![]() ![]() Each watch section mans essential navigational and operational functions for 6 h and then turns over control to the next watch section. A typical crew consists of approximately 120 men, most of who are organized into 3 “watch” sections. 2 Nuclear power provides a nearly inexhaustible supply of energy that allows submerged operations for extended periods of time, essentially limited only by food supplies. Submariners work and live in a unique, fully self-contained environment. This particular CPAP usage report shows an unusual pattern of shift work distinctive of U.S. Compliance may even be encouraged by shipmates bothered by snoring, as was the case with this patient. Although military members may work and sleep in austere environments, CPAP can be successfully employed aboard ship. 1 For example, extended or “recovery” sleep on weekends and shifting of the major sleep period are easily recognized on the graphs of CPAP usage reports and provide opportunities to counsel patients regarding the effects of accumulated sleep debt as well as measures that promote better sleep and wakefulness in shift workers. In addition to providing data relevant to the efficacy of treatment, CPAP usage reports may show sleep-wake patterns that are suggestive of chronically insufficient weeknight sleep, shift work, or circadian rhythm disorders. Objective measurement of CPAP usage is widely available with current devices and has been mandated by the Center for Medicare and Medicaid Services (CMS). A sample of his CPAP usage report from this period is shown in Figure 1.ĭiagnosis: “6-on, 12-off” submarine shift work schedule. Review of his CPAP compliance report confirmed inconsistent usage with the exception of a conspicuous 3-month period. At the time of his evaluation in our office, he reported using CPAP sporadically and scored 11/24 on the Epworth Sleepiness Scale. Physical examination was notable for obesity (body mass index 36.6) and a Mallampati class 4 airway. He reported drinking 3-4 caffeinated beverages/week, rarely used alcohol, and was a lifelong nonsmoker. The patient's medical history was significant for hypertension which was controlled with an ACE inhibitor. Although markedly improved following the procedure (AHI 18), snoring and symptoms recurred, prompting treatment with a CPAP device one year later. He had been previously diagnosed with severe obstructive sleep apnea (apnea-hypopnea index 97) and underwent tonsillectomy and nasal turbinate reduction. Navy was referred to us for ongoing continuous positive airway pressure (CPAP) management. A 31-year-old male sonar technician in the U.S. ![]()
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