All About Telehealth for Sleep Disorders Telehealth allows doctors to care for people virtually over a phone call, text message, or most commonly, video chat. Although some situations require an in-person visit, telehealth is a great option when you can't get to the doctor's office for your sleep disorder. If you're new to telehealth, here's what you need to know. Medicare will cover telehealth visits just like in-person visits, but state Medicaid programs and private insurers vary, so confirm your coverage in advance. With telehealth, even though you're not in the doctor's office, your private health information is still covered by HIPAA, so it will remain confidential and secure. Although your sleep specialist can't give you a physical exam or provide certain therapies via telehealth, they can write prescriptions and offer quality care, especially if you prepare in advance. Before your telehealth appointment:- Review recent entries in your sleep diary if you keep one- List your symptoms, including dates and severity- Note any side effects from your sleep disorder medications or treatments- Ask if there's anything you should do ahead of time, like adjust your diet- Document any new stresses or recent life changes- Track your eating and drinking, noting what, when, and how much you consume-and include caffeine, nicotine, and alcohol- Compile a list of your health conditions and medications, including any vitamins or supplements- Record your vital signs if you own a thermometer, blood pressure monitor, or another device- Charge your computer or phone- Make sure your internet is reliable- Download any telehealth apps your specific provider may require- Find a quiet, private space to conduct the call- Be prepared with pen and paper or a note-taking app Turn to Healthgrades to connect with the right specialist to treat your sleep disorder via telehealth. And share this video to spread the word!

My name is Stacy, and this is my sleep apnea confession. In 2015, I had my first sleep study, and it was discovered that sleep apnea was causing me to wake up 22 times per hour. Though most people don't like the news of a sleep apnea diagnosis, I was really excited to finally have an answer about what was making me so tired and to have a clear path to treatment. It had taken me 15 years of complaining to my doctor about fatigue to finally get a referral to a sleep study. So, I was really happy to finally have answers. What scares me the most about sleep apnea is that so many people have it, but are undiagnosed. And then beyond that, there's lots of people who are diagnosed, but they're refusing treatment because of the stigma around PAP therapy. There's a lot of risks around sleep apnea. It's even beyond sleepiness and snoring. There's a lot of health risks involved, some of which are life threatening. So, that scares me a lot when it comes to sleep apnea. The silver lining of having sleep apnea is that I get to spread the word all around the world about how to get treated and diagnosed. I have found so much purpose in connecting with others who have sleep apnea and sharing my journey with them. I try very hard to set a really good example for people when it comes to CPAP therapy use and being consistent with it. And I've gotten messages from people that say that I have inspired them to stick with CPAP therapy. And for me, that makes the whole journey worth it.

Sleep Apnea By the Numbers Nearly 1 billion adults live with sleep apnea worldwide.22 million people in the United States have sleep apnea.1 - 4% of American children have sleep apnea.60% of people with sleep apnea are obese.30 or more pauses in breathing can occur every hour with sleep apnea.980 Americans die annually in traffic accidents related to sleep apnea.17% of Americans with sleep apnea also have depression.80% of people with sleep apnea go undiagnosed.

