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1. Preparation

WHAT IS SLEEP APNOEA?

Sleep apnoea is a disorder that affects your breathing while you are asleep. This condition causes you to stop breathing for short periods of time. An apnoea is the frame of time when the breathing stops and dependent on the severity, can last anywhere from 10 to 90 seconds. Once the brain registers the lack of oxygen, it sends a message to the body that wakes you to begin breathing once again. The degree of severity of your sleep apnoea is based on how often your breathing stops.

  • Mild: 15-20 interruptions per hour
  • Moderate: 30-50 interruptions per hour
  • Severe: over 50 interruptions per hour

sleep-apnoea.gif

There are three types of sleep apnoea and they are:

  • Obstructive sleep apnoea – This type of sleep apnoea is the most common and occurs when the muscles in the back of the throat and the tongue relax causing an obstruction that blocks the airway.
  • Central sleep apnoea – This rare condition is caused by a delay in the transmission signal from the brain that instructs the body to draw a breath.
  • Mixed sleep apnoea – This is a mixture of both obstructive sleep apnoea and central sleep apnoea. Normally it begins as an un-obstructive apnoea and gradually becomes obstructive sleep apnoea. It is not as common as obstructive sleep apnoea but is much more common than central sleep apnoea.

AM I AT RISK?

Sleep apnoea is most common in men of middle age who snore but the elderly, women (especially during menopause) and children are sometimes affected as well. Obesity is the main contributing factor of sleep apnoea but there are also other risks such as:

  • Facial deformity
  • Large tonsils
  • Medication like sleeping pills
  • Nasal congestion
  • Conditions such as diabetes or an under active thyroid
  • A small receding chin

If you are at risk your GP may refer you to a specialist who can then assess you for this risk and refer you for sleep studies if necessary.

HOW DO I CHOOSE A SPECIALIST?

Your GP, or the doctor you first consult, will be able to recommend and refer you to a Physician who can organise for you to be assessed.

You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical specialty has a governing body to which the consultants belong. These are often good organisations to turn to for information about what you can expect from your medical specialist. You can access The Royal Australasia College of Physicians via their website at www.racp.edu.au.

The list of questions below may help you to better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital(s) does a particular doctor operate from, and what are their fees. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website).

To access a list of Physicians who participate in HCF’s Medicover no gap arrangement:

  • Call HCF Member Services on 13 13 34
  • Visit one of HCF’s customer service branches
  • Access HCF’s website at www.hcf.com.au / members / find a health professional / find a doctor

Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment. Some doctors who participate in the HCF medicover no gap arrangement have chosen not to be listed on the HCF website. Therefore you will need to check with your doctor.

WHAT SHOULD I ASK MY SPECIALIST?

  • Make sure you fully understand the test that is planned; do not be afraid to ask. It is your right to know all the relevant information, as this is part of informed clinical consent. Your doctor will ask you to sign a consent form.
  • Apart from what the procedure is about you should also ask about:
    • Preparation
    • Follow up appointments - jot down any questions or concerns you may have so that you can ask your doctor at your next appointment
  • Your medication should be continued as usual because this is a test to monitor your usual night's sleep.To be completely accurate, you should not change anything that you would normally do.

WHERE IS A SLEEP STUDY DONE?

A sleep study is done as an inpatient in a hospital or specialised sleep facility.

HOW LONG IS THE PROCEDURE?

You will be admitted in the evening of the sleep study and monitored overnight.

WHO IS INVOLVED?

The health professionals involved in the procedure are the sleep scientist or registered nurse who will administer the sleep test.

HOW DO I PREPARE FOR A SLEEP STUDY?

Women are required to remove all cosmetics from their faces and men, unless they have a beard, are asked to be clean-shaven.

A replication of your normal night's sleep is required for testing to be accurate, so eating dinner at your regular time and consuming your usual amount of alcohol is recommended.

WHAT DO I TAKE WITH ME TO THE HOSPITAL/SLEEP FACILITY?

