Remedies for Snoring; don’t be fooled.

According to studies, one in three people of all ages snore and more than ½ of all people over age 60

snores. But alas, there is no one definitive solution to the aggravating problem. Because snoring is such a

pervasive and aggravating problem with no definitive solution there exist literally hundreds of over-the-counter

remedies that make up a billion dollar business. Few if any of those remedies have been scrutinized by objective, scientific study; they may all be rip offs as the following abstract from the Journal, Otolaryngology - Head and Neck Surgery indicates. It summarizes a scientific study of 3 of the most popular snoring remedies – oral lubricating spray, nasal strips that stick to the outside of the nose, and a head positioning pillow. Clearly, more of these studies are needed!

Michaelson PG, Mair EA.

Department of Otolaryngology-Head and Neck Surgery, Wilford Hall USAF Medical Center, San Antonio, TX

78236, USA.

OBJECTIVE: The study goal was to critically evaluate 3 popular noninvasive treatments for snoring: an oral spray lubricant applied before bedtime, a nasal strip designed to maintain nasal valve patency, and a head-positioning pillow. STUDY DESIGN: Prospective, randomized blinded clinical trial of 3 popular noninvasive snore aids using objective acoustic snoring analysis and subjective patient and bed-partner questionnaires in 40 snoring patients. A digital recorder allowed snoring analysis with data collected in the home environment over 1 week.

RESULTS: There is neither objective nor subjective benefit to the use of tested popular noninvasive snore aids. Palatal snoring, palatal loudness, average loudness of snoring, averaged palatal flutter frequency, and respiratory disturbance index did not significantly change when comparing the 3 snoring aids with no treatment. Subjective comments and complications are reviewed as well. CONCLUSION: This is the first prospective comparison trial of popular noninvasive snoring aids. There is no significant objective or subjective snoring improvement in the anti-snoring aids studied compared with the use of no aid.

SIGNIFICANCE: Outcome studies aid in verifying or refuting claims made by popular noninvasive snore aids.




How’s Your Circadian Rhythm Treating You?

How’s Your Circadian Rhythm Treating You?

Monday, September 15, 2014 at 6:37AM
Dr. Weil in Healthy Aging, inflammation, sleep, sleeping

If your sleep schedule and mealtimes are irregular, you can upset the balance of your circadian rhythm, which is responsible for the 24-hour cycle of our physiology. Add poor diet to that and you may risk triggering harmful inflammation in your body, a recent study suggests.

Researchers at Rush University Medical Center looked at the effect of circadian rhythm disruptions in male mice fed two different diets. To alter circadian patterns, investigators reversed the cycles of exposure to light and dark in the test mice. Then they fed some of the mice regular mouse chow, and put the others on a high-fat, high-sugar diet. The combination of the circadian rhythm disruption and the high-fat, high-sugar diet led to higher concentrations of bacteria known to promote inflammation in the digestive systems of that group of mice. No such changes occurred in the mice that stayed on the usual mouse diet despite the same alteration of their circadian rhythm. The researchers concluded that to trigger inflammation a “second hit” (such as poor diet) must be present along with circadian rhythm disruption. They suggest that humans whose circadian rhythms are out of sync with daylight because of shift work or “social jet lag” (a normal schedule during the week but late nights and sleeping late on weekends) might mitigate risks of inflammatory damage by eating and sleeping on a regular schedule, and by taking prebiotics or probiotics to “normalize the effects of circadian rhythm disruption on the intestinal microbiota to reduce the presence of inflammation.”

My take? Almost without exception, wherever I am and whatever I am doing, I go to bed early enough to get eight hours of sleep and wake up at dawn. I could still get my eight hours by retiring later and rising later, but the pattern I follow does more than just give me sufficient sleep - it syncs my own circadian rhythms with those of the sun. I have found that this routine is best for my overall energy and well-being. My colleague, sleep expert Rubin Naiman, Ph.D., tells me that most people are underexposed to darkness by night and get insufficient light by day, particularly in the morning. He adds that most of us spend the bulk of our waking hours indoors in what is relatively dampened light, while healthy levels of light naturally energize us, drawing us outward into the world. Healthy patterns of light exposure also help us maintain normal circadian cycles, Dr. Naiman reports.

