SLEEP APNOEA

We welcome Eric Chrenowski, B.Sc.(Hons.Biotech.), B.Pharm, MBA, Sleep Apnoea Specialist writing our guest post

“Working as a professional services pharmacist and sleep apnoea expert, I thought I would share some of my personal experiences that I have seen in various parts of Australia. These experiences range from diagnosis, treatment and inadequate training of providers of CPAP resulting in poor standards of CPAP therapy patient outcomes.

The condition that I am referring to is hugely undiagnosed in our communities today.

This condition is called Sleep Apnoea.

“Sleep apnoea occurs when someone stops breathing for 10 seconds or longer in their sleep. This can happen as often as 30 times an hour during sleep, and in severe cases even more.”

Sleep apnoea occurs when someone stops breathing for 10 seconds or longer in their sleep. This can happen as often as 30 times an hour during sleep, and in severe cases even more. Anatomically, as the airways begin to close off and the lungs are deprived of oxygen, the heart rate increases; sleep is disturbed, and the body goes into a panic mode. Sleep is eventually disturbed and the body takes a gasp as the airways are forced open again.

The condition of Sleep Apnoea affects both men and women, but it is more prevalent in men. Statistically, the condition affects about 25 % of men and 9 % of women but the true number remains a mystery as the Sleep Apnoea Condition goes very undiagnosed. The number can in fact be much larger than this.

The consequences of untreated sleep apnoea are many and vary from sleepiness throughout the day, preventing daytime functioning, to an increased incidence of cardiovascular conditions such as hypertension, heart attack, stroke, among other medical conditions.

So what is the solution to this?

Well, the gold standard and most effective treatment which is not a cure is CPAP therapy.  CPAP treatment involves using a small machine to pump air at a continuous pressure through a mask worn over your mouth, nose or both. This pressure acts as a pneumatic splint to the airway – holding it open and preventing it from closing during sleep – while still allowing for normal breathing.

The benefits of CPAP therapy include decreased daytime sleepiness, improved memory and cognitive function, treating hypertension, reducing risk of Myocardial infarction, reducing risk for diabetes, controlling GERD, and can improve depressive symptoms.

As I have consulted patients in various parts of Australia on this condition, I was able to observe how some community pharmacies are providing the CPAP service for these Sleep Apnoea patients. What I found was something very disappointing. Instead of providing a service that included data downloads and changing the settings on the machine such as pressure and humidity, machines were simply being sold by these providers of CPAP without any consults and service. This resulted in poor patient compliance, patients ending up with incorrect machines, incorrect masks which led to lots of leaks coming out of the mask thereby making the CPAP therapy less effective and in certain cases didn’t even help the patient.

There was one situation where a man was given a choice to have a white or black machine from that CPAP provider without the proper explanation that the white machine is used for females as the pressure algorithm is tailored to female sleep apnoea, not male. There was a lack of training and resources provided to staff at these locations and owners simply just wanted to push CPAP machines and equipment. Where is the professional service and patient care?

However, there are providers out there that are doing this correctly with the proper patient care and service support. My goal here is to educate the public on how to access these services so that CPAP therapy can be treated correctly to allow for optimal patient care.

Respirico is a company that has been around for about 12  years that provides exceptional support and service for people with Sleep Apnoea. As a dedicated CPAP provider, Respirico can provide the full service and support that customers should expect, and can also provide an effective link between the patient and the referring Doctor. 

To achieve the best outcome in any medical situation it is important to assemble a competent team.  In the case of sleep apnea, the team should include the GP, the Sleep Specialist, the diagnostic service, the treatment provider, and of course the patient.  Each of these team members is a specialist in their own field, and should not be expected to do the work of other team members.  Some organisations purport to be able to do the lot, but this always results in a less than satisfactory outcome for the patient. 

So where does the Pharmacist fit into all of this? 

Many Pharmacies have dabbled in sleep diagnostics and CPAP treatment only to find out that it is not compatible with Pharmacy and  most have failed miserably.  They just don’t have the time and infrastructure for the extensive training and patient support that is required.  Diagnostics and treatment are complex areas that should be left to the experts.  Nevertheless, Pharmacists can play an important role in this field, by leveraging their relationship with Doctors and their patients.

Respirico has recently pioneered a new model that includes the local pharmacy in the team.  The model is aimed at full service pharmacies that pride themselves in providing professional services.  A participating Pharmacy would host a Sleep Awareness Day at their pharmacy once or twice a year, while the other team members would provide the staff, the equipment and the expertise.  The Pharmacist would utilise his or her relationships with the local Doctors, to promote the event.  The Pharmacy benefits by enhancing its professional reputation with doctors and patients alike, and by attracting new customers to its door.  On the Sleep Awareness day, team members will offer screening for sleep disorders, information leaflets, CPAP product displays and CPAP downloads and assessments, all free of charge.  Customers identified as being at risk, would be encouraged to undergo a sleep study, while existing CPAP users would have the opportunity to upgrade their equipment.

Respirico has outlets throughout South Australia, in Western Victoria, and in Sydney, and works in collaboration with many Sleep Physicians, Diagnostic services and General Practitioners. 

Eric Chrenowski, B.Sc.(Hons.Biotech.), B.Pharm, MBA,