  • Do not bring any valuables with you, a wedding band is acceptable.
  • Bring your usual night attire
  • Bring your robe and slippers
  • Bring any toiletries you will require
  • Bring any medication that you would usually take at night and in the morning
  • You may also wish to bring a book if you normally read before going to sleep
  • You may want to bring your own pillow
  • A change of clothes for the next day

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

For your information, the average charges for claims paid for Sleep Apnoea admissions for the financial year 13/14 are provided below:

On Average

Charge Medicare Pays HCF Pays 3 If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement 4 If your doctor USES HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor USES HCF’s No Gap Arrangement
Total Average Hospital Component (accommodation and hospital related services) $525

$0

$525
1 Medical Services Component
Diagnostic Procedures $801 $465 $334 $276 0.3% $0 99.7%
2 Total Average Medical Services $801 $465 $334 $276 0.3% $0 99.7%
Hospital and Medical Services Average for Sleep Apnoea Admissions $1,326 $465 $859 $276 0.3% $0 5 99.7%

Sleep Apnoea_14.GIF

Points to Note:

  • Charges are based on HCF claims for a sample size of 4,772 same day admissions in participating day surgeries or private participating hospitals (day surgeries/private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare items 12203, 12206 and 12209.
  • As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation and hospital related services).

1 These medical services are in-patient services only.


2 The medical charges are based on averages and each episode of care is different, i.e.

you may not have all of these medical services, and/or you may also have other medical

services not indicated here e.g. specialist consultations. Therefore, the total average

medical service charge ($801) differs from the sum of the individual average charges as

shown.


3 Doctors who do not use the HCF no-gap arrangement have a higher average out of

pocket charge, as their charges are higher than those doctors who use the no-gap

arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the

average benefits plus the average out of pocket charge you pay will not equate to the

charge as shown in the table.


4 Doctors’ charges vary so always ask your doctor whether he/she will participate in

HCF’s No Gap Arrangements.


HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the

Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered

under the HCF Medicover No Gap arrangement will receive as full payment for

services provided. This also applies to unregistered providers should they charge within

the schedule of benefit listed. This arrangement ensures that our members incur no out of

pocket expense.


5This percentage indicates the total coverage of hospital and medical services for all

sleep apnoea admissions. The percentages shown for each type of medical service are

much higher as they are calculated for those services only and not the entire admission,

2. Day of procedure

WHAT HAPPENS TO ME AT THE HOSPITAL/SLEEP FACILITY?

When you arrive at the hospital or sleep clinic, the admissions clerk will attend to the paperwork associated with your stay. On admission a nurse will orientate you to your surroundings, ask your medical history, confirm your medication and will ask about any known allergies. The consent for the test is attended to by the doctor.

Once this admission procedure is completed, you will be shown to your sleeping area where a number of sensors called electrodes are placed on your scalp, face, chin, chest and legs. Sensor bands are wrapped around both your chest and abdomen.

The skin, where the sensors are to be placed, requires preparation to ensure that the sensors stay in place when stuck on. Preparation may include wiping the area with an alcohol swab.

Placement and application of the sensors can take up to an hour.

WHAT CAN I EXPECT DURING A SLEEP STUDY?

Once you are asleep, the sleep scientist or registered nurse will observe recordings from an adjacent room. There are a number of different measurements done while you are asleep.

Electroencephalogram (EEG) – From a series of small metal electrodes attached to the head, electrical brain activity is measured. The measurement of brain waves shows whether you are awake or asleep and if you are asleep, the stage of sleep you are in.

Electro-oculogram (EOG) – The electrode that is placed near each eye records eye movement. This recording helps to tell the difference between Rapid Eye Movement (REM) sleep, which is the dream state, from other kinds of sleep. This is an important determination as some people have an increase in sleeping problems while in REM sleep.

Electromyogram (EMG) – Muscle activity is measured through the electrodes placed on the chin and calves. Chin muscle movement helps determine REM sleep and an increase in leg movement helps to diagnose a condition called periodic leg movement disorder which is a condition that disrupts sleep because of periodic movements like jerking or shudders.

Electrocardiogram (ECG) – Electrodes on the upper chest, near each arm, establish whether there are any irregularities in the heartbeat and rhythm during sleep.

Breathing – Thermistors which are heat sensitive devices, are placed in front of the mouth and nose to measure whether or not you are experiencing apnoeas. Breathing effort as well as any interruptions are measured by the loose velcro bands that are placed around the chest and abdomen.

Blood Oxygen Levels – A probe called an oximeter is clipped on to the ear or finger to measure blood oxygen levels.

Body Position – A device that has been placed on the chest records whether you are lying on your side, back or front.