It's the Journey Not the Destination
Make each day count, with an outlook that both serene and inspired. Dr. Weil's website, Spontaneous Happiness, has everything you need to get on the path to emotional well-being. From exclusive videos and interactive tools to simple and effective methods that promote well-being, we can help you make each day a little brighter. Learn more - start your 10-day free trial today and save 25% when you join.

Robin N. Voigt et al, “Circadian Disorganization Alters Intestinal Microbiota,” PLOS One DOI: 10.1371/journal.pone.0097500

Article originally appeared on Natural Health Information (

See website for complete article licensing information.



Sleep Hygiene

Sleep hygiene is all about establishing and maintaining good sleep habits. Following these guidelines will lead to good sleep hygiene and will help you optimize your sleep.

  • Avoid caffeine four to six hours before bedtime. Excessive consumption of tea, coffee or cola drinks during the day may disrupt your nighttime sleep.
  • Avoid nicotine near bedtime and during nighttime awakenings.
  • Alcohol at bedtime may actually disrupt rather than help your sleep. Use alcohol in moderation and know that even though alcohol use near bedtime may cause sedation and help you with sleep onset, it may also cause you to awaken later in the night.
  • Don’t go to bed hungry. Eating a light snack near bedtime may help you sleep, but a heavy meal too close to bedtime may interfere with your sleep.
  • Do not exercise before sleep. Avoid strenuous exercise within three to four hours of your bedtime although exercise late in the afternoon can help to deepen your sleep. Exercise is alerting and raises your body temperature. You may want to begin exercising after you sleep instead.
  • Minimize noise, light and excessive temperatures. Try wearing earplugs or use a white noise machine or a fan to block out other noises. Lower the room temperature (a cool temperature improves sleep).
  • Take a warm bath.
  • Don’t activate your brain by looking at a clock or doing other stressful mental activities.
  • Go to bed when sleepy hopefully about the same time every day.
  • Maintain a regular schedule even on weekends and days off. If you can’t get enough sleep, naps as short as 15 minutes can be helpful.

If you have tried some of these tips and you still don’t get enough sleep and you still feel tired, it may be time to seek professional help at Alto Sleep Clinic.



What’s keeping you awake?

If you have trouble going to sleep you may have insomnia. Insomnia is the most common sleep problem and it is recognizable by difficulty falling asleep, staying asleep, having a sense of light and un-refreshing sleep or waking up too early. Transient insomnia usually lasts for a few nights while short-term insomnia last for two to four weeks. These may not require treatment. But for some people insomnia may be chronic lasting for months or years.

 Insomnia is often caused by stress, but other sleep or medical disorders, poor sleep habits, medications, caffeine or even anxiety about falling asleep may cause it. However, if the anxiety that keeps you awake is due to chronic insomnia you need to discover the underlying cause.

Other contributing causes could be noise, extreme temperature change or problems in your sleep schedule such as jet lag or changing shift work. The daytime consequences of insomnia are fatigue, lack of energy, difficulty concentrating, irritability, anxiety, impaired memory and sleepiness.

 Chronic insomnia needs to be diagnosed and underlying medical or psychological problems treated. Like any sleep disorder, treatment of chronic insomnia takes understanding and ruling out a sleep disorder can be an important first step. Help in identifying the cause of insomnia will soon be available at the Forks Community Hospital Sleep Disorders Clinic. Instead of insomnia, perhaps the problem is simply a misperception about your sleep that can be relieved with a sleep study. Some people will sleep most of the night and believe they didn’t sleep at all thus causing a degree of anxiety. Seeing the data from an all night sleep recording that shows normal sleep can help relieve that anxiety. There are specific and effective relaxation techniques that can reduce anxiety and body tension and if discovered, other sleep disorders can be treated if they are the cause of your insomnia.






Frequently asked questions about Sleep Apnea

Remember, diagnosing Obstructive Sleep Apnea (OSA) starts with your physician.

Q: What is sleep apnea?

