Sleep Apnea Treatment

Posted on September 30, 2011 by Bill (LoneWolf) Nickerson

So, you have sleep apnea (or even sleep hypopnea). You have several options available to you for treating it. You also have the option to ignore it and hope it goes away. By the way, the last option doesn’t work. Don’t bother trying it.

There really isn’t a total cure for apnea at this point, but several treatments have been used successfully and your doctors can help you to look at which options might be best for you.

There are 2 goals in treatment: 1) eliminate apnea events and 2) remove sleep deprivation symptoms. Meeting the first goal is a big step towards meeting the second, but you still need to focus on getting quality sleep once your apnea is stopped.

5 Options for Sleep Apnea Treatment

There are 5 different categories of treatment for sleep apnea. Within each of these categories there are several different options. Let’s try to make some sense of them.

Medications

There are currently no drug treatments for sleep apnea although treatment for hypothyrodism or acromegaly will eliminate apnea if it is caused by those disorders.

Keep in mind that many medications (including sleeping pills, tranquilizers, antihistamines and muscle relaxants) can have a negative affect on apnea. Talk to your doctor about any medications that you take regularly.

CPAP

CPAP stands for Constant Positive Airway Pressure. This is the use of pressurized air in your airways to prevent the collapse associated with apnea. Note that this is not correcting the problem that causes the collapse (i.e. the failure of the muscles to control the airway during sleep) but it helps to keep the air moving in and out of your lungs.

This is the most common form of treatment for both obstructive and central forms of sleep apnea. It is also used in cases of hypopnea (heavy snoring to the point that breathing is restricted but not stopped).

There are actually 3 classes of machines that are lumped together in the CPAP family. When we talk about CPAP machines in general we also include the others.

CPAP

The traditional CPAP machine which is set at a constant pressure that is applied throughout the night (hence the name Constant) is the least expensive type of machine.

BiPAP

There is also a family of BiPAP machines (Bilevel Positive Airway Pressure) which have 2 levels of pressure: one for breathing in and the other for breathing out. These machines are better suited to those who require high pressure which makes exhaling difficult. The machine cycles through the 2 pressures as you breathe in and out.

APAP

Finally, there are APAP machines (Automatic Positive Air Pressure). These are either CPAP or BiPAP machines that automatically adjust the pressure level(s) based on how you are breathing. They will monitor your breathing with each breath during the night and if they detect apnea happening the level will increase. The nice thing about these machines is that they adjust to you. The minimum pressure that is required to prevent your apnea will fluctuate over time — even during the night. A CPAP or BiPAP machine is set to the worst case pressure and is often more than you really need.

Masks, etc.

All of these machines need a way to deliver the air pressure to you. Most people use a nasal mask which fits over the nose. The air is blown in through your nose during the night. While this works for most CPAP users, many people don’t breathe well through the nose. It is possible to get an oral mask (mouth only), full face mask (mouth and nose) or total face mask (covers from forehead to chin). There are also nasal prongs and nasal pillows which fit into your nostrils. Some people find these more comfortable than a mask.

Humidity

Many CPAP users find that having the extra air flowing through their system leads to dry mouth, sore throats and/or irritated sinuses. To deal with this, most CPAP machines are equipped with a humidifier system (either built in or as an accessory). This will provide heated, moist air to the mask and it will alleviate most of the symptoms. If you use a humidifier you will need to figure out what heat setting works best for you. The higher settings will provide more moisture as well as warmer air.

I personally use a traditional CPAP machine since my pressure prescription is not too high or uncomfortable. I also use a nasal mask which helps me to breathe through my nose rather than my mouth. It helps me to avoid dry mouth and sore throats that way. I don’t normally use the humidifier with my machine most of the year. However, in the dead of winter when the air is really dry I will use it without any heat. I find that with heat it gets too moist for me.

Oral Appliances

Mouthpieces are another common treatment for sleep apnea. These are sometimes referred to as dental devices or oral appliances. They are worn in the mouth during the night and will position the tongue and/or lower jaw to keep the airway open.

Once again, they do not treat the underlying failure of the muscles to keep the airway open.

Many people find that a mouthpiece is more comfortable and easier to use than a CPAP machine. They also do not require electrical power so they are convenient if you travel a lot or like to camp out in the wilderness. You are also not hooked up to anything so getting up at night is easier to manage.

While it is possible to get a generic mouthpiece for sleep apnea, most patients who go this route will have a specially fitted mouthpiece designed by a dentist who is trained to do this. If you want to go this route your sleep clinic will be able to refer you to a qualified dentist.

One drawback to this treatment is that it isn’t effective in every case. Mouthpieces only affect part of the airway so you may still have reduced airflow or blockage deeper in your throat that they cannot deal with. It can be quite expensive to have a mouthpiece custom built for you only to find that it doesn’t fully treat your apnea.

Surgery

One area that has a lot of controversy is the use of surgery to correct sleep apnea. While surgery has often been effective at reducing and eliminating snoring, the results for sleep apnea are less promising. However, it does work for some people.

Common Surgery Techniques

As a sleep apnea treatment, surgery is usually focused on removing the uvula, part of the soft palate, part of the sides of the throat (pharynx) and possibly tonsils and adenoids. The goal in this type of surgery is to reduce the tissue that blocks the airway. It can be done using a scalpel (UPPP — uvulopalatopharyngoplasty) or a laser (LAUP — laser assisted uvuloplasty). In the laser surgery, the tonsils and pharynx are not affected.

A newer procedure which shows some promise is somnoplasty. This uses targeted high frequency radio waves to shrink and tighten the tissues that cause problems. This procedure is simpler and less painful than UPPP or LAUP. It can also be more specifically targeted and may be able to deal with problem areas deeper into the throat.

Less Common Techniques

In some cases, problems