Brand new Sleep Apnoea treatment – No masks

Extract from: Thomas Jefferson University Hospitals Website.

Brand New Sleep Apnea Treatment – No Masks
by Katharine M. Krauss on Wednesday, November 19th, 2014 in News and Events.

This morning at 8:30 am, a Jefferson patient became the first person in the Philadelphia area to receive a new treatment for obstructive sleep apnea. Inspire upper airway stimulation therapy, approved by the Food and Drug Administration in April, 2014, is an implanted sensor that delivers mild stimulation to key airway muscles, keeping them open during sleep. It has been clinically proven to significantly reduce sleep apnea and significantly improve quality of life measures. Inspire therapy is an alternative to Continuous Positive Airway Pressure (C.P.A.P.) sleep masks for patients who can’t use them—and only about 30 percent of patients diagnosed with Obstructive Sleep Apnea and prescribed with C.P.A.P. masks actually do use them.
Obstructive sleep apnea affects an estimated 18 million Americans and occurs when the tongue and other soft tissues relax during sleep and obstruct the airway. This causes recurrent awakening and leads to daytime sleepiness or fatigue and increased risk of heart attack, stroke, weight gain, and high blood pressure. The effects of sleep apnea can be life-threatening: Recently, a patient being treated at Jefferson was taken off a heart transplant list because his condition improved markedly after he was treated for obstructive sleep apnea.
Jefferson otolaryngology surgeon Dr. Maurits Boon and Dr. Karl Doghramji , Medical Director of the Jefferson Sleep Disorders Center explained the new therapy to a packed room at a health education seminar at the Navy Yard last week.
“This represents a huge shift in the way we are able to treat sleep apnea for patients who cannot tolerate CPAP therapy,” said Dr. Boon, M.D. “Initial results from studies suggest great effectiveness with very low surgical risk. We are proud to be the first center in Philadelphia to offer this treatment and we believe it will make a huge difference in our approach to treating this frustrating disease
“CPAP is a highly effective treatment for OSA. However, a sizable number of individuals with OSA cannot tolerate CPAP,” said Dr. Doghrmaji. “We work diligently with these patients to overcome this inability. However many are still unable to utilize CPAP, or cannot do so due to a variety of medical reasons. Thankfully, a variety of alternative treatments are available including dental appliances and surgical therapies. Upper airway stimulation represents the most recently introduced alternative. Clinical studies with this device indicate that it is a highly effective method for the treatment of obstructive sleep apnea, and represents a dramatic advance in our ability to treat this serious condition.

Sleep apnoea trust’s conference – Oxford

Sleep Apnoea Trust’s Conference

Lesley Bagnall attended the Sleep Apnoea Trust’s Conference in Oxford on Saturday 18th October.

There were a number of interesting new products on show at the manufacturers’ stands.

BREAS were showing the new Z1 with its integrated battery system called the PowerShell.
Weighing only 284 grams and able to fit on one’s hand, the Z1 is the smallest, lightest CPAPmachine on the market. It can be powered from the mains, but fitted into the PowerShell it can run all night from a single charge with no leads. A very neat little machine that would be ideal for travelling.

On the same stand was a small plastic device which could fit between the CPAP machine and the hose and provide humidification without the need for water and a humidifier. Again ideal when travelling, especially useful to use on aeroplanes where you cannot use a conventional water filled humidifier.
These small plastic devices can be used for a week before replacing and should cost about £2.

Intus had a large selection of useful products on show, including that other very useful machine for travelling the Transcend. At 450g it is not as light as the Z1, but it is still a very light, compact machine. The Transcend has an APAP as well as a CPAP version available. (The Z1 only has a CPAP version at the moment.)
The Transcend batteries are very lightweight and come in overnight or 3 day versions, with a solar battery charger also available.

Philips Respironics have designed a travel briefcase which can hold your laptop and your pap machine. (there is a youtube video showing it – the 2 parts can be unzipped and used separately).

