Sleep Disorder Therapies
6 Minute Walk Test
The original purpose of the six-minute walk was to test exercise tolerance in chronic respiratory disease and heart failure. The test has since been used as a performance-based measure of functional exercise capacity in other populations including healthy older adults, people undergoing knee or hip arthroplasty, fibromyalgia, and scleroderma. It has also been used with children. The six-minute walk test (6MWT) measures the distance an individual can walk over a total of six minutes on a hard, flat surface. The goal is for the individual to walk as far as possible in six minutes. The individual is allowed to self-pace and rest as needed as they traverse back and forth along a marked walkway.
Allergic Bronchopulmonary Aspergillosis (ABPA)
Allergic bronchopulmonary aspergillosis (called ABPA for short) is a problem in the lungs that is not very common. It is caused by a severe allergic reaction after being exposed to a type of fungus called Aspergillus.
Bronchial thermoplasty is an innovative, new, non-drug procedure developed for the treatment of severe persistent asthma. Bronchial thermoplasty delivered by the Alair® System uses thermal energy to reduce the muscle associated with airway constriction in asthma patients. Bronchial thermoplasty delivered by the Alair® System is performed under direct visualization through the working channel of a standard flexible bronchoscope that is introduced through a patient’s nose or mouth and into their lungs. The tip of the small-diameter Alair® catheter is expanded to contact the walls of targeted airways reachable by the bronchoscope. Controlled thermal energy then is delivered to the airway walls to reduce the presence of airway smooth muscle that narrows the airways in patients with asthma. Bronchial thermoplasty is performed in a bronchoscopy/ endoscopy suite and takes about an hour to complete. The minimally invasive procedure, like many other flexible endoscopy procedures, is done under moderate sedation. No incision is necessary. Post-procedure, patients typically are observed and monitored for approximately 2-4 hours.
Bronchoscopy is a procedure to look directly at the airways in the lungs using a thin, lighted tube (bronchoscope). The bronchoscope is put in the nose or mouth. It is moved down the throat and windpipe (trachea), and into the airways. A healthcare provider can then see the voice box (larynx), trachea, large airways to the lungs (bronchi), and smaller branches of the bronchi (bronchioles). There are 2 types of bronchoscope: flexible and rigid. Both types come in different widths.
A rigid bronchoscope is a straight tube. It’s only used to view the larger airways. It may be used within the bronchi to remove a large amount of secretions or blood, control bleeding, remove foreign objects, remove diseased tissue (lesions), or do procedures, such as stents and other treatments.
A flexible bronchoscope is used more often. Unlike the rigid scope, it can be moved down into the smaller airways (bronchioles). The flexible bronchoscope may be used to place a breathing tube in the airway to help give oxygen, suction out secretions, take tissue samples (biopsy), or put medicine into the lungs.
Once your lung cancer is diagnosed, staging tells you and your health care provider about the size of your cancer (tumor) and how far it has spread. The stage of your cancer is based on your symptoms, results from tests like a CT scan, and biopsies. A biopsy involves removing a piece of tissue (usually from your lung or lymph node), and looking at it under a microscope.
The stages of lung cancer are listed as I, II, III, and IV for non-small cell lung cancer and “limited” or “extensive” for small cell lung cancer. The higher the number (or when the word “extensive” is used) means the bigger the tumor and/or the more the cancer has spread.
Cardiopulmonary Exercise Testing (CPET)
Cardiopulmonary exercise testing (CPET or CPEX), also referred to as a VO2 (oxygen consumption) test, is a specialized type of stress test or exercise test that measures your exercise ability. Information about the heart and lungs is collected to understand if the body’s response to exercise is normal or abnormal.
Chest CT Scan
A chest CT scan is a more detailed type of chest x-ray. This painless imaging test takes many detailed pictures, called slices, of your lungs and the inside of your chest. Computers can combine these pictures to create three-dimensional (3D) models to help show the size, shape, and position of your lungs and structures in your chest. This imaging test is often done to follow up on abnormal findings from earlier chest x rays. A chest CT scan also can help determine the cause of lung symptoms such as shortness of breath or chest pain, or check to see if you have certain lung problems such as a tumor, excess fluid around the lungs that is known as pleural effusion, pulmonary embolism, emphysema, tuberculosis, and pneumonia.
Chest Tube (Thoracostomy)
Chest tube thoracostomy (thor-ack-ost-oh-me), commonly referred to as “putting in a chest tube”, is a procedure that is done to drain fluid, blood, or air from the space around the lungs. This procedure may be done when a patient has a disease, such as pneumonia or cancer, that causes extra fluid to build up in the space around the lungs (called a pleural effusion).
Diaphragm pacing is a way to help support people who cannot breathe on their own. It can be used in place of a mechanical ventilator at times. It is a treatment option for some people diagnosed with congenital central hypoventilation syndrome (CCHS) as well as those who have suffered a high cervical spinal cord injury.