A: The most common type of sleep disordered breathing, sleep apnea is a serious and potentially life-threatening condition that is far more common than generally understood. First widely recognized in 1965, sleep apnea is a breathing disorder characterized by interruptions of breathing during sleep, usually accompanied by loud snoring. It owes its name to a Greek word, apnea, meaning, "want of breath." There are two types of sleep apnea: central and obstructive. Central sleep apnea occurs when the brain fails to send the appropriate signals to the breathing muscles to initiate respirations. Obstructive sleep apnea (OSA), which is far more common, occurs when air cannot flow into or out of the person's nose or mouth despite respiratory efforts due to collapse and blockage of the airways. Mixed sleep apnea is a combination of the two.

For people experiencing OSA, the number of involuntary breathing pauses or "apneic events" in a given night may be as high as 20 to 60 or more per hour, each lasting 10 seconds or longer. While these breathing pauses usually are accompanied by snoring, not everyone who snores has this condition. The frequent interruption of restorative sleep often leads to excessive daytime sleepiness and may be associated with an early morning headache.

Q: Who gets sleep apnea?

A: Sleep apnea occurs in all age groups and both sexes but is most common among middle-aged men. It has been estimated that as many as 20 million Americans have sleep apnea. Published reports claim that 24 percent of middle-aged men and 9 percent of middle-aged women have sleep apnea, along with excessive daytime sleepiness, while other studies report that 9 percent of the general population has OSA. Less than 5 percent of sleep apnea sufferers have been diagnosed and treated. People most likely to have or develop sleep apnea include those who snore loudly, are overweight, have high blood pressure, or have some physical abnormality in the nose, throat, or other parts of the upper airway.

Q: What causes sleep apnea?

A: Collapse and blockage of the airway causes the interruptions in breathing during sleep. Apnea usually occurs when the throat muscles and tongue relax during sleep and partially block the opening of the airway. When the muscles of the base of the tongue, the soft palate and the uvula (the small fleshy tissue hanging from the center of the back of the throat) relax and sag, the airway becomes blocked, making breathing labored and noisy and even stopping it entirely.

Obesity aggravates the narrowing of the airway and causes other changes which intensify OSA. With a narrowed airway, air cannot easily flow into or out of the nose or mouth despite attempts to breathe. The results are heavy snoring, cessation of breathing for short periods, and frequent arousals that reduce the amount of time spend in the deepest, most restful stages of sleep. Ingestion of alcohol and sleeping pills also increases the frequency and duration of apneas.

Q: What are the implications of sleep apnea?

A: Apnea patients often suffer from excessive daytime sleepiness, with consequences such as impaired functioning, depression, memory and judgment problems, resulting in a statistically higher involvement in traffic accidents. According to the National Highway Traffic Safety Administration, people who are asleep at the wheel cause approximately 56,000 police-reported automobile crashes per year.

Sleep apnea has been shown to cause high blood pressure and may be associated with irregular heartbeat, heart attack and stroke, each a potentially life-threatening condition. Every apneac event produces increases in systemic and pulmonary artery pressure. According to a recent study by the American College of Cardiology, people who snore regularly are more at risk of developing cardiovascular disease than those who do not snore. Another recent study reported in the New England Journal of Medicine found that people who experience apneic events during sleep are up to three times more likely to develop high blood pressure, with the increased risk proportional to the number of apneic events per night.

Q: What are the signs of sleep apnea?

A: The main symptoms of sleep apnea are chronic, loud snoring, gasping or choking episodes during sleep and excessive daytime sleepiness (EDS). The latter can result in cognitive difficulties, irritability, mood changes, anxiety or depression. Another warning sign is early onset of high blood pressure (hypertension). Possible predictors of OSA are obesity, a thick neck, family history, or anatomic abnormalities in the upper airway or facial structure. Age, male gender, smoking and use of alcohol or sedatives also have been correlated to an increased risk of OSA.

Q: How is normal breathing restored after an apnea episode?

A: During the apneic event,. the increased airway resistance is sensed by the brain and triggers an arousal out of deep sleep. With each arousal, a signal is sent from the brain to the upper airway muscles to open the airway; and breathing is resumed, often with a loud snort or gasp. Frequent arousals, although necessary for breathing to restart, prevent the patient from getting enough restorative sleep.

