ( Figure 2A ). The funnel plot on the publication bias across cognitive studies appeared symmetrically low ( Supplementary Figure 1 of the Supplementary Data).

Table 2

Subgroup analysis

Meta-regression

Outcome or measure

k

SMD
(95% CI)

P value

I2 (%)

Coefficient
(95% CI)

P value

R2
(% of heterogeneity accounted for)

Intervention length

<20 weeks

9
-0.4751 [-0.7235;−0.2267]*
0.0002

50.7

7.429
0.0064 a
34.4

Intervention method

Interactive

6

−0.1899 [-0.4811; 0.1013]

0.2011

68.2

3.981
0.0460 a
45.1

Efficacy of Musical Intervention in Quality of Life

A meta-analysis about the quality of life of people living with dementia after the intervention with music therapy was designed. The analysis included three studies (286 cases). The results suggested that there was an effect on the quality of life of patients once the intervention is finished (SMD = −0.36, 95% CI: −0.62, 0.10) ( Figure 2B ). On the other hand, no significant effect of music therapy was observed when carrying out the analysis (two studies; 166 cases) of the quality of life of people living with dementia 6 months after the intervention (SMD = −0.34, 95% CI: −0.78, 0.10) ( Figure 2C ). The heterogeneity of the studies was small in the short-term analysis but >25 in the long term ( I ² = 12 and I ² = 42, respectively).

Supplementary Figures 1B,C in the supplementary data represent the funnel plot about the quality of life measured after the intervention and 6 months later. Data indicate that there is no publication bias.

Efficacy of Musical Intervention in the Depressive State

Finally, in order to evaluate the influence of music therapy on the depressive state associated with dementia, in both the short and long terms, we analyzed its effect when the intervention had just ended and 6 months after the treatment. The result of the meta-analysis (5 studies, 342 cases) suggested that there was no short-term effect on the depressive state of the patients (SMD = 0.16, 95% CI: −0.54, 0.87) ( Figure 2D ). However, when studying the depressive state of patients 6 months after the intervention to know if there is a long-term effect (4 studies, 290 cases), the result indicated that music therapy could have a positive effect on the depressive state of people living with dementia (SMD = −0.25, 95% CI: −0.68, 0.18) ( Figure 2E ). In both cases, the heterogeneity of the studies was high [ I ² = 89% ( P < 0.0001) in the short term; I ² = 66% ( P < 0.01) in the long term]. The funnel plot of the depressive state after the intervention and about the depressive state at 6 months denotes that there is no publication bias ( Supplementary Figures 1D,E in the Supplementary Data).

Discussion

The main objective of this work was to study through systematic review and meta-analysis whether the application of music as a therapy has an effect on cognitive function, quality of life, and/or depressive state in a group of specific diseases such as dementia. Nowadays, there is a growing incidence of this pathology in the population ( 1), and therefore, it is necessary to develop treatments and activities to relieve its symptoms. In addition, there is not enough scientific evidence about the efficacy of music as a therapy on the cognitive and behavioral states of these patients.

Our results suggest that music therapy has a positive effect on cognitive function for people living with dementia. To reach that assumption, we performed a comprehensive systematic review that includes eight studies with 816 subjects. We observed that listening to music is the intervention type with the greatest positive effect on cognitive function. This could be explained because listening to music integrates perception of sounds, rhythms, and lyrics and the response to the sound and requires attention to an environment, which implies that our brain has many areas activated. Those events are linked to wide cortical activation ( 14, 15, 45). In addition, music training is a strong stimulus for neuroplastic changes. So music could decrease neuronal degeneration by enhancing cerebral plasticity and inducing the creation of new connections in the brain ( 46, 47). However, the heterogeneity presented by the different studies included in the meta-analysis does not allow us to reach reliable conclusions ( I ²⁼75%). This heterogeneity may be due to the design of each study, the difference in the type of intervention carried out, and the number of participants among other variables ( 41). Meta-regression showed that the intervention method, interactive or passive, is a significant source of heterogeneity accounting for 45.1% of the total heterogeneity detected ( Table 2 ). We observed a significant effect on cognitive function in the passive intervention group ( P = 0.0004). This result is in agreement with our previous analysis where listening to music has the greatest effect. Other sources of heterogeneity found when we analyzed the effect of music therapy on the cognitive function were the intervention length and the number of sessions per week (34.4 and 9.4%, respectively), the latter not being significant ( Table 2 ). Based on the literature, there is a huge diversity in the scheduling of music treatment duration. In our case, sessions varied from 90 min once a week during 10 or 20 weeks to 60 min during 40 weeks. It seems that the length for the entire music intervention procedure might be a crucial element for successful results and seems to be associated with the intervention type ( 48- 50). We observed that shorter intervention periods (<20 weeks) had a greater effect on people living with dementia than longer intervention ones. This finding is not enough to draw further conclusion due to the heterogeneity found. According to our results, although the number of sessions per week seems not to have an impact on music therapy effectiveness, a greater frequency of therapy seems to be of particular importance ( 48).

Xu et al. and Roman-Caballero et al. showed similar results in two meta-analysis studies conducted on musical intervention in cognitive dysfunction in healthy older adults ( 18, 23). In fact, as in our study, the level of heterogeneity found was also very wide. Van der Steen et al. also analyzed music-based therapeutic intervention on cognition in people with dementia ( 51). They found low-quality evidence that music-based therapeutic interventions may have little or no effect on cognition. Nevertheless, they did not analyze the effects in relation to the overall duration of the treatment, the number of sessions, and the type of music intervention.

After analysis of the secondary outcomes, music therapy surprisingly did not have a marked effect. Regarding quality of life, our data suggested a positive effect once the therapy is finished, but it was not durable after 6 months of music intervention. On the other hand, the study evaluating the effect of music therapy on the depressive state of people living with dementia showed no improvement in the state of these patients when they were evaluated after the intervention. However, if the depressive state was evaluated after 6 months from treatment, a shift in favor of music therapy was observed. This result suggests that the effects of music are not immediate and that the design of progressive and continuous interventions is necessary in order to obtain successful results as has also been discussed by Leubner and Hinterberger ( 49).

Xu et al. observed that, both in the analysis of the depressive state and in the quality of life, music therapy does not have a positive effect ( 23). These data corroborate the results obtained in the short term in our study. However, they did not measure the effects of long-term music therapy. Furthermore, Dyer et al. found that music as a non-pharmacological intervention improves behavioral and psychological symptoms of dementia but concluded that further research is required ( 2, 52). Van der Steen et al. also compared the effect music-based therapeutic intervention versus usual care or versus other activities on depression and emotional well-being ( 51). Likewise, at the end of treatment, they found low-quality evidence that the musical interventions may improve emotional well-being and quality of life.

Music is a pleasant stimulus, especially when it is adapted to one's personal preferences, and it can evoke positive emotions. Some studies have demonstrated that music therapy had an influence on levels of hormones such as cortisol. It also affects the autonomic nervous systems by decreasing stress-related activation ( 53, 54). At the same time, some studies suggest that music promotes several neurotransmitters, such as endorphins, endocannabinoids, dopamine, and nitric oxide. This implies that music takes part in reward, stress, and arousal processes ( 55). However, the lack of standardized methods for musical stimulus selection is a common feature in the studies we have reviewed. Additionally, the absence of a suitable control of the intervention to match levels of arousal, attentional engagement, mood state modification, or emotional qualities between participants may be a reason for the differences between studies ( 55). Furthermore, our results have likely been influenced by the type of test used to evaluate depression symptoms. Most studies used questionnaires that were based on self-assessment. However, it is unclear whether this approach is valid to detect changes regarding symptom improvement. Future approaches should add measurements of physiological body reactions, such as skin conductance and heart rate, for more objectivity ( 49).

Conclusions

This study shows evidence with a positive trend supporting music therapy for the improvement of cognitive function in people living with dementia. Additionally, the study reveals a positive result for treatment of long-term depression, without showing an effect on short-term depression in these patients. Furthermore, music therapy seems to improve quality of life of people with dementia once the intervention is finished, but it does not have a long-lasting effect.

Limitations And Potential Explanations

This meta-analysis had several limitations. First, there are many clinical trials in development like NCT03496675 and NCT03271190 ( Clinicaltrials.gov), whose completion is estimated to be in 2024 and 2022, respectively, which could not be included in this analysis ( 56, 57). Secondly, there are several important limitations in the design of the trials included. First, some of the studies included had a very small sample size (<100 participants), which means that they may lack enough participants to detect differences between groups. Also, the musical interventions and the method used to evaluate the cognitive function and depression were diverse and make it difficult to state clearly their benefit when compared to usual care. The lack of standardized methods for musical stimulus selection is a common drawback in the studies we reviewed and a probable contributor to inconsistencies across studies ( 55).

Finally, we could not perform a subgroup analysis regarding dementia severity to evaluate when music intervention would be more appropriate in the disease trajectory. This was due to the fact that in all studies selected, participants with different dementia stage were randomly assigned to the intervention or control group. Besides, almost all trials in the literature were focused on the mild or moderate stage of dementia, and there were few studies about people living with severe dementia. However, those studies do not evaluate cognitive function ( 58).

Future Research Recommendation

Despite the limitations, music is a non-pharmacological intervention, noninvasive, and without side effects, and its application is economical ( 53, 54). For this reason, in order to confirm the effect of musical interventions, more clinical trials on the effect of music therapy should be promoted. The tests should include a high number of participants, be robust, and be randomized. As explained, music therapy methods and techniques used in clinical practice are diverse. Therefore, it is necessary to design standardized clinical trials that evaluate cognitive function and the disease behavioral features through the same battery of tests to obtain comparable results. On the other hand, there were no high-quality longitudinal studies that demonstrated long-term benefits of music therapy. It is also important to develop study designs that will be sensitive to the nature and severity of dementia. Future music therapy studies need to define a theoretical model, include better-focused outcome measures, and discuss how the findings may improve the well-being of people with dementia as discussed by McDermott et al. ( 45). and many others ( 49, 54, 55).

The investment in research in this novel therapy could lead to its implementation as a new and alternative intervention together with current cognitive-behavioral and pharmacological therapies.

Data Availability Statement

All datasets generated for this study are included in the article/ Supplementary Material.

Author Contributions

CM-M and PM-M: did systematic review and review the manuscript. CM-M and RC: meta-analysis. RC: meta-regression and sub-group analysis and review the manuscript. CP: design the study, conceptualization, supervision, wrote the paper.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

10. Kales HC, Gitlin LN, Lyketsos CG. Assessment and management of behavioral and psychological symptoms of dementia. BMJ. (2015) 350(mar02 7):h369. 10.1136/bmj.h369 [[ PubMed] [ PMC free article] [ CrossRef] Google Scholar]

44. Viechtbauer Conducting meta-analyses in R with the metafor Package. J Stat Softw. (2010) 36:3 10.18637/jss.v036.i03 [[ CrossRef] Google Scholar]

58. Sakamoto M, Ando H, Tsutou A. Comparing the effects of different individualized music interventions for elderly individuals with severe dementia. (2013) 2013:775-84. 10.1017/S1041610212002256 [[ PubMed] [ PMC free article] [ CrossRef] Google Scholar]

Articles from Frontiers in Medicine are provided here courtesy of Frontiers Media SA

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Music Therapy in the Treatment of Dementia: A Systematic Review and Meta-Analysis

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Background: Dementia is a neurological condition characterized by deterioration in cognitive, behavioral, social, and emotional functions. Pharmacological interventions are available but have limited effect in treating many of the disease's features. ...

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Music appears to be a unique and powerful stimulus for reaffirming personal identity and social connectedness in individuals with dementia.

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Among the most significant artistic expressions, music is embedded in the fabric of human culture and identity. We have all been exposed to music in some way, whether by listening to recordings, playing an instrument, attending concerts, or dancing. It provides a unique emotional experience that takes on personal and social meaning in endless respects. As a neurologist specializing in dementia, I have long wondered about the connections of music and memory and the relationship of music to cognition. Do individuals with dementia, for example, get any benefit from exposure to music? If so, what are those benefits, and how do they work?

Over the last 25 years, many published reports and studies have examined and attempted to shed light on the relationship of music to cognitive impairment. Ahead, I will offer a broad overview of several notable studies.

PRACTICAL POINTER

Music can elicit emotions and memories and help provide a link to a person's past and promote interconnection with caregivers and others with dementia. Recent findings suggest that that musical training delays cognitive decline and promotes brain plasticity in the elderly brain. More studies are needed to confirm the specific benefits of music therapy.

Understanding Procedural Memory

Despite the level of brain impairment and severity in dementia, certain activities remain preserved in most instances and are very resistant to decline. These include activities such as pedaling an indoor bicycle, enjoying music, dancing, and throwing a baseball. The person doing these activities may not know who you are or who they are, but these activities were learned and engrained in their younger years and remain. The memory for these activities is called Procedural Memory (PM). Memory for events, knowledge, and reasoning, known as Explicit Memory (EM), gradually disappears as dementia worsens.

What does the literature say about the value of music in people with dementia and other categories of cognitive impairment? Let's first look at individuals with predominantly moderate to severe memory impairment. In his famous book Musicology, published in 2007, the late Oliver Sacks discussed a few patients with severe memory impairment only. ¹ In particular, he discussed the English musician Clive Wearing, who developed Herpes Encephalitis in his 40s. It predominantly damaged his medial temporal lobes responsible for normal memory function. His memory span was less than 15 seconds. He could not preserve new memories and had loss of almost his entire past. His wife Deborah stated that it was as if every waking moment was the first waking moment. "He always feels he just emerged from unconsciousness and arising from the dead," she said.

Dr. Sacks interviewed Clive in his home and noted some Bach music sitting on top of the piano and asked him to play it. Clive said he had never played it or seen it before. He then started playing "Prelude 9 in E major" and remembered playing it before. His memory for that particular piece only occurred while he played it. With this music he was able to improvise, joke, and play with any piece of music. His general knowledge or semantic memory was greatly affected along with his episodic and day-to-day memories. Clive was safe enough in his home but would get immediately lost if he went out alone. His musical powers, however, were totally intact. He was able to automatically read music, sing the notes, play the keyboard, and sing with his wife and create his own world. Clive did not lose any skills he acquired in the past before his encephalitis and he was able to learn new skills with training and practice, even if he would retain no memory for the practice sessions. Without any intact explicit memory, Clive could not remember from day to day which piece he chose to work on previously, or that he ever worked on it before. Without close direction from someone else, he was incapable of undertaking the process of learning any new piece irrespective of his considerable technical skills. Twenty years after his encephalitis, Clive had dropped out of space and time, but when seen at the keyboard alone or with his wife, he was himself again and wholly alive. His life revolved around filling the present-the now-and that only occurred when he was totally immersed in his music.

Interestingly, the response to music is preserved even when the dementia is advanced, such as when patients have impairment of executive function (judgment, planning, reasoning and insight), speech, and language.

Music and Dementia: Looking at the Data

Musical perception, musical emotion, and musical memory can survive long after other forms of memory and cognitive function have disappeared. In non-demented Parkinson's disease, music therapy can lead to fluent motor flow, such as dancing. But once the music stops, so does the improvement in motor function. In dementia it can improve mood, behavior, and in some cases cognitive function, which can persist for hours and days after the music stops. Music also does not need to be familiar to exert these improvements and one does not need to have any formal knowledge of music or be musically inclined to enjoy music and respond to it at the deepest level.

Music and Agitation

Agitation is one of the most common behavioral concerns in dementia and present in more than 50 percent of cases. There are at least three subtypes of agitation that occur in Dementia: 1. Physically nonaggressive behavior such as wandering. 2. Physically aggressive behavior such as hitting and kicking. 3. Verbal vocal agitation such as shouting, repeating words and demanding attention. This agitation, regardless of type, leads to caregiver distress and predicts nursing home placement and greater use of restraints and psychotropic drugs, causing increased cognitive decline, stroke and death. This has triggered the important need for non-pharmacologic therapies, such as music, to manage agitation. It is important to know that music therapy can help agitation but it is not necessarily better than other recreational activities, such as playing with puzzles, robotic animals, and squeezing a ball. Dementia patients respond better with individualized activities including personally preferred music.

Listening to familiar music can elicit pleasurable responses such as smiling or moving/dancing even when communication is lost. ² Singing has also been shown to improve behavior, mood, and cognitive function in some dementia cases. ³ From a physiological standpoint, music can also increase the heart rate and hormone levels in cognitively impaired patients. ⁴ Moreover, playing a musical instrument can delay the onset of future cognitive decline and reduce the risk of dementia. ⁵ Thus, music appears to be a necessity for dementia patients.

Of note, most of the studies discussing music and dementia come from patients with AD. Much less is known about its impact on other causes of dementia, however, studies have shown that singing, playing a musical instrument, and composing music are often well preserved in severe AD as well as frontotemporal dementia (FTD). ⁶⁻⁷ Some studies have shown that musicians with AD can learn to play new tunes. ⁸ People with AD showed preserved recognition of familiar tunes similar to normal healthy individuals, but learning and recognition after 24-hour delay was impaired in familiar and unfamiliar melodies. In a 2009 study, AD patients exposed repeatedly to new melodies were able to recognize these songs for up to eight weeks. ⁹ This did not occur with music repeated less frequently.

Familiar tunes and lyrics can be recognized across all stages of AD. ¹⁰ Due to bonds formed early in life between highly familiar tunes and lyrics, the ability to recognize such information is very functional in individuals with AD. The ability to detect pitch distortion or recall songs from spoken lyrics is usually impaired. Also noted is that the sense of familiarity in AD is preserved, whereas recollection that involves retrieval of information is impaired. In a study of two musicians, one with AD and one with FTD (behavioral variant), investigators found that the FTD case showed preserved recognition of musical composition, but the AD case showed deficits in this area compared to healthy musicians. ¹¹

Behavior and Cognition. A large number of studies claim that music intervention has positive effects on behavior, agitation, mood, and cognition in dementia. For example, short-term music therapy has been found to reduce mood symptoms, such as depression and anxiety, ¹² while longer music therapy (over three months) has also been shown to be very effective. ¹³ Another study found that the beneficial effects of individual music therapy on anxiety and depression lasted up to eight weeks. ¹⁴

In a study comparing standard care to regular singing or music listening sessions over 10 weeks in 89 people with dementia (type not specified), music sessions improved general cognition (MMSE score), attention, and executive function compared to standard care. ¹⁵ Singing appeared to evoke personal remote memories by increasing recall of names of children, friends, and immediate short story recall.

Music in the form of a song has been shown to be an effective verbal memory aid in mild AD. Verbal information presented as lyrics in an unfamiliar song rather than the spoken word is better recognized in forced choice testing. Several studies have reported that music listening facilitates recall of personal memories (involuntary autobiographical memory) in people with AD. It's worth noting, however, that cafeteria noise can yield the same result, suggesting any type of auditory stimulation could produce this effect. In AD, personally selected music (music rated high on familiarity and emotion) has led to more specific memories, is recalled more quickly, and is rated higher in emotional content. The memories recalled were more positive than negative in feelings compared to younger and older healthy adults.

It is worth noting that the experimental rigor of many of these trials is lacking, and biases have interfered with results. Some of the limitations of these studies include small sample sizes, lack of randomization, group dissimilarity, and no control groups. The results of many of these studies, therefore, need to be interpreted with some caution. Nevertheless, music appears to be a unique and powerful stimulus for reaffirming personal identity and social connectedness in persons with dementia, which is crucial for optimal well being, despite severe memory impairment as in AD.

Music Expertise, Aging Cognition,
and Dementia Risk

Music can have a significant impact on memory and cognition beyond merely listening to it. In fact, musicians have been shown to have greater volume of the auditory cortex (surface), premotor regions, cerebellum, and anterior corpus callosum compared to non-musicians. Musicians are likely to recruit both halves of the brain when performing music tasks (such as detection of pitch) and use multiple rather than single strategies to perform music cognition tasks. Studies have shown that elderly musicians outperform non-musicians on tasks assessing auditory processing, cognitive control, and comprehension of speech in noisy environments. ¹⁶⁻¹⁷ This has also been shown to occur in elderly persons with minimal early music training and even after a short period of music training in those with no previous music training. In addition, music training early in life was associated with faster neural responses to speech in elderly individuals.