To gain enough information for an accurate assessment, you will need to be monitored for 8 hours.

3. Aftercare

WHAT HAPPENS AFTER A SLEEP STUDY?

In the morning, the sensors and bands will be removed. Unlike the application of the sensors that can take up to an hour, the removal of the sensors only takes about 5 minutes.

Once the sensors are removed, you will be able to go home. A scoring and report of the results of your sleep study will be sent to your referring doctor.

If you are diagnosed with sleep apnoea there are a number of treatment options, dependent on the severity.

Mild sleep apnoea can be treated by a change in your behaviour. This would include losing weight, sleeping on your side or using a mouth device that reduces snoring and keeps the airway open. Your specialist will advise what treatment is best for you.

If you are diagnosed with moderate to severe sleep apnoea, the usual treatment is with Continuous Positive Airway Pressure (CPAP). This is a device that blows air into your nose using a nose mask, keeping the airway open and unobstructed.

There are many different CPAP machines on the market. Ensure you make an informed choice when choosing yours. Some things to consider are: size (especially if you plan on travelling), humidification (some models do not have this feature). Another important consideration is the way the air pressure is delivered; with some machines this can be set at a certain pressure, while others automatically respond to your requirements. You should be referred to a sleep apnoea consultant who can provide you information on your various options and aid you in your decision making. These individuals will be able to help you make an informed decision about which CPAP machine will best suit your needs.

If you are diagnosed with sleep apnoea and are required to sleep with a CPAP machine then you may be admitted for another night in order to monitor and adjust your new machine before taking it home with you.

In some cases there are physical problems that cause the airways to block during sleep. In these cases surgery may be required. These surgeries may include:

  • Removal of tonsils and adenoids
  • Nasal surgery to remove polyps or correction of deviated nasal septum
  • Removal of excess tissue at back of throat
  • Corrective surgery for jaw or hard palate deformity

1. Preparation

WHAT IS SLEEP APNOEA?

Sleep apnoea is a disorder that affects your breathing while you are asleep. This condition causes you to stop breathing for short periods of time. An apnoea is the frame of time when the breathing stops and dependent on the severity, can last anywhere from 10 to 90 seconds. Once the brain registers the lack of oxygen, it sends a message to the body that wakes you to begin breathing once again. The degree of severity of your sleep apnoea is based on how often your breathing stops.

  • Mild: 15-20 interruptions per hour
  • Moderate: 30-50 interruptions per hour
  • Severe: over 50 interruptions per hour

sleep-apnoea.gif

There are three types of sleep apnoea and they are:

  • Obstructive sleep apnoea – This type of sleep apnoea is the most common and occurs when the muscles in the back of the throat and the tongue relax causing an obstruction that blocks the airway.
  • Central sleep apnoea – This rare condition is caused by a delay in the transmission signal from the brain that instructs the body to draw a breath.
  • Mixed sleep apnoea – This is a mixture of both obstructive sleep apnoea and central sleep apnoea. Normally it begins as an un-obstructive apnoea and gradually becomes obstructive sleep apnoea. It is not as common as obstructive sleep apnoea but is much more common than central sleep apnoea.

AM I AT RISK?

Sleep apnoea is most common in men of middle age who snore but the elderly, women (especially during menopause) and children are sometimes affected as well. Obesity is the main contributing factor of sleep apnoea but there are also other risks such as:

  • Facial deformity
  • Large tonsils
  • Medication like sleeping pills
  • Nasal congestion
  • Conditions such as diabetes or an under active thyroid
  • A small receding chin

If you are at risk your GP may refer you to a specialist who can then assess you for this risk and refer you for sleep studies if necessary.

HOW DO I CHOOSE A SPECIALIST?

Your GP, or the doctor you first consult, will be able to recommend and refer your to a Physician who can organise for you to be assessed.

You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical specialty has a governing body to which the consultants belong. These are often good organisations to turn to for information about what you can expect from your medical specialist. You can access The Royal Australasia College of Physicians via their website www.racp.edu.au

The list of questions below may help you to better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital(s) does a particular doctor operate from, and what are their fees. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website).

To access a list of Physicians who participate in HCF’s Medicover no gap arrangement:

  • Call HCF Member Services on 13 13 34
  • Visit one of HCF’s customer service branches
  • Access HCF’s website at www.hcf.com.au / members / find a health professional / find a doctor

Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment. Some doctors who participate in the HCF medicover no gap arrangement have chosen not to be listed on the HCF website. Therefore you will need to check with your doctor.