Bing: Tiring. Dorren: Terrifying. Susan: Irritating. Bing: Confusing. Dorren: Claustrophobic. Susan: Unpredictable. Bing: It's an exhausting problem to have. I was truck driving. I must've been tired because I pulled over to the side of the road and I parked right behind another truck, but I woke up with my hands on the wheel, and I slammed on my brakes because I thought I was driving. I had no clue. Dorren: When I decided to look into it, I didn't know anything about it. I had never heard of sleep apnea. So I went in for the initial stay at a sleep center. After the first night, the technician said, "You had 72 episodes which were deemed as instances where you actually stopped breathing." Susan: I didn't realize this, but I would sometimes have night terrors. I would suddenly, like, shout in the middle of the night. And I remember one time when my husband and I were first married, he jumped out of bed and grabbed a golf club because he thought somebody was actually in our bedroom because I screamed so loudly. Troy: I always felt somewhat guilty, and I apologized to my family for letting myself get that sick. And then one of the sessions with, I think it was my ENT, I had my wife come in, and he said very clearly, "This isn't your fault. There are structural issues, there are genetic issues, but there are some things that you can do to help it." Susan: The ENT said, "You know, let's start with the CPAP," and at first I was a little terrified by the machine. Antonio: I feel a little depressed about it because I'm dependent on a machine to live, basically. When I sleep I'm on life support, that's how I feel. Dorren: Yeah, and getting adjusted to this new machine. I'm paranoid about my wife and her getting used to the machine, so I'm making adjustments. Troy: Well, a few years ago my daughter is playing doctor using my mask on the cat as if she was a vet. Antonio: Aw. Troy: I didn't know that until I got all the fur in my face that night. But like you, I felt like it was a life sentence, but now I feel like it was a life saver because if I'm not doing that, then I'm going to get sicker. Troy: Let your family know what's going on with you so that they understand the symptoms and see if things are getting worse. Susan: My tip is keeping your unit clean. Just like brushing your teeth and washing your face, it just became a matter of making sure that it was part of my routine. Antonio: Obviously the mask is the biggest part. If you see that it's not going to fit your face well, or you're just uncomfortable with it, try something else. You know, I've had friends who were diagnosed, but they gave up on it, and I'm like, "Why?" And they're like, "No, no, I can't deal with that mask." I'm like, "So what, you're going to trade that for a heart attack?" Susan: Right. Antonio: I mean, that's the end game, that's what's going to happen. Troy: And that's good advice, especially if they've got other risk factors, too. Antonio: Yes. Troy: The device is, like the commercial, it's part of a healthy breakfast. Weight loss, watching what you eat, use your device.

Karen: He was at the point--he fell asleep driving the car down a highway, and we were heading for the medial strip and I am yelling, and it startled him, and he missed the medial strip- Bing: I remember none of this. Karen: Yes, because he had no clue, but it's because he wasn't getting sleep. Karen: It's hard for me to hear him struggle to breathe, not because they are noises, but because of what the result might be and all the things that sleep apnea can lead to, the heart problems and a ton of other things. Susan: Then of course when you have sleep apnea, you're not quiet. So my husband, he's a very light sleeper. He would hear me making my noises in the night, and once he's awake, he's awake for the whole night. Troy: Well my wife puts up the pillow wall, so she is suffering because of my malady. Antonio: It's funny, when we go traveling and I forget the machine, which has happened a couple of times, oof, it's bad. It's bad. Because I sound like a truck downshifting, and it's a nightmare not just for my wife but then it becomes a nightmare for the kids, and cranky kids is not good to have. Susan: I was like Cleopatra, the queen of denial. I really didn't think it was me. I really didn't think I had a problem. I thought it had to do with my husband just being oversensitive or what have you. But he had read an article about sleep apnea and all the things that it can be a sign of. He got very nervous, and he just put his foot down and said, "You really have to go see a doctor." Darren: For me, acknowledging her sanity, as I affectionately call it, I decided to look into it. I didn't know anything about it. I had never heard of sleep apnea. So, the first mask I was the full facial. Karen: Once the machine comes into play, again, there's different struggles there, too--the sounds, the extra noise. Troy: It's funny you say about the noises. The first week I had the mask and machine on, my wife heard a wind sound and went to every window on our floor not realizing that it was me. Darren: For her, it was essentially the trying to make the transition from things that go argh in the night to the new hum from the machine. Antonio: Yeah, it was just a light sound. Even though the machine itself is still somewhat loud, she's gotten used to that. It's become more of like a white sound for her. Karen: The noise was minor compared to all that that I heard before. Bing: I don't get up anymore, do I? Karen: Yes, you stay asleep thankfully. It means I can sleep, too. So I would suggest to your spouses, your partner, keep the communication open, and if you think the machine isn't working right, go back and get a recheck. Sometimes you have to have more than one machine until you get it right, too. You have to try this one or try that one, so it's good to encourage your partner, "If you hear me sounding loud again, let me know. Let me know so that I can go and have that problem solved again and have it re-looked at."

