We've covered the benefits of exercise for improving the quality of your sleep and how to balance sleep and exercise (click here).

In this post we'll cover the importance of sleep for athletes at all levels, including recent scientific studies that look at the benefits of sleep for recovery after exercise.

Telemedicine was a hot topic at this year's Sleep conference, a joint meeting of the American Academy of Sleep Medicine and the Sleep Research Society, in Denver, Colorado.

Telemedicine has been embraced by primary care physicians in rural areas who struggle to arrange for specialist consultations for their patients who have limited access due to the cost or convenience of traveling to the major cities where these specialists usually reside.

If telemedicine can increase access to specialists, can it help the millions of undiagnosed Americans suffering with sleep apnea and other sleep disorders?

I talk to many people I encounter in my day-to-day activities about sleep apnea. Recently, I went for my routine eye check and my opthamolgist told me that he can diagnose sleep apnea too!

Most often, he has discovered sleep apnea when one of his patients is sedated for surgery, but less often he sees an eye disorder that is almost always associated with sleep apnea, called floppy eye syndrome.

CPAP is the only treatment that is 100% effective for treating obstructive sleep apnea, but a lot of patients struggle with using the device properly and using it every night.

CPAP works by blowing air into the air way to keep the airway from closing at night (this closure is called an apnea, learn more about obstructive sleep apnea here). CPAP therapy consists of a flow generation device, called the PAP machine, or blower, tubing that delivers the air to your airway and a mask that is strapped to your face at night to allow the pressurized air to flow into your airway and your exhalation to come out.

While many people have no difficulty using CPAP and report the best sleep of their lives in the first weeks after they start therapy, this isn't the case for everyone. In this post we cover the top side effects of PAP therapy (any device- CPAP, APAP or bi-level, read about the difference between these devices here) and how you can reduce or even avoid them.

While CPAP (continuous positive airway pressure) therapy is the gold-standard therapy for obstructive sleep apnea, we know that it isn't easy. Barriers to compliance with CPAP therapy include the discomfort of sleeping while wearing a mask, having air blown through your airway all night, the inconvenience of traveling with a CPAP machine and the cost of the machine and replacement supplies. While CPAP is the only therapy that is 100% effective (when used) for sleep apnea, many sleep apnea sufferers search for alternatives (we cover a few here). In this blog post we'll review an interesting option called hypoglossal nerve stimulation therapy (HGNS).

In a new study released in the Journal of Clinical Endocrinology and Metabolism, researchers found that sleep duration is associated with insulin sensitivity and beta cell function (glucose tolerance) in healthy men.

While the researchers state the that evidence is circumstantial and that this study did not show cause and effect, recent studies have shown similar decreases. More than 29 million Americans have diabetes. During the last 50 years, the average self-reported sleep duration per person has decreased by 1.5 to 2 hours and the prevalence of diabetes has doubled in the same time period, according the this study's primary author, Femke Rutters, PhD, of The Netherlands. 

Many people suffering with sleep disorders are wary of sleep testing because of the inconvenience (discomfort) of spending the night in a sleep center. In-center testing can also be cost prohibitive, especially with the rise in insurance plan co-pays and high deductibles.  

Fortunately, HST—home sleep apnea testing—is providing an increasingly convenient and comfortable alternative to sleeping in a sleep center.

What is the difference between in-center and at-home sleep testing?

1. You don't have health insurance.

This is a no-brainer. If you don't have health insurance, but have sleep apnea, you will need to pay cash for your machine and supplies. 

If you're having a hard time making ends meet, check out the organizations listed in this post that offer free or low-cost CPAP and supplies.

2. You have a high deductible health plan.

Many Americans now have higher deductibles to meet before their health insurance benefits kick in (check out our guide for understanding your health insurance here). While we understand that having a higher deductible usually means lower monthly premiums and that some benefits, like preventative care, are covered before you meet your deductible, almost all plans require you meet your entire individual or family deductible before CPAP and supplies, or sleep studies, are covered. Especially at the beginning of the year, this can mean paying entirely out of pocket for your new CPAP and supplies.

Even if you have insurance, you may prefer to shop online and pay cash for CPAP and supplies. While most online suppliers will not bill your health insurance (most of them aren't contracted with any insurances at all) some will and many will provide you with a list of codes so that you can submit the bill to your insurance. While you won't receive anything back from your insurance, you will receive "credit" towards your deductible. Especially if you or another family members expects to use your insurance throughout the year, you want to make sure every dollar you spend out of pocket is counted towards your deductible (learn about in-network vs. out-of-network deductibles and coverage differences here).

You should also consider using your HSA (health savings account) or FSA (flexible spending account) funds to pay for CPAP and supplies online. Save your receipts!

Like iPhones, CPAP machines have changed a lot over the past few years. The latest models are even starting to look like Apple devices. These changes in the form and function of CPAPs serve very important purposes.

(1) If a CPAP machine is more attractive and user-friendly, someone diagnosed with sleep apnea is more likely to use it.

• They're quieter and smaller.
• It's easier to turn on and off (many turn on automatically once you put on the mask and start breathing).

(2) If the technology allows for wireless transmission of usage data, the CPAP supplier (for some of you that might be us, learn more about "smart machines" here) doesn't have to hassle patients for smartcard download. When compliance data is required by the insurance company, the provider can easily access the data (here's a post where we talk about our process).

• Your CPAP supplier can help you troubleshoot when you're having issues with therapy. They can even adjust the settings remotely on some machines.
• You have access to your usage data, either online or on an app. Knowledge is power.
• If/when your insurance company requires proof of usage for your device rental or purchase or when it's time for new supplies, your supplier can easily obatin the info and send it directly to the insurance company. No need to mess with shipping cards back and forth.

(3) New devices are better at treating sleep apnea. That's a big deal.

So, now that you want a new machine, you're going to ask, "How do I get a new CPAP?"

Our flagship West Los Angeles sleep lab opens soon- Stay tuned! Beautiful! Quiet! Roomy! https://t.co/mIqETR19qV pic.twitter.com/sgGsMppkg6

— Kermit Newman (@SleepDrCEO) June 18, 2016

Due to increasing education and awareness of sleep apnea and it's consequences, we've seen an increase in referrals for sleep studies this past year. While some patients are qualifying for at-home sleep apnea testing (HST), many patients still require an overnight stay in a sleep center. As a result, we are opening two new sleep centers this month in West Los Angeles and Los Alamitos.

Sleep apnea is a serious disease with serious consequences, like heart disease and diabetes. We know that people with untreated severe cases of sleep apnea are more likely to suffer from devastating cardiovascular issues (read our post about the link between sleep apnea and heart disease) and while the link between sleep apnea and diabetes is still being researched, studies show that about 71% of people with diabetes may have sleep apnea (read that post here).

More and more physicians are talking to their patients about sleep disorders and identifying those at the highest risk for sleep apnea. 

“Approximately 1 in 15 American adults is afflicted with moderate to severe sleep apnea which is now known to be an independent risk factor for hypertension, cardiovascular disease , cerebrovascular disease and other conditions such as type 2 diabetes.  Unfortunately, many patients remain undiagnosed. These new facilites should alleviate some of the pressure on physicians who are identifying patients who are at risk for this life-threatening disorder.”

-Said Mostafavi, M.D., F.C.C.P., F.A.A.S.M., Chief Medical Officer of Advanced Sleep Medicine Services, Inc.