New Treatments and Advances

Major Breakthroughs In The Treatment Of Sleep Apnea And Related Conditions Now Available At The Regional Neurology And Sleep Medicine Institute

This is one of the reasons that we see so many patients from distant states and even from other countries!

There are three basic causes of serious–even life-threatening–breathing problems during sleep: collapse of the throat, failure to make any effort to breathe, and failure to breathe deeply enough to maintain oxygen levels.

The Regional Neurology And Sleep Medicine Institute is dedicated to ensuring that we remain at the forefront of sleep medicine care. Our Center is one of the few sleep centers to provide treatments for all three of these problems!

  • Adaptive Servoventilation (ASV™), developed by ResMed, now makes it possible to help patients whose central sleep apnea (CSA) will not respond to any other treatment!
    • CSA afflicts roughly half of patients with congestive heart failure and a large percentage of patients with atrial fibrillation.
    • CSA develops in approximately 15% of patients with obstructive sleep apnea who are started on CPAP or bilevel PAP.
    • CSA can render treatments for heart failure ineffective and may also accelerate worsening of heart function.
    • CSA can account for patients’ inability to use CPAP or bilevel PAP for their sleep apnea.
    • ASV tends to be extremely effective–usually normalizing breathing!–and it typically is comfortable and easy to use, because it constantly adapts to the patient’s needs.

The Regional Neurology And Sleep Medicine Institute was one of the first sleep faciliies to begin treating patients with this revolutionary new therapy. We have extensive experience with its use and have treated over one hundred and forty patients with ASV. We regard it as the greatest advance in the treatment of sleep apnea since introduction of CPAP in the mid-1980’s.

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  • Average Volume Assured Pressure Support (AVAPS™), developed by Respironics, is an exciting new technology developed for yet another dangerous and widespread health problem that had always been extremely difficult to treat.
    • Hypoventilation refers to breathing too shallowly which can have two serious consequences, related to the fact that when we inhale, we bring oxygen into our lungs, and when we exhale, we eliminate carbon dioxide, a waste product. These consequences are:
      • Drops in blood oxygen levels.
      • A build-up of carbon dioxide in the body (carbon dioxide retention). Carbon dioxide acts much like a narcotic, reducing one’s drive to breathe–sometimes to dangerous degrees that can even lead to complete cessation of breathing (respiratory arrest).

Causes of hypoventilation include:

        • Severe obesity which restricts the depth of breathing.
        • Restricted breathing due to spine deformities (such as kyphoscoliosis).
        • Weakness of the muscles used in breathing (ex: post-polio syndrome, muscular dystrophies).
        • Chronic lung disease (such as COPD, emphysema).
  • AVAPS™ differs from standard bilevel positive airway pressure (BiPAP™) in that it ensures that the patient will breathe in a targeted tidal volume (the amount of air inhaled into the lungs), as set by the physician, to ensure an adequate depth of breathing. It is now available for home use and is a special feature that is built in to special BiPAP™ machines.

AVAPS™ was just introduced in the United States in December, 2007. The Columbus Community Health Regional Sleep Disorders Center is the first in Columbus to begin using this revolutionary treatment! It is available in all our recording bedrooms and already is making a major difference for patients who previously would have been extemely difficult to treat.

If you have low oxygen levels during sleep, you may have had to use oxygen during the night. Oxygen is usually delivered by a concentrator: a heavy piece of equipment that is an major obstacle to travel and which generates both noise and heat. In some patients, excessive oxygen doses also may reduce breathing drive with worsening elevations of carbon dioxide. AVAPS™ has already eliminated the need for oxygen in some of our patients, and it can represent a safer, more logical and direct solution for low oxygen levels. Furthermore, it is essentially the same size as a BiPAP™ machine, rendering it travel friendly!