In one study, musically naïve participants (ages 30-85) who received six months of piano lessons compared with no treatment control group showed improved performance on specific cognitive tasks that represent executive function, such as speed of processing information, verbal fluency, and enhanced mood. ¹⁸ These studies suggest that music training may have a protective effect in the face of age-related mild cognitive changes and can occur even after short periods of training in the elderly. This raises the question of whether music expertise gives rise to greater cognitive reserve and access to different strategies in the musician brain and may potentially reduce the risks of dementia. 19,5 Lending further weight to this notion is a study in which researchers interviewed 23 elderly former orchestra members (mean age 77 years old) and found that no participant was aware of current or former members of the orchestra with dementia. ²⁰ Findings from a five-year prospective study evaluating frequency of engagement of leisure activities in 469 people over 75 years of age who did not have dementia revealed that playing a musical instrument was one of several leisure activities associated with reduced risk of dementia. ⁵ While these results are encouraging, the potential protective effect of musical expertise in the face of neuropathology requires more investigation.

Music and Dementia: Key Considerations

Recent randomized controlled studies have shown the efficacy of music intervention in improving the well-being of individuals with dementia and their caregivers.

- Music abilities are not completely spared in dementia.

- Different dementias likely respond differently to music intervention (Alzheimer's disease versus frontotemporal dementia), and more studies are needed in other dementias, including vascular, Parkinson's disease dementia, and Lewy Body dementia.

- Musical training appears to delay cognitive decline and promote brain plasticity in the elderly brain, but more studies with pathology are needed.

- The development and use of the MiDAS assessment scale has provided insight into who is likely to show improved quality of life or reduction in psychiatric symptoms in response to music therapy.

Musical composing in the presence of cognitive impairment has been studied in the famous French composer Maurice Ravel, who is especially known for his musical piece "Bolero," amongst others. In October 1932, Ravel was involved in a car accident and suffered facial and chest injuries. He also developed progressive cognitive decline, ²¹ having difficulty writing and even signing his name. In addition to trouble writing music, he could no longer conduct an orchestra (even his own music). Partially intact were his perceptual auditory abilities, and he was able to recognize his own composed works. He could also recognize slight mistakes when someone was playing his music.

When Ravel died, no autopsy was performed. In reviewing his case, neurologists have suggested that he had a progressive neurodegenerative disease, such as the primary progressive aphasia variant of frontal temporal dementia, which causes inability to carry out speech and the normal use of the left upper extremity (he was right-handed). Ravel underwent brain surgery on the right side and the neurosurgeon noted a very shrunken brain size and dilated ventricles in the brain. Other neurologists considered Alzheimer's disease, stroke, etc., but the exact cause was not proven. Most neurologists believe his car accident was not the cause of his disorder but was perhaps the proverbial straw that broke the camel's back, allowing a neurodegenerative disorder to start showing itself.

Whether Ravel's brain disorder influenced his musical writings is difficult to say, but there is strong evidence that the composer had a brain disorder that predominantly affected the left side of his brain. The speech and language centers are predominantly on the left side of the brain, which explains his impaired speech, writing and reading difficulties, and the use and control of the right hand. Moreover, his ability to recognize his music and errors played by other musicians suggest the right side of his brain was still functional. Studies by musicians and neurologists have suggested that Ravel was impaired with his illness in the late 1920s and early 1930s when he was composing "Bolero" and "Concerto for the Left Hand." "Bolero" turned out to be a very different composition than his other works, suggesting a possible imbalance of both sides of the brain. "Concerto for the Left Hand" consists of one movement and greater use of wind instruments, while themes and phrases are much shorter and less elaborate. Music experts stated that this composition avoids the difficulty of elaborating a complex structured theme, which was not the usual standard of his previous music. They believe when this was written his disease was already very active and the piece was based predominantly on the right side of the brain. This information and other studies in normal individuals strongly suggest that music-related functions are not lateralized to one side of the brain as language, speech, and following commands in a normal limb.

Benefits of Music Therapy

The aim of music therapy in people with dementia is to address emotions, cognitive powers, thoughts, and memories-to stimulate them and bring them to the fore. It aims to enrich and give freedom, stability, organization, and focus. Evaluation of music therapy and its impact is a complex task. Clinically significant changes are often highly individual and standardized outcome measures may not always portray what matters most. No studies before 2014 used dementia-specific validated music therapy outcome measures. In an articled entitled "The Development of Music in Dementia Assessment Scales (MiDAS)," investigators sought to obtain a deeper understanding on the meaning and value of music for people with Dementia. ²² They elected to engage three focus groups-family caregivers, care home staff, and music therapists-in addition to dementia patients, who play an important role in giving an opinion on how music plays a role in dementia. The focus groups and interviews aimed to investigate the meaning and experience of music for people with dementia and observed the effects of music. The key questions asked in these groups were:

To people with dementia: What does music mean to you? What do you think of your music therapy/music activities? In what way is music important to you?

To families, staff, and therapists: What changes and responses do you observe in your families/clients following music therapy or music activities? How do you know if music is meaningful to the person?

One dementia patient observes: "Medications have horrible side effects such as sleepiness, and music focuses me different from reading a newspaper. I get carried away singing you don't want to stop."

A staff member noted about a dementia patient: "Before music therapy he was often withdrawn, wander around the corridor, or stuck in a wheelchair. During a music session, there is a real sense of group interaction and humor."

After evaluation of these focus groups and getting detailed input, the authors decided that five important areas had to be included in any music scale: Interest, Response, Initiation, Involvement, and Enjoyment. Importantly, MiDAS was not developed for a specific music therapy and has been used in active music making, singing, and dancing with music. This scale system is based on individual optimal levels (the best score the individual can achieve), rather than a uniform pre-determined set of scores. The optimum score will be different in each individual and may change as the dementia progresses. When the MiDAS system is used, it can also be compared with cognitive tests or quality of life.

Further analysis of the qualitive data revealed that the effects of music for people with dementia goes beyond reduction of behavioral and psychological symptoms. They also noted that individual preference of music is closely linked to personal identity and personal history. Moreover, sustaining "here and now" musical and interpersonal connectedness helps value the uniqueness of an individual and help maintain the quality of his/her life.

Conclusion

How and why music is beneficial to cognitive impaired individuals and the extent to which efficacy of music surpasses that of other pleasant activities remains to be further clarified. ²³ Nevertheless, it's clear from the available data that music plays a role in cognition and that music therapy can be potentially beneficial for some dementia patients.
Ronald Devere, MD is director of the Alzheimer's Disease and Memory Disorders Center in Austin, Texas.

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Music and Dementia: An Overview - Practical Neurology

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Among the most significant artistic expressions, music is embedded in the fabric of human culture and identity. We have all been exposed to music in some way, whether by listening to recordings, playing an instrument, attending concerts, or dancing. It provides a unique emotional experience that takes on personal and social meaning in endless respects.

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How socialization improves the quality of life of aging adults

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How socialization improves the quality of life of aging adults

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In your younger years, chances are you had a fairly wide circle of friends and acquaintances. Whether through school, work, or neighborhood playtime, you probably saw numerous friends come and go over the years.

With age comes an ever-shrinking social circle, partly because you meet fewer people on an ongoing basis. But this reduced socialization may be by design. One study revealed that monkeys tended to be more selective about their friends as they aged, and experts believe this may apply to their human counterparts. As you learn and grow, you become more discerning about the people you associate with on a regular basis.

But reduced socialization can actually come at a price for older adults. By getting out there and interacting with your peers on an ongoing basis, you can improve your physical and mental health. Here are a few ways socialization can help you stay healthy as you age.

Improved overall wellbeing

Loneliness and isolation are real issues facing seniors today, having been linked to depression in individuals of all ages. But seniors face a bigger risk of loneliness than other age groups since often they find themselves living alone after the death of a spouse. Interacting with others can give a senior something to look forward to every day while also providing those connections that are so important to overall well-being. Feelings of depression can vastly impact every area of life, often creating more of a sense of isolation.  By making an effort to participate in social activities, the risk of depression lessens, increasing quality of life on the whole.

Improved cognitive function

Multiple studies have linked socialization with improved cognitive function, including a recent one that found that seniors who socialized retained their episodic memory better than groups that didn’t. If you can combine your social get-togethers with aerobic exercise, you can boost these benefits further. One study found that aerobic exercise can reduce those instances when you can’t quite find the word you’re trying to say. You’ll also feel happier afterward, thanks to the increase in endorphins that exercise provides. This improved cognitive function can actually aid in the slowing of memory loss, giving you a sharper mind and more positive experiences.

Reduced risk of dementia

Although the jury’s still out on the cause and best course of prevention for dementia, past studies have linked social interaction and reduced risk. One study looked at 593 participants over the course of six years and connected socialization to a reduced likelihood of developing the condition. The study also compared two groups and found those involved in an interactive discussion group showed increased brain volumes. Higher brain volume has been linked to reduced dementia risk.

Better physical health

One by-product of social interaction is often that you’re simply more active. At the very least, you leave the comfort of your favorite chair to have lunch or play games with a group of friends. Ideally, you’re spending that time going for a leisurely walk or taking a yoga class. Physical activity not only bolsters brain health, but it also helps keep you physically active, and physical activity has been linked to a longer life, even in smaller amounts.

Socialization can extend your life. But even better, it can make sure that you make the most of every moment of those extra years. Even if you find small ways to socialize with others, it can make a difference in your overall physical and mental health.

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How socialization improves the quality of life of aging adults

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Studies have found that seniors who lead an active social life benefit from increased memory, improved cognitive function and more.

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Walking and Talking: How Socializing During Exercise Affects Your Health

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Walking and Talking: How Socializing During Exercise Affects Your Health

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By Ryan Lawson, exercise specialist
Hopefully by now we all know there are countless physical benefits to integrating exercise into our daily routine. Even though we may know exercise is great for us, occasionally life gets in the way or we lose our motivation to stay physically active. Whether it's because we've hit a plateau or we are just struggling to find the time, it's important that we overcome these speed bumps along the way.

This is where integrating socialization into your exercise can be paramount. Often, the motivation, accountability and benefits of exercising-either with a partner or in a group setting-cannot be understated. There have been plenty of studies that have found that combining a social setting with physical activity leads to positive mental and physical well-being.

The mental and physical benefits of exercise go hand-in-hand. It has been proven time and time again that exercise helps us better cope with depression, anxiety and stress. Regular physical activity has even been shown to help increase our focus on everyday tasks. Exercise allows the body to produce and release endorphins, which in turn lead to a more positive mental state. The many positive benefits of exercise on mental health include feeling better overall, higher self-esteem and sharper memory and thinking.

Now that we know how exercise helps with our mental health, it's also important to look at the benefits of exercising on our social well-being. We live in a world where most social events are centered around food. This doesn't have to be the case. Integrating exercise into our social life has been shown to have a positive impact on more than just our physical health. For example, exercising with a friend, or in a group setting, passes the time quicker, makes us more likely to try new things and brings variety because we all have different skills and knowledge. Also, having a regular exercise buddy means you're going to have someone there to motivate and support you, as well as hold you accountable.

Don't be afraid to get creative. There are multiple ways to combine physical and social activities. For example, you could:

Get a group of friends together and go hiking and exploring at a state park.

Sign up for team sports

Find a local fitness class

Get a dog to take walks

Sign up for a road race

No matter what you do, it's important you find something you like and make sure to participate in it with people who have similar interests.

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Walking and Talking: How Socializing During Exercise Affects Your Health

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By Ryan Lawson, exercise specialist Hopefully by now we all know there are countless physical benefits to integrating exercise into our daily routine. Even though we may know exercise is great for us, occasionally life gets in the way or we lose our motivation to stay physically active.

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How to Increase your Vitality and Quality of Life through Exercise and Socialization

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How to Increase your Vitality and Quality of Life through Exercise and Socialization

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January 18, 2018

Since the beginning of time, men and women have searched for ways to enhance their vitality and overall quality of their life with the hope of erasing the signs and symptoms of aging. Even though the “Fountain of Youth” does not exist, there are recommended steps that can be incorporated into your life at all ages. These recommendations should follow your physician’s advice and your personal preferences and interests.

One major recommendation that most individuals receive when visiting their physician is to incorporate exercise into their life. Exercise routines will vary based on personal interests, physical strength, time commitments and budgets. But everyone can exercise and should find a way to incorporate some type of physical activity into their life. Studies by researchers at the Mayo Clinic Proceedings (Sept, 2011) have proven that exercise can prevent falls which can lead to fractures and impairments which are one of the largest reasons for loss of independence, physical decline and hospitalizations in seniors. (If you do experience a fall resulting in a fracture or other injury, look into entering a quality rehabilitation program. Finding the right care can help you get back on your feet safely.) Also, recent information published by the Center for Disease Control and Prevention (CDC) recommended exercise to increase muscle strength, reduce fat and prevent osteoporosis (US.Gov). No matter if your exercise involves walking, moving during chores, participating in a sport, spending some time moving your arms or legs, or getting out of your chair, benefits can result including reduced depression and anxiety, increased enjoyment, and associated improvement in memory.

Another concern as we age is memory decline, reduction in concentration and other associated cognitive impairments. New literature suggests that physical exercise may serve as a preventive step in reducing the risk of dementia or cognitive impairments. Studies have shown that exercise may also reduce the risk of stroke and heart disease (Mayo Clinic Proceeding, 2011). There are also recommended steps to help improve memory loss and/or cognitive impairments. It is important to find ways to challenge your mind by learning new information, participating in a class, attending a senior center, doing puzzles, using a computer and reading. The brain can be compared to a computer that needs exercise. There are also techniques that you can utilize to enhance your memory. Some people will create mnemonics that use visual clues, rhymes, or sentences to help remember names and facts. You may remember using these techniques as a student when preparing for a test. Another technique is called chunking, where large amounts of information or facts are put in smaller lists.

People who find ways to enjoy their lives may also experience increased vitality.

It is important to find ways to have fun and look forward to an upcoming event.

If you are suffering from an illness, don’t delay finding forms of enjoyment even though you may need to modify your approach. Connect to others through various forms of socialization, including spending time outside of your home, talking on the phone, using email or writing a letter. Programs and services, like Abramson Medical Adult Day Services, can provide activities and social opportunities for those who need extra support because of an illness or other disability.

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How to Increase your Quality of Life through Exercise and Socialization

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Find out on How to Increase your Vitality and Quality of Life through Exercise and Socialization onFull Spectrum LLC .

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How is Parkinson’s Disease Related to Sleep Apnea?

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How is Parkinson’s Disease Related to Sleep Apnea?

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There may be a link between sleep apnea and Parkinson’s disease. The impact of poor sleep on brain tissue over time may contribute to the early stages of the degenerative condition.Read to know more.

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There may be a link between sleep apnea and Parkinson's disease. The impact of poor sleep on brain tissue over time may contribute to the early stages of the degenerative condition. Getting a good night's rest is essential for brain well-being. That means sleep disorders need to be taken seriously to ensure future brain health.

What is Parkinson's Disease?

Parkinson's disease is a degenerative neurological disorder that affects balance, movement, and coordination. Named for James Parkinson, the English doctor who identified the disease in 1817, Parkinson's afflicts nearly 10 million people worldwide. ¹

The brain disorder is associated with a loss of dopamine-producing nerve cells inside the brain which help regulate movement and mobility.

Since Parkinson's affects everyone differently, how each patient lives their life with the disease is unique. Parkinson's patients are best to maintain a positive attitude and stay focused on keeping good health through diet and exercise.

What Causes Parkinson's Disease?

While the loss of these critical nerve cells has been identified as the basis of Parkinson's disease, no direct cause has been identified. The disease does have some typical patterns.

Most common in people over the age of 60

Men are more likely to get the disease than women

Head injuries, brain inflammation, environmental toxins, and genetics are all suspected causes of the disease

Some research suggests that a healthy lifestyle may help reduce the risk of Parkinson's disease. However, the best approach is to notice and address the signs as soon as possible. The unique way the disease affects individuals sometimes makes it difficult to diagnose. Doctors will look for tell-tale indicators of the disease.

Signs of Parkinson's Disease

Patients with early signs of Parkinson's may experience tremors, changes in their handwriting, difficulty walking, poor sleep, changes in voice and posture, and also changes in facial expression. Movement symptoms may start on one side of the body and then gradually affect both sides.

Although there is no test for Parkinson's disease, these early indicators usually lead to closer examination and observation of the patient to determine a diagnosis. Only the typical early signs and other additional indicators clue doctors to the disease.

Other indicators include:

a loss of sense of smell

mood changes

chronic fatigue

skin problems

constipation

dementia, delusions, and hallucinations

difficulty chewing and swallowing

Identifying Sleep Apnea in a Person with Parkinson's

While the results are inconclusive, there is strong evidence that sleep apnea may impact Parkinson's disease. Sleep apnea reduces oxygenation to the brain, which then over time can stimulate a specific protein alpha-synuclein in the blood. This elevated protein level becomes toxic and begins the degenerative process of Parkinson's in the brain. ²

Identifying sleep apnea symptoms in a person with Parkinson's can help with managing the progression of the disease. Look for these indicators of obstructive sleep apnea.

Waking up gasping for air at night

Loud snoring

Morning headaches

Drowsiness during the day

Dry mouth or sore throat in the morning

Changes in mood and irritability

Why is it Important to Treat OSA in Parkinson's Patients?

Many of the mental side effects of Parkinson's disease can be helped by improving sleep. Treating OSA reduces apneas at night and can also reduce many of the daytime symptoms aggravated by not sleeping well.

Sleep apnea treatment can reduce brain fog, mood problems, and also daytime drowsiness that can make Parkinson's disease worse. Common issues like anxiety and cognitive function also improved with CPAP compliance.

While sleep apnea treatment may not stop the progression of Parkinson's disease, it can help the patient with improved quality of life while managing the disease.

Where Can I Buy CPAP Therapy Equipment?

The CPAP Shop is an authorized dealer of all CPAP equipment and provides free shipping for all purchases above $99 in the continental USA. Find the best range of Philips and ResMed CPAP Machines and accessories at The CPAP Shop website.

For additional information on various topics concerning sleep apnea and CPAP products, please refer to our blog. It is constantly updated and offers free advice and information. If you'd like to learn more about the quality sleep apnea products we carry, or if you have additional questions, don't hesitate to call us at (866) 414-9700, or you can contact us through our website.

References

1. United Brain Association. Parkinson's Disease.

2. Parkinson's News Today. Carvalho, Joana. Lack of Tissue Oxygenation from Sleep Apnea Linked to Parkinson's, Study Suggests April 30, 2019.

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How is Parkinson's Disease Related to Sleep Apnea?

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There may be a link between sleep apnea and Parkinson's disease. The impact of poor sleep on brain tissue over time may contribute to the early stages of the degenerative condition. Getting a good night's rest is essential for brain well-being. That means sleep disorders need to be taken seriously to ensure future brain health.

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Lack of Tissue Oxygenation from Sleep Apnea Linked to Parkinson’s

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Lack of Tissue Oxygenation from Sleep Apnea Linked to Parkinson’s

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Lack of tissue oxygenation associated with episodes of upper airway obstruction in patients with obstructive sleep apnea syndrome (OSAS) may increase the levels of alpha-synuclein in the blood and may contribute to the development of Parkinson’s disease, a study says.

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Lack of tissue oxygenation associated with episodes of upper airway obstruction in patients with obstructive sleep apnea syndrome (OSAS) may increase the levels of alpha-synuclein in the blood and may contribute to the development of Parkinson's disease, a study says.

The study, "Plasma α‐synuclein levels are increased in patients with obstructive sleep apnea syndrome," was published in the Annals of Clinical and Translational Neurology.

Parkinson's disease mainly results from the gradual loss of dopaminergic neurons in the substantia nigra, a region of the brain responsible for controlling movement.

The disease also seems to be associated with overproduction of the protein alpha-synuclein in nerve cells of the brain. When this protein clumps together, it gives rise to small toxic deposits inside brain cells, called Lewy bodies, inflicting damage and eventually killing them.

