Obstructive Sleep Apnea versus Central Sleep Apnea
Obstructive sleep apnea is when the airwaybecomes narrowed or obstructed and you're making the effort to breathe but we do notsee any flow in air movement coming from your nose or mouth. Where central sleep apnea occurswhere your brain forgets to tell your body to breathe. If we're looking at it from avery simplistic term and so we do not see the drive to breathe. So the first step isto come into the and be seen by one of our physicians in the sleep medicine .We'll go through a questionnaire and try to determine what risk factors we think you havefor sleep apnea such as obesity, snoring, daytime sleepiness and then if we think thatyou have a high risk for meeting those criteria
then we would set you up for a sleep studyeither in your home to do an overnight sleep study or in our laboratory, depending on yoursituation. The CPAP can be used to treat both conditions and, in some patients, that isenough. However, there are some patients that have more complex types of central sleep apneathat require more complicated types of machines to treat that condition. Obstructive sleepapnea actually has been linked to a lot of other problems such as high blood pressureand then, you know, difficulty functioning during the day. If it goes untreated for along period of time there's an increased risk of early heart problems and those types ofthings.
Compensation 101 How did I get this rating
If you've receiveda rating with multiple disabilitiesand wondered how VA got the combined percentage,the following information and example can help youunderstand. VA uses a concept calledthe quot;Whole Person Theoryquot; to determine Veteran'scombined disability rating. This method ensures thata disability rating can never be greater than 100,since a person cannot be
more than 100% able bodied. The disability isdetermined by using the quot;Combined Rating Tablequot;located at 38 CFR 4.25. To use the rating table,you need to start with the highest disabilitypercentage, and from there, arrange them in orderof severity, highest to lowest. For example, if there aretwo disabilities evaluated 50 and 30 percent disabling,the highest degree
or most severe disability in this example 50% will be foundin the left column. Then, the otherless severe disability in this example 30% will be found in the top row. The figures appearingin the space where the left columnand top row intersect will represent the combinedvalue of both disabilities. This combined value willthen be converted
to the nearest numberdivisible by 10. Remember, combined valuesending in 5 or higher, will be adjusted upward to the nearest number divisible by 10. Combined values endingin 4 or lower, will be rounded down to the nearest divisible by 10. The rounding is only doneat the very end after all the disabilitieshave been combined. Let's begin withJoe Veteran as an example.
Joe has been ratedfor the following disabilities in order of severity: 30% PostTraumatic Stress Disorder (PTSD), 20% Diabetes Mellitus,10% Peripheral Neuropathy. Joe has a combined rating of 50%. This combined rating wasderived by the following method. Start with the greatestdisability and then combine them using Table 1in 38 CFR 4.25.
First take the 30% ratingand find it in the left column. Then take the nexthighest disability which is 20% from the top row. The figures appearingin the space where the column and row intersect will represent the combined value of the two. The value is 44. Use this value for theleft row and then find
InHome versus InLab Sleep Disorder Studies
Typically everyone used to be evaluated inthe al setting versus at home. But as things are evolving with insurance companies,fewer companies are actually paying for the in lab studies. So I would say the majorityof our practice has become using the inhome sleep studies. If we're just looking for primarysleep disorders such as obstructive sleep apnea that in home study is very effective.If we are concerned about some other type of parasomnia, movement disorders, those typesof things, those would need to be done in lab where we have more extensive monitoring.Also things like narcolepsy we would send somebody to the lab. If we decide to do aninhome sleep study we would set you up for
an appointment to come back to meet with ourrespiratory therapist and she would help you determine where to put all of the little electrodesthat we use. You have some that go on your chest and some that go under your nose. Soshe would teach you how to set that up for yourself when you get home as well as a littleflow sheet on what to do. You can bring a family member as well to help you remember.Then you take the the equipment home that night with you and basically just do whatshe told you to do as far as hooking everything up and then you go to sleep in your own bedand sleep normally how you would normally do and then the next morning you would getup, take everything off and return the equipment
to us. We would download the information thatwe were able to obtain from that and determine whether you met criteria to diagnose you withsleep apnea or another sleep disorder. The main things that we measure for a home sleepstudy is we measure your oxygen levels and we also measure if we have decreased in yourflow of your breathing or if your breathing actually stops altogether.