WHAT SHOULD I ASK MY SPECIALIST?

  • Make sure you fully understand the test that is planned; do not be afraid to ask. It is your right to know all the relevant information, as this is part of informed clinical consent. Your doctor will ask you to sign a consent form.
  • Apart from what the procedure is about you should also ask about:
    • Preparation
    • Follow up appointments - jot down any questions or concerns you may have so that you can ask your doctor at your next appointment
  • Your medication should be continued as usual because this is a test to monitor your usual night's sleep. To be completely accurate, you should not change anything that you would normally do.

WHERE IS A SLEEP STUDY DONE?

A sleep study is done as an inpatient in a hospital or specialised sleep facility.

HOW LONG IS THE PROCEDURE?

You will be admitted in the evening of the sleep study and monitored overnight.

WHO IS INVOLVED?

The health professionals involved in the procedure are the sleep scientist or registered nurse who will administer the sleep test.

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

For your information, the average charges for claims paid for Sleep Apnoea admissions for the financial year 13/14 are provided below:

On Average

Charge Medicare Pays HCF Pays 3 If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement 4 If your doctor USES HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor USES HCF’s No Gap Arrangement
Total Average Hospital Component (accommodation and hospital related services) $525

$0

$525
1 Medical Services Component
Diagnostic Procedures $801 $465 $334 $276 0.3% $0 99.7%
2 Total Average Medical Services $801 $465 $334 $276 0.3% $0 99.7%
Hospital and Medical Services Average for Sleep Apnoea Admissions $1,326 $465 $859 $276 0.3% $0 5 99.7%

Sleep Apnoea_14.GIF

Points to Note:

  • Charges are based on HCF claims for a sample size of 4,772 same day admissions in participating day surgeries or private participating hospitals (day surgeries/private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare items 12203, 12206 and 12209.
  • As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation and hospital related services).

1 These medical services are in-patient services only.


2 The medical charges are based on averages and each episode of care is different, i.e.

you may not have all of these medical services, and/or you may also have other medical

services not indicated here e.g. specialist consultations. Therefore, the total average

medical service charge ($801) differs from the sum of the individual average charges as

shown.


3 Doctors who do not use the HCF no-gap arrangement have a higher average out of

pocket charge, as their charges are higher than those doctors who use the no-gap

arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the

average benefits plus the average out of pocket charge you pay will not equate to the

charge as shown in the table.


4 Doctors’ charges vary so always ask your doctor whether he/she will participate in

HCF’s No Gap Arrangements.


HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the

Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered

under the HCF Medicover No Gap arrangement will receive as full payment for

services provided. This also applies to unregistered providers should they charge within

theschedule of benefit listed. This arrangement ensures that our members incur no out of

pocket expense.


5 This percentage indicates the total coverage of hospital and medical services for all

sleep apnoea admissions. The percentages shown for each type of medical service are

much higher as they are calculated for those services only and not the entire admission,

which includes all medical services and the hospital services. In an admission you may

have one medical service with an out of pocket expense, which then excludes the whole

admission from being fully covered. Hence the significant difference in percentage for

individual types of medical services as compared to the total admission fully covered.

HOW DO I PREPARE FOR A SLEEP STUDY?

Women are required to remove all cosmetics from their faces and men, unless they have a beard, are asked to be clean-shaven.

A replication of your normal night's sleep is required for testing to be accurate, so eating dinner at your regular time and consuming your usual amount of alcohol is recommended.

WHAT DO I TAKE WITH ME TO THE HOSPITAL/SLEEP FACILITY?

  • Do not bring any valuables with you, a wedding band is acceptable.
  • Bring your usual night attire
  • Bring your robe and slippers
  • Bring any toiletries you will require
  • Bring any medication that you would usually take at night and in the morning
  • You may also wish to bring a book if you normally read before going to sleep
  • You may want to bring your own pillow
  • A change of clothes for the next day

2. Day of procedure

WHAT HAPPENS TO ME AT THE HOSPITAL/SLEEP FACILITY?

When you arrive at the hospital or sleep clinic, the admissions clerk will attend to the paperwork associated with your stay. On admission a nurse will orientate you to your surroundings, ask your medical history, confirm your medication and will ask about any known allergies. The consent for the test is attended to by the doctor.