Dr. Elshinawy: It is very dangerous not to treat sleep apnea, especially if someone has severe sleep apnea. Dr. Greenberg: Sleep apnea is a disorder where breathing becomes abnormal during sleep. The main thing that is a big risk from patients with sleep apnea is their daytime sleepiness, which really affects daytime function and can be a real hazard if they're falling asleep during safety-sensitive activities, i.e. driving. Dr. Davis: Sleep apnea is very strongly associated with cardiovascular and cerebrovascular risk, heart attack risk and stroke risk, uncontrolled blood pressure problems, arrhythmias like A-fib in particular. Dr. Greenberg: Other problems associated with sleep apnea have been abnormalities in glucose metabolism and an increase in the risk of diabetes and other metabolic disorders. Dr. Davis: The more severe your apnea is, the more significant that risk is. Dr. Greenberg: CPAP therapy is the mainstay of treatment for most people. Dr. Davis: It stands for continuous positive airway pressure. It's basically using the mechanics of air, it's just pressurized air physically holding open your airway. The other major alternative option is a dental device which basically sort of fits in your mouth, pulls your jaw out a little bit, holds it there, prevents airway collapse that way. That's good for mild sleep apnea, but CPAP is still really the gold standard for it. Dr. Elshinawy: I see a lot of patients who have been previously diagnosed with sleep apnea and not adherent to CPAP, and I find they really were not taught properly what this disorder is, what it does to their body, what it can do to their health in the future. Dr. Davis: I generally tell people, give it your best shot and have an open mind. Not only are we helping your cardiac risk and your stroke risk, we're also, hopefully, one of the goals is to make you feel better, more energy during the day. I always try to have people understand that this isn't just a theoretical risk reduction, this actually can benefit your quality of life.

Dr. Elshinawy: There are two forms of insomnia. There's acute insomnia and there's chronic insomnia. Dr. Greenberg: We're focusing on chronic insomnia, defined as difficulty initiating or maintaining sleep two to three times a week for at least three months. Dr. Davis: So, sleeping pills really are not intended to be used for people with chronic insomnia. The heart of treating someone with insomnia is to change behavior. Dr. Elshinawy: So the best treatment we have now is called cognitive behavioral therapy. Dr. Greenberg: So, what are some of the principles of behavioral therapy? The first is to regularize the sleep-wake schedule, whether it's 6 o'clock in the morning or 9 o'clock in the morning, someone should stick to that on a daily basis. Dr. Elshinawy: We teach the person not to stay in bed much longer than they're expecting to sleep. So, if you're expecting to sleep no more than four hours, you shouldn't be in bed for much longer than four and a half hours. Dr. Elshinawy: A lot of people stay in bed for eight, nine because they feel, "If I do that, I have a better chance of increasing my sleep." And that's actually the opposite of what happens. Dr. Ahmed: Other strategies that we pursue include progressive muscle relaxation, guided imagery, often using meditation tapes. Dr. Davis: It's very important to have a cool environment, a comfortable environment, not eating a lot of carbs right before bed, not eating a lot of spicy food right before bed, not having a lot of alcohol every night. Dr. Elshinawy: Avoid caffeine for at least six hours before bedtime. Dr. Greenberg: The electronic devices should really be put aside. As many people know, the blue light wavelength can actually delay sleep. Dr. Elshinawy: And there's been studies that show people who exercise, and it could mean just walking for 30 minutes a day, they actually will increase their sleep time by 40 minutes a night as long as they're exercising on a consistent basis. Dr. Elshinawy: The number one thing I tell people is you really have to restrict the bedroom to two activities only, and that is sleep and sex. Once you start bringing the bills and the iPad and your lunch trays, your sleep is never going to be normal again. Dr. Davis: And the last thing is probably just to not panic. A lot of people with insomnia tend to catastrophize, which is what the psychologists call it. Dr. Ahmed: They worry about their sleep all day. They go to bed early because they think they need to rest. They spend hours willing themselves to sleep and then they end up in an internal conflict, which only escalates the insomnia. Dr. Davis: But one bad night doesn't have to lead to more of them.

