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VA’s ‘Telesleep’ a Breath of Fresh Air

female nurse placing an oxygen mask on a female patient

Perfect Fit — Tricia Harris, a nurse at the Houston VA, shows Marine Corps Veteran Christy Simmons how to use the Positive Airway Pressure machine. Photo by Deborah Williams, Houston VA

by Tom Cramer, VA Staff Writer
Thursday, July 18, 2013

The Michael E. DeBakey VA Medical Center in Houston, Texas is using a new Telehealth technology called ‘Telesleep’ to treat Veterans in rural areas who are suffering from sleep-related breathing disorders.

“Telesleep currently provides Veterans at seven of our community outpatient clinics with faster diagnosis and treatment options for sleep-related breathing disorders such as obstructive sleep apnea,” explained Adam Walmus, director of the medical center. “It’s one more way we’re delivering the right care to our Veterans at the right place, at the right time.”

Breathing Stops

Obstructive sleep apnea is one of the most common types of sleep disorders. It occurs when the upper airway becomes narrow as the upper airway muscles relax naturally during sleep.

“With sleep apnea, breathing stops or becomes very shallow,” said Tricia Harris, a nurse at the Houston VA. “This type of event may happen hundreds of times each night. It reduces oxygen in your blood and causes arousal from sleep. The low oxygen is the main reason for other medical problems like heart disease.”

Harris said a major symptom of obstructive sleep apnea is extremely loud snoring, sometimes so loud that your bed partner finds it intolerable.

“Other indications that you may have sleep apnea are obesity, persistent daytime sleepiness, bouts of waking up out of breath during the night, and frequently waking in the morning with a dry mouth or a headache,” the nurse explained. “A patient with sleep apnea usually wakes up feeling un-refreshed and tired.”

Home Sleep Test May be Best

Harris noted that only home sleep testing or a study conducted in a sleep laboratory can show definitively that sleep apnea is present and determine its severity.

“For many Veterans living in rural areas, participating in a sleep laboratory might not be practical,” the nurse said. “For these Veterans, home sleep testing is often the best way to go.”

St. Hilaire Saint Firmin, a respiratory therapist at the Houston VA, said Veterans who are identified by their primary care physicians as candidates for a sleep study are scheduled for a group diagnostic session at their nearest VA clinic.

“We use video conferencing to connect them with a sleep physician and a health technician here at the medical center,” the therapist said. “Once the diagnostic session concludes, we give each Veteran a home sleep testing kit and train them on how to properly use it. Later, the Veteran returns the device to us; we extract the data from the device and send it to our sleep physician for evaluation and diagnosis.”

Once the physician makes a diagnosis of obstructive sleep apnea, the Veteran returns to the clinic to receive their Positive Airway Pressure machine.

One Size Fits All

“The Veteran uses the machine at night while they’re sleeping,” Saint explained. “It’s basically a nasal or facial mask held in place by Velcro straps around the patient's head. The mask is connected by a tube to a small fan-generated air flow machine about the size of a shoe box. The machine increases air pressure in the throat so that the airway doesn’t collapse when you breathe in.”

Dr. Amir Sharafkhaneh, medical director of the Houston VA’s Sleep Disorder Center, said untreated sleep apnea can lead to a number of serious health problems.

“This condition, if not corrected, is associated with a variety of health problems that might otherwise be avoided if the patient were simply getting enough oxygen during sleep,” the doctor said. “These include high blood pressure, heart failure and other cardiovascular diseases; stroke, memory problems, weight gain, impotence, and headaches.”

Sharafkhaneh said sleep apnea, fortunately, is not that hard to diagnose and treat, even in Veterans living in very rural areas.

“Telesleep allows us to evaluate and treat these Veterans remotely, in the comfort of their own home, in a more timely and efficient manner,” he said. “Being able to provide this service in the Veteran’s home is just another example of taking health care to where the Veteran lives.”