Of note, alpha-synuclein phosphorylation - a chemical modification in which a phosphate group is added to the protein - is known to occur in Parkinson's disease, and is thought to be a critical step in disease progression as it enhances alpha-synuclein's toxicity, possibly by increasing the formation of alpha synuclein aggregates.

"Recent studies found that [obstructive sleep apnea] was a risk factor for PD [Parkinson's disease] onset, and hypoxia [lack of oxygen] may have contributed to it. [In addition,] previous studies both in vitro and in vivo revealed that hypoxia is able to induce overexpression of alpha‐synuclein (...). However, the detail mechanism remains to be further investigated," the researchers wrote.

In this study, a group of Chinese scientists investigated the relationship between lack of tissue oxygenation caused by episodes of upper airway obstruction during sleep, and the levels of alpha-synuclein in patients with OSAS.

OSAS occurs when the throat muscles intermittently relax and block upper airways during sleep.

The study enrolled 42 patients who had been diagnosed with OSAS (eight with mild, 16 with moderate and 18 with severe OSAS) and 46 age- and sex-matched individuals with simple snoring (controls). The levels of total and phosphorylated alpha-synuclein in the patients' blood plasma were measured by Enzyme-Linked Immunosorbent Assay (ELISA), a technique that allows researchers to measure the amount of a specific protein of interest using an enzymatic reaction).

Results showed that patients with OSAS had significantly higher levels of both total (37.68 ng/ml vs 21.08 ng/ml) and phosphorylated (26.87 ng/ml vs 14.61 ng/ml) alpha-synuclein in the plasma compared to controls.

Moreover, correlation analyses revealed the levels of both total and phosphorylated alpha-synuclein were positively correlated with the apnea-hypopnea index (an index that measures the severity of sleep apnea) and the oxygen desaturation index (an index that measures the number of times oxygen levels dip below a given threshold during sleep).

Conversely, the levels of both total and phosphorylated alpha-synuclein in the plasma were negatively correlated with the lowest and mean oxyhemoglobin saturations - the fraction of hemoglobin (red blood cells) bound to oxygen relative to the total hemoglobin found in the blood.

"In summary, the present study found that increased alpha-synuclein levels in the plasma are correlated with the degree of hypoxia in OSAS, indicating that chronic hypoxia caused by OSAS may be involved in the pathogenesis [disease manifestations]" of Parkinson's, the scientists concluded.

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Lack of Tissue Oxygenation from Sleep Apnea Linked to Parkinson's...

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Lack of tissue oxygenation associated with episodes of upper airway obstruction in patients with obstructive sleep apnea syndrome (OSAS) may increase the levels of alpha-synuclein in the blood and may contribute to the development of Parkinson's disease, a study says. The study, "Plasma...

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The Interaction between Obstructive Sleep Apnea and Parkinson’s Disease

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The Interaction between Obstructive Sleep Apnea and Parkinson’s Disease

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Parkinson’s disease (PD) is a relentlessly progressive neurodegenerative disorder associated with hallmark motor and nonmotor symptoms (NMS) such as sleep disturbances and cognitive dysfunction.

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Parkinson's disease (PD) is a relentlessly progressive neurodegenerative disorder associated with hallmark motor and nonmotor symptoms (NMS) such as sleep disturbances and cognitive dysfunction. While dopaminergic treatments have improved the motor aspects of PD, progression remains inevitable. Research has recently increasingly focused on strategies to modify disease progression and on nonmotor manifestations of PD, given their impact on patients' quality of life. Obstructive sleep apnea (OSA) is a treatable sleep disorder, common in the general population, associated with excessive daytime sleepiness and neurocognitive deficits. Neuroimaging has demonstrated structural and functional changes in OSA patients; in animal models, OSA causes brain inflammation and oxidative injury, including in key areas involved in PD pathophysiology such as locus coeruleus. The prevalence of OSA in PD has been variable in studies to date, and potential consequences and interrelationship between the two disorders have not been well studied. There is however emerging evidence that OSA is associated with increased NMS in PD, particularly cognitive dysfunction. This review focuses on the possible interrelationship between OSA and PD. Mechanisms promoting OSA in PD will be reviewed, as well as mechanisms whereby OSA can affect the neurodegenerative process in PD.

1. Introduction

Parkinson's disease (PD) is the second most frequent neurodegenerative disorder, and its prevalence is expected to increase as the population ages [ 1]. Obstructive sleep apnea (OSA) is a treatable sleep disorder that is common in the general population and is associated with adverse outcomes including cognitive dysfunction [ 2]. OSA results in sleep fragmentation and intermittent hypoxemia that can have significant detrimental consequences on the brain. However, OSA prevalence in PD has been variable in studies to date in part due to methodological variability, such that until recently, OSA has not been perceived to be a significant issue in PD. Thus, to date, the potential consequences and interrelationship between OSA and PD have not been well studied. However, when already affected by a degenerative process like PD, one could speculate that the brain may be more vulnerable to the effects of OSA due to reduced ability to compensate and also more responsive to OSA treatment. In this paper, we explore the possible bidirectional relationship between OSA and PD (Figure 1). We review the possible pathophysiologic factors predisposing to OSA in the context of PD. We then review the known consequences of OSA on the brain. These data suggest that OSA may play a significant role in the neurodegenerative process of PD, particularly as it relates to cognitive dysfunction.

2. OSA Overview

3. OSA in Other Neurological Disorders

OSA risk is increased with male sex, older age, and higher body mass index (BMI), but also in conditions such as neuromuscular disorders [ 11], epilepsy [ 12], multiple sclerosis [ 13], and stroke [ 14]. Moreover, in CNS disorders, OSA appears to modify the manifestations or disease course, which suggests a bidirectional relationship. For example, OSA is associated with an increased incidence of stroke [ 15, 16]. In turn, OSA appears to be associated with poorer outcome at discharge and up to 12 months and increased mortality at 12 months after stroke [ 17]. Furthermore, despite the difficulty in applying continuous positive airway pressure (CPAP) therapy in patients soon after a stroke, functional outcomes were improved in patients treated for their OSA in two randomized controlled trials (RCT) [ 18, 19]. In MS, we reported that OSA was associated with increased fatigue [ 20], which is one of the most frequent, pervasive, and incapacitating symptoms of MS. Treatment of OSA led to improved fatigue [ 21]. OSA has also been associated with poor seizure control in epilepsy [ 12]. Patients with OSA who were compliant with CPAP had reduced seizure frequency [ 22].

4. OSA and Cognitive Function

The response of neurocognitive dysfunction to CPAP therapy in the general population has been variable and incomplete [ 32- 35]. This has been suggested to stem from near-normal cognitive function before CPAP, lack of statistical power [ 32, 35], poor compliance with treatment [ 36], or irreversible brain damage from long-standing OSA [ 37].

A recent meta-analysis evaluating the effect of CPAP on various subtypes of executive function found a significant beneficial effect [ 38]. However, the APPLES trial [ 35], a large multicenter RCT of CPAP versus sham CPAP which evaluated three domains of cognitive function in OSA (attention and psychomotor function, learning and memory, executive, and frontal lobe function), failed to show the expected benefits. In this study, individuals with a Mini-Mental State Examination score ≤ 26 (normal cutoff in healthy adults) were excluded. Hence, only those with scores within the normal range were included, and there was little room for further improvement. The authors advanced the "cognitive reserve theory" to explain lack of positive results. That is, some individuals may have greater preexisting flexibility in neural function and capacity to cope with disruption, or better compensatory mechanisms [ 39]. Possibly, then, a detrimental effect of OSA on cognition may only become apparent in individuals with reduced cognitive reserve, or with another predisposing condition to cognitive dysfunction.

5. OSA Prevalence in PD and Possible Pathogenic Mechanisms

Sleep disturbances are frequent in PD and include insomnia, hypersomnia, sleep architecture and circadian abnormalities, restless legs syndrome, and REM Sleep Behavior Disorder (RBD) [ 45]. OSA is reported to occur in 20-60% of PD subjects [ 46- 51]. This wide range likely reflects differences in patient populations, small sample sizes with selection bias, and most importantly differences in scoring of respiratory events between laboratories [ 5]. In particular, studies suggesting a low prevalence of OSA in PD have included only hypopneas with desaturations [ 48], overlooking entirely respiratory events causing sleep fragmentation without hypoxemia. It has also been suggested that OSA prevalence in more advanced PD might be reduced compared with the general population due to lower body mass index of PD patients [ 52]. However, this may depend on the criteria used to define OSA, as hypoxemia is more likely to be associated with a higher BMI. OSA in PD may not follow the same pattern as in the general population. Trotti and Bliwise did not find BMI to be correlated with OSA severity in PD [ 51]. Correlation between OSA severity and PD severity has been found in two studies [ 47, 50] and in our own work [ 53], though causality cannot be inferred from these cross-sectional studies. While OSA does not appear to be more common in PD than the general population, it is clear that the two conditions do not uncommonly coexist, either because OSA is frequent in the general population and thus coincides with PD, or due to PD-related changes predisposing to OSA, or both.

PD is also associated with autonomic dysfunction, which may impair control of breathing, particularly during non-REM sleep where respiration is predominantly dependent on chemical drive. Such a mechanism has been suggested as a partial explanation of the high prevalence of sleep-disordered breathing in the Shy-Drager syndrome [ 59, 60]. Abnormal afferent chemosensitive feedback control to the central respiratory generator has been implicated [ 59]. This is consistent with reports of sleep-disordered breathing, occasionally fatal, occurring in patients undergoing cervical cordotomy for pain relief, which is associated with other manifestations of autonomic dysfunction [ 61]. OSA itself can alter autonomic function with consequences beyond the sleep period, particularly increased sympathetic tone that is associated with baroreflex and chemoreflex changes [ 62, 63]. Control of breathing is affected, potentially further promoting OSA. In PD, chemosensitivity to hypoxia was found to be reduced, despite normal pulmonary function, and this was associated with reduced dyspnea in hypoxic conditions [ 64]. Respiratory drive in response to hypercapnia was also found to be reduced [ 65], possibly as a result of involvement by the PD neurodegenerative process of the brainstem [ 66], where the central chemoreceptor and respiratory centers are located. An abnormal hypercapnic response can predispose to hypoventilation, especially in sleep. Moreover, activity of upper airway dilator muscles, a key element in OSA pathophysiology, is modulated by respiratory drive and CO ₂ levels [ 67, 68]. How these mechanisms affect the upper airway and respiration during sleep in patients with PD has not been directly studied.

Sleep fragmentation may itself induce respiratory disturbances. A change in sleep state such as the transition from wakefulness to sleep is associated with a change in respiration manifesting as periodic breathing, usually transient. However, in individuals with a low arousal threshold, a modest fluctuation in breathing may trigger an arousal. Arousals from sleep following a respiratory event lead to hyperpnea and hypocapnia, which in turn may trigger another respiratory pause upon return to sleep, triggering a cycle of respiratory instability, further promulgating OSA [ 69]. In mice, sleep fragmentation resulted in impaired arousal responses to hypercapnia [ 70], which could prolong apneas and hypopneas. In humans, sleep fragmentation led to increased upper airway collapsibility in sleep [ 71], increasing propensity for OSA. In PD, sleep fragmentation and dysfunction occur as part of the disease. This is thought to be multifactorial, due in part to dysfunctional sleep circuits but also to medications and comorbidities [ 72]. Hence the intrinsic sleep fragmentation in PD may be a factor in progression of OSA in this condition.

6. Mechanisms of Deleterious OSA Effects on the Brain

6.1. Intermittent Hypoxemia

The mechanisms involved in the effects of OSA on the brain in general and on cognitive function in particular have not been clearly elucidated, but several factors could play a role. OSA is increasingly being incriminated as causing neural injury. Intermittent hypoxemia in particular has been implicated, possibly through mechanisms of ischemia/reperfusion [ 73], and oxidative injury [ 74]. OSA with hypoxemia is also associated with delayed peripheral nerve conduction [ 75] and treatment of OSA partially reverses the dysfunction [ 76]. In animal models, exposure of rodents to intermittent hypoxemia resulted in impaired learning and memory that did not normalize after a recovery period. Increased astrocytes and neuronal apoptosis were found in frontal cortex areas (including cingulate gyrus) and certain hippocampal regions, implying differential neuronal susceptibility [ 77]. Reduction in striatal norepinephrine concentration was also shown as a result of intermittent hypoxemia [ 78], as well as injury in specific catecholaminergic neuron groups, notably the dopaminergic periaqueductal gray and locus coeruleus [ 79]. NADPH oxidase [ 80] and iNOS [ 73] were found to mediate this injury and the associated proinflammatory response. The proinflammatory transcription factor NF- κB is also induced by intermittent hypoxemia in OSA [ 81, 82] causing systemic inflammation. Evidence of systemic inflammation in OSA was found with elevated plasma levels of C reactive protein [ 83], TNF- α, interleukin- (IL-) 6 [ 84, 85], and IL-8 [ 86]. IL-6 and TNF- α levels correlated with OSA severity [ 87]. This likely contributes to neuroinflammation [ 88] which promotes neurodegeneration [ 89, 90]. Although these OSA-related mechanisms might theoretically exacerbate PD neuropathology, they have not been studied to date in PD.

Intermittent hypoxemia in mice has also been found to be associated with reduced expression of brain-derived neurotrophic factor (BDNF) in the hippocampus and reduced long-term potentiation [ 91]. This could explain some cognitive deficits, as reduced BDNF levels have been associated with impaired cognition [ 92, 93]. However, in humans, serum BDNF levels were no different in OSA versus control subjects [ 94].

It should be noted that while OSA-related hypoxemia in humans has been associated with cognitive deficits in some studies [ 95, 96], others have found a paradoxical apparently protective effect [ 97]. Recent data suggest that there may be an ischemic preconditioning effect in some OSA patients [ 98]. Hence the exact role of hypoxemia as a cause of cognitive deficit in humans remains to be clarified, though severity of the intermittent hypoxia likely plays a role [ 88]. In PD hypoxemia associated with OSA is less marked as compared with non-PD individuals [ 48]. This is due to the lower BMI of PD patients with OSA. However, individuals earlier in the course of their PD may have a higher BMI, including before diagnosis, and hypoxemia might be a more important factor in that setting. Moreover, it is unknown what level of hypoxemia might be considered "safe" in PD. It is possible that what is inconsequential or protective in an otherwise healthy brain may be deleterious in PD. More research will be needed to clarify these relationships.

6.2. Sleep Fragmentation

In addition to hypoxemia, OSA is associated with sleep fragmentation, which appears to be a key factor in brain dysfunction and cognitive outcomes. Some deficits in OSA are similar to those occurring in sleep deprivation [ 99]. In a longitudinal study of elderly individuals, sleep fragmentation related to OSA, but not hypoxemia, was associated with cognitive decline [ 30]. Sleep fragmentation due to OSA was also found to be the best predictor of episodic memory deficits [ 100]. In mice, sleep fragmentation results in learning deficits. This was found to be associated with increased gene expression and activity of NADPH oxidase in the hippocampus and cortex of wild type mice [ 101]. However, mutant mice lacking NADPH oxidase activity were protected from the learning deficits. Chronic sleep fragmentation was also found to selectively increase cortical expression of TNF- α [ 102]. Moreover sleepiness and learning deficits associated with sleep fragmentation were absent in TNF- α double receptor knockout mice and in mice treated with a TNF- α neutralizing antibody [ 102]. Hence, sleep fragmentation appears to induce oxidative stress and inflammation just as intermittent hypoxia does. Interestingly, in a sleep fragmentation animal model of OSA, there was reduced neuronal excitability in the locus coeruleus [ 70], an area implicated in PD pathophysiology (compare with below).

6.3. Glymphatics

Recently a novel waste clearance system operating in the brain has been characterized, termed the glymphatic system [ 103]. It involves transport of CSF along periarterial spaces, via convective flow through the brain parenchyma and perivenous spaces into the cervical lymphatic system, eliminating soluble proteins and metabolites. Its function declines with age and this has been suggested to contribute to the accumulation of abnormal proteins in the extracellular space, such as β-amyloid or α-synuclein, rendering the brain more vulnerable to neurodegenerative pathologies. The particularity of this system is that it is activated only during sleep. Therefore, any process leading to sleep fragmentation can disrupt this system, resulting in potentially adverse consequences on brain homeostasis. It is known that dementia in PD often results from an "admixture of pathologies" [ 104- 106], including Lewy body but also Alzheimer-related pathologies, with a smaller component of cerebrovascular pathology. One could therefore speculate that glymphatic abnormalities may be a nonspecific mechanism predisposing to cognitive dysfunction in PD. Glymphatics could be affected by sleep fragmentation or hemodynamic changes occurring in OSA. Intermittent hypoxia has also been implicated in potential blood-brain barrier dysfunction and alteration in brain water and solute fluxes, through a number of mechanisms stemming from a chronic maladaptive response [ 88].

6.4. Role of the Locus Coeruleus

The locus coeruleus has been implicated in cognitive decline in the general population. A recent autopsy study from a longitudinal clinical-pathologic cohort study on aging found that lower locus coeruleus neuronal density was associated with lower baseline level of cognition and faster cognitive decline [ 107]. An imaging study showed that locus coeruleus connectivity was correlated with memory scores and was reduced in patients with mild cognitive impairment [ 108]. With regards to PD, a recent case series and review by Del Tredici and Braak [ 104] focused on the role of noradrenergic defects in the locus coeruleus in development of dementia in PD.

The effects of intermittent hypoxemia and sleep fragmentation on the locus coeruleus and other specific brain regions, as described above, may have significant implications in PD. While the key abnormality in PD pathophysiology is loss of dopaminergic neurons of the substantia nigra, resulting in depletion of dopamine from the basal ganglia, other regions of neurodegeneration have been identified, which may better correlate with the nonmotor symptoms of PD [ 109, 110]. Locus coeruleus neurons specifically have been implicated in pathophysiology of PD: loss of their trophic influences may increase sensitivity of dopaminergic neurons to neurotoxic insults [ 111, 112]. The currently emerging concept of PD pathogenesis revolves around a combination of genetic, cellular, and environmental factors that independently or concomitantly result in cell death, possibly by triggering mitochondrial dysfunction and oxidative stress, abnormal protein degradation, and other forms of subcellular dysfunction [ 113]. After disease onset, regardless of the initial insult, the progression of cell loss may result from common pathways that include oxidative and nitrosative stress and neuroinflammation [ 113- 115]. Neuroinflammation appears to play a key part in pathogenesis of PD. Nonsteroidal anti-inflammatory drugs decrease the risk of PD [ 116], and inflammatory cytokines are increased in the serum and/or cerebrospinal fluid of PD patients [IL-2, TNF α, IL-6, RANTES, osteopontin, and IL-1 β]. In PD animal models, intranigral infusion of TNF α blockers attenuated dopaminergic neurodegeneration, while mice lacking TNF receptors 1 and 2 had attenuated striatal damage after injection of MPTP [ 115]. In the process of neuroinflammation, microglia became activated and capable of antimicrobial and toxic functions: damage to dopaminergic neurons can occur through reactive oxygen and nitrogen species, produced, respectively, by NADPH oxidase and inducible NO synthase (iNOS) [ 90]. As described above, activation of oxidative and nitrosative processes has been described in OSA. OSA, therefore, could be an additional insult on an already vulnerable brain, promoting the inflammatory neurodegenerative mechanisms and accelerating functional decline.

7. Sleep and Cognitive Function in PD

Cognitive dysfunction is found in 20-40% of patients with early PD but is a major cause of long-term disability [ 113]. In one large study, after 20 years' follow-up, 83% of survivors had dementia [ 120]. The most commonly documented deficits in early PD are in executive "frontal" functions [ 121, 122] and memory [ 123, 124].

Sleep is a state that is crucial for proper cognitive function. It allows for consolidation of declarative memory [ 125] and of "implicitly" learned motor skills [ 126]. Implicit learning is dependent on attention [ 127] and is sensitive to sleep effects [ 128]. Poor sleep quality affects memory consolidation [ 129] and executive function [ 130, 131] in older adults. Changes in sleep EEG characteristics (sleep spindles and slow waves) with aging have been implicated in reduction in sleep-dependent memory consolidation in older adults [ 129].

