A Journey to Optimizing Breathing and Sleep Quality 

Dr. Dan Gartenberg, Sleep Scientist, Experiments With Wesper for Diagnosing Sleep Apnea

June, 16, 2023

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This is likely the simplest and most accurate way to evaluate sleep disordered breathing at night that includes measuring breathing events (hypopneas), pulse oximetry, sleep stages, sleep position, and much more.  You can also use the system in conjunction with the SleepSpace software. In this tutorial we go over examples of tracking Dr. Gartenberg's breathing at night using Wesper and the process of getting diagnosed with mild sleep apnea. Continue following Dr. Gartenberg's journey of trying to address and treat his apnea and monitoring it using the Wesper device. 

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Night 1 Review of Wesper Sleep

In the first night of tracking, Dr. Gartenberg confirms that he does appear to have an issue with disruptive breathing throughout the night. We will track for 2 more nights and then get a consult from an expert at Wesper in order to evaluate the next steps to address this issue. Healthy breathing throughout has a major impact on the cardiovascular system, especially hypertension, in addition to almost every chronic health disease. It is therefore essential to wellness to get this issue diagnosed and treated.

Night 2 Measuring Snoring and Breathing Events

This is the second of three nights where Dr. Gartenberg evaluates Wesper my breathing improved somewhat. One possible explanation for this improvement is that on this day Dr. Gartenberg exercised for an hour on his bicycle. However, the Wesper still indicates a possible breathing issue because the number of breathing events per hour is above four. This variability in breathing from night-to-night is why it is essential to use a device like Wesper for three nights (not necessarily in a row). This provides a full picture of typical night-time airflow.

Night 3 of Evaluating Pulse Oxygenation and Hypopneas

On the final day of evaluating whether Dr. Gartenberg has sleep apnea, we again confirmed a major issue. This is the worst night of breathing yet, with more than 15 events per hour. This registers at the cutoff of moderate sleep apnea. According to the American Academy of Sleep Medicine (AASM), sleep apnea is categorized as mild if there are 5-15 events per hour, moderate if there are 15-30 events per hour, and severe with more than 30 events per hour. In the next step, we will get a detailed analysis from Wesper's sleep coach Chelsea regarding my data. We will delve into whether position plays a role in my issue. Often times people with sleep apnea have more events when they sleep on their back than in other sleeping positions. The number of breathing events can also change by factors like sleep stage. This can help us understand ways to potentially treat the issue. The recommended treatment for Obstructive Sleep Apnea (OSA) is CPAP, but mandibular advancement devices (MADs) created by your dentist can also work for mild to moderate cases.

Getting diagnosed for Obstructive Sleep Apnea (OSA)

It turns out his fears about having this problem were indeed founded. The helpful specialist at Wesper identified that there was likely an issue. The system determined that for him, it wasn't positional apnea where it is worse when sleeping on one side or another. However, there was evidence that more breathing events occurred during Rapid Eye Movement (REM) sleep compared to the other stages of sleep. This is a common issue where the airway can sometimes collapse more in REM, and thus the term "REM-related OSA" was coined.

After speaking with Chelsea, the helpful representative at Wesper, Dr. Gartenberg decided to get formally diagnosed by a doctor using the Wesper system. A diagnosis was provided so the next steps of treatment are now underway. Follow along to learn more about treatment options. The recommended treatments include:

1) CPAP (gold standard)
2) Mandibular Advancement Devices (effective for mild to moderate cases)
3) Inspire implant
4) Behavioral intervention can help to some degree with weight loss playing a major role, but also refraining from alcohol and possibly myofunctional therapy
5) Combining these methods can also have an even greater effect on improving sleep quality.

If you snore, clench at night, perceive yourself as gasping at night, or are very tired during the day, it is essential for you to go through a similar process as Dr. Gartenberg and get diagnosed

Next Steps... Seeing how my treatment is working

There are three main treatments for Sleep Apnea that are well supported and backed by the clinical community. Please see a doctor when evaluating the best treatment option for you:

1) CPAP (gold standard treatment)
2) Mandibular advancement device (MAD), which can be made by a dentist
3) Inspire implantable device (surgery typically done by an ENT)

Since Dr. Gartenberg's case of sleep apnea was mild, he decided to get an MAD made by his dentist. About half of the device was covered by insurance but it still ended up costing about $1,500 out of pocket. The device works by pushing your jaw forward and holding it in place, which prevents blockages in breathing that cause obstructive sleep apnea.

In the next steps of Dr. Gartenberg's breathing optimization journey, he will use Wesper to evaluate the effectiveness of this treatment. 

Post Sleep Apnea Diagnosis 

After getting my sleep apnea diagnosis from Wesper and their team of doctors, my next step was to get treated. I opted for having a Mandibular Advancement Device (MAD) made for me by my dentist. These devices typically cost ~$3,000 and can be billed through medical insurance if you have a diagnosis of sleep apnea and are not willing to use a CPAP. Insurance will typically pay 80-90% of the costs if you have a PPO. After my dentist made a mold of my bite, I got the MAD in a few weeks. I then evaluated my sleep apnea again and found that I successfully resolved the issue! My breathing was now almost normal throughout the night with ~5 events per hour. My next steps include weight loss and trying to get my Apnea Hypopnea Index as low as possible. My goal is 0-1 events per hour. Hopefully my weight loss goals will get me there!