Thoracic and Sleep Group Queensland People caring for how you breathe and sleep

January 31, 2017


Filed under: Blog — Mark Russell-Pavier @ 11:35 pm

One of the best known exercises for falling sleep is counting sheep. It is very common in some cultures and people, who practise that, visualize an endless series of identical white sheep jumping over a fence, while counting them. But this is not the number one and it does not solve the trouble falling asleep for some people, for that reason experts advise to try some of these tips when you are in bed.

  1. Breathing exercise: Notice your breathing with your eyes closed. Turn all your attention to your natural breathing, feeling how the air enters and leave through your mouth. Visualize the flow of air as it passes and reaches various sites of your body.
  2. landscape scenicGuided imagery: Close your eyes and relax in a comfortable position in bed. Begin to visualize a scene, memory, or story that you find calming. For example: a favourite vacation or calming outdoor spot, a relaxing activity like curling up with a book in your favourite chair, or something repetitive like remembering the steps of an exercise or dance routine. The key is to find something that allows you to focus your attention and let go of other thoughts.
  1. Try Acupressure: Acupressure is an ancient therapy that involves finger placement and pressure over specific points on the body. The Huffington Post quoted to Leigh Gilkey and Siri Michel, acupuncturists and founders of Essential Acupuncture in Chicago, who affirm that self-administered acupressure before bed can promote a restful night of uninterrupted sleep and, in the event of an unwanted night-time awakening, can help get you back to sleep. The points to treat insomnia include: Anmian, located behind the ear. Behind the ear is a bone called the mastoid process. Place your finger on the mastoid process and slide back off the bone and slightly upwards. Look for a little depression and press in a downward motion. Liver 3, located on the top of the foot. Place a finger between the first toe and the second toe and push toward your ankle. There is a depression before the junction of the first and second metatarsal bones. Simply pressing on it or pulling in a downward motion is great for activating this point.



Do you have Asthma… Are you sure?

Filed under: Blog — Mark Russell-Pavier @ 11:30 pm

Asthma is a common respiratory condition, which is actually an inflammatory disorder of the lungs. For some people it can occur sporadically i.e. during exercise, but for others it is a chronic condition that effects their day to day life. Asthma can and is often treated with inhalers, and while there is no cure, often these treatments can reduce the symptoms of asthma to a level that does not seemingly effect a person’s day to day life. However, what if you don’t have asthma but you were told that you do? Every day you would be using medication that you don’t need. Conversely what if you were told you don’t have asthma, but you actually did? Proper diagnostic testing is plays such an important role in the diagnosis and management of Asthma.


Aaron et al. looked at 613 randomly chosen asthma patients in Canada, and sought to find out if these patients truly had Asthma or not. What they found was that 33% of patients no longer showed signs of the condition. These patients were taken off their medication (under supervision as a part of the study) and the researchers found that 27% of these patients actually had nothing wrong with them at all. What was also worrying is that the researchers did some digging into the medical history of these patients and found that the bare minimum testing required for asthma diagnosis (spirometry) was not performed. If the right tests are not done, it’s not a big step to think that the wrong diagnoses can happen. Now if this many people are given an incorrect positive diagnosis i.e. they are told they have asthma (called a false positive), how many people are walking around with asthma who have been told they don’t have it (called a false negative). Take home message: without the proper testing, it is easy to end up with the wrong diagnosis.


Here at TSGQ we take respiratory diagnostics very seriously, in fact spirometry is only one of many respiratory tests we routinely perform. Not only do we perform spirometry very well, we actually give training session to doctors and nurses to also help them better perform this test. Keep in mind that spirometry is only one test, there are also more bulk billed respiratory tests we can perform, along with spirometry to give really high quality results. We call these tests when combined; a complex lung function test. The reason we do these other tests (FeNO, gas exchance etc) is to give a much more high quality service to our patients. However we must say that if you have any questions about Asthma, or your health to please contact your doctor and speak to them.


Original article:

Optimal nap length during night shifts

Filed under: Blog — Mark Russell-Pavier @ 11:08 pm

A recent study investigated the performance of participants during sleep deprivation during a simulated night shift after different length naps.

31 adults attended a 3 day study that included one baseline sleep (22:00-07:00) and one experimental sleep deprivation night involving either, No nap, a 10 min nap or a 30 min nap.