8. Neuroimaging in relation to Cognitive Function in OSA and PD

Structural and functional changes on brain imaging associated with neurocognitive deficits have been found in OSA patients [ 23, 33, 141- 143]. They include decreased grey matter in the hippocampus and temporal lobe, anterior cingulate, and cerebellum, as well as in the frontal and parietal lobes. CPAP therapy appears to increase gray-matter volume in hippocampal and frontal structures [ 33]. In PD, cortical atrophy in the hippocampus and frontal areas has been found in patients with mild cognitive impairment (MCI), but not in cognitively intact PD patients [ 144]. Most studies report a correlation of temporal lobe atrophy with poor memory in PD [ 145, 146], but some find a correlation between memory problems and frontal regions [ 147], or with medial temporal and frontal lobes [ 145]. It is conceivable that the variability in results is related at least partly to confounding effects of OSA, which was not accounted for in those studies. In that similar brain regions have been found to be affected in OSA, particularly temporal and frontal areas [ 33, 141]; OSA may contribute significantly to the cortical atrophy patterns identified in PD-MCI.

9. Preliminary Data on Impact of OSA in PD

10. Conclusion

Clearly, many questions remain and further work in this area will be necessary to clarify the role of OSA in PD. In a possible bidirectional relationship, OSA is potentially both a manifestation of PD, as well as a factor contributing to its signs and progression. Large prospective cohort studies will be needed to evaluate the impact of OSA on progression of PD-related cognitive dysfunction, as well as motor dysfunction. OSA has the merit of being largely correctable, such that effective treatment can readily improve its symptoms. RCTs will be needed to assess the effect of OSA therapies in PD. Treatment typically includes CPAP, though possibly other modalities could be more effective in PD than in the general population, given the somewhat different pathophysiology of OSA in PD. Moreover, if a deleterious effect of OSA on PD progression is confirmed, OSA treatment could be evaluated as a disease-modifying therapy, which could potentially delay cognitive decline or motor dysfunction.

Conflict of Interests

The authors declare that there is no conflict of interests regarding the publication of this paper.

Acknowledgments

This work was supported by the McGill University Health Centre (MUHC) Department of Medicine, the Research Institute of the MUHC, and the American Thoracic Society Foundation.

References

1. C. Iber, S. Ancoli-Israel, A. L. Chesson, and S. F. Quan, The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, American Academy of Sleep Medicine, Westchester, Ill, USA, 1st edition, 2007.

2. A. R. Schwartz, D. C. Thut, R. G. Brower et al., "Modulation of maximal inspiratory airflow by neuromuscular activity: effect of COView at: ₂," Journal of Applied Physiology, vol. 74, no. 4, pp. 1597-1605, 1993. Google Scholar

3. A. K. Htoo, H. Greenberg, S. Tongia et al., "Activation of nuclear factor κB in obstructive sleep apnea: a pathway leading to systemic inflammation," Sleep and Breathing, vol. 10, no. 1, pp. 43-50, 2006.

4. V. Ramesh, D. Nair, S. X. L. Zhang et al., "Disrupted sleep without sleep curtailment induces sleepiness and cognitive dysfunction via the tumor necrosis factor-α pathway," Journal of Neuroinflammation, vol. 9, article 91, 2012.

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The Interaction between Obstructive Sleep Apnea and Parkinson's Disease: Possible Mechanisms and Implications for Cognitive Function

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Parkinson’s disease (PD) is a relentlessly progressive neurodegenerative disorder associated with hallmark motor and nonmotor symptoms (NMS) such as sleep disturbances and cognitive dysfunction. While dopaminergic treatments have improved the motor aspects of PD, progression remains inevitable. Research has recently increasingly focused on strategies to modify disease progression and on nonmotor manifestations of PD, given their impact on patients’ quality of life.

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COPD doesn’t have to mean confinement to your home. Portable oxygen concentrators allow you to take your oxygen therapy with you anywhere in the world.Read on to know more.

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COPD doesn’t have to mean confinement to your home. Portable oxygen concentrators allow you to take your oxygen therapy with you anywhere in the world. With guidance from your doctor and the right equipment COPD patients can enjoy the freedom to travel abroad for vacations, business or to visit family. Here are some tips regarding traveling abroad with COPD.

Can You Travel with COPD?

While COPD can feel like a barrier to travel for most patients, modern portable oxygen concentrators offer the same effective and reliable oxygen therapy as home units. Traveling abroad with COPD is certainly doable. With a portable oxygen concentrator and approval from a doctor most COPD patients are free to book trips, including international trips without concern.

How Does Altitude Affect COPD?

Traveling to other countries may mean having to take high altitude flights. High altitudes can worsen symptoms of COPD as it requires more oxygen to breath normally. Use an FAA approved portable oxygen concentrator to support your respiration during high altitude travel and make sure your respiratory illness is within a safe range for high altitudes by checking with your doctor.

Tips for Air Travel with Oxygen If You Have COPD

Schedule an Appointment with Your Doctor

Let your doctor know you plan to travel abroad. Your doctor will know best if your COPD is not too severe for air travel. For most cases of COPD, a doctor will recommend proper supplemental oxygen use during your trip, including adjustments to your oxygen flow settings and even a recommended portable oxygen concentrator.

Carry Your Medical Records

Be sure to bring your medical records on your trip. If any emergency occurs, your medical records will inform doctors abroad about your medical condition. Even if traveling in a country where English may not be the native language, documentation can be translated and may be critical to your healthcare.

Try Not to Travel Alone

A traveling companion is always helpful when going abroad with COPD. Even though you may be fully capable of traveling alone with COPD, having someone else in attendance can help in an emergency. If you become incapacitated due to your illness, a friend or relative is present to act if you can’t.

Check and Review Your Insurance

Check in with your health insurance provider to review coverage for any medical needs while traveling abroad. Make sure your policy covers you if you need to see a doctor in another country for any reason. You may need to supplement health insurance to support your international travel plans if your policy only provides domestic coverage.

Carry a Portable Oxygen Concentrator

Select a reliable portable oxygen concentrator that fits the needs for your trip. Good portable oxygen concentrators (POCs) are small, lightweight, compact and FAA approved for travel. Many portable concentrators come with handy carrying cases that allow you to continue discreet oxygen therapy during an international flight. Make sure the portable oxygen concentrator you select meets your oxygen therapy prescription requirements.

Check for Your Medical Supplies and Nebulizer

Backup Supplies

Take along extras such as connectors, nasal cannulas, and backup batteries for your portable oxygen concentrator to keep your trip abroad stress-free. Don’t forget any prescribed medications.

Nebulizer

Pack a portable nebulizer as a quick fix for respiratory difficulty while abroad. Misted medicine can be a helpful aid for minor breathing problems, so you don’t always have to rely on supplemental oxygen.

Carry and Use a Pulse Oximeter

Take along a pulse oximeter to monitor your blood oxygen levels on your trip. Pulse oximeters are inexpensive and compact instruments that ensure that oxygen is saturating from your respiratory system to the rest of your body. It’s the easiest way to know when away from home if your COPD is causing a drop in blood oxygen levels.

Check all Oxygen Equipment

Nasal Cannula

Bring a new nasal cannula on your trip so you don’t experience leaks while you are away from home.

Batteries

Batteries for portable oxygen concentrators give you power when none is available. Look for batteries with long life so you don’t have to recharge often. Make sure your batteries are compatible with your portable oxygen concentrator.

Exercise Your Calf Muscles

Your trip abroad may involve some walking. So, it’s important to get yourself limber for any extra physical activity, especially if your COPD has kept you inactive for a period of time. Be sure to exercise your calf muscles with stretches to ensure you don’t get cramps when walking about.

Prepare for Medical Care at Your Destination

You can think ahead to prepare for any emergencies by finding a doctor for a quick check up at your international destination. Find a doctor that speaks your language and can be informed ahead of time of your COPD before you arrive. A simple examination can give you peace of mind for the rest of your trip.

Where Can I Buy Travel Oxygen Concentrators for Traveling with COPD?

You can find portable oxygen concentrators at most medical supply stores. Or you can shop online effortlessly as you prepare for your trip abroad with everything you need at The Oxygen Concentrator Supplies Stop. Our knowledgeable staff will help you with the supplemental oxygen essentials for international travel.

Chris Vasta is the president of The CPAP Shop and an expert in sleep and respiratory therapy. He often provides insights on product design and functionality on various manufacturers’ prototypes and is frequently tapped to provide reviews on new releases.

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Can you travel abroad with COPD? Traveling abroad with COPD can be a hassle. Learn all you need to do when traveling with COPD in this detailed article.

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Air travel for patients with chronic obstructive pulmonary disease

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Air travel for patients with chronic obstructive pulmonary disease

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This case report aims to assist primary care physicians in managing borderline hypoxemic patients with chronic obstructive pulmonary disease (COPD), enabling them to fly safely.

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INTRODUCTION

This case report aims to assist primary care physicians in managing borderline hypoxemic patients with chronic obstructive pulmonary disease (COPD), enabling them to fly safely.

CASE REPORT

A 63-year-old female smoker (80 pack years) travelled from Athens, Greece to Amsterdam in The Netherlands. She had been diagnosed with hypertension, moderate COPD, mild cardiac failure, and severe osteoarthritis in the left knee. Thirty minutes after take-off she started to experience severe dyspnea, without tachycardia or chest pain, that required immediate medical attention. After administering oxygen at 2L/min, the symptoms slowly improved and she arrived safely in Amsterdam.

The patient had experienced similar symptoms during other flights in the past. Her GP thought that she should be examined by cardiologists and pulmonologists to assess the possible need for in-flight oxygen supplementation. The cardiologist conducted a full clinical examination, as well as an electrocardiogram and heart ultrasound, and decided that, as the cause of the oxygen desaturation during flight was not from her heart, she should be referred to pulmonologists for further assessment.

The pulmonologists conducted spirometry and an arterial saturated oxygen (SaO ₂) test. The results were: a forced expiratory volume in 1second (FEV1) of 60% predicted; an FEV1/forced vital capacity (FVC) of 0.65; and a SaO ₂ of 94%. The patient did not perform a 6-minute walking distance test (6MWT) as this was not possible due to the severe osteoarthritis of her left knee. As a hypoxia inhalation test was not available, even in the tertiary hospital, the pulmonologist said that the patient would probably need in-flight oxygen supplementation. This was based only on the available calculations (equations) for determining the need for oxygen supplementation in flight. The pulmonologist did not give precise advice to the patient and, as a result, the patient experienced the same dyspnea during flight as she had done before.

As the patient had experienced severe dyspnoea in previous flights, should her doctors be more careful and prepare her journey in a safer way?

DISCUSSION

COPD is a major public-health problem that, it is estimated, will be the fourth leading cause of death by 2030.1 Two billion passengers travel each year by airplane;2 18-44% have COPD.3,4 Patients with moderate to severe COPD often develop symptoms due to hypoxia during flight, and most of them do not consult a physician before air travel as they have non-clinically significant hypoxemia at sea level.3 A study in Norway showed that 25% of the patients with COPD developed hypoxia-related symptoms in flight.4

Air pressure drops as altitude increases. The effects of increased altitude and the associated hypobaric features can result in hypoxia. Healthy individuals respond to hypoxia by increasing ventilation, balancing the hypobaric changes without any symptoms. Ventilation can be increased by increasing tidal volume and/or increasing respiratory rate.5 However, increasing tidal volume for patients with respiratory problems, and especially for those with COPD, is a difficult task as they are often hyperinflated. Patients with respiratory failure will always need in-flight oxygen; it is highly likely that patients with moderate to severe COPD need in-flight oxygen as well.

Investigations

In patients with COPD, previous experiences during flights, medical history including GOLD-stage status, dyspnea assessment, and clinical examination should all be assessed. The physiological tests to assess fitness for flight that are currently available are:

diffusing capacity tests;

arterial blood gas tests;

hypoxemia prediction equations; and

the hypoxia inhalation test.

Although the practical usefulness of FEV1, partial pressure of oxygen in the blood (PaO ₂), and SaO ₂ tests in successfully assessing the need for oxygen supplementation is questioned in several publications,6,7 a rule of thumb is that patients with an SaO ₂ of >95% will probably not need oxygen during flight, while those with an SaO ₂ of <92% will. Patients with an SaO ₂ of 92-95% are considered borderline.8 The need for oxygen supplementation in patients with COPD during flights can be calculated using different equations. For example:

PaO ₂(mm Hg) (8000 feet) = (0.238 × [PaO ₂ sea level]) + (20.098 × [FEV1/FVC]) + 22.258

Although this equation is usually reliable, it might be inaccurate in borderline situations. In such cases, the most accurate test is the hypoxia inhalation test by breathing an oxygen fraction of 15% at sea level; however, this is seldom performed in clinical practice. Patients with a post-hypoxia inhalation test saturation of <85% need in-flight oxygen. Independently, if a hypoxia-altitude simulation test or a hypobaric chamber is used to achieve hypoxia conditions, special caution to oxygen titration is needed - using a nasal cannula underestimates the oxygen dose required. The oxygen delivery equipment can result in the same PaO ₂ when a continuous-flow or oxygen-conserving device is used, whereas PaO ₂ is lower when portable oxygen concentrators (POCs) are used.10

In-flight oxygen is usually prescribed at a rate of 2-4L/min and should be given by nasal cannulae.7 This will partially reverse altitude-induced hypoxemia symptoms in patients with COPD.11 Nowadays, many airlines allow POCs on board, but often only specific types.7 Box 1 shows a practical guidance to help ensure safe air travel for patients with COPD.

Box 1. Guidance to help ensure safe air travel for patients with COPD

Notes

Consent

The patient has provided written consent for this article to be published.

Provenance

Freely submitted; externally peer reviewed.

Competing interests

The authors have declared no competing interests.

REFERENCES

1. Mathers CD, Loncar D. Updated projections of global mortality and burden of disease, 2002-2030: data sources, methods, and results. Geneva: WHO; 2005. [ Google Scholar]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners

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Air travel for patients with chronic obstructive pulmonary disease: a case report

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This case report aims to assist primary care physicians in managing borderline hypoxemic patients with chronic obstructive pulmonary disease (COPD), enabling them to fly safely. A 63-year-old female smoker (80 pack years) travelled from Athens, Greece to Amsterdam in The Netherlands. She had been diagnosed with hypertension, moderate COPD, mild cardiac failure, and severe osteoarthritis in the left knee.

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Find out about tips for traveling with COPD, including tips for transporting your oxygen when flying.

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Overview

Chronic Obstructive Pulmonary Disease (COPD) and Travel

Do you have COPD and have upcoming travel plans? To ensure your safety, some extra planning time will be needed.

Checklist before you travel

Did you notify your doctor? If you've been in the hospital recently, check with your doctor for clearance before traveling.

Did you obtain the necessary paperwork to travel? (You might need a letter from your healthcare provider that verifies all of your medications, including oxygen.)

Do you have a copy of your oxygen prescription? Carry the prescription with you. You will need to show the prescription to travel personnel.

Do you have the name and phone number of the following healthcare professionals with you: your doctor, your respiratory therapist, your oxygen supplier, and home healthcare company representative (if applicable)?

Do you have enough medication with you? Remember to pack all medication and supplies in your carry-on luggage. Also keep a list of current medications with you at all times.

Are you wearing your emergency medical identification?

Additional tips for travelers on oxygen therapy

Call your home healthcare company and tell them where you're going and how you're getting there. They can help you arrange for oxygen when you arrive.

Learn how to use your portable oxygen system and know how long the oxygen will last. Check ahead to see if you need oxygen refills to complete your trip.

Contact the travel carrier (airline, cruise ship, bus) when making your reservations to obtain information about your oxygen needs. There may be a fee related to oxygen use.

Personal portable oxygen concentrators can be taken aboard many airlines; check in advance to see if your air carrier allows this. Advance notice will be required.

If you have any questions, ask your healthcare provider(s).

Using oxygen doesn't mean you can't travel, but it does mean you have to plan ahead. Plan ahead for changes in time zones and increased or decreased activity.
Additional tips based on your mode of travel
Airplane
Call the airline several weeks ahead of time to obtain the airline's policy and make arrangements. The airline may need a letter from your doctor, a brief medical history, and a current oxygen prescription.

You may be able to use a portable oxygen concentrator. You should call your airline to check on their specific rules.

You will need to carry extra batteries for your equipment.

You cannot bring or use oxygen cylinders or liquid oxygen on the airplane.

You will need to make arrangements for oxygen delivery with the airline and your oxygen supplier. The airline will charge a fee for using a tank on the plane. The fee might be payable only in cash.

Direct flights are recommended whenever possible.

Get a seat near the airplane bathroom to minimize walking while flying.

Bus or Train
Call the local terminal management several weeks before you depart.

Tell the management that you are traveling with oxygen and request seating on a lower level. You will probably be able to take your own oxygen on board.
Cruise Ship
Call the cruise line 4 to 6 weeks before you depart.

The cruise line may need a letter from your doctor, a brief medical history, and a current oxygen prescription.

You'll need to make prior arrangements to have your oxygen units delivered directly to the cruise ship before you depart.

Car

Don't allow anyone to smoke in the car.

Open the window a crack.

Place the oxygen unit upright on the seat beside you. If possible, secure the oxygen with a seat belt. Place extra oxygen units flat on the floor behind the seat.

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Do you have COPD and have upcoming travel plans? To ensure your safety, some extra planning time will be needed. Did you notify your doctor? If you've been in the hospital recently, check with your doctor for clearance before traveling. Did you obtain the necessary paperwork to travel?

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Our comprehensive list of senior living and elder care terminology defines everything from the most basic to more complex terms. See elder care terminology.

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Senior Living & Health Glossary

We want you to be as informed as possible on the topic of senior health. That is why the Abramson Center has compiled this comprehensive list of elder care terminology, covering everything from the most basic senior health terms to the most complex. And we are always updating this senior health glossary, so please check back!

Don't see the information you were looking for here? Contact a care advisor now.

Elder Care & Senior Living Terminology

Abramson Senior Care:

A term for the spectrum of senior healthcare services provided by the Abramson Center for Jewish Life, from short-stay rehabilition to in-home care, to hospice and more. Learn more about various senior services here.

A form of medical treatment that is short-term but extremely active, such as for an urgent medical emergency. Learn more about acute care here.

ADLS (Activities of Daily Living):

Activities that people do everyday without requiring assistance, such as dressing, bathing, and eating. The ability to complete these activities is frequently used to determine what level of care a person requires. Learn more about ADLS here.

Adult Living Facilities:

See Assisted Living Facilities.

Advance Healthcare Directive:

A legal document outlining what actions should be taken regarding one's health if they are no longer able to make these decisions themselves.

Alzheimer's Disease:

A common form of dementia that causes memory and behavioral issues and worsens with age. Learn more about Alzheimer's disease here.

Assisted Living:

A form of elder care that provides independent adults with some assistance for everyday activities. Learn more about assisted living here.

Assisted Living Facility:

A facility, such as a retirement community, that provides assisted living medical services to independent adults who require some help with daily tasks. Learn more about assisted living facilities here.

Birnhak Transitional Care:

Short-term, medical rehabilitation services provided by the Abramson Center for Jewish Life. Learn more about Birnhak Transitional Care here.

Care Advisors:

Experienced senior care consultants available by phone 24/7 to provide free advice, referral information, and guidance on senior care-related issues. Learn more about care advisors here.

A person who provides regular care for an elderly person. Caregivers are frequently loved ones of the elderly or a paid service provider. Learn more about caregivers here.

Caregiver Burnout:

Mental, emotional, and physical exhaustion brought on by caring for an ailing loved one. Learn more about caregiver burnout here.

Caregiver Stress:

See Caregiver Burnout.

Caregiver Support:

Help provided to a caregiver of someone ailing. This support can come in many different forms and can help prevent caregiver burnout. Learn more about caregiver support here.

Caregiver Support Group:

A group of caregivers and medical professionals who meet regularly to share caregiving advice, information, and resources. Learn more about caregiver support groups here.

Certified Nursing Assistant:

Nursing assistants who provide care to patients under the supervision of a registered nurse or licensed practical nurse.