If your health care provider thinks you may have Pulmonary Hypertension, they will order tests to see if there is a strain on the right side of your heart. Usually, the ﬁrst test they order will be an ultrasound of your heart (echocardiogram). An echocardiogram is a noninvasive (the skin is not pierced) procedure used to assess the heart's function and structures. During the procedure, a transducer (like a microphone) sends out sound waves at a frequency too high to be heard. When the transducer is placed on the chest at certain locations and angles, the sound waves move through the skin and other body tissues to the heart tissues, where the waves bounce or "echo" off of the heart structures. These sound waves are sent to a computer that can create moving images of the heart walls and valves.
An electrocardiogram (EKG) is a test that measures the electrical activity of the heartbeat. With each beat, an electrical impulse (or “wave”) travels through the heart. This wave causes the muscle to squeeze and pump blood from the heart. A normal heartbeat on EKG will show the timing of the top and lower chambers. Electrocardiography is a useful adjunct to other pulmonary tests because it provides information about the right side of the heart and therefore pulmonary disorders such as chronic pulmonary hypertension and pulmonary embolism.
Endobronchial Ultrasound Bronchoscopy Procedure (EBUS)
EBUS (endobronchial ultrasound) bronchoscopy is a procedure used to diagnose different types of lung disorders, including inflammation, infections, or cancer. Performed by a pulmonologist, EBUS bronchoscopy uses a flexible tube that goes through your mouth and into your windpipe and lungs. Similar to, though smaller than, the device used during a colonoscopy, the EBUS scope has a video camera with an ultrasound probe attached to create local images of your lungs and nearby lymph nodes in order to accurately locate and evaluate areas seen on x-rays or scans that need a closer look.
Extracorporeal Membrane Oxygenation (ECMO)
Extracorporeal membrane oxygenation (ECMO) is a life support machine. People who need ECMO have a severe and life-threatening illness that stops their heart or lungs from working properly. For example, ECMO is used during life-threatening conditions such as severe lung damage from infection, or shock after a massive heart attack.
Lung Transplant Evaluation
Lung transplantation is a treatment option for certain patients with advanced lung disease. It is mainly considered after other medical therapies have been exhausted. It is time to consider lung transplantation when your life expectancy is predicted to be only 1 to 2 years without the transplant, or when your lung symptoms have severely limited your quality of life.
Methacholine Challenge Test
A methacholine challenge test is a type of test used to help diagnose asthma. Methacholine is an inhaled drug that causes mild narrowing of the airways in the lungs, like asthma. The test starts with a baseline breathing test (spirometry) to check how well your lungs are working. Progressively larger doses of inhaled methacholine are given by a nebulizer. Spirometry will be performed before and after every dose of inhaled methacholine to measure the amount of airway narrowing. A methacholine challenge test is considered positive if methacholine causes the lung function to drop by 20% or more compared to your baseline. A negative methacholine challenge test nearly rules out a diagnosis of asthma.
A pleurodesis is a procedure done to treat repeated collapsed lungs or fluid build up between the lung and chest wall lining that will not go away. Medicines (doxycycline or talc powder) are put into the space between your lung and chest wall. This causes irritation or swelling between the two layers, helping the lung stick to the wall of the chest. This should stop the buildup of fluid or air in that space and keep the lung inflated.
Pulmonary Artery Catheterization
An arterial catheter is a thin, hollow tube that is placed into an artery (blood vessel) in the wrist, groin, or other location to measure blood pressure more accurately than is possible with a blood pressure cuff. This is often called an “art line” in the intensive care unit (ICU). Measuring blood gases can be very important when a person has a critical illness. Oxygen and carbon dioxide are the important gases exchanged in the lungs and carried by the blood. Oxygen is brought into the body when we breathe in. All of our cells require oxygen to survive. Delivery of oxygen can be affected by problems in the lungs, circulation (movement of blood through the arteries and veins), or blood.
Pulmonary Function Tests (PFT)
Pulmonary function tests (PFT’s) are breathing tests to find out how well you move air in and out of your lungs and how well oxygen enters your bloodstream. The most common PFT’s are spirometry, diffusion studies, and body plethysmography. Sometimes only one test is done, other times all tests will be scheduled on the same day.
Pulse oximetry is a way to measure how much oxygen your blood is carrying. By using a small device called a pulse oximeter, your blood oxygen level can be checked without needing to be stuck with a needle. The blood oxygen level measured with an oximeter is called your oxygen saturation level (abbreviated O2sat or SaO2). This is a percentage of how much oxygen your blood is carrying compared to the maximum it is capable of carrying. Normally, more than 89% of your red blood should be carrying oxygen.
Spirometry is the most common type of pulmonary function or breathing test. This test measures how much air you can breathe in and out of your lungs, as well as how easily and fast you can blow the air out of your lungs. Your doctor may order spirometry if you have wheezing, shortness of breath, or a cough. This can help diagnose problems like asthma and COPD, or can be done to check lung function before a surgery. You may also have spirometry done if you are being treated for a chronic lung disease, such as COPD, asthma, or pulmonary fibrosis, to determine if your disease is improving or worsening and whether your medications or inhalers are working properly.