Q: When should sleep apnea be suspected?

A: Bed partners or family members are often the first to suspect that something is wrong, usually from their heavy snoring and apparent struggle to breathe. Coworkers or friends of the sleep apnea sufferer may notice that the individual falls asleep during the day at inappropriate times, such as while driving a car, working or talking. The patient may not be aware of the underlying condition, but it is important that the person see a doctor for evaluation of the sleep problem.

Q: How is sleep apnea diagnosed?

A: In addition to the primary care physician, ear, nose and throat (ENT) doctors, pulmonologists, neurologists, or other physicians with specialty training in sleep disorders may be involved in making a definitive diagnosis and initiating treatment. Diagnosis of sleep apnea is not simple because there can be many different reasons for disturbed sleep. Several tests are available for evaluating a person for sleep apnea.

Polysomnography is a laboratory procedure that records a variety of body functions during sleep, such as the electrical activity of the brain, eye movement, muscle activity, heart rate, respiratory effort, air flow, and blood oxygen levels. These tests are used both to diagnose sleep apnea and to determine its severity.

Diagnostic tests usually are performed in a sleep disorders center, but new technology now allows some sleep studies to be conducted in the patient's home.

The SSI Web site will give physicians secure access to patient data and enable doctors to track outcomes, build a personal Web site and perform a number of other functions to help build the practice and improve patient care.

Q: How is sleep apnea treated?

A: The specific therapy for sleep apnea is tailored to the individual patient based on medical history, physical examination, and the results of a sleep study. There are currently no effective pharmacological agents available to treat OSA..

Behavioral changes may be all that is needed in mild cases of sleep apnea, including avoidance of alcohol, tobacco, and sleeping pills, which make the airway more likely to collapse during sleep and prolong the apneic periods.. Even a 10 percent weight loss can reduce the number of apneic events for most overweight patients. In some patients with mild sleep apnea, breathing pauses occur only when they sleep on their backs. In such cases, use of pillows and other devices that help them sleep in a side position is often helpful.

Physical or mechanical therapy procedures include nasal continuous positive airway pressure (CPAP), in which the patient wears a mask over the nose during sleep, and air pressure from a pump prevents airway collapse. The air pressure is adjusted so that it is just enough to prevent the throat from collapsing during sleep. Dental appliances that reposition the lower jaw and the tongue have been helpful to some patients with mild sleep apnea or who snore but do not have apnea.

Surgery helps many patients with sleep apnea. Some of the more common procedures include removal of adenoids and tonsils (especially in children), nasal polyps or other growths or tissue in the airway and correction of structural deformities.

There are relatively new procedures that use radio waves to reduce the size of some airway structures, such as the palate and the back of the tongue. Uvulopalatopharyngoplasty (UPPP) and laser-assisted uvulopalatoplasty (LAUP) are other procedures used to remove excess tissue at the back of the throat (tonsils, uvula, and part of the soft palate). Both procedures may decrease or eliminate snoring but not eliminate sleep apnea itself. In severe, life-threatening cases, a tracheostomy may be performed, which involves creating a small hole in the windpipe and inserting a tube into the opening to create an artificial airway. Finally, surgical procedures to treat obesity are sometimes recommended for sleep apnea patients who are morbidly obese.

Q: How large is the market for diagnosing and treating sleep apnea?

A: Sleep disorders represent a growing area of opportunity because there are so many unmet needs in both diagnosis and treatment, according to a survey published by Decision Resources, Inc., a subsidiary of Arthur D. Little, Inc. An estimated 40 million Americans who snore chronically are candidates for a sleep apnea test. Healthcare costs for sleep apnea have been estimated at more than $15 billion. Awareness among physicians about the potentially serious outcomes of OSA has increased over the last several years, however there is still considerable underdiagnosis of sleep apnea.





Do you snore?