A fat-like waxy substance that is found in all cells in the body. Cholesterol serves a number of different functions, although too much cholesterol can combine with other substances to form plaque that can buildup in arteries and cause a health risk.

Chronic Illness:

A disease or illness that persists for 3 months or more.

Cognitive Rehabilitation:

A form of rehabilitation therapy that focuses specifically on cognitive skills. Learn more about cognitive rehabilitation here.

Severe decline of mental ability that interferes with a person's daily life. Dementia is a catch-all term for any loss of cognitive functioning. Learn more about dementia here.

A medical process that purifies the blood, replacing the normal function of the kidneys. Learn more about dialysis here.

Care for an elderly person in need of assistance with everyday activities. Learn more about elder care here.

A person who is considered old or aging. Although the exact number differs from country to country, many agree that old age begins somewhere between 65 and 70.

Geriatric Care Manager:

A healthcare professional who helps an elderly individual and his or her family members identify the individuals physical and mental needs and finds way to meet those needs. Learn more about geriatric care managers here.

Geriatric Research Studies:

Scientific studies that examine issues related to aging and the elderly. Learn more about the Abramson Center's geriatric research studies here.

Can either refer to an elderly person, or anything related to the elderly, in particular healthcare for the elderly.

Healthy Aging:

The act of maintaining health and wellbeing as you age. Learn more about healthy aging here.

High Blood Pressure:

Blood pressure, the force of your blood against the walls of blood vessels, that is consistently and dangerously high.

The act of providing healthcare and some other services to seniors in their homes, to avoid frequent trips to the doctor or hospital, and to support common household chores and other needs such as bathing. Learn more about home care here.

Home Health Aide:

A healthcare professional who provides in-home care to those with issues such as chronic illnesses or age-related problems.

Home Health Care:

See Home Care.

A healthcare service that provides comfort, care, and pain relief to the terminally ill. Learn more about hospice here.

Independent Living Apartment:

A senior residence that allows older people to maintain their independence and receive assistance as needed. Learn more about independent living apartments here.

Independent Living Community:

An apartment complex or retirement community featuring several individual independent living homes. Learn more about independent living communities here.

Jewish Values:

Values, beliefs, and guiding principles of the Jewish people.

Constitutes people who classify themselves as Lesbian, Gay, Bisexual, Transgender, Questioning, Queer and all Others.

LGBTQ+ Senior Care:

Care that addresses the needs of LGBTQ+ seniors. Learn more here.

Long Term Care:

Medical services that address any and all needs of patients, allowing them to live as independently as possible. Learn more about long term care here.

Meals on Wheels:

A national service that delivers meals to the elderly.

A federal program that provides health coverage to several different groups, including the elderly and low-income individuals.

Adult care care services where trained professionals provide care and recreation to aging seniors during the day. The specific services of the Abramson Center for Jewish Life are located in Philadelphia, PA. Learn more about medical adult day here.

Federal program that provides health insurance to American citizens 65 years of age or older.

Memory Care:

A form of long-term care that is specifically designed for patients suffering from dementia or other memory issues. Learn more about memory care here.

Memory Care Facility:

A healthcare facility that specializes in memory care. Learn more about memory care facilities here.

The independent living apartments of the Abramson Center for Jewish Life. Learn more about Mildred Shor Inn here.

Music Therapy:

The act of using music to address the emotional, cognitive, and physical needs of an individual. Learn more about music therapy here.

Nurse Practitioner:

A registered nurse capable of treating certain conditions without requiring a doctor's supervision.

Occupational Therapy:

A form of therapy that encourages rehabilitation through the performance of everyday activities.

Palliative Care:

Care for people with a serious illness that focuses on improving quality of life, often during treatment. Palliative care can even be used to treat the side effects and symptoms of ongoing treatment for the illness.

Personal Care:

Assisting with the basic physical needs of the patient, including bathing, feeding, and personal hygiene.

The philosophy that healthcare should be focused on each individual patient as a complete person in order to understand the best treatment and care possible for individual needs. Learn more about person-centered care here.

Pet Therapy:

Animal assisted therapy that uses dogs and other animals to address a number of different medical issues. Learn more about pet therapy here.

Physical Therapy:

The act of using physical techniques, such as exercise, to treat injuries or diseases.

Polisher Research Institute:

The geriatric research institute of the Abramson Center for Jewish Life, where research is conducted and published on the latest advances in treating people physically and mentally. Learn more about the PRI here.

Primary Care Doctor:

A general healthcare professional who manages the overall care of his or her patients, as opposed to a specialist in one particular field. Learn more about primary care doctors here.

Primary Care Physician:

See primary care doctor.

Quality of Life:

A person's well-being. In healthcare terms, quality of life includes physical, emotional, and spiritual well-being - ensuring the patient is as comfortable as possible.

In healthcare, rehab usually refers to treatment after surgery or a+B58n illness, most often cognitive illnesses such as a stroke or physical issues, such as recuperating following a total knee replacement. Learn more about rehab here.

Respite Care:

Short-term care for an elderly person in order to provide some relief to the caregiver(s). Respite care can also help in preventing caregiver burnout. Learn more about respite care here.

Senior Care Advisors (Senior Care Consultants):

See Care Advisors.

Senior Care Management:

The managing of an elderly person's care, including providing information and advice to caregivers, along with personalized care plans. Learn more about senior care management here.

Senior Care:

Specialized care that addresses the needs of an elderly person.

Senior Center:

A community center for seniors that provides for their various needs. Senior centers can usually be found throughout the country.

Senior Concierge Services:

See Senior Care Management.

Senior Day Care Center:

Senior centers that provide daytime medical assistance, on-site healthcare professionals, and enriching activities for older adults. Learn more about senior day care centers here.

Senior Mobility:

The ability of a senior to move with purpose around his or her environment. Learn more about senior mobility.

Senior Personal Care Services:

The act of providing assistance with activities of daily living, including cooking, cleaning, laundry, and other basic chores. Learn more about senior personal care services here.

A person of more advanced age, usually over 65 years old.

See Short-Term Rehabilitation.

Short-Term Rehabilitation:

Ongoing medical treatment that addresses issues following surgery or injury. Learn more about short-term rehabilitation here.

Skilled Nursing Care:

Healthcare treatment that can only be administered by a licensed nurse.

Skilled Nursing Facility:

A facility that provides skilled nursing care to patients.

Spectrum of Care:

A holistic approach to medicine that monitors all aspects of a patient's health over time.

An interruption of blood supply to the brain cause by a blockage of arteries.

Sub-Acute Care:

Intensive, comprehensive inpatient care for patients with an acute illness.

Transitional Care:

Rehabilitation care to help patients after discharge from the hospital. Learn more about transitional care here.

# data[].attributes.attachment_link.description
We want you to be as informed as possible on the topic of senior health. That is why the Abramson Center has compiled this comprehensive list of elder care terminology, covering everything from the most basic senior health terms to the most complex. And we are always updating this senior health glossary, so please check back!

# data[].attributes.body
A glossary of elder care terminology, including terms related to assisted living, long-term care insurance, senior care, and in-home care.

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ADLs (Activities of Daily Living) - ADLs are defined activities with which most elder care (or senior care) company caregivers provide assistance. Most companies that provide care define ADLs very broadly, describing them as any non-medical activity needed in the home. For example, a company may say they provide assistance with the ADLs cooking, cleaning, bathing, dressing, meal preparation, continence care, transportation, exercise assistance, medication reminders, light housekeeping and companionship.

Long-term care insurance companies define ADLs very specifically and include six or seven of the following activities:

Bathing

Dressing

Toileting

Transferring

Eating

Feeding (being able to lift a fork or spoon from plate to mouth)

Ambulating

It is important that when you hear of ADLs you understand who is saying it and what specifically is meant.

APS (Adult Protective Services) - APSs are county or state departments where you and your staff will report all elder abuse (physical, emotional, sexual and verbal). If you have an elder care business, it is important to identify your state or county's office, phone number and reporting procedure, to set a policy in place with your staff, and to train your caregivers on any mandatory reporting laws in your area.

Assisted Living Facility (AL) - ALs are elder care facilities that are licensed by the state to provide room/board, meals, medication management and care. Assisted living facilities are usually large, hotel-like buildings with many rooms and many common areas (dining room, game rooms, libraries, common activity areas). Many times AL facilities have a base rate per month for room/board/meals and then different levels or tiers of care. For example, Level One may be bathing three times per week and light housekeeping services one time per week. Level Two may include all of the Level One care in addition to transfer assistance to the dining room. Level Three care may include all of the Level One and Two services, in addition to assistance with continence care medication management.

Most of the time these levels of care are based on a point system that coincide with all ADLs or needed activities. Once they cross over certain thresholds, they fall into a different level with additional costs to the resident. AL facilities are usually a great fit for people who are very social by nature and need lower levels of care - staffing can sometimes be one caregiver to 12-15 residents. Usually lifestyle and activities are what draw people to AL facilities.

(SNF) "Sniff" Skilled Nursing Facility - A SNF is a facility that provides both short-term rehabilitation services and long-term custodial services. SNFs are also referred to as nursing homes or rehab centers. Medicare pays for SNF stays as long as it is preceded by a three-day hospitalization and the patient meets criteria for rehab. As soon as a senior patient stops meeting criteria for rehab (usually because they have either plateaued, met treatment goals or start to decline in function), they are no longer eligible for Medicare reimbursement and are discharged. Medicare regulations note this is up to 100 days, but that is not always the case. Most Medicare patients meet criteria to be discharged well before day 40 and, if a Medicare Part C patient is receiving care through an MCO, they usually are discharged around day 14.

Social worker - When you hear about a social worker it can mean very different things. Social workers who work at hospitals, home health and hospice companies are usually LCSWs (Licensed Clinical Social Worker) or MSWs (Master of Social Work). From these degrees, they have extensive training and experience. Social service departments are found in many SNFs, which may have "social workers" who do not hold a degree or a lot of training. In some cases, they may have worked in another area in the SNF and been promoted to the social worker position. Some large SNFs are required to have social worker with a degree depending on state regulations.

Case Manager - A Case Manager is usually a RN or LCSW who manages the patient's stay in a hospital or SNF. Many Case Managers belong to Case Management Society of America (CMSA) and can also be certified as a Certified Case Manager (CCM). It may be valuable to build a relationship with your local chapter of CMSA and even consider sponsoring meetings.

Durable Medical Equipment (DME) - DME is equipment such as wheelchairs, walkers, hospital beds, oxygen and three-in-one commodes that patients need as they are recovering at home. Medicare pays for DME that is prescribed by a doctor and falls under Medicare's covered benefits.

Three-in-One Commode - This piece of equipment is a commode/toilet that can be used as a bedside commode (1), shower chair (2) and raised toilet seat (3).

Hoyer Lift - A Hoyer lift is used to lift someone out of bed and then lowers him or her elsewhere, and vice versa. These are mainly used for those who are non-ambulatory and needs total assistance.

Private Duty - Private duty refers to private pay services. Most people who work in the elder care market refer to home care companies as private duty companies. It really refers to the fact that most home care/private duty services are paid for privately and out-of-pocket. Private duty is not limited to non-medical home care companies, as there are also some private duty skilled providers.

National Private Duty Association of America (NPDA) - The NPDA is one of the most well-known trade organizations for private duty home care (elder care) companies. It may be beneficial to join a chapter in your local marker to provide credibility.

Discharge Planners - Discharge Planners are usually either RNs or social workers (LCSWs and MSWs) responsible for discharging patients out of a hospital into either a SNF or the home environment. These discharge planners coordinate many types of goods and services including home health, DME, home care, hospice, and palliative care.

Medicare - Medicare is a Federal health insurance program run by the Federal government and primarily covers people over the age of 65 (some Medicare recipients are under 65, but are disabled). Medicare benefits are either administered through its own system called Fee For Service (FFS) Medicare or through a Medicare Advantage plan run by a Managed Care Organization (MCO). The best way to determine how a patient is covered is to ask if they have a Medicare card issued by Medicare or a card issued by their MCO who administers the benefit.

Medicare is broken into four sections:

Medicare Part A - The first program instituted. Covers hospital stays.

Medicare Part B - The second part of the program implement and covers doctor, SNF, home health and DME care.

Medicare Part C or Medicare Advantage - This section of the Medicare program comes into play when a Managed Care Organization bundles all Part A and B services into one offering, and sells it as an all inclusive Medicare offering. The government instituted Part C as a way to try to control the rising costs that were occurring in a government run program. In Part C the Federal government pays a set amount per month to a MCO through a network of contracts with hospitals and doctors who manage that pool of money. Because MCO's have been able to set up contracts with hospital groups and doctor groups, they have been able to manage the Medicare patients with cost savings.

Medicare Part D - This section of the Medicare plane encompasses prescription drug coverage and can either be stand-alone drug coverage for Medicare Fee for Service (FFS) or combined with a Medicare Part C plan.

Medicare's FFS is when Medicare beneficiaries choose to run their Medicare benefit directly through Medicare for Part A and B, and do not sign up for a MCO under Part C.

Managed Care Organization (MCO) - An MCO is an organization that sets up networks of contracts with doctors, hospitals, SNFs and home health agencies, and bundles those contracts together to provide a discounted bundled offering of health care services.

Medicaid - Medicaid is a Federal program run by each state and provides care for low income and certain disabled people. States usually set criteria for coverage and determine eligibility. Some states have Medicaid waiver programs that will reimburse for caregiver services and most also pay for long term patients to stay in SNF settings once they have no income to pay for other forms of care. It is important to find out if your state has a Medicaid waiver program that pays for elder care services or adult family home placement.

Independent Physicians Association (IPA) - An IPA is a group of doctors who have banded together to contract with hospitals or MCOs. In some cases, IPAs are now combining with hospitals, SNFs, and home health agencies to bolster their negotiating power with MCOs. In some mature markets, IPAs are even looking to contract and become direct providers with Medicare as ACOs (Accountable Care Organizations).

Dual Eligibles or Medi-Medis - These are patients that qualify for both Medicare and Medicaid programs. Many Dual Eligibles are paid for by the state Medicaid program in a Long-term Care setting and, in some states, can be reimbursed for caregiver services.

Hospitalists - Hospitalists are doctors who work exclusively in hospitals and manage patient care as they transition though the hospital. These are usually contracted groups of doctors who specialize in critical care hospital-based care situations.

Residential Care Facility for Elderly (RCFE) - RCFEs are licensed elder care facilities. In the state of California, this is a broad term used to cover any licensed elder care facility. Assisted living, board and care, memory care and, in some cases, independent living facilities fall under the RCFE classification.

Board and Care (B&C) and Adult Family Homes (AFH) - These are homes in residential neighborhoods that are retrofitted for elder care. Many times these homes have capacity and licensing through your state to care for up to six seniors. Most provide one caregiver per three residents (two for six). These homes usually have an all inclusive fee structure and include room, board, meals and care in the monthly cost.

G-Tube - A G-tube is a feeding tube placed in the patient's stomach to feed the patient liquid food. Often G-tubes are put in place when the elder care patient is having difficulty swallowing.

Foley Catheter - A Foley catheteris a tube placed in bladder and hooked to bag that voids urine.

Sundowning - This is a symptom of Alzheimer's patients - behavior can dramatically change during a certain period of the day (usually the later afternoon). Symptoms of the Alzheimer's are usually more severe during this time of day and can range from mild to combative.

Veterans Aid and Attendance Benefit - This benefit is a pension program for veterans who served during a time of war and need assistance paying for assisted living or home care services. This program is one of the key resource guides distributed to referral sources and will be covered thoroughly in training.

Hospital - Acute hospital care is defined as necessary treatment of a disease or injury requiring continuous management in a hospital setting. Medicare reimburses for an acute care hospitalization for both diagnosis and treatment.

Skilled Nursing Facility (SNF), Nursing Home or Rehabilitation center - Most skilled nursing facilities provide two types of services:

Short-Term Rehab - Short-term rehab focuses on physical therapy, speech therapy, occupational therapy and nursing/skilled needs. After a consecutive three-day hospital stay, Medicare reimburses these services.

Long-Term Custodial - Long-term custodial care focuses on the long-term care of seniors and includes bathing, dressing, feeding and other activities of daily living.

These services are not paid by Medicare, but can be paid by Medicaid if patient qualifies or can be paid for privately.

Home Health Agency - Physical Therapy (PT), speech therapy (ST), occupational therapy (OT), Social Worker (SW) or skilled nursing care are provided by home health agencies in the client's home. To qualify, this requires a physicians order and medical reason, but does not require a three-day hospital stay.

Medicare pays for these services as long as the homebound patient has a medicalneed to be seen in the home.

Note: Home Health visits are anywhere from half an hour to one and a half hours, and are for a finite amount of time depending on diagnosis (i.e. two to three visits per week for three to five weeks). Home health visits are focused on medical need and do not cover a caregiver for heavy custodial care needs.

Hospice - Hospicefocuses on managing the medical needs and comfort of those who have been diagnosed with life-threatening diagnosis such as cancer, dementia, COPD, CHF, end-stage heart or lung disease or even failure to thrive marked by progressive decline in nutritional intake, functions, weight loss or sudden disorientation.

Medicare pays for all hospice services rendered and can include the following resources to assist families:

To qualify, a physician must make clinical determination that life expectancy is less than six months.

Note: Hospice visits are usually intermittent and not intended to be used as main source of custodial or non-medical elder care. Families or hired caregivers are used to provide extended custodial care such as bathing, dressing, cooking, cleaning or companion services.

Palliative Care - This type of elder care focuses on the medical care for those diagnosed with life-threatening diseases, similar to hospice. The main difference of palliative care from hospice is that there is no definite life expectancy needed to enter into palliative care programs. Hospice requires less than six months life expectancy.

Most palliative care programs are reimbursed under the Hospice Medicare Reimbursement with little to no out-of-pocket costs to families who receive these medical services.

Non-Medical Home Care, Caregiver or Custodial Care Services - Caregiving services are focused on providing non-medical custodial services including cooking, cleaning, bathing, dressing, continence care, light housekeeping and companionship. This type of care is paid for out-of-pocket through long-term care insurance policies or through the Veterans Aid and Attendance Benefit.

Independent Living Facility (IL) - ILs are apartment complexes that allow seniors to live independently with structured activities they can choose to participate in with others their age. Usually there is no care provided. In some ILs meals are offered to residents and in others they are not. ILs are paid for out-of-pocket and are usually the least expensive of any private pay option, but have limited care options for those who need assistance.

Placement Services - This website provides complementary assistance to those looking for the best environment for their loved ones. Placement services refer people to different AL, IL, B&C homes or home care companies depending on their budget and care needs. It's important to work with a placement company that actually drives you around and shows you the different places they recommend so you can make an educated decision.

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Resources ADLs (Activities of Daily Living) - ADLs are defined activities with which most elder care (or senior care) company caregivers provide assistance. Most companies that provide care define ADLs very broadly, describing them as any non-medical activity needed in the home.

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Senior Care Terms Defined-Living Branches 

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Senior Care Terms Defined-Living Branches 

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Read about Senior Care Terms Defined On Living Branches.

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Choosing the right care for your loved one is difficult and overwhelming. When it comes to senior care, there are so many terms that are so similar, yet mean the difference between necessary, and inadequate care for your loved one. The language surrounding senior care has been changing, so here is a list of compiled senior care terms to help you make the right decision for your loved one.

Assisted Living

Those who want help with daily tasks like meal preparation, medication management, and activities of daily living such as dressing, bathing, etc., but do not require the medical care that comes with living in a nursing home have needs that fit with Assisted Living. Assisted Living communities must meet certain requirements that allow seniors to age in place.They must offer residents refrigerators, microwaves, and personal living units with locking doors. Personal bathrooms must have toilets, sinks, wall mirrors, shower/tub, and an emergency notification system. A maximum of two people can share a living unit. With regards to care, an Assisted Living community must have a licensed nurse on duty and a registered dietician on staff at all times. They may also offer Memory Care and physical therapy. More specific requirements for care and staffing can be found on the Department of Human Services website. It is important to note that Pennsylvania licenses both Assisted Living and Personal Care communities to provide for persons needing this level of assistance

Life Plan Community or Continuing Care Retirement Community (CCRC)

A Life Plan Community, also referred to as a Continuing Care Retirement Community or CCRC, provides seniors the freedom of independent living combined with the comfort of having medical care and staff on site. Life Plan Communities are designed to grow with seniors as their needs change. These communities help residents to transition from independent living to personal care, assisted living, memory care, skilled nursing, or other senior care options. An important distinction between Life Plan Communities and Independent Living Communities is that Life Plan Communities typically require an entrance fee as a part of the commitment from the community to provide lifelong care.