Patricia: Living with insomnia can be absolutely excruciating. Kevin: You are tired all the time. Mino: I'm sorry, I'm having a moment because all I want to do is get to sleep. Patricia: Trying to get a restful night's sleep can be the loneliest feeling in the entire world. Mino: I'm up all night worried about all kinds of things, so I have the anxiety that's keeping me up. Frank: During the day, depending on how the night was, of course, it could be stressful. You get irritable. Mino: I get agitated. I'm yawning all the time. Kevin: It's a nightmare as far as trying to focus and concentrate on things. Patricia: I had a hard time holding a job. My performance was completely affected by the fact that I was ready to fall asleep as soon as I got to my desk. Jo Ann: I mean, I could drink enough coffee, but that's just too much coffee. Then I walk around, I got the jitters. Patricia: From what I've read, people normally fall asleep within about half an hour after getting into bed. With me, it can be anywhere between two to six hours. Frank: I absolutely recommend that you see your doctor. The doctor, for me, was a lifesaver. She recommended I take testosterone, of all things, twice a month. Patricia: My current treatment plan is an as-needed anti-anxiety medication. Other people use it for epilepsy and for panic attacks. Kevin: I have found that walking, especially at night, has helped. Frank: Every morning I go to the gym for about an hour. Kevin: At nighttime, I usually will try to have a little bit of a snack. Patricia: Drop the alcohol, watch out for sugar, any sort of refined flours. Jo Ann: Take a shower, try to relax, do a little yoga, a little meditation. Whatever it is that you have to accomplish, you can accomplish it tomorrow. Patricia: I put on upper astral meditation tapes. Anything that's going to be relaxing. Frank: I kicked my girlfriend out of bed because she snores. Kevin: One of the things that I do a lot also is smile, because that helps me actually to stay awake, and I blink a lot also. But those two things actually help me to be a little more focused. Patricia: I would just like anyone that is diagnosed with insomnia to know that nobody has ever died from it. It's very frustrating. It can be debilitating, but it's not lethal. It will pass, and it's not going to hurt you. It's just really frustrating and inconvenient.

Joe: Living with narcolepsy is exhausting, to say the least. Rodney: It is all-encompassing. I can feel it in my chest, in my head. Joe: Cognitively, it's tough to think through things. Candice: My day-to-day consists of trying to stay up and trying to function and trying to remember. Dr. Davis: Narcolepsy is a neurologic issue where, essentially, you have lost a chemical in the brain that helps stabilize sleep and wake. Candice: I have narcolepsy with cataplexy, so with that, it's hard for me to do a lot of things that I like, like singing and playing handball. Before, I could work two jobs, go to school full-time, and I'd be all right, still take care of my kids. I can never do that right now. Rodney: On a weekend, when I don't have to work, I can get eight to ten hours of sleep and still, the following day, have to take naps every four to five hours. Candice: I do have sleep attacks, and they're horrible. Rodney: Just imagine yourself at the sleepiest you have ever been in your life. Joe: I did have one instance, unfortunately, where I was driving and I fell asleep at the wheel. We were coming back from Florida, my girlfriend and I. I felt myself, this kind of coming over me. I was going to stop at the next rest stop. Next thing I know, I'm in the woods, I'm dodging trees, and my body just somehow woke up. We both, thank God, walked away kind of untouched. Candice: Thanksgiving, I stayed up all night cooking. I went to the supermarket. I fell. I said, "Well, wait, did I just fall asleep?" Rodney: At least in my case, if you push off a sleep attack long enough, if you fight it, my dreams begin to bleed in, and I started to hallucinate. Joe: Then there's also a mental fatigue. With the things that I feel like I should know and have known, I feel like I have to constantly go back and remind myself about. I have noticed myself drinking more coffee in those situations, and that has helped me. Candice: Your brain says, "You should not be sleeping right now," but your body is like, "Stay right here." Rodney: A sleep specialist put me on a very low dosage stimulant. It did work, but it also made my heart rate a little high, and that freaked me out. Joe: I actually tried three different medicines. Each of those medicines - and, unfortunately, it's just something that I've had to deal with - have had side effects. Rodney: I take caffeine pills over the counter. Candice: I've just learned my limitations. I don't do more than I can do. Rodney: I take naps during my break, during my lunch. Candice: I am absolutely nothing without medication. Dr. Davis: One of our goals with finding narcolepsy is just that - to find it early, because their life can really turn around when you find and treat it. Candice: Narcolepsy is not for the weak. You've got to be strong. You've got to be strong. Otherwise, depression will take over. You have to get reacquainted with yourself. You have to come to terms with the new you, love the new you, and live with the new you.