Resmed had on show their new range of masks and pap machines. Those of you who were at our SASA conference in Stirling this year, will have already had a chance to see the AirSense 10.
This latest range of pap machines have a number of new features, including wireless connectivity, making it possible for sleep clinicians to remotely monitor and
adjust treatment to meet patients’ needs more effectively.

I am delighted to see that the AirSense range includes a machine designed specifically for women. The differences are not just cosmetic, the AutoSet for Her uses an algorithm based on Resmed’s AutoSet Algorithm, but adapted to respond better to the different needs of female patients with OSA.
Resmed, Philips Respironics and Fisher and Paykel all showed masks that were very lightweight and had minimal headgear. If you haven’t looked at masks for a while, now would be a good time to take another look, the variety out there is quite impressive.

SASA Conference 2014.

The Conference was told of important developments.

Mr Wilson welcomed everyone to the Annual Conference then introduced the guest speakers and other guests.

There were five guest speakers, and the subjects in their talks covered a wide variety of interesting developments related to sleep apnoea.

In his talk, Dr Eric Livingston, of Glasgow Royal Infirmary, reported on the activities of the British Thoracic Society, the British Lung Foundation, and the Obstructive Sleep Apnoea Advisory Group.   Dr Livingston also provided updated information from the Department of Vehicle Licensing Agency related to matters involving sleep apnoea. He also spoke about the proposed oxygen/CPAP initiative.

Dr Ian Morrison, a consultant neurologist at Ninewells Hospital in Dundee, has a specialist clinical interest in the diagnosis and management of patients with    complex sleep behaviour disorders and also epilepsy, and his talk was about understanding the pathogenesis of both rapid eye movement and non-rapid eye  movement sleep disorders and the forensic implications of sleep behaviours.

Julie Kidson, of N.H.S. Shetland, reported on her recent survey of O.S.A. provision in the Shetland Isles.

Stirling based Dr Pramod Subbaraman, of the British Society of Dental Sleep Medicine, spoke about dental appliances and their use in treating O.S.A., including history and recent developments.

Phyllis Murphie, a respiratory nurse consultant at  Dumfries and Galloway Royal Infirmary, detailed ideas about service improvements, with particular reference to telemedicine review and open access clinics.

After the guest speakers a forum/discussion panel followed. The panel answering questions from the floor comprised Kath Hope, of Hope2Sleep; Julie Kidson; Phyllis Murphie; Pramod Subbaraman, and S.A.S.A. representatives.

Members were also able to explore O.S.A. equipment displays by Intus Healthcare, Philips,   ResMed ad Hope2Sleep.

The conference’s sponsors were Dolbymedical,     ResMed and intusHEALTHCARE.

Evening Meeting April 2014

The Dundee Law

A Tayside SASA meeting was held in Menzieshill Community Centre, Dundee.  It was held in the evening to accommodate people who are unable to attend meetings during working hours.

We welcomed two new members who seemed pleased with the information they received and we look forward to seeing them at the next evening meeting.  The date of this will be posted once arrangements are made.




Evening Meeting

There will be a meeting in Tayside this week which will be held on Wednesday 2nd April 2014.

The venue is Menzieshill Community Centre, Dundee  6.00pm-8.00pm.  Some people have pointed out that they cannot get to meetings during the day so hopefully an evening one may be suitable for some.

All welcome, members old and new.  Tea, coffee cake and biscuits provided.

SASA Conference and AGM, September 20th, 2014


“Event of the Year”

PLEASE PUT THIS DATE IN YOUR DIARY:                                       

Wallace’s Monument, Stirling


Saturday 20th September 2014  9.30am-4.00pm   

SASA  Conference & AGM.

The Golden Lion Hotel,

8/10 King Street, 

Stirling, FK8 1BD,

Further details will follow.

It is hoped that many members, old and new, will attend. There will be speakers on various topics to do with OSA and should be a very interesting day.

SASA meeting – Wednesday 12th March 2014

The most recent meeting of the Tayside SASA Sleep Apnoea group was held on Wednesday 12th March at Kingsway East Fire Station, Dundee.