Nursing Home or Health Care

Nursing homes provide a higher level of medical care than can be acquired from an Assisted Living or Personal Care community. Nursing homes provide round-the-clock nursing care, prepared meals, rehab services such as physical, occupational, and speech therapy, and complete assistance with activities of daily living. They are federally regulated and can accept Medicare and Medicaid. At Living Branches we refer to this part of the community as Health Care.

Independent Senior Living or Independent Living

Independent Senior Living is for those who want to live on their own in an apartment, house, villa, condo, etc, but take advantage of senior community perks, including no-maintenance living. In addition by moving to Independent Living, residents can join a community of like-minded individuals of similar ages and with similar interests. They can take classes and participate in as many fun community activities as they choose. Seniors in independent living communities only pay for the services and amenities they are enjoying at that time, and not the care or medical services at an Assisted Living or Personal Care community.

Residential Living

Residential Living is another term for Independent Living. At Living Branches residents have the choice of apartments, villas, or cottages with various floor plans and prices. Seniors live independently but gain a close community and have the convenience of Residential Living amenities such as dining options and a fitness center at their fingertips.

Residential Care

Residential Care facilities are small, private facilities with fewer than 20 residents. Residents live in either shared or private rooms and receive care and meal preparation although medical staff are not on site. Residents of Residential Care facilities may be elders, but they may also be children, have disabilities, mental illness, learning disabilities, Alzheimer's, or any other condition that requires assistance and care.

Supportive Living

Supportive Living is a description for any community providing care for residents. The goal of Supportive Living is to improve the quality of life of residents, whether they reside in Personal Care, Memory Care, Assisted Living, or Skilled Nursing.

Personal Care

Personal Care was distinguished from Assisted Living in Pennsylvania in 2011. Personal Care communities are similar to Assisted Living communities, although they are licensed through a different office of the PA Department of Human Services. Personal Care communities encourage residents to be as independent as possible by providing support to residents. At a minimum Personal Care provides meals, housekeeping and laundry services, as well as whatever assistance with activities of daily living each resident may need. For some this may mean bathing or dressing assistance, administering medications, or simply reminding residents of opportunities for socialization through activity programming.

Memory Care (Memory Support)

Memory Care is a special level of support provided for those with dementia or Alzheimer's. Memory Care involves expert care to ensure a structured, routine based, and safe environment. Specially-trained staff may work with individuals to help slow memory loss through specific activities, community engagement, and fitness and diet programs. Memory Care communities provide round-the-clock supervised care with carefully constructed layouts designed to promote resident safety and security.

Rehabilitation or Skilled Nursing

A rehabilitation community is designed for seniors to achieve rehabilitation goals, typically after a medical or health incident. Some rehab communities are free-standing buildings; many are within a skilled nursing community. Wherever the location, residents do not stay long term at a rehab community. Rehabs provide nursing and medical staff, such as physical or occupational therapists, who work with patients so they may return to their home or the larger skilled nursing community.

Long Term Care

Long term care is a generic term for any care that does not focus on acute illness or diagnosis but instead manages daily struggles with everyday tasks and medical symptoms. Long term care can be delivered in nursing homes, skilled nursing, Assisted Living, or Personal Care communities.

Home Health Care

Home Health Care encapsulates a wide range of medical services provided by nurses or therapists for injuries or chronic illness. A health care provider comes to the home to provide medical services on a regular basis.

Home Care

As opposed to home health care, home care provides non-medical help with activities of daily living. Tasks that home care helps with include meal preparation, dressing or bathing, reminders to take medication, transportation, and companionship.

Senior Care at Living Branches

Learn more about the variety of senior care options offered at Living Branches, including Personal Care, Memory Care, Health Care, and more! Living Branches will work with you and your loved ones to make sure the right type of care and services are provided. Contact Living Branches today to speak with an expert about your senior care needs.

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Senior Care Terms Defined - Living Branches

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Choosing the right care for your loved one is difficult and overwhelming. When it comes to senior care, there are so many terms that are so similar, yet mean the difference between necessary, and inadequate care for your loved one.

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5 Paths to Finding Your Purpose & Meaning in Retirement

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5 Paths to Finding Your Purpose & Meaning in Retirement

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Are you struggling with finding your purpose in retirement? Here are 5 paths to finding purpose in life after retirement.

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We work hard all our lives to achieve a certain level of success, only to find ourselves unfulfilled and wondering what it's all for.

That's if you're like most older adults, anyway - who fall into the common trap that life happens in three clean stages.

The reality is that modern retirement is all about living a life of solely leisure. There's so much more potential that's being untapped for specifically older adults.

If you're nearing retirement age or are already retired, finding your purpose is more important than ever. A purposeful life after retirement can be rewarding and enriching .

Of course, finding meaning during retirement can be a challenge.

Especially if you're like most people who derive their sense of purpose from their jobs . After years of hard work and accomplishments, you may feel lost without your career identity. In fact, many do - 31% of retirees report struggling with a lack of purpose .

We get it - it's difficult to let go of your past identity, even if it no longer serves you.

Which is why in this blog post, we'll discuss why finding your purpose is so important in retirement, plus some tips on how you can find meaning in your golden years.

Let's first quickly cover most people find purpose.

When Do You Find Your Purpose in Life?

If you're still searching for your purpose as an older adult, we have some good news.

But this research doesn't mean these trends are the hard rule. It's simply a reflection of what's been happening in our culture's past and present. And as you know, we're super fans of shifting our culture to honor and highlight older adults and their unique gifts.

The most promising news is that the right tools, structure, and support are available to help you not only find your post-career purpose, but also it.

Age-related decline can be counteracted through plenty of areas in your life, like , proactive exercise and social interactions healthy nutrition, giving back, creativity, and yes - your purpose during retirement.

Just think of it this way - in retirement, you have the time and space to explore your passions and discover your purpose. And with the right structure in place, you can start living with more purpose.

And you should, here's why.

Why You Need a Purpose in Retirement

A growing body of research is proving that purpose is a significant asset in life.

24% lower likelihood of becoming physically inactive

33% lower chance of developing sleep problems

22% lower likelihood of developing unhealthy body mass index

But the benefits don't stop there. Leading a purposeful life leads to:

Hopefully, those are enough benefits to convince you that your post-career purpose is definitely worth finding.

And if so, now that we've covered the , let's go over the of finding your purpose in retirement.

5 Paths to Finding Your Purpose in Retirement

#1 Connect with Your Authentic Self

Spend time getting to know yourself, your values, and what's important to you.

And don't get me wrong, as an older adult with over a handful of decades under your belt, you probably already know yourself quite well.

What's key for pre-retirees and retirees, though, is opening up to the reinvented you - someone who is willing to connect with themselves on a deeper, more authentic level in this new life phase

We, humans, are designed to grow, change, and develop at life stage - retirement is no different. And in fact, it's more critical during retirement because of the stats we mentioned above and because you no longer have the pressure of a career and family life structure.

So in this current life phase, consider these self-reflection questions as a way to get to know your best self during retirement:

What are the things that make you who you are?

What are the things that are most important to you?

How would these change if you weren't a mother, father, employee, neighbor?

What do you want your life to stand for?

These are just some of the questions you have to ask yourself. We also recommend downloading this workbook on finding clarity and once you have a list of values, you can start thinking about how they can guide your decisions toward your retirement life.

There are nuances to your core values - as in, the activities, people, and places that you're naturally drawn to will be different for two people who share a similar core value. This means it will take some deeper soul searching and introspection to find clarity. But once you do the inner work, it will be easier to connect with your authentic self and show up in a way that's true to yourself.

As actor Ben Stein once put it:

"The first step to getting the things you want out of life is this: Decide what you want."

#2 Recognize & Share Your Unique Gifts

Everyone has talents and strengths that make them special and unique. When it comes to your purpose in retirement, it's less about finding some monumental new thing to do with your life and more about recognizing and sharing with others the unique gifts you've been blessed with.

And this goes well beyond the skills and experience that you've acquired throughout your career and family life.

Sharing his unique gifts with others showed up in a variety of new ways. Chris has:

Published books on new topics that aligned with his new life phase and wisdom, like his most recent work Finding Meaning & Success

Learned how to play the piano to teach his grandchildren new skills at his home-hosted "grandparent camp"

Took dance lessons as a way to prioritize and deepen his marriage

To find your purpose in retirement, we urge you to be open-minded and go through a process of self-discovery that often reveals new ways of sharing and expressing your unique gifts with the world.

You can also shift and broaden your perspective by asking family and friends for input about your natural strengths and passions, beyond your career and job roles. They may see things in you that you don't see yourself. And their answers could also inspire your next step.

No matter how you go about it, don't be afraid to embrace your uniqueness and share it with the world. It could be the key to finding renewed purpose in life after retirement.

#3 Explore & Deepen Your Relationships

Examining your past, current, and potential relationships could be the missing puzzle piece of finding your purpose in retirement.

Some questions to ponder as you reflect on your connections, past and present:

Which people in your life energize or drain you, and why?

Are they supportive and encouraging, or do they constantly judge and bring you down?

Do you enjoy spending time with them, or do you feel obligated and then exhausted after being around them?

Who's lifestyle do you admire or want to emulate and why?

It's important to surround yourself with people who lift you up and make you a better version of yourself. These are the people in your "Circle of Influence" who encourage your growth, hold you accountable for positive changes, and support you through tough challenges.

When you find your "tribe", a place where you can really be yourself and where you feel at home, you've found your "Circle of Influence" community. And they'll naturally lead you to honing skills and developing interests inside a purposeful life.

There's a caveat here, too: Give others the chance to change and grow, too.

If someone from your "Circle of Concern" is draining your energy and it often feels like they're holding you back, sometimes simply ditching that relationship isn't an easy option.

For instance, it's very common for marriages to go through a big transitional period as each partner enters retirement. Differences appear larger, new conflicts arise, and it may seem like just plain of work.

Of course, the best relationships in life take the most work, so it's worth putting in the effort to rekindle relationships and bonds of people who were once in your Circle of Influence.

#4 Dig Into Your Passions

Passions are a fundamental part of your purpose . But they're not synonyms that can be used interchangeably.

Our favorite distinction is: passions are for you and purpose is for others.

And of course, the two go hand-in-hand; the more fulfillment you get from what you do, the more likely you are to feel like your life has meaning and purpose.

Plus, following your passions in life doesn't just make you happier and more fulfilled - it can also help you find your purpose. When you're passionate about something, it's easier to see how that passion can be woven into your life's purpose.

When you know what makes your heart sing know that it's a reflection of your authentic self, everything else seems to fall into place. So start by exploring what naturally gives you the most energy and excitement, what makes you happiest. Chances are, those passions will point the way.

#5 Help Yourself By Helping Others

When we think about our lives, most of us want to feel like we've made a difference - that we've done something with our time on earth that mattered. And oftentimes, helping others is what gives our life meaning.

Researchers have found that we're born with an innate desire to be helpful . Even hungry infants are willing to altruistically share their food with other babies.

We're simply wired for connection. When you help someone else, it makes you feel like you're part of something larger than yourself - something that matters to all of humanity.

Not to mention the other amazing benefits of volunteering and doing charity work . Why not volunteer your time and talents to causes you're passionate about? Retirement is the perfect time to give back (and maybe even get in return).

It's also a great time to focus on the legacy you want to leave behind. How do you want to be remembered and what impact do you want to make on this earth? There's no limit, big or small, to the difference you can make by helping others.

Find Meaning in the Little Things in Life After 60

Our final tip is to focus on the little things that make the biggest differences. These little things will show up as moments throughout your day that energize and excite you the most. Their tiny clues lead you to the right decisions.

Except if you shift your perspective and let yourself be thrilled by the minute details that energize you in the present moment, the cumulative effect of this habit will absolutely make life beautiful.

We urge you to seize every moment and simply enjoy the journey. It's the little moments that make life worth living.

You already have all the answers within you, they're just yearning to get out.

Here's to allowing your purpose and passions to flow out, and making your retirement years your best years.

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5 Paths to Finding Your Purpose & Meaning in Retirement Life

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We work hard all our lives to achieve a certain level of success, only to find ourselves unfulfilled and wondering what it's all for. That's if you're like most older adults, anyway - who fall into the common trap that life happens in three clean stages.

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The Key to Finding Purpose in One’s Senior Years

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The Key to Finding Purpose in One’s Senior Years

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These are just some of the ways seniors can begin prioritizing gratitude on a daily basis. There’s a multitude of avenues for adopting this practice.

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"For the meaning of life differs from man to man, from day to day and from hour to hour. What matters, therefore, is not the meaning of life in general but rather the specific meaning of a person's life at a given moment."
This powerful quote comes from the well-known book, Man's Search for Meaning, by the revered Holocaust survivor Viktor Frankl. It touches on the human nature of finding purpose and meaning in one's life-a challenge that can become more elusive as we age. In one of our recent articles, we discussed The Undeniable Link Between Having Purpose & Aging Well, which explored some of the fundamental reasons why it's important for seniors to stay connected to their sense of purpose.

Despite the immense research supporting the vital role a sense of purpose plays in the physical health, mental cognition and emotional well-being of older adults, many seniors still struggle to maintain this connection. It could be argued that for some, an essential element of the equation is missing. Here, we're highlighting the significance of practicing gratitude in one's search for purpose during their senior years, including valuable insights on how to make gratitude a part of everyday life.

How Gratitude Supports a Strong Sense of Purpose

An interesting byproduct of consistently practicing gratitude is the ability to pinpoint that which is most important to a person, at any given moment or period in their life. When you realize what it is you are inherently grateful for, you have a deeper understanding of the people, experiences and other gifts that truly matter to you. And in knowing what matters most, a person has the insight to foster purpose around those specific elements.

To put this in perspective, let's use the example of family. Perhaps in your practice of gratitude, you realize that one of the things you are most grateful for is the strong bond you share with children, grandchildren and other members of your family. Having the support and love of family is something for which you are immensely thankful. This sheds light on the fact that family means a great deal to you, which is a vital key to unlocking your inner sense of purpose.

Maybe your purpose revolves around leaving a legacy for your family or cultivating a strong sense of family for generations to come. It might be related to a passion for helping other people who aren't blessed with a similar family support system, or a desire to counsel families who are struggling with relationship challenges. Whatever the specific purpose might be, it is the employment of gratitude that can open up those insights and strengthen one's connection to their purpose.

This is a hopeful reality for seniors, who may feel that the changes in their life have distorted their true sense of purpose. When you realize that gratitude can pave the way to purpose regardless of your age or experience in life, the possibilities for regaining that connection are virtually limitless.

Fringe Benefits of Gratitude for Seniors

In addition to laying the groundwork for inner purpose, gratitude can have some pretty amazing benefits for seniors who recognize the importance of this practice. Here are just a few to consider:

It's amazing how many different ways a person's overall well-being can be impacted by making gratitude a staple in their daily routine. For those seniors who want to become more involved in gratitude practices but don't know where to start, we've got some simple ideas to help support your effort.

3 Easy Ways to Make Gratitude a Routine Practice

Keep a journal. Gratitude journals have become increasingly popular in today's culture, as they are a tangible way to remind oneself about what you already have and appreciate in your life. There are guided gratitude journals that prompt specific responses and practices, or you can create your own simple process for journaling with just a pen and paper. The important thing is to make it a daily routine, carving out time for this practice in everyday life.

Engage in meditation. Whether you opt for a formal meditation class or make time and space for your own unique process of meditation at home, there's real power in the practice of consciously reflecting on that which you're grateful for. Meditation can help create not just the idea of gratitude, but the actual experience of it. It can help clear your mind so you're open to new ideas about gratitude in your life, and receptive to your own intuition.

Actively express your gratitude. Let others know when you are grateful for them or their words and actions. Expressions of thanks go a long way in terms of internalizing the gratitude you feel. It could be simply thanking the barista who made your morning coffee or sending a note of appreciation to the neighbor who gave you a lift to a doctor's appointment. These seemingly small expressions of gratitude are actually quite significant in the larger scheme. They help make gratitude an ongoing priority and practice in one's life.

These are just some of the ways seniors can begin prioritizing gratitude on a daily basis. There's a multitude of avenues for adopting this practice, from leveraging prayer to becoming more active in volunteer opportunities and community causes. Be sure to opt for whatever gratitude outlet feels right for you so it becomes a natural part of your day and an empowering element in connecting with your sense of purpose.

For additional tips on senior health and lifestyle issues, check out our blog. To find out how United Methodist Homes provides a wealth of offerings and opportunities to support the health and wellbeing of our residents, contact us today or schedule a complimentary visit now.

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The Key to Finding Purpose in One's Senior Years

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"For the meaning of life differs from man to man, from day to day and from hour to hour. What matters, therefore, is not the meaning of life in general but rather the specific meaning of a person's life at a given moment."

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Finding Purpose in Your Life During Your Senior Years-Full Spectrum, LLC

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Finding Purpose in Your Life During Your Senior Years-Full Spectrum, LLC

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Does one's purpose need to be redefined throughout the course of life or is it defined during the early years? Various theories answer this question with contradictory opinions.
active senior, keeping active, finding purpose, life's purposeactive senior, keeping active, finding purpose, life's purpose

The renowned psychologist Erick Erikson postulated that one's purpose was defined based on various phases in one's life. Whereas newer theorists like Gene Cohen Ph.D. believes that one's purpose can be redefined especially during the senior years. The French language uses the term, "Raison d'etre" which is translated to mean, "Reason for being". Despite various interpretations or your personal theory, individuals need a reason to essentially "get up each morning. " As children and young adults, our purpose may be more clearly defined due to societal requirements including attendance at school, participation in sports, religious education and part-time jobs. Later in life, due to marital commitments, obligations to family members and significant others and/or career responsibilities, we may not have time to define our purpose based on personal interests. One's purpose may change due to the development of new technologies, delayed retirements, longer lives, second careers, and adult children returning home. At this same time, economic restrictions, personal health issues and the need to care for others, may result in redefining our purpose but should not restrict the fulfillment of life long goals.

The need to explore, find and enhance your purpose in life is an ongoing part of living. There is no specific formula to find purpose in one's life, but there are steps you can take;

Don't retire early - People often look forward to not working and count the days to retirement. Retirement can be a wonderful time but this phase of life should involve a great deal of thought process. Pre-planning for retirement is a helpful step that can involve assessing your financial situation, possibly with an outside advisor. It is also helpful to consider what activities or interests will occupy your time. Often individuals will consult a retirement coach, complete a personal interest inventory, journal or write a preliminary calendar of plans.

Volunteer - Giving back to others can reduce depression, anxiety and at the same time contribute to an individual's purpose in life. Networking is a way to meet new people as you develop new skills and share many of your passions. Helping others can contribute to building your confidence and self-esteem while you are providing needed services to your community. According to a study conducted by the Corporation for National and Community Services," The Health Benefits of Volunteering," showed that states with higher volunteer rates have overall better health and lower rates of heart disease."

Explore new interests - Retirement and the senior years is a wonderful time to explore interests that you previously did not have time to pursue. Many people feel that finances are a major restriction. There are many free or inexpensive discussions and groups at libraries, senior/adult centers, churches, synagogues, YMCAs and fitness centers.

Ask for advice from others/find a mentor - It is helpful to spend time with someone who has successfully retired and has found a purpose in their life during their senior years which is not solely defined as working. You can attend some of their activities, meet some of their friends and learn about their roadblocks/mistakes.

Socialize - There is nothing wrong with spending time alone but don't become a solitary individual during your senior years. Your purpose may be to relax, watch television, use the computer, and/or converse with friends on the phone. It is healthy to spend time outside of your home in the company of others.