Do you snore? Is someone's snoring keeping you up at night? If so, you are not alone. 40 million Americans suffer from some form of sleep-disordered breathing. Obstructive Sleep Apnea (OSA) is the most common form of sleep-disordered breathing and affects an estimated 18 million people in the United States: 2% of middle-aged women and 4% of middle-aged men. The vast majority of patients are undiagnosed.

If left untreated, OSA can have serious and potentially life-threatening complications, including heart disease, high blood pressure, stroke, depression, impaired cognitive performance and increased driving accident rates.

If you or someone you care about may have sleep apnea, see a sleep expert doctor. Once properly diagnosed, OSA can be effectively treated. Your doctor may recommend a sleep study to measure certain patterns during sleep, such as breathing and heart rate.

Most sleep studies are performed overnight in a Sleep Laboratory or Clinic or patient can take a Home Study device home.

If you need any sleep testings or have any questions, please come visit us at 305 South Drive, Suite 4, conveniently located across El Camino Hospital.

Or call us at 650.967.8787



Excessive Daytime Sleepiness

 Excessive daytime sleepiness (EDS) is the most common complaint evaluated by sleep-disorder specialists. While sleep apnea is the most common cause of EDS there are a number of other conditions that may cause it. To understand and treat EDS, it’s necessary to know the patient’s medical history and to explore relevant symptoms before diagnosing sleep apnea as the cause. For example, congestive heart failure is commonly associated with sleep apnea and patients with renal failure may experience restless leg movement. Some medications can also cause daytime sleepiness. 

Among the possible causes of EDS are upper airway resistance, narcolepsy, depression, restless leg syndrome, withdrawal from stimulants, insufficient sleep, drug dependence and abuse, medication side effects, brain tumors and forms of hypersomnia (over sleeping at night).

A good sleep history is needed to diagnose EDS and that can include a sleep study, information about the patient’s sleep habits from his/her bed partner and a medical history. Determining whether a sleep disorder or if just inadequate sleep causing EDS is a necessary step to solving the problem. The patient is asked about which activities are compromised by decreased alertness. Recording the normal bedtime, wake time and average hours of sleep help determine whether the patient has a sleep problem or is just trying to get by on inadequate sleep. 

Questioning a patient’s bed partner is helpful in evaluating a patient with EDS. A history of apnea or leg jerks can aid the diagnosis. The age at onset of symptoms also provides a clue to the disorder. Apnea typically occurs in middle aged or older patients while narcolepsy usually starts in late adolescence or the 20s.

The care and understanding needed to find the cause of EDS or other sleep disorder will be available at the Alto Sleep Clinic.




Detecting Sleep Apnea

Its All About Sleep

One of the most common of the sleep disorders is “sleep apnea,” an interruption of breathing during sleep consisting of brief periods during the night when breathing stops, accompanied by loud snoring.  People with sleep apnea do not get enough oxygen during sleep causing them to wake up briefly during the night to breathe. Usually there is no memory of these awakenings.

 The most common form is “obstructive sleep apnea” usually caused by an obstruction in the throat that can be caused by several factors including excess weight, large tonsils, snoring, and alcohol consumption before sleep. It is a recurrent interruption in breathing that may cause awakenings that can disturb your sleep. In severe cases it may lead to dangerous sleepiness during the day.

 Sleep apnea results from sleep-related muscle relaxation in the upper airway causing a decrease or blockage of air for brief periods. Undiagnosed obstructive sleep apnea can be a life-threatening condition that may lead to heart attacks, strokes, impotence, high blood pressures or other conditions.


Just because you or your partner snores, doesn’t mean they are suffering from sleep apnea. Primary snoring has several variations with one consistent thread. There is no apnea (cessation of breathing) and you wake up refreshed with no evidence of insomnia or other sleep disorders.

 Diagnosing and treatment of sleep apnea takes understanding.  A diagnosis of sleep apnea is usually done through a painless sleep test called polysomnography (poly-som-no-graphy) conducted in a sleep clinic such as the one at AltoSleep Clinic. These tests are usually covered by insurance.

 Mild sleep apnea can be treated with behavioral changes such as sleeping on your side and losing weight. Moderate to severe apnea is usually treated with a CPAP (continuous positive airway pressure) machine that blows air into your nose and/or mouth through a mask keeping your airway unobstructed.