It was a very successful meeting, with another new member joining our group, having been given information at Ninewells Sleep Clinic. We had a lot of discussion re masks, humidifiers etc and Lesley had a selection of equipment for us to see. There was a lot of chat about the new website which was about to be launched.  Members all enjoyed tea, coffee, cake and biscuits.

New members are always welcome. Watch out for details of our next Tayside meeting. Please come along and join us if you would like more information on Sleep Apnoea, advice on masks etc or other topics. Tea/coffee available.


For more information please contact:
Lesley Bagnall – Tayside Representative
Mobile: 0779 355 3606 – email:

Treading a finer line on “The Patient Pathway”


Having attended the British Sleep Society Anniversary Meeting in Edinburgh, SASA were invited by Judy Harris, OSA Project Manager at British Lung Foundation, to attend the Foundation’s OSA conference in Blackpool at the Hilton Hotel, Blackpool on Saturday 1st February 2014. The conference was directed at health care professionals who manage sleep services and commissioners of sleep and respiratory services and was attended by clinicians from all parts of the UK.

The Conference looked at the patient pathway for people with OSA and how this varied in different areas of the UK, examined where they are in terms of national standards and discussed ways to ensure the treatment of OSA remains a priority in the future.

The financial benefits of treating OSA are considerable. The cost of a fatal road traffic accident can be as much as £1.25 million (Department of Transport figures), whereas the cost of treating an OSA patient with CPAP is only £1,300.

Sleep clinics across the UK are all reporting a significant increase in patients being referred. It is predicted that the number of patients being diagnosed with OSA is likely to continue to rise. It is estimated that only 1/5 of those with OSA have been diagnosed so far. OSA is often linked to obesity and obesity trends are still rising.  Increasingly sleep clinics are overloaded and finding it hard to cope with the increased patient numbers.

Professor John Stradling, Professor of Respiratory Medicine, Oxford University, suggested that one solution might be for GPs to take on a greater role, just as they now do, for example, in the treatment of diabetic patients. He outlined several possible models that this greater GP involvement might take. Initial home sleep studies might be done by GPs with results then referred on to a sleep centre. Devices such as Grey Flash or Apnoea Link or other similar home sleep study devices might be used, perhaps by a group of GP surgeries working together in conjunction with their local sleep centre. Some such models have already been trialled in conjunction with the Oxford Sleep Centre.

Initial screening could be carried out by GPs. ESS (The Epworth Sleepiness Scale) is one commonly used method. Another is the STOP BANG screening tool devised by a Canadian anaesthetist .  A third screening method becoming more widely used is the Australian one referred to as: OSA – 50: 

Overweight                         If Yes  Score

men with waist over 40″                  3

women with waist over 35″

Snoring                                       3

Apnoeas                                     3

50 years or older                           2

Professor Stradling also posed the question whether certain groups should be screened for OSA. For example, those with particular conditions such as Type 2 diabetes, diabetic retinopathy or ischaemic heart disease or those who are professional drivers, such as bus, lorry or coach drivers.

Dr Maxine Hardinge from the Oxford Sleep Unit spoke about setting up a “One Stop Shop” for the assessment and diagnosis of OSA. The one stop shop approach had been trialled there in an effort to shorten the patient pathway from initial referral to final diagnosis and treatment. However, they found that having only one appointment was less successful for patients, who felt there was too much information to take in at one time, and they have now moved to a “two stop”system, with a follow up appointment being scheduled for 3 weeks after the initial appointment.

John O’Reilly, Consultant in Sleep and Respiratory Medicine at University Hospital, Aintree described the setting up of a sleep service. The Aintree development was designed to be used as a sleep lab at night and to be used for clinics during the day to make the most effective use of the space available. He also spoke of how cost effective the treatment for OSA is. The costs of treating a patient with PAP therapy are all front loaded, with the cost of CPAP treatment being cost effective after 2 years.