Performance was tested by a 3-min psychomotor vigilance task (PVT-B), digit-symbol substitution task (DSST), fatigue scale, sleepiness scale, and self-rated performance scale which were undertaken pre-nap (03:00) and at 2, 17, 32, and 47 min post-nap.

During the no nap condition, performance deteriorated as time went on compared to the pre-nap test showing a progressive decline in performance with sleep deprivation.

During the 30min nap, performance immediately deteriorated from the pre nap test and was still worse at 47 mins post nap, indicating sleep inertia had set in.

During the 10min nap, performance did not change after the nap, and helped to mitigate the deteriorations seen with sleep deprivation.

A short 10 minute nap is the optimal length of time to offset short term performance impairment when sleep deprived.

Not all Auto titrating CPAP machines are the same

Filed under: Blog — Mark Russell-Pavier @ 11:04 pm

Recent technology developments have revolutionised CPAP machines in the past years allowing for more widespread access to CPAP treatment where an attended laboratory may not be located.

Furthermore, auto titrating CPAP has given some users better comfort and compliance by allowing a lower average pressure to be delivered overnight, the machine giving the highest pressures only when needed (when sleeping on your back)

However, manufacturers have always kept their auto-titrating algorithms secret to prevent copying and each brand does things a little bit differently which can impact on the treatment effectiveness for some patients.  This has led to a number of validation studies testing the appropriateness of auto-titrating devices as the technology emerged from the leading manufacturers.  Since its introduction auto-titrating CPAP has been proven as an acceptable tool and feature to assist Physicians in determining pressure requirements or as a treatment modality for patients who tolerate it better than set pressure CPAP.

Recently however, there has been an increase in the manufacturers offering CPAP machines with the Chinese market coming on board.

J Clin Sleep Med. 2015 Jul 15;11(7):725-34. doi: 10.5664/jcsm.4844.

All APAPs Are Not Equivalent for the Treatment of Sleep Disordered Breathing: A Bench Evaluation of Eleven Commercially Available Devices.

The use of auto-titrating continuous positive airway pressure for treatment of adult obstructive sleep apnea. An American Academy of Sleep Medicine review.

Are there any long term side effects to using a Mandibular advancement splint?

Filed under: Blog — Mark Russell-Pavier @ 10:18 pm

It has been well documented how the use of a Mandibular Advancement Splint (MAS) can treat mild to moderate sleep apnoea and can be more easily tolerated than other treatment options such as CPAP for many patients. TS_MAS

While this is becoming a popular choice for patients, we should remember to ask ourselves;

Are there any side effects?  Would it hurt to put my jaw forward all night?  Can this affect my teeth over a long period of time?

A recent study looked at long term side effects of MAS use over 3 years and found there were some changes seen in the Temporomandibular Joint (TMJ) such as clicking sounds and crepitus as well as changes to orofacial function such as reduced overbite and increased jaw protrusive movement.  However these changes seemed to be less harmful than previously reported in other studies.

TS_OverbiteOverjetAnother study looked at changes in teeth position after 10 years of MAS treatment.  They also found a decrease of the overjet and the overbite and changes in occlusion (the contacts between the top and bottom teeth).  These changes in dentition may be favourable or unfavourable and may continue to develop with continue MAS use.

It is important to remember a Mandibular Advancement Splint for Sleep Apnoea or snoring treatment is not simply a ‘mouthguard’ you should buy off the shelf and try.  There are many different types that may or may not be appropriate.  Long term therapy should be managed with Sleep Physicians, Dentists and Allied Health professionals to ensure the treatment is appropriately prescribed and side effects can be managed appropriately.



Oral Rehabil. 2017 Jan 17. doi: 10.1111/joor.12485. [Epub ahead of print]

Long-term side effects on the temporomandibular joints and orofacial function in patients with obstructive sleep apnea treated with a mandibular advancement device.

January 20, 2017

Tablet and phone use reduces total sleep time in kids:

Filed under: Blog — Mark Russell-Pavier @ 6:38 am

Portable mobile phones and media devices have become a fantastic baby-sitter and necessary part of children’s lives for schooling and entertainment.  A recent Meta-analysis was done on 20 of the strongest methodological studies looking at school-age children between 6-19 years and the effects of media device use in the sleep environment and sleep outcomes.

There was a strong association between bedtime media device use and inadequate sleep quantity, poor sleep quality and excessive daytime sleepiness.

Additionally, children who had access to but didn’t use their devices at night were more likely to have inadequate sleep quantity, quality and excessive daytime tiredness.