How to Get Kids to Sleep More


      By Ashley Merryman

Asking sleep experts for advice on how to put children to bed often feels like an exercise in futility. The standard tips are banal and predictable: avoid caffeine; remove the TV from their bedroom; don’t sleep on a full stomach; put up dark blinds. You have the feeling the experts are holding out on us—there has to be something more. And there is. Here’s the stuff they’d love to tell you, if they weren’t afraid of overwhelming you with science.

Can a Lack of Sleep Hurt Your Child's Cognitive Skills?

• Ever wonder why most people sleep better when their bedrooms are cool? It’s because the circadian rhythm system that helps regulate sleep cycles is not just light sensitive, it’s temperature sensitive. Anything above a neutral air temperature both slows the body’s initiation of sleep and changes sleep patterns—a hotter room means an increase in non-REM sleep.

• 77 percent of children use television as part of their pre-bedtime routine. Sitting still and vegging out for half an hour should, theoretically, help a child unwind, as long as they’re not watching a show that excites them too much. However, the brightness of the screen undermines the theory. The light from a television or computer can delay both the necessary drop in core body temperature and melatonin production—and thus delaying sleep onset—by two hours.

• We’re all familiar with the agony of being super exhausted, yet not being able to fall asleep for hours. What gives? It’s because after just a few days of shortened sleep, the brain starts making extra stress hormone Cortisol. It takes six times as long for this stress hormone to drop to a low-enough level that sleep is possible.

• In one study of 170 children, those in white-collar families tended to be in bed later and get up earlier than those in working-class families. Yet they actually got more actual sleep. How is that possible? It’s because their bedtimes and wake-times were more consistent; they stuck to their routine. This made their sleep more efficient—they rolled around in bed far less.

• Inconsistent bedtimes are, for all practical purposes, homemade jet lag—the de-synchronization of the two systems that regulate sleep, the circadian rhythm and the homeostatic pressure system. Staying up three hours later on weekends is equivalent to flying across three time zones every weekend.

• With children averaging three hours of television per day, it’s hard to make the case children are universally overscheduled. But the most driven children are the most overscheduled—and the most sleep deprived. In some ways, these busy overachievers are those who concern the experts the most. According to University of Minnesota’s Dr. Kyla Wahlstrom, a motivated student can sacrifice sleep to maintain high GPAs, but she may pay for that success with higher levels of depression and stress. Teen boys who have a high number of extracurriculars are significantly more likely to be involved in a fall-asleep car crash. And those with part-time jobs both sleep less and have lower grades.

• For the majority of kids, rather than thinking it’s a choice between sleep and activities, the opposite is true: Students who sleep more are involved in more afterschool activities—with no detriment to their grades. They have the energy to be involved. Schools that have delayed start times have seen their students sleep more and increase their participation in sports and extracurricular.

• Naps are not quite the salve we imagine. They appease the homeostatic pressure system, but not the circadian. You wake up feeling better—a two-hour nap is equivalent to 150 mg of caffeine—but naps do nothing to repair diminished cognitive functioning. The intellect is just as dulled after the nap as before. Kindergartners who take long naps, for instance, do worse on puzzle-solving.

• 16 percent of kids snore a few times a week. As recently as 2002, the American Academy of Pediatrics opined that children’s snoring was a benign condition not warranting treatment. Just five years later, researchers now caution that kids’ snoring is not like adult snoring at all—even a little snoring is a major cause for concern, because their developing brains can be deprived of oxygen.

• Common sleep disorders such as nightmares, restless leg syndrome, and frequent night waking can have a startlingly negative impact on children’s development—from using drugs at 14 to having clinical-level anxiety as adults. Research by University of Michigan’s Dr. Ronald Chervin indicates as many as 25 percent of kids diagnosed with ADHD have an underlying sleep disorder causing their symptoms. If treated for their sleep disorder, the ADHD would magically disappear. Despite the risks posed by sleep disturbance, the number of children treated for them is “vanishingly small.” Parents should consult a qualified sleep specialist—few pediatricians have expertise with sleep problems. Waiting to see if a child grows out of a sleep problem isn’t the answer.