Assess your strengths and interests - In finding in your purpose; it is always helpful to record your strengths and interests. You may rediscover interests from your childhood or hobbies that you have delayed due to other requirements.

Follow your passions - It is essential to follow your passions in life when discovering or rediscovering your purpose. Don't put yourself in a predicament that you need to have only one passion in your life or define your passion based on economic goals or the goals of others. According to poet Edward Hirsch, "finding that irresistible thing in your life that you can't live without can be a struggle, but once you discover it, don't let go." Take actions in finding your passions and have fun along the way.

Challenge your roadblocks - Throughout our lives, we often have naysayers that challenge our passions or our purpose in life. Sometimes we can be our own worse critics. We often develop roadblocks or negative thoughts when we are working on pursuing our passion in life. This pattern often occurs throughout our lives. Individuals often find reasons for not pursuing their passions including economics, family obligations and self-doubt.

The senior years are a wonderful time to pursue your passions and purpose in your life.

This is your beginning of a positive self-exploratory process. You may know the path or purpose that you want to pursue or you may begin a new direction. Enjoy the journey as your find and fulfill your purpose.

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Finding Purpose in Your Life During Your Senior Years - Full Spectrum LLC

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Does one's purpose need to be redefined throughout the course of life or is it defined during the early years? Various theories answer this question with contradictory opinions. active senior, keeping active, finding purpose, life's purposeactive senior, keeping active, finding purpose, life's purpose The renowned psychologist Erick Erikson postulated that one's purpose was defined based on various phases in one's life.

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Find about how Aligned Medical Group, P.C. can help you to Treat Your Chronic or Recurring Knee Pain.

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Are you Looking for Non-invasive Ways to Treat Chronic or Recurring Knee Pain?

Knee pain is one of the most common problems that people deal with, especially as they get older. Everything from normal aging to years of running can take its toll, leaving you with aching, throbbing knees throughout the day. Just putting up with knee pain isn't the answer. Our Paoli, PA, practitioners can provide you with a holistic medicine approach that will not only identify the underlying cause of your knee pain but also provide you with a treatment plan to help you finally combat your pain and take control of your life again.

What Causes Knee Pain?

It's important to be able to determine the cause of your knee pain. Some of the most common causes we see include,

Arthritis

Ligament tears and injuries (e.g. ACL, PCL, or MCL)

Meniscus tear

Tendonitis

Bursitis

Dislocated kneecap

How is Knee Pain Treated?

If you've avoided certain activities to see if the pain gets better, and you've tried over-the-counter medications and other remedies that still aren't offering ample relief of your knee pain, then it's time to turn to our Paoli, PA, medical team. We offer a holistic approach to care, which means that we often combine traditional treatments with alternative therapies for a more comprehensive treatment and care plan.

We may need to run imaging tests to detect tears, inflammation, joint damage, and other issues. Once we have a diagnosis then we can create your custom treatment plan. Some of how we may treat your knee pain include,

Sarapin injections

Hyaluronic acid injections

Custom orthotics or knee bracing

Chiropractic care

Physical therapy

HTC/P regenerative medicine injections

Our goal is to provide not only relief but also the proper treatments to help you heal. We also want to provide you with the care you need to avoid needing surgery. If you're having trouble getting knee pain under control and you wish to avoid surgery, our team can work with you to find alternative therapies and treatment options to help manage your pain successfully.

If knee pain is impacting your daily routine, the medical team at Aligned Medical Group in Paoli, PA, can help you find solutions. Call us today at (484) 483-6077 to schedule an evaluation with us and to discuss what treatments are available to you.

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Knee pain is one of the most common problems that people deal with, especially as they get older. Everything from normal aging to years of running can take its toll, leaving you with aching, throbbing knees throughout the day. Just putting up with knee pain isn't the answer.

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There are many causes of knee pain, from sprains to arthritis to mechanical problems. Here's how to sort out which condition may be causing your symptoms.

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Your knee is a complex piece of equipment, and as a result, many common conditions and injuries can cause knee pain.

"There are a number of different ligaments around and inside the knee, as well as tendons and bursae - little fluid-filled sacs that can get inflamed," says Joel Press, MD, physiatrist-in-chief at the Hospital for Special Surgery and professor of rehabilitation medicine at Weill Cornell Medical College, both in New York City. "There are lots of different structures there, and a lot of these types of pains will overlap."

In general, if you have fever, warmth of the knee, lack of full range of motion in the knee, or acute weight-bearing pain in the knee, you should see a doctor, says Robert Gotlin, DO, team physician for the Harlem Wizards who also practices physical medicine and rehabilitation in New York City. "It's important to see a doctor to obtain a precise diagnosis, prevent further knee damage, address the root cause of the pain, and intervene with an appropriate remedy," he explains.

Common Causes of Knee Pain

Here are some of the more common causes of knee pain, and their typical symptoms:

Bursitis

If you notice that your knee pain is accompanied by sudden swelling, redness, or a warm feeling on the affected area, you should seek a doctor's care. The bursa - a fluid-filled sac in the knee that helps lubricate the joint - might be infected. Certain factors, like previous joint injuries or a wound on the knee, can increase your risk for this kind of infection. Infections can also cause fever, chills, and nausea, so be on the lookout for those symptoms, too. If you think you have bursitis, it's best to limit your activity until the knee is evaluated by a physician, says Dr. Gotlin. Most bursitis in the knee does not need surgery and can be treated with remedies such as ice and anti-inflammatories (like ibuprofen).

Sciatica

This condition, which generally refers to pain that travels from the lower back into the lower leg or legs, can be caused by pressure of a disc onto a nerve in the lower back. "If the pain is not localized to the knee only, and involves the lower leg in general, this type of knee pain may be related to sciatica, and not to the knee itself," explains Gotlin. However, sciatic pain is not usually isolated to just the knee. "If you suffer with leg pain that starts in the lower back and refers to the knee, looking at the low back as a cause of knee pain would be prudent," adds Gotlin.

Sprains and Torn Cartilage

Ligament sprains of the knee are usually caused by a blow to the knee or a sudden twist of the knee, according to Johns Hopkins Medicine. Common symptoms include feeling a pop, pain, swelling, instability (knee buckles when walking), or difficulty walking, says Gotlin.

Torn cartilage, which can occur with injuries of the knee or with arthritis, is another common cause of knee pain, adds Gotlin. Trauma (or generalized wear and tear) to the knee can tear the menisci, which are cushioning pads of connective tissue that also absorb shock located within the knee joint. Knee buckling, swelling, and pain during specific motions may indicate torn cartilage.

Arthritis

According to Mayo Clinic, the following types of arthritis are most likely to cause knee pain:

Osteoarthritis occurs when the cartilage in your knee deteriorates with use and age. Weight-bearing pain, activity-related swelling, and decreased range of motion may indicate osteoarthritis, says Gotlin.

Rheumatoid arthritis (RA) is an autoimmune condition that can affect the knee joint. Pain, deformities of the knee joint, and swelling may indicate RA, notes Gotlin.

Gout, which occurs when uric acid crystals build up in the joint, has specific symptoms, including a very painful, red, warm-to-the-touch knee joint, per Gotlin.

Pseudogout, which is caused by calcium-containing crystals in the joint fluid, is similar to gout, but tends to be less symptomatic, explains Gotlin.

Septic arthritis, which occurs when your knee joint becomes infected, can lead to swelling, pain, and redness, along with fever and a general feeling of malaise. It's usually not caused by trauma to the knee. Call your doctor immediately if you're having symptoms of septic arthritis, as it can quickly cause significant damage to the knee cartilage.

Tendonitis

Tendonitis, or inflammation of the tendons, is another common cause of knee pain, according to Johns Hopkins. Tendonitis of the patellar (knee) tendon, known as jumper's knee, frequently occurs in sports like basketball, where the force of hitting the ground after a jump can strain the tendon. Symptoms of tendonitis typically include range of motion pain, local tenderness, and pain-related weakness of the knee, says Gotlin.

Other Causes and Symptoms of Knee Pain

Other injuries, syndromes, and mechanical problems may also cause knee pain. These include:

ACL Injury An ACL injury occurs when you tear your anterior cruciate ligament (ACL), which is one of the four ligaments that connect your shinbone to your thighbone. It's a common injury among people who play sports like basketball and soccer, which require sudden changes in direction. Call your doctor immediately if you experience symptoms of an ACL injury, such as a loud pop or "popping" sensation in the knee, advises Mayo Clinic.

Fractures A knee fracture can occur if the knee bones, including the kneecap (patella), break during incidents like falls or auto accidents. It can also be caused by something as slight as stepping the wrong way if your bones are weaker due to osteoporosis, per Mayo Clinic. Call your doctor right away if you experience symptoms of a knee fracture, which include sudden pain around the kneecap or in the knee itself, possibly with swelling; inability to bend or straighten the knee or to hold the leg out straight; deformed appearance of the knee; or bone protruding from the skin of the knee, per Johns Hopkins.

Patellofemoral Pain Syndrome Patellofemoral pain syndrome, which is sometimes called runner's knee, refers to pain between the kneecap and the thighbone, per Mayo Clinic. This condition is common in athletes and young adults, and can develop in older adults due to arthritis.

Mechanical Problems Several mechanical problems with the knee can also cause pain, including:

Iliotibial Band Syndrome (ITBS) ITBS occurs when the iliotibial band - the tough band of tissue extending from the outside of your hip to the outside of your knee - becomes so tight that it starts to rub against the outside of your thighbone. The condition commonly affects runners and cyclists. Talk to your doctor if you have symptoms of ITBS, which include hip pain, a clicking sensation on the outside of your knee, knee pain, warmth, or redness, per the Cleveland Clinic.

Dislocated Kneecap A dislocated kneecap, also called a patellar dislocation, happens when the triangular bone that covers the front of your knee slips out of place, explains Mayo Clinic. Call your doctor if you experience symptoms of a dislocated kneecap, such as an audible pop, buckling of the knee, intense pain, sudden swelling, bruising or locking of the knee, inability to walk, or your kneecap is visually out of place, per the Cleveland Clinic.

Loose Body A "loose body" can occur when injury or degeneration of bone or cartilage causes a piece of bone or cartilage to break off and float in the joint space, which can affect knee joint movement, notes Mayo Clinic. This condition can cause a sensation of locking in the joint, or make it difficult to move or fully extend the joint, explains Northwell Health. Call your doctor if you have symptoms of a loose body.

Hip or Foot Pain Hip or foot pain may alter the way you walk, which can cause stress to your knee joint and lead to knee pain, per Mayo Clinic.

Remember, if your knee pain is severe or isn't going away after a few days or weeks, it's important to see a doctor, who will perform an exam along with lab tests or imaging to identify the cause of the pain and recommend the appropriate treatment, therapy, or intervention.

"The physician must get a good history to see how this came about, do a physical exam to try to pinpoint these structures, and try to correlate that with any type of imaging studies that are done," says Dr. Press.

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Your knee is a complex piece of equipment, and as a result, many common conditions and injuries can cause knee pain. "There are a number of different ligaments around and inside the knee, as well as tendons and bursae - little fluid-filled sacs that can get inflamed," says Joel Press, MD, physiatrist-in-chief at the Hospital for Special Surgery and professor of rehabilitation medicine at Weill Cornell Medical College, both in New York City.

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Knee pain is a common complaint that affects people of all ages. Knee pain may be the result of an injury, such as a ruptured ligament or torn cartilage. Medical conditions — including arthritis, gout and infections — also can cause knee pain.

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Overview

Knee pain is a common complaint that affects people of all ages. Knee pain may be the result of an injury, such as a ruptured ligament or torn cartilage. Medical conditions - including arthritis, gout and infections - also can cause knee pain.

Many types of minor knee pain respond well to self-care measures. Physical therapy and knee braces also can help relieve pain. In some cases, however, your knee may require surgical repair.

Symptoms

The location and severity of knee pain may vary, depending on the cause of the problem. Signs and symptoms that sometimes accompany knee pain include:

Swelling and stiffness

Redness and warmth to the touch

Weakness or instability

Popping or crunching noises

Inability to fully straighten the knee

When to see a doctor

Call your doctor if you:

Can't bear weight on your knee or feel as if your knee is unstable or gives out

Have marked knee swelling

Are unable to fully extend or flex your knee

See an obvious deformity in your leg or knee

Have a fever, in addition to redness, pain and swelling in your knee

Have severe knee pain that is associated with an injury

Causes

Knee pain can be caused by injuries, mechanical problems, types of arthritis and other problems.

Injuries

A knee injury can affect any of the ligaments, tendons or fluid-filled sacs (bursae) that surround your knee joint as well as the bones, cartilage and ligaments that form the joint itself. Some of the more common knee injuries include:

ACL injury. An ACL injury is a tear of the anterior cruciate ligament (ACL) - one of four ligaments that connect your shinbone to your thighbone. An ACL injury is particularly common in people who play basketball, soccer or other sports that require sudden changes in direction.

Fractures. The bones of the knee, including the kneecap (patella), can be broken during falls or auto accidents. Also, people whose bones have been weakened by osteoporosis can sometimes sustain a knee fracture simply by stepping wrong.

Torn meniscus. The meniscus is the tough, rubbery cartilage that acts as a shock absorber between your shinbone and thighbone. It can be torn if you suddenly twist your knee while bearing weight on it.

Knee bursitis. Some knee injuries cause inflammation in the bursae, the small sacs of fluid that cushion the outside of your knee joint so that tendons and ligaments glide smoothly over the joint.

Patellar tendinitis. Tendinitis causes irritation and inflammation of one or more tendons - the thick, fibrous tissues that attach muscles to bones. This inflammation can happen when there's an injury to the patellar tendon, which runs from the kneecap (patella) to the shinbone and allows you to kick, run and jump. Runners, skiers, cyclists, and those involved in jumping sports and activities may develop patellar tendinitis.

Mechanical problems

Some examples of mechanical problems that can cause knee pain include:

Loose body. Sometimes injury or degeneration of bone or cartilage can cause a piece of bone or cartilage to break off and float in the joint space. This may not create any problems unless the loose body interferes with knee joint movement, in which case the effect is something like a pencil caught in a door hinge.

Iliotibial band syndrome. This occurs when the tough band of tissue that extends from the outside of your hip to the outside of your knee (iliotibial band) becomes so tight that it rubs against the outer portion of your thighbone. Distance runners and cyclists are especially susceptible to iliotibial band syndrome.

Dislocated kneecap. This occurs when the triangular bone that covers the front of your knee (patella) slips out of place, usually to the outside of your knee. In some cases, the kneecap may stay displaced and you'll be able to see the dislocation.

Hip or foot pain. If you have hip or foot pain, you may change the way you walk to spare your painful joint. But this altered gait can place more stress on your knee joint and cause knee pain.

Types of arthritis

More than 100 different types of arthritis exist. The varieties most likely to affect the knee include:

Osteoarthritis. Sometimes called degenerative arthritis, osteoarthritis is the most common type of arthritis. It's a wear-and-tear condition that occurs when the cartilage in your knee deteriorates with use and age.

Rheumatoid arthritis. The most debilitating form of arthritis, rheumatoid arthritis is an autoimmune condition that can affect almost any joint in your body, including your knees. Although rheumatoid arthritis is a chronic disease, it tends to vary in severity and may even come and go.

Gout. This type of arthritis occurs when uric acid crystals build up in the joint. While gout most commonly affects the big toe, it can also occur in the knee.

Pseudogout. Often mistaken for gout, pseudogout is caused by calcium-containing crystals that develop in the joint fluid. Knees are the most common joint affected by pseudogout.

Septic arthritis. Sometimes your knee joint can become infected, leading to swelling, pain and redness. Septic arthritis often occurs with a fever, and there's usually no trauma before the onset of pain. Septic arthritis can quickly cause extensive damage to the knee cartilage. If you have knee pain with any of the symptoms of septic arthritis, see your doctor right away.

Other problems

Patellofemoral pain syndrome is a general term that refers to pain arising between the kneecap and the underlying thighbone. It's common in athletes; in young adults, especially those whose kneecap doesn't track properly in its groove; and in older adults, who usually develop the condition as a result of arthritis of the kneecap.

Risk factors

A number of factors can increase your risk of having knee problems, including:

Excess weight. Being overweight or obese increases stress on your knee joints, even during ordinary activities such as walking or going up and down stairs. It also puts you at increased risk of osteoarthritis by accelerating the breakdown of joint cartilage.

Lack of muscle flexibility or strength. A lack of strength and flexibility can increase the risk of knee injuries. Strong muscles help stabilize and protect your joints, and muscle flexibility can help you achieve full range of motion.

Certain sports or occupations. Some sports put greater stress on your knees than do others. Alpine skiing with its rigid ski boots and potential for falls, basketball's jumps and pivots, and the repeated pounding your knees take when you run or jog all increase your risk of knee injury. Jobs that require repetitive stress on the knees such as construction or farming also can increase your risk.

Previous injury. Having a previous knee injury makes it more likely that you'll injure your knee again.

Complications

Not all knee pain is serious. But some knee injuries and medical conditions, such as osteoarthritis, can lead to increasing pain, joint damage and disability if left untreated. And having a knee injury - even a minor one - makes it more likely that you'll have similar injuries in the future.

Prevention

Although it's not always possible to prevent knee pain, the following suggestions may help ward off injuries and joint deterioration:

Keep extra pounds off. Maintain a healthy weight; it's one of the best things you can do for your knees. Every extra pound puts additional strain on your joints, increasing the risk of injuries and osteoarthritis.

Be in shape to play your sport. To prepare your muscles for the demands of sports participation, take time for conditioning.

Practice perfectly. Make sure the technique and movement patterns you use in your sports or activity are the best they can be. Lessons from a professional can be very helpful.

Get strong, stay flexible. Weak muscles are a leading cause of knee injuries. You'll benefit from building up your quadriceps and hamstrings, the muscles on the front and back of your thighs that help support your knees. Balance and stability training helps the muscles around your knees work together more effectively.

And because tight muscles also can contribute to injury, stretching is important. Try to include flexibility exercises in your workouts.

Be smart about exercise. If you have osteoarthritis, chronic knee pain or recurring injuries, you may need to change the way you exercise. Consider switching to swimming, water aerobics or other low-impact activities - at least for a few days a week. Sometimes simply limiting high-impact activities will provide relief.

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Knee pain is a common complaint that affects people of all ages. Knee pain may be the result of an injury, such as a ruptured ligament or torn cartilage. Medical conditions - including arthritis, gout and infections - also can cause knee pain. Many types of minor knee pain respond well to self-care measures.

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Review of ResMed's AirFit N10 Nasal CPAP Mask

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Review of ResMed's AirFit N10 Nasal CPAP Mask

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In this article, we detail all the AirFit N10's features and benefits. Even more, we delve into common problems patients may experience with this CPAP mask and discuss various solutions. We finish with real customer reviews from.

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Getting diagnosed with obstructive sleep apnea weighs heavily on our patients. There is a swath of information available and treatment options can vary from patient to patient.

There has been a major growth in understanding of just how much obstructive sleep apnea impacts the overall health and well-being of a person. Along with that growth has come a wide variety of continuous positive airway pressure (CPAP) machines, masks , and accessories.

The wonderful staff here at Sleep Resolutions knows how overwhelming it can be to get quality information and direction. One thing we really strive to do for all our patients is to find the information and deliver it. After all, we believe our patients are like family, and we want you to be able to make the decisions that work best for you and your sleep therapy.

Having a clear understanding of the different types of machines, mask, and accessories available will help you find the right fit for you. Being comfortable in your sleep mask plays a significant role in your compliance with your sleep therapy.

Here is our complete review of ResMed's AirFit N10 Nasal mask.
ResMed's AirFit N10 nasal mask has been ranked as the "overall first choice by patients when compared to industry-leading CPAP nasal masks."
This nasal mask features:

Therapy pressure between 4 to 40 cm H20

Operating temperatures between 41 to 104 degrees F (5-40 degrees C)

Operating humidity between 15% to 95% non condensing

Noise emitted at 30 dBA (uncertainty of 3 dBA)

Dimensions 19.0'' (H) x 6.10'' (W) x 4.33'' (D)

Service life is dependent on the care, intensity of usage, maintenance, and environmental conditions in which the mask is used in and stored.

