Sleep Apnea

What is it? Are you at risk? What are the options?

What is sleep apnea?

Sleep apnea is a serious condition where the upper airway becomes blocked repeatedly during sleep, reducing or completely stopping air flow, resulting in a pause of 10 seconds or longer in your ability to breathe. If this happens at least 5 times per hour, every hour on average, this results in a diagnosis of mild OSA. After you regain your breath, the cycle repeats itself - all night long.

How common is sleep apnea?

The onset of obstructive sleep apnea (OSA) may occur at any age. Based on the Academy of Sleep Medicine (AASM) 2012, it has been estimated that 170 million adults in the 40 countries of the Americas may suffer from OSA. Goodier, Rob. (2019, June 19). More than a third of people in the Americas may have obstructive sleep apnea. “Our Standards: The Thomson Reuters Trust Principles.”

What are the signs and symptoms of sleep apnea?

Fatigue and daytime sleepiness
Snoring
Hypertension
Depression
Diabetes
Obesity
Gasping, choking, or coughing during sleep
Morning headaches
Irritability and/or emotional instability
Dry mouth and/or sore throat in the morning
Decreased sex drive
Impaired concentration/memory loss
Driving and work-related accidents
Irregular heartbeat
Restless leg syndrome

How does obstructive sleep apnea (OSA) affect my health?

High blood pressure: If you already have it, sleep apnea can make it worse. When you wake up often during the night, your body experiences a stress response. Your hormone system goes into overdrive, which boosts your blood pressure levels. Also, the level of oxygen in your blood drops when you can’t breathe well, which may add to the problem.
Heart disease: People with sleep apnea are more likely to have heart attacks. The causes may be low oxygen or the stress of waking up often. Strokes and atrial fibrillation - a fast, fluttering heartbeat - are also linked with the condition. Sleep apnea disrupts how your body takes in oxygen, making it difficult for your brain to control how blood flow in your arteries and the brain itself.
Type 2 diabetes: Sleep apnea is common among people with this condition; 80% or more of them may have sleep apnea. Obesity raises your risk for both disorders. Although studies haven’t shown a cause-and-effect link between sleep apnea and type 2 diabetes, not getting enough shut-eye can keep your body from using insulin properly, which leads to diabetes.
Weight gain: Extra pounds raise your chances of getting sleep apnea, and the condition also makes it harder to slim down. When you’re overweight, you can have fatty deposits in your neck that block breathing at night. On the flip side, sleep apnea can make your body release more of the hormone ghrelin, which makes you crave carbs and sweets. With extreme long term fatigue, you might not be able to turn the food you eat into energy as efficiently, which can lead to weight gain.
Adult asthma: Science hasn’t proven a link to sleep apnea, but people who get sleep apnea treatment may find they have fewer asthma attacks.
Acid reflux: There’s no proof that sleep apnea causes this kind of heartburn, but many people say it’s a problem. Treating reflux seems to improve apnea symptoms for some people; in turn, treating OSA may help relieve symptoms of reflux.
Car accidents. When you are groggy, your risk of falling asleep at the wheel is raised. People with sleep apnea are up to five times more likely than normal sleepers to have traffic accidents.

How is my heart affected if I have sleep apnea?

In a word, damage. Over time, the heart cannot maintain its activity when being starved of oxygen, night after night. Heart Failure, Coronary Artery Disease (CAD), Hypertension, Atrial Fibrillation, and Enlarged Heart (cardiomyopathy) are all conditions that can develop if sleep apnea goes untreated. Studies show that untreated sleep apnea can increase your risk of stroke, heart attack and sudden cardiac death by as much as 30%.

Does sleep apnea affect the brain?

Studies show sleep apnea causes memory loss and can play a role in depression. It also increases your risk of Alzheimer’s disease and dementia. Sleep plays a vital role in brain health; the brain is able to process the elimination of toxins much more rapidly when asleep than when awake. The brain also consolidates long term memory by strengthening neural connections during sleep.

Can sleep apnea affect weight loss?

Poor sleep is a major factor in weight gain. Lack of sleep will affect your nightly hormones, leptin and ghrelin, which tell you when to eat and when you are full. When sleep deprived, your metabolism will not function properly. You will also lack the drive and energy to exercise and make healthier food choices.

What is CPAP therapy?

CPAP stands for continuous positive airway pressure and is the gold standard treatment for sleep apnea. As you sleep, a CPAP provides air pressure at a prescribed setting, based on the results of your sleep study. The constant air flow keeps your airway open, allowing for restful sleep. The CPAP machine doesn’t breathe for you. You can breathe in and out normally on your own.