12 helpful tips for using CPAP

  1. Begin using your CPAP for short periods of time during the day while you watch TV or read.
  2. Use the "ramp" setting on your unit so the air pressure increases slowly to the proper level.
  3. Use CPAP every night and for every nap. Using it less often reduces the health benefits and makes it harder for your body to get used to it.
  4. Newer CPAP models are virtually silent; however, if you find the sound of your CPAP machine to be bothersome, place the unit under your bed to dampen the sound.
  5. Make small adjustments to your mask, tubing, straps and headgear until you get the right fit.
  6. Use a saline nasal spray to ease mild nasal congestion.
  7. Take a nasal decongestant to relieve more severe nasal or sinus congestion.
  8. Use a heated humidifier that fits your CPAP model to enhance your breathing comfort.
  9. Try a system that uses nasal pillows if traditional masks give you problems.
  10. Clean your mask, tubing and headgear once a week.
  11. Regularly check and replace the filters for your CPAP unit and humidifier.
  12. Work closely with your sleep doctor and your CPAP supplier to make sure that you have the machine, mask and air pressure setting that works best for you.




Replacing CPAP machines

Unique therapy for women

The AirSense 10 AutoSet™ for Her is the first sleep apnea machine designed to provide female-specific therapy. Combining this revolutionary new machine with a "for Her" version of one of our AirFit™ masks gives female patients a comprehensive setup tailored for women. A new beginning in therapy choices The AirSense™ 10 series of CPAP and APAP machines and the AirCurve™ 10 (bilevel) series feature built-in humidification and built-in wireless – no module or SD card is needed. These connected machines make troubleshooting easier and you can even change patient settings on them remotely using AirView™, ResMed’s online platform.

Helping patients replace their current CPAP machines

With the recent launch of ResMed Air Solutions, right now is a great time for patients who require a replacement CPAP machine or qualify for a new one. ResMed Air Solutions provides an out-of-the-box, completely seamless connection between you and your patients throughout the treatment journey.

See the Medicare Replacement Guidelines on page 2 for more details on which patients may qualify.

Find out more at

More than five years

The replacement of an item past the five-year lifetime will be considered in cases of irreparable wear if the item has been in continuous use by the patient, on either a rental or purchase basis, for the equipment’s useful lifetime.

• Irreparable wear:

– Irreparable wear refers to deterioration sustained from day-to-day usage over time and a specific event cannot be identified.

– In cases involving irreparable wear, the Reasonable Useful Lifetime (RUL) of the equipment is taken into consideration, and in no case can it be less than five years old.

– Computation of the useful lifetime is based on when the equipment is delivered to the patient, not the age of the equipment.

– A physician’s written order is needed to reaffirm the medical necessity of the item.

• If a PAP machine is replaced following the five-year RUL, there must be a face-to-face evaluation by the treating physician documenting that the patient continues to use and benefit from the PAP machine. There is no requirement for a new sleep test or trial period.


  • Repair and Replacement Sources:
  • CMS/Pub. 100-02. Transmittal 30. February 18, 2005
  • CMS/Pub. 100-02. Transmittal 582. October 28, 2009
  • CMS IOM, Publication 100-4, Chapter 20,“Supplier Replacement of Beneficiary-owned Capped Rental Equipment Based upon Accumulated Repair Costs” email notification, DME MAC Listserve, June 8, 2012
  • Medicare Benefit Policy Manual, 100-02, Chapter 15, Section 100.2 Supplier Manual, Chapter 5 CMS, “PAP Devices for the Treatment of OSA (L171),” U.S. Department of Health and Human Services


Distributed by ResMed Corp, 9001 Spectrum Center Boulevard, San Diego, CA 92123 USA +1 858 836 5000 or 1 800 424 0737 (toll free). See for other ResMed locations worldwide. AirCurve, AirFit,

AirSense, AirView and AutoSet are trademarks and/or registered trademarks of the ResMed family of companies. Specifications may change without notice. © 2014 ResMed. 1018332/1 2014-11

Medicare Replacement Guidelines