A number of speakers spoke about the management of OSA and the importance of ongoing support. The drop out rates for patients using CPAP vary considerably from centre to centre. It is very important that adequate support is available for new patients in the early stages of using CPAP. The first week of use is an important predictor of long term success. Some centres are now looking at using wireless technology, as this makes day by day monitoring possible, so that intervention can be done early if there are problems such as too many mask leaks or the machine not being used.

One speaker highlighted some of the problems their centre was encountering where patients had arrived from other centres, where ongoing support was not being given. Among the problems encountered were old or ill fitting masks, patients demotivated because of lack of timely support and patients who needed re-titration because of weight gain or weight loss.

Dr David Dawson Bradford described a service being offered by Phillips Respironics for the remote diagnosis of truck drivers.  MOST – management of sleep therapy . Drivers are offered a two nights home sleep study, followed by a clinic appointment where the sleep study is gone through with the patient and OSA and the use of a PAP device is explained.The patient is then fitted for a mask and given an auto-titrating PAP machine. Patients are followed up at 48 hours and then given a phone call at 1 week to go over the data.  There is further data recall at 4 weeks, 3 months and then 6 months,and a follow up clinic appointment at 6 weeks. This level of ongoing patient support should help to reduce the drop out rate for patients using PAP therapy.       

Ongoing support may be improved through the use of modern technology, such as remote monitoring. However, having staff available to assess the information may still present a problem.

Following a break, the Conference delegates broke up into 4 groups to continue  ‘The Patient Pathway’ discussion.

This was followed by a session looking at OSA minimum standards, led by representatives from England, Scotland, Northern Ireland and Wales.

Finally the conference closed with a panel of experts who put forward suggestions as to how to ensure OSA is made a priority within the NHS.   This is one area where the BLF have made great strides in raising awareness with Governments as well as the General Public.

Annual Conference Dundee 2013

Members of the Scottish Association for Sleep Apnoea (SASA) learned at their annual conference on Saturday 21st September 2013 that technology may soon make a significant change to the way the therapy used in the treatment of the breathing-related condition is managed.

The 50 members who attended the event at the West Park Conference Centre in Perth Road, Dundee, were told that a revolutionary electronic system can now make it possible for clinicians to remotely monitor the use of the breathing apparatus that assists patients’ breathing while they are asleep, and intervene rapidly in the event that the patient encounters any issues with the device.

The new system will also enable health care providers to manage more patients without increasing staff overhead costs and to improve personalised care plans and vital statistics monitoring, while reducing the requirement for home and office patient visits.

The conference was assured that the use of such technology was governed by strict legal rules.

News of this development was among topics covered by principal speakers Dr Tom McKay, clinical director, Department of Sleep Medicine, Royal Infirmary of Edinburgh, and Lizzie Hill, from the sleep research unit at Edinburgh.

SASA Chairman Mike Wilson proposed thanks.

Below are pictures of some of the SASA members and guest speakers at the Annual Conference.

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Poster for Ninewells

This is a copy of a Poster which is now on display at the Respiratory/Sleep Clinic at Ninewells Hospital.

Did you know there is an organisation run locally that can help with many of the questions you may have regarding Sleep Apnoea?

The groups are run by people who suffer from the same complaint and are therefore very empathetic to your problems.

Having problems coping with the mask?

Skin irritated by wearing the mask?

Keeping the hose in the most comfortable position for you?

These are problems that we have all experienced and have solutions to most of them.    A brilliant website we know can assist with these and more.  Handy tips for coping on a daily basis.

Why not contact us on the number local to you and find out more?

Meetings held all over Tayside, Perth and Fife and new members are always welcome.

The local contacts are:

Mrs Lesley Bagnall         Phone: 07513 198543   or   email:

Murray Phillips                  Phone: 077869 55564 or email:

SASA is a Scottish Charity:  SCO23352

This is a copy of a compliments slip which is now being distributed at the Respiratory/Sleep Clinic at Ninewells Hospital.

Compliments Slip





SASA is a Scottish Charity:  SCO23352