Once this admission procedure is completed, you will be shown to your sleeping area where a number of sensors called electrodes are placed on your scalp, face, chin, chest and legs. Sensor bands are wrapped around both your chest and abdomen.

The skin, where the sensors are to be placed, requires preparation to ensure that the sensors stay in place when stuck on. Preparation may include wiping the area with an alcohol swab.

Placement and application of the sensors can take up to an hour.

WHAT CAN I EXPECT DURING A SLEEP STUDY?

Once you are asleep, the sleep scientist or registered nurse will observe recordings from an adjacent room. There are a number of different measurements done while you are asleep.

Electroencephalogram (EEG) – From a series of small metal electrodes attached to the head, electrical brain activity is measured. The measurement of brain waves shows whether you are awake or asleep and if you are asleep, the stage of sleep you are in.

Electro-oculogram (EOG) – The electrode that is placed near each eye records eye movement. This recording helps to tell the difference between Rapid Eye Movement (REM) sleep, which is the dream state, from other kinds of sleep. This is an important determination as some people have an increase in sleeping problems while in REM sleep.

Electromyogram (EMG) – Muscle activity is measured through the electrodes placed on the chin and calves. Chin muscle movement helps determine REM sleep and an increase in leg movement helps to diagnose a condition called periodic leg movement disorder which is a condition that disrupts sleep because of periodic movements like jerking or shudders.

Electrocardiogram (ECG) – Electrodes on the upper chest, near each arm, establish whether there are any irregularities in the heartbeat and rhythm during sleep.

Breathing – Thermistors which are heat sensitive devices, are placed in front of the mouth and nose to measure whether or not you are experiencing apnoeas. Breathing effort as well as any interruptions are measured by the loose velcro bands that are placed around the chest and abdomen.

Blood Oxygen Levels – A probe called an oximeter is clipped on to the ear or finger to measure blood oxygen levels.

Body Position – A device that has been placed on the chest records whether you are lying on your side, back or front.

To gain enough information for an accurate assessment, you will need to be monitored for 8 hours.

3. Aftercare

WHAT HAPPENS AFTER A SLEEP STUDY?

In the morning, the sensors and bands will be removed. Unlike the application of the sensors that can take up to an hour, the removal of the sensors only takes about 5 minutes.

Once the sensors are removed, you will be able to go home. A scoring and report of the results of your sleep study will be sent to your referring doctor.

If you are diagnosed with sleep apnoea there are a number of treatment options, dependent on the severity.

Mild sleep apnoea can be treated by a change in your behaviour. This would include losing weight, sleeping on your side or using a mouth device that reduces snoring and keeps the airway open. Your specialist will advise what treatment is best for you.

If you are diagnosed with moderate to severe sleep apnoea, the usual treatment is with Continuous Positive Airway Pressure (CPAP). This is a device that blows air into your nose using a nose mask, keeping the airway open and unobstructed.

There are many different CPAP machines on the market. Ensure you make an informed choice when choosing yours. Some things to consider are: size (especially if you plan on travelling), humidification (some models do not have this feature). Another important consideration is the way the air pressure is delivered; with some machines this can be set at a certain pressure, while others automatically respond to your requirements. You should be referred to a sleep apnoea consultant who can provide you information on your various options and aid you in your decision making. These individuals will be able to help you make an informed decision about which CPAP machine will best suit your needs.

If you are diagnosed with sleep apnoea and are required to sleep with a CPAP machine then you may be admitted for another night in order to monitor and adjust your new machine before taking it home with you.

In some cases there are physical problems that cause the airways to block during sleep. In these cases surgery may be required. These surgeries may include:

  • Removal of tonsils and adenoids
  • Nasal surgery to remove polyps or correction of deviated nasal septum
  • Removal of excess tissue at back of throat
  • Corrective surgery for jaw or hard palate deformity
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Disclaimer: Information is provided by HCF in good faith for the convenience of members. It is not an endorsement or recommendation of any form of treatment, nor is it a substitute for medical advice, and you should rely on the advice of your treating doctors in relation to all matters concerning your health. Every effort has been taken to ensure the accuracy of this information, however, HCF takes no responsibility for any injury, loss, damage or other consequence of the use of this information.