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Thoracic Medicine

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Sleep Medicine

Latest News

Often times when we can’t sleep or we feel tired throughout the day, there are common “quick fixes” which we use to help us fall asleep easier and give us an extra boost in the morning. However, some of these habits can often be detrimental to your sleep health, affecting you not just at night, but throughout the day as well.

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New research has found that the less we sleep in midlife, the faster our brains can decline and lead to cognitive impairment in old age.

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“What is happening in YOUR sleep?!? How can you really know? Ever thought of using a sleep app? There are some misunderstandings to what data is relevant when using sleep apps so understanding the limitations are IMPORTANT. "It is always recommended to follow up with a sleep study to be sure nothing is missed. “

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A diagnosis of obstructive sleep apnoea (OSA) may raise the risk of osteoporosis, particularly among women or older individuals, according to a new study. OSA is a condition that causes brief interruptions in breathing during sleep. If left untreated, OSA can raise the risk for stroke, cardiovascular disease and heart attacks.  New research shows that OSA may also increase the risk of osteoporosis.

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Insomnia predisposes individuals to increased risk of stroke and this association is profound among young adults – up to eight times greater among insomniacs 18 to 34 years old.  The results of a recent study underscore the clinical importance of identifying and treating insomnia.

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Heavy drinking damages the body in many ways. In addition to liver failure, alcoholics are at a much greater risk of developing pneumonia and life threatening acute respiratory distress syndrome (ARDS), for which there is no treatment. Researchers suspect that alcoholics are more susceptible to these lung diseases because the immune system in the lung is no longer strong enough to protect from infection and damage, but, it had been unclear why the immune system in the lung fails.

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Home Oxygen Therapy

What is the aim of oxygen therapy?

The aim of home oxygen therapy is to increase the levels of oxygen in the blood, relax the blood vessels in the lungs and to avoid the long term conditions that chronic low oxygen levels can cause.  Home oxygen therapy has been proven to improve quality of life, general well-being and the longevity of people with Chronic Obstructive Pulmonary Disease (COPD).


Why do I need Home Oxygen?

Oxygen is essential for life.  Sometimes in lung disease, the body has trouble delivering enough oxygen into the blood where it is carried to our organs and tissues.  In these cases, home oxygen can increase the level of oxygen in the blood, improving function of the whole body.


Who uses home oxygen?

In Australia to be eligible for home oxygen therapy funded through the Medical Aid Subsidy Scheme (MASS) you require a thoracic physician review. As part of this assessment you will require an arterial blood gas (ABG) measurement on room air.
Home oxygen therapy is for people who have low levels of oxygen in their blood, due to a lung or heart disease. People who may need oxygen at home include those with chronic obstructive pulmonary disease (COPD), alpha 1 antitrypsin deficiency, pulmonary hypertension, heart failure, severe angina, cystic fibrosis and lung cancer.


How is oxygen provided?

An oxygen concentrator (see image below) is the most common method of providing oxygen.  The air that we breathe is made up of oxygen and nitrogen.  A concentrator is an electronic pump that filters out the nitrogen and supplies oxygen through tubing.  Often electricity costs for running the concentrator can be subsidized.
Oxygen can also be provided via pre-filled cylinders - these are more expensive and need to continually be replaced.  
Supplementary (portable or ambulatory) oxygen therapy (in addition to fixed or domiciliary oxygen therapy) is a necessity for active patients who leave their homes and for daily activities. Although ambulatory oxygen therapy is prescribed for such patients little is known about the effectiveness of long term ambulatory oxygen therapy in such situations.

 

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Will I have to use the oxygen all the time?

border.eclipse_portable_oxygen_concentratorEveryone is different and your doctor will give you a prescription outlining exactly how long and how often you need to use the oxygen.  You will be given a flow-rate that your oxygen will be set to (usually between 1 and 4 Litres per minute) and a recommended number of hours per day during which the oxygen should be used.  It is important that you follow your prescription to get the maximum benefit from having home oxygen.  From time to time, your doctor will assess your oxygen prescription and may change it depending on how you are going.

 Oxygen and Sleep

Some patients with COPD who desaturate and drop their oxygen levels at night may also have associated obstructive sleep apnoea syndrome (OSAS). Risk factors include obesity, thyroid disease, cardiac disease, and diabetes mellitus. OSAS may also have carbon dioxide (CO2) retention which will influence the safe amount of oxygen that will be prescribed.
If suspected of OSAS a diagnostic sleep study is recommended as often oxygen alone is not indicated. Treatment may require continuous positive airway pressure (CPAP) with or without supplemental oxygen.


How do I qualify for the Medical Aid Subsidy Scheme?

When the arterial oxygen tension (PaO2) is 55mmHg or less (or 59mmHg or less when conditions such as cor pulmonale, pulmonary hypertension or polycythaemia are present).

 

  • In remote areas, when arterial blood gas estimations are unavailable, hypoxaemia must be demonstrated by oximetry indicating an oxygen saturation of 85% or less (or 90% or less when conditions such as cor pulmonale, pulmonary hypertension or polycythaemia are present).
  • In all cases, applicants should be on maximum medical treatment. Arterial blood gas estimations (or oximetry measurements in remote areas only), should be obtained after the condition is considered to be stable.
  • The above measurements are required for both the initial application and the first (four month) reapplication. Clinical assessment only (without measurements) is required for subsequent annual reapplications.


For more information on Home Oxygen Therapy see these links:

Australian Prescriber Magazine
Australian Lung Foundation

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