We all use mobile phones and tablets on a daily basis, generally at night and often in bed.  Let’s set an example and put the phone down at night so our children (and we all) can get a good night sleep.

Association Between Portable Screen-Based Media Device Access or Use and Sleep Outcomes: A Systematic Review and Meta-analysis.

Concussion and Sleep

Filed under: Blog — Mark Russell-Pavier @ 5:55 am

A 2016 pilot study from the American Academy of Sleep Medicine investigated the acute effects of concussion on sleep quality and quantity. This study utilised actigraphy to examine the changes in sleep quality and quantity acutely following concussion at home rather than in a hospital or sleep laboratory. Parameters included total sleep time (nTST), 24H sleep time (TST), wake after sleep onset (WASO), and sleep efficiency (SE). The study followed seven young adults with acute concussion, and ten control subjects. They were tested for five days following injury, and then again 30-days following. Participants utilised actigraphy devices and sleep journals.

The investigation discovered increased nTST and TST following concussion. This is consistent with subjective and objective studies that reported poorer sleep quality following concussion. The reduction in sleep quality was maintained in the 30-day testing. This result is consistent with anecdotal reports of poor sleep quality lasting months and years after concussion.

Confirming that poorer sleep quality results from concussions has a number of implications. The foremost of which is the suggested predisposition of concussed individuals to a cascade of conditions secondary to poor sleep quality.

Raikes AC, Schaefer SY. Sleep 2016; ePub(ePub): ePub.

January 19, 2017

Why your holidays can make you tired and sleepy

Filed under: Blog — Mark Russell-Pavier @ 12:55 am

The seasonal festivities bring an increasingly commodity and more hours to sleep, however can bring a surprising level of tiredness as well. This can be caused for a variety of reasons that was described in an article published in ABC news last year. These facts are relevant nowadays because every year is pretty similar.


Kermit-alcohol Alcohol

Alcohol can impact on sleep for some time after you have consumed it. Binge drinking can reduce melatonin, the hormone that makes us sleepy, for maybe five or seven nights.

They quoted Professor Dorothy Bruck who says “Often when people go on holidays, they drink a lot more alcohol and this can have a really detrimental effect on the quality of your sleep”. If it’s just a couple of drinks, the disruptive impact will be limited to that night.

“[The alcohol] might help you go to sleep and for the first half of the night, your sleep can be dead to the world. But the second half of the night, [sleep] is much more fragmented,” Dr Bruck says.


Tummy troubles

The holiday season is also a time when people tend to eat a bit more than normal. They also tend to feast on a wider variety of foods; some of which may disagree with their. Discomfort in the digestive system can cause sleep disturbances, with chilli and other spicy foods a particular problem, according to recent researchers.

Other stimulants foods as a sugary dessert can be a problem too, if people eat just before bed. Dr Bruck says. The good thing is that the effect should not last longer than an hour or two.

Daytime napsDaytimeNap

Afternoon siestas when you don’t have to work can be one of the nicest parts of being on holidays, but can be modify our circadian rhythm and make us sleepy during the normal routine.

We often link an afternoon break in our alertness to the effects of eating lunch. But the “mid-afternoon dip”, is actually a normal characteristic of our circadian rhythm and can happen whether you have had food or not, Dr Bruck says.



Crash into bed, not your car.

Filed under: Blog — Mark Russell-Pavier @ 12:26 am

We all get tired, and most of us drive cars. Doing both at the same time can be dangerous. Plenty of data exists to highlight the damage done by drowsy driving each year. We know that naps improve cognition (providing they are of the right length of time), and that fatigue reduces reaction times and can lead to errors. Fridulv Sagberg recently published a study for the institute of transport in Norway which found some other interesting facts about falling asleep while driving:

  • 1 in 10 males reported falling asleep driving in the previous 12 months, with 40% of these drivers reporting running off the road during these episodes of sleep-driving
  • Drivers reluctance to stop driving despite being tired is thought to have contributed to sleep related accidents

The following was found to increase the odds of falling asleep behind the wheel:Crash into bed image

  • Dry roads
  • High speed limits eg. highways
  • Driving your own car
  • High education

Here in Queensland, and in Australia for that matter we have lots of dry weather, lots of highways, most of us own cars and we seemingly have a high standard of education… so lets be smart here people, just don’t drive tired.



January 13, 2017

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