Having problems with your CPAP therapy?

Difficulty Falling Asleep:

Try pressure ramp at beginning of sleep period.
Request trial of auto adjusting device.

Difficulty Maintaining Sleep:

Try pressure ramp at beginning of sleep period.
Trial of auto adjusting device.
Go to bed when tired and at a reasonable time.
Avoid stimulants, exercise and alcohol 4 hours prior to bedtime.
Address mask problems.

Trouble Breathing Over the Constant Pressure of the CPAP:

Begin using CPAP for short periods of time during the day. Use it while you are watching TV or reading. This can help your body begin to adjust to the air pressure.
Use for short periods of time and gradually increase the length of your time.
Focus on breathing at a nice, slow pace.
Use the unit’s “ramp” setting.
May request a new machine with exhalation pressure relief
Contact physician for order for desensitization or pressure change.

Mask Leaks:

Adjust headgear straps. The mask should be as loose as possible, while still creating a seal.
Consult CPAP therapist for a mask fitting.
Inspect mask for stiffness, cracks or breaks. Replace mask, cushion or straps if needed.
Wash mask daily; wash face nightly.
A moustache will cause slight leak; if this is a problem, do not worry. Use of nasal pillows can achieve a better seal, instead of a full face or nasal mask. For a full beard, smooth the beard with lanolin where the seal makes contact. Full face masks work well for CPAP users with full beards.
Wear dentures while sleeping with CPAP. Support tubing above head, such as above bed level.
Special CPAP pillows are available. They are designed to minimize contact of the CPAP mask with the pillow, when sleeping on your side.

Nasal Pillow Mask Leaks or Sore Nostrils:

Pillows are meant to slip gently in the nostrils and when properly placed, should not appear to be lifted.
Nasal pillows are set in a “barrel or canister-like piece”, which is meant to be rotated into, or out and away, from the nostrils.
If nostrils become irritated or sore, readjust angle of the pillow entry in to the nostrils.
If leaks occur, use the next size larger nasal pillow.

Skin Irritation, Pressure Sores or Blisters:

If your mask has a forehead arm or adjustment feature, try readjusting that first.
Adjust headgear straps. The mask should be as loose as possible, while still creating a seal.
Consult CPAP therapist for a mask fitting.
Try a different mask made of different components.
Mask strap covers may be needed.
Keep your face and mask clean to prevent oil build-up.
Use a barrier between your skin and the mask such as 3M’s Micropore tape, paper tape, or Squib’s Duoderm.
Consult your physician.

Sore, Dry, Irritated or Swollen Eyes:

If your mask has a forehead arm or adjustment feature, try readjusting that first.
Try re-setting the mask on the face.
Adjust headgear.
Check all of the connections.
Inspect mask for stiffness, cracks, or breaks. Replace mask if needed.
Use an eye patch.
Resize your mask.

Dry Nose and/or Throat, Nasal Congestion, Runny Nose, Sneezing or Nosebleed:

Try a chin strap.
Use heated humidification.
Use a full face mask.
Try saline nasal spray or nasal gel before bedtime and upon awakening.
Try a full face mask if using nasal mask or pillows.
Check out how much water has been used from the water chamber of the humidifier. More than half indicates a major mask leak or mouth leak. May need a chin strap. (Note: If very little water has evaporated and the heater plate is working, this is a sign of a very good mask fit.)
Place unit on bedside table to keep dust and/or animal hair out of machine.
Condition may improve over time.
Consult your physician if symptoms persist.

Water In Tubing:

Insulate tubing with a hose cover or keep underneath covers.
Increase temperature in bedroom.
Lower humidity setting on the humidifier.
Keep windows closed.
Heating tube now available.

CPAP Unit Too Noisy:

Check if air filter is clean and not blocked by outside items.
Add a length of hose and place unit further away.

Bed Partner Intolerance and/or Anxiety:

Change type of mask.
Address mask fit issues.
Consult physician if OSA symptoms still present. CPAP pressure may need to be changed.
Promote education.

Continued Snoring:

Contact physician; pressure may need to be adjusted.

Weight Loss or Gain:

You may have to have your CPAP pressure level adjusted. Contact your physician.

Air From Machine Seems Hotter Than Normal:

Clean the air filter or replace with new filter.
Be sure there is at least one foot of space around the entire machine and that vents are not obstructed.