Thoracentesis (thor-a-sen-tee-sis) is a procedure that is done to remove a sample of fluid from around the lung. The lung is covered with a tissue called the pleura. The inside of the chest is also lined with pleura. The space between these two areas is called the pleural space. This space normally contains just a thin layer of fluid, however, some conditions such as pneumonia, some types of cancer, or congestive heart failure may cause excessive fluid to develop (pleural effusion).
Adaptive Sero-Ventilation (ASV)
While the other PAP machines are used mainly in treating Obstructive Sleep Apnea, an ASV machine is used mainly to treat Central Sleep Apnea. Central Sleep Apnea is different from Obstructive Sleep Apnea in that OSA is an issue of a blocked airway causing a lack of oxygen, where CSA is an issue of the brain not sending the proper signals to the body to continue breathing while sleeping. The key difference in ASV therapy is that it provides support to regular breathing. It uses an algorithm that detects significant reductions or pauses in breathing and intervenes with just enough support to maintain the patient's breathing at 90% of what had been normal prior to decreased breathing.
Automatic Positive Airway Pressure (APAP)
If you are on APAP therapy, your machine will be set to a pressure range (a minimum and maximum pressure). The amount of pressure that you receive at any given moment will be somewhere between those two numbers. For example, if your range is 5-15cmH2o, you could be receiving a pressure as low as 5cmH20 or as high as 15cmH20. These machines are equipped with very specific technology that analyzes your breathing all night long and adjusts the pressure up and down as you need it. The range that is set on your machine was determined during your sleep study. APAP machines are more expensive than CPAP machines.
Bilevel Positive Airway Pressure (BiPAP)
If you are using BiPAP therapy, your machine will not be set to deliver a range of pressures, but it will be set with two separate pressures, one when breathing in, and a different one when breathing out. The higher pressure (IPAP) is delivered during inspiration to keep your airway open, and the lower pressure (EPAP) is delivered when you exhale. Some people who are ordered a very high pressure to relieve their apneas may find it difficult to breathe out against that pressure during CPAP therapy. If you are unable to use CPAP therapy for this reason, BiPAP® therapy may be an option.
CPAP Titration Study
A CPAP titration study is a type of in-lab sleep study used to calibrate continuous positive airway pressure (CPAP) therapy. CPAP is a common treatment used to manage sleep-related breathing disorders including obstructive sleep apnea, central sleep apnea, and hypoventilation and hypoxemia. Once you are diagnosed with one of these disorders, you may need a CPAP study before you can begin treatment.
Body Position Therapy
There are some individuals who only show signs of sleep apnea in certain body positions, especially when sleeping on the back. If you are experiencing sleep apnea, the sleep medicine specialists at Jefferson may recommend positional therapy. This therapy involves positioning your body so that your airway is more likely to remain open while sleeping. For example, sleeping on your side or elevating your back from the waist up by using a foam wedge.
Bright Light Therapy
Light therapy is a treatment used for people who suffer from circadian rhythm sleep disorders. Your body has an internal clock that tells it when it is time to be asleep and when it is time to be awake.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) helps you change actions or thoughts that hurt your ability to sleep well. It helps you develop habits that promote a healthy pattern of sleep. Talk to your doctor or to a sleep specialist to see if one of these methods might improve your sleep.
Continuous positive airway pressure (CPAP)
Continuous positive airway pressure (CPAP) therapy is the frontline treatment for obstructive sleep apnea. CPAP therapy keeps your airway open during the night by gently providing a constant stream of air through a mask you wear while you sleep. This eliminates the breathing pauses caused by sleep apnea, so you will no longer snore or make choking noises in your sleep. You will be able to sleep through the night without your body waking up from a lack of oxygen.
Medications can be used to reduce some sleep-related problems. Each medication targets a specific part of the brain. It is the brain that controls when your body sleeps and when it is awake. This is a complex process that also involves your heart, lungs, and muscles.
Oral Appliance Therapy
Oral appliance therapy is a treatment for snoring and obstructive sleep apnea. It involves wearing a removable oral appliance in your mouth as you sleep. The device fits much like a sports mouth guard or orthodontic retainer. An oral appliance prevents your airway from collapsing by either holding the tongue or supporting the jaw in a forward position. You must be custom fitted for an oral appliance in order for it to be effective. Over-the-counter devices are not recommended as a treatment option for snoring or obstructive sleep apnea.
In-Lab Sleep Study (Polysomnogram)
An in-lab sleep study provides a board-certified sleep medicine physician with the most complete evaluation of your sleep. You will be required to stay overnight at a sleep center, hospital, or a hotel room. An in-lab sleep study, also known as a polysomnogram, records your brain waves, heartbeats, and breathing as you sleep. It also charts your eye movements, limb movements, and oxygen in your blood. This data will help your doctor make a diagnosis and develop a treatment plan.
Take-Home Sleep Study
Home sleep apnea testing provides a board-certified sleep medicine physician with the information he or she needs to diagnose obstructive sleep apnea. It allows you to sleep at home wearing equipment that collects information about how you breathe during sleep. You will usually set up the testing equipment yourself. There are a variety of home sleep apnea testing devices that have different sensors and equipment. These devices measure your breathing and blood oxygen levels. Some also may measure your heart rate or other information about your body.