Dead space is the empty volume of the mask to the end of the swivel, when using the large cushions it's 104mL.

ResMed does not use BPA, PVC, DEHP, phthalates, or natural rubber latex in the making of the Airfit N10 nasal mask.

The AirFit N10 features a unique under-thee-ye frame that allows patients the visual freedom to wear glasses, watch tv, or read a book before bed. Along with the frame there are removable strap cushions that rest against your face comfortable while ensuring a quality seal. The removable support cushions ease the washing process.

Another great feature is that all of the stitching is on the inside of the frame, reducing the likelihood of the mask/headgear from snagging throughout the night.

ResMed highlights the minimalistic design of this mask and the key-clips. The key-clips are magnetic and create a solid clasp with little effort.

The magnetic key-clips also allow for easy removal and reattachment. This is a great feature for those that use the bathroom during the night.

The lightweight design and flexible tubing allow for all sleeping positions without compromising the seal.

The AirFit N10 nasal mask has passive venting to reduce rebreathing.

Just as all our patients are different, so are all CPAP masks. Although each mask has its strengths, there are common problems that occur while you adjust to your mask. The majority of the time the issues that arise can be fixed with a little direction.

The Mask is Noisy

The most common reasons that the AirFit N10 nasal mask could be noisy are blockages in the venting, incorrectly assembled mask, or air leaks.

First, check the venting. Always use a soft bristle brush to clean the vent.

Should that not correct the noisy mask, try to disassemble the mask and reassemble it following the instructions provided with your mask.

Another solution is to refit or reposition the mask. Readjust the headgear straps to ensure the mask is close enough to form a quality seal.

Mask Leaking Around Face

There are a number of reasons that could cause the mask to leak around your face. The mask may need to be repositioned. The AirFit N10 has the ResMed logo on it. Make sure that logo is facing downward on the bottom of the cushion.

Another solution is to pull the mask away from your face to reposition. While repositioning the mask, check to make sure the lower corners of the mask are completely covering your nose. Re-adjust your headgear to bring the mask closer to your face to ensure a quality seal.

Follow the instructions provided and refit your mask. Check the cushion to ensure that it is also in the correct position. The cushion membrane may be folded. Use a pinching motion to ease the cushion back into the correct form.

You may simply have the wrong size of mask. You will need to speak with your sleep medicine provider. ResMed has as sizing template for the AirFit N10 that should be use to ensure accurate sizing.

Incorrect Fit

The mask may be incorrectly assembled. Disassemble the mask and reassemble following the instructions provided. The cushion might be dirty. Clean the cushion to see if that resolves the issue.

If those two options do not resolved the incorrect fit, then seek out assistance from your sleep medicine provider. The mask may be the wrong size. Always make sure that your sleep medicine provider is using the ResMed's fitting template to ensure accurate sizing.

Knowing the features of the mask is only half the information. FInding how this mask works for other patients can provide you some insight into this mask. We always ask our patients for honest feedback given their experiences with any CPAP machine, mask, or accessory.

Here is some of valued feedback.

"I have been using my CPAP for about 15 years and this is by far the best mask as there are no straps across my forehead. Very comfortable. Minimal air leakage."

"So, as a kid I got teased for having a Big Nose. That's possibly why I'm not giving this 5 starts. It doesn't seem to be deep enough, from my perspective. That's the only downside I've found to using this mask (and I've worn all kinds over the many years I've been using CPAP). It has minimal interference, and is easy to take off and re-attach. Simple, easy to use. I just don't like my nose being that close to the hose side of the mask."

As always, Sleep Resolutions is here to provide you with the best experience possible. If you have any questions or would like to speak to one of our highly trained medical technicians about the ResMed AirFit N10 nasal mask, click the link below. We will provide you with a scheduled free 10-minute phone consultation or a one-on-one appointment.

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2019 Review of ResMed's AirFit N10 Nasal CPAP Mask

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Looking for an honest review of ResMed's AirFit N10 Nasal CPAP Mask? In this article, we detail all the AirFit N10's features and benefits. Even more, we delve into common problems patients may experience with this CPAP mask and discuss various solutions. We finish with real customer reviews from...

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AirFit N10 is ResMed’s first-generation nasal CPAP mask

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AirFit N10 is ResMed’s first-generation nasal CPAP mask

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In today’s popular AirFit series AirFit N10 is ResMed’s first-generation nasal CPAP mask

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AirFit N10 is ResMed's first-generation nasal CPAP mask in today's popular AirFit series.

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ResMed For Her AirFit carries a wide range of full face, nasal, and nasal pillow masks for women. Find all details and comparison of the best ResMed For Her CPAP Mask.

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ResMed AirFit CPAP masks offer a variety of designs to fit any CPAP user, including CPAP masks shaped to specifically fit a woman's facial contours and meet her needs for CPAP therapy. Created for maximum comfort and a secure seal, these masks offer CPAP compliance without many of the issues most CPAP users have to manage.

ResMed AirFit N10 Nasal CPAP Mask for Her

CPAP users will love the ease of use of the ResMed AirFit N10 for Her. Simply slip out of the mask using magnetic headgear clips and never fumble with headgear adjustments again. The adjustable headgear on this mask is perfect for users with smaller head sizes. No matter how many times you get up in the night, your AirFit N10 keeps its settings so you can go back to sleep without a disturbance.

Shop ResMed AirFit N10 Nasal Mask For Her
Features

Comfortable and secure seal

Diffused air design for a quiet night performance

Clear field of vision

Magnetic clips for easy removal

Design

Flexible tubing for ease of movement

Soft cushioning

SoftEdge headgear made from soft-knit material

Designed for easy, hassle-free fitting and less adjustment

Benefits

More freedom for active sleepers

Reduced red marks on the face

Easy to use while reading or watching TV

Quieter performance for peaceful sleep

ResMed AirFit F10 Full Face CPAP Mask for Her

The ResMed AirFit F10 Full Face For Her CPAP Mask uses an innovative design that creates a comfortable mask and CPAP experience when compared to other full face CPAP masks. It was designed with pink accents and a smaller minimalist design with female patients in mind. The additional levels of comfort in this mask make it stand out, while still delivering the same performance and reliability that other ResMed full face masks offer. Users will also enjoy the SpringAir and SoftEdge features to improve the comfort and compliance for CPAP therapy.

Shop ResMed AirFit F10 Full Face Mask For Her
Features

Clear field of vision

Quiet diffused air venting

Easy remove headgear straps

Quick-release elbow hose connection

Design

Smaller, lighter mask design

Comfortable fitting headgear

Consistently secure seal

Contoured fit

Benefits

Easy to maintain and clean

More comfort for peaceful sleep

Easy to adjust and adapt to any face shape or size

ResMed AirFit P10 Nasal Pillow CPAP Mask for Her

The ResMed AirFit P10 For Her precisely contours a woman's facial features while providing the highest level of nasal pillow CPAP therapy. The dual wall design delivers airflow gently into the nose and creates a secure seal, all while minimizing facial contact. The P10 For Her provides all of the unique benefits of the standard AirFit P10 mask with cushion sizes that deliver effectiveness and comfort in a smaller size.

Clinical studies reveal that users of the AirFit P10 enjoyed 40 more minutes of sleep per night. There's no better nasal pillow mask for staying compliant with your CPAP therapy.

Shop ResMed AirFit P10 Nasal Pillow Mask For Her
Features

Flexible tubing for freedom of movement

QuickFit elastic headgear for minimal adjustment

Quieter performance

Design

Dual-wall design for gentle airflow

Minimal facial contact for fewer red marks

Lightweight for more comfort

Benefits

No-fuss fitting

Ideal for active sleepers

Easy and comfortable to wear while watching TV

Side by Side Comparison of the ResMed For Her AirFit Series

The Best ResMed For Her CPAP Mask

Customers select ResMed CPAP Masks for Her for their unique design for women. Most women CPAP users must compromise to fit CPAP masks for men to their face shape and size. The unique and innovative option gives female CPAP users a choice.

Customers also enjoy the enhanced comfort, ease of use, and flexible design that makes CPAP therapy more comfortable and more convenient.

The CPAP Shop does not recommend any ResMed CPAP Mask for Her exclusively. We are an authorized retailer for all major CPAP Machines and Mask.

Where Can I Buy ResMed For Her CPAP Masks?

You can find ResMed CPAP Masks for Her at most medical supply stores. You can also shop online at The CPAP Shop. The CPAP Shop offers affordable pricing, expert assistance to help you select the best ResMed CPAP mask for you, and a no-hassle 30-day money-back guarantee. Our knowledgeable staff is also able to assist you by calling 866-414-9700.

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ResMed AirFit CPAP masks offer a variety of designs to fit any CPAP user, including CPAP masks shaped to specifically fit a woman's facial contours and meet her needs for CPAP therapy. Created for maximum comfort and a secure seal, these masks offer CPAP compliance without many of the issues most CPAP users have to manage.

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Obstructive Sleep Apnea Signs and Symptoms

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Obstructive Sleep Apnea Signs and Symptoms

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Read on to know about sleep apnea,obstructive sleep apnea,signs and symptoms.

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Sleep apnea is a sleep disorder in which a person's breathing is repeatedly interrupted throughout the night. This occurs when the muscles in the throat relax and the airway narrows or collapses as they breathe in. When the person can't get enough air, the blood oxygen level drops. The brain immediately jolts the body awake to reopen the airway. Sometimes this episode goes unnoticed and other times, it may cause the person to wake up gasping for air. In persons with sleep apnea, these apnea episodes can occur as many as 30 times per hour.

An estimated 22 million Americans suffer from sleep apnea and a majority are undiagnosed. Sleep apnea, left untreated, has been linked to frequent headaches, an inability to concentrate, and daytime drowsiness. Long-term complications include increased risk for cardiovascular disease, diabetes, stroke, and even death. Here are some signs and symptoms of sleep apnea. If these sound familiar, it may be time to order a home sleep apnea test to confirm if an obstructive sleep apnea (OSA) diagnosis.

Obstructive Sleep Apnea (OSA) Symptoms

Do you feel tired, lethargic or irritable even when you've had a full 8 hours of sleep? Do you wake up with a dry mouth, sore throat, or headache? Does your bed partner often complain about your snoring or gasping for air during sleep? If so, there may be a more serious problem going on. In particular, with chronic sleep issues and sleep apnea impacting millions of people, it may be necessary to determine the underlying cause of your problem.

Sleep apnea is a condition where your breathing is repeatedly interrupted during sleep. This occurs when the muscles in the back of the throat relax, narrowing or collapsing your airways as you struggle to breathe. The brain then realizes there is a dangerous lack of oxygen and jolts the body awake to make sure a breath is taken. In OSA, this pattern can occur 5-30 times or more per hour and that lack of air can have serious repercussions. Here is what you need to know about the signs and symptoms of OSA.

Signs of Sleep Apnea

What are the Risk Factors for Sleep Apnea?

While sleep apnea can affect anyone, including women and children, there are certain characteristics that put you at higher risk. These include:

Overweight. Obesity greatly increases your risk for sleep apnea as the extra fat around the neck may obstruct your breathing.

Gender. Men are 2-3 times more likely to have OSA than women. However, the risk factor for women increases significantly after menopause.

Age. Sleep apnea occurs significantly more in older adults.

Genetics. Those with narrower airways are at higher risk for OSA.

Family history. Having family members with OSA might increase your risk.

Smoking. Smoking increases inflammation and fluid retention in the upper airway, making smokers 3 times more likely to have OSA than non-smokers.

Use of alcohol, sedatives, or tranquilizers. These relax the muscles in your throat, which can worse OSA.

Nasal congestion. If you have trouble breathing through your nose, even if it is due to allergies, you are at a higher risk to develop OSA.

Obstructive Sleep Apnea Symptoms

How do you know if you have OSA? The first step is to identify the signs and symptoms. Here's a simple checklist to get you started:

Loud snoring

Reported apneas, or times when your bed partner notes that you gasp for air or stop breathing altogether

Waking up abruptly with shortness of breath

Dry mouth or sore throat

Headaches in the morning

Insomnia or difficulty staying asleep

Hypersomnia or excessive daytime sleepiness

Trouble focusing or concentrating while awake

Irritability

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Obstructive Sleep Apnea Signs and Symptoms

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Learn the signs of sleep apnea. We list obstructive sleep apnea (OSA) symptoms like excessive sleepiness, loud snoring, gasping for air and daytime fatigue.

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Sleep Statistics - Facts and Data About Sleep 2022 | Sleep Foundation

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Sleep Statistics - Facts and Data About Sleep 2022 | Sleep Foundation

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Looking for the facts about sleep? Our in-depth look at sleep statistics gives hard data about sleep needs, disorders, and the impacts of sleep deprivation.

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Sleep plays an integral role in health. A good night's sleep empowers the body to recover and lets you wake up refreshed and ready to take on the day.

Unfortunately, many people have sleep problems and don't get the rest that they need. Insufficient sleep and poor quality sleep can be due to diverse factors including sleep disorders, medical conditions, and mental health. Sleep issues affect people of all ages, and its impacts can be far-reaching.

While sleep is too complex to sum up with only numbers, reviewing basic facts and figures about sleep can help you understand how sleep works, why it's important, and the depth of the sleep deprivation problem in the United States.

Statistics About How We Sleep

📝 Got a hot tip? Pitch us your story idea, share your expertise with SleepFoundation.org, or let us know about your sleep experiences right here.

Statistics About Insufficient Sleep

Almost half of all Americans⁸ say they feel sleepy during the day between three and seven days per week.

35.2% of all adults in the U.S.report sleeping on average for less than seven hours per night.

At 43%, Hawaii has the highest percentage of adults who get seven or fewer hours of sleep per night. South Dakota, at 26%, has the lowest percentage.

Of major cities in the United States, Boulder, Colorado has the lowest percentage of adults who sleep less than seven hours per night, coming in at 24.2%. Camden, New Jersey and Detroit, Michigan tie for the highest rate, with 49.8% of adults in those cities reporting short sleep.

When compared to whites, black adults are almost twice as likely to describe sleeping too little and are 60% more likely to report sleeping too much.

After adjusting for age, insufficient sleep by race and ethnicity shows clear differences with 46.3% of Native Hawaiians/Pacific Islanders, 45.8% of black people, 40.4% of American Indians/Alaska Natives, 37.5% of Asians, 34.5% of Hispanics, and 33.4% of whites reporting getting less than seven hours of sleep.

42.6% of single parents sleep less than seven hours per night compared to 32.7% of adults in two-parent homes and 31% of adults with no children.

32.6% of working adults reported sleeping six or fewer hours per night in 2017-2018, up from 28.4% in 2008-2009.

More than 44% of workers in production-focused industries, such as factory workers and plant operators, report getting seven hours of sleep or less per night.

Active duty service members are 34% more likely to report insufficient sleep than people with no history of military service.

Statistics About Sleep Disorders

People may apply up to 250 pounds of force when grinding their teeth during sleep.

Statistics About Sleep Disruptions

Statistics About Sleep in Children and Teens

Statistics About the Impact of Insufficient Sleep

Statistics About Sleep and Mental Health

Statistics About Sleep Hygiene

Sleep hygiene is a term that includes both the bedroom environment and sleep-related habits. Optimizing sleep hygiene can play an important role in addressing sleep insufficiency.

93% of people⁵⁷ say that a comfortable mattress is important to being able to get quality sleep.

Statistics About Sleep Aids

+69 Sources

National Sleep Foundation. (2020, March 7). The National Sleep Foundation's 2020 Sleep in America® Poll Shows Alarming Level of Sleepiness and Low Levels of Action. Retrieved October 22, 2020, from

National Sleep Foundation. (2012, April 1). There's No Place Like Home for Sleep According to New National Bedroom Poll. Retrieved October 8, 2020, from

National Sleep Foundation. (2012, April 1). Bedroom Poll: Summary of Findings. Retrieved October 22, 2020, from

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Sleep plays an integral role in health. A good night's sleep empowers the body to recover and lets you wake up refreshed and ready to take on the day. Unfortunately, many people have sleep problems and don't get the rest that they need.

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Sleep | The Nutrition Source | Harvard T.H. Chan School of Public Health

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Sleep | The Nutrition Source | Harvard T.H. Chan School of Public Health

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Read on to know more about sleep, What Happens When We Sleep? ,Hormones that Regulate Sleep Cycles and more.

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Sleep is as essential to our daily needs as food and water. Although we may feel that sleep simply rests our tired bodies, our brain remains active throughout the night. Sleep plays a critical role…

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DeVilbiss 10L Concentrator Filter Replacement - Oxygen Concentrator Shop

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DeVilbiss 10L Concentrator Filter Replacement - Oxygen Concentrator Shop

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Read to know How to Change the Filter On a DeVilbiss Oxygen Concentrator.

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How to Change the Filter On a DeVilbiss Oxygen Concentrator

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Read how to change, remove and clean DeVilbiss 10L Oxygen Concentrator filters. This is a detailed for how to maintain your DeVilbiss Oxygen Concentrator.

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Oxygen Therapy | Hyperbaric Oxygen Therapy

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Oxygen Therapy | Hyperbaric Oxygen Therapy

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Oxygen therapy is a treatment that provides you with extra oxygen to breathe in. It is also called supplemental oxygen.Read to know more.

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What is oxygen?

Oxygen is a gas that your body needs to work properly. Your cells need oxygen to make energy. Your lungs absorb oxygen from the air you breathe. The oxygen enters your blood from your lungs and travels to your organs and body tissues.

Certain medical conditions can cause your blood oxygen levels to be too low. Low blood oxygen may make you feel short of breath, tired, or confused. It can also damage your body. Oxygen therapy can help you get more oxygen.

What is oxygen therapy?

Oxygen therapy is a treatment that provides you with extra oxygen to breathe in. It is also called supplemental oxygen. It is only available through a prescription from your health care provider. You may get it in the hospital, another medical setting, or at home. Some people only need it for a short period of time. Others will need long-term oxygen therapy.

There are different types of devices that can give you oxygen. Some use tanks of liquid or gas oxygen. Others use an oxygen concentrator, which pulls oxygen out of the air. You will get the oxygen through a nose tube (cannula), a mask, or a tent. The extra oxygen is breathed in along with normal air.

There are portable versions of the tanks and oxygen concentrators. They can make it easier for you to move around while using your therapy.

Who needs oxygen therapy?

You may need oxygen therapy if you have a condition that causes low blood oxygen, such as:

What are the risks of using oxygen therapy?

Oxygen therapy is generally safe, but it can cause side effects. They include a dry or bloody nose, tiredness, and morning headaches.

Oxygen poses a fire risk, so you should never smoke or use flammable materials when using oxygen. If you use oxygen tanks, make sure your tank is secured and stays upright. If it falls and cracks or the top breaks off, the tank can fly like a missile.

What is hyperbaric oxygen therapy?

Hyperbaric oxygen therapy (HBOT) is a different type of oxygen therapy. It involves breathing oxygen in a pressurized chamber or tube. This allows your lungs to gather up to three times more oxygen than you would get by breathing oxygen at normal air pressure. The extra oxygen moves through your blood and to your organs and body tissues. HBOT is used to treat certain serious wounds, burns, injuries, and infections. It also treats air or gas embolisms (bubbles of air in your bloodstream), decompression sickness suffered by divers, and carbon monoxide poisoning.

But some treatment centers claim that HBOT can treat almost anything, including HIV/AIDS, Alzheimer's disease, autism, and cancer. The U.S. Food and Drug Administration (FDA) has not cleared or approved the use of HBOT for these conditions. There are risks to using HBOT, so always check with your primary health care provider before you try it.

NIH: National Heart, Lung, and Blood Institute

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Oxygen Therapy | Hyperbaric Oxygen Therapy | MedlinePlus

# data[].attributes.attachment_link.description
Oxygen is a gas that your body needs to work properly. Your cells need oxygen to make energy. Your lungs absorb oxygen from the air you breathe. The oxygen enters your blood from your lungs and travels to your organs and body tissues. Certain medical conditions can cause your blood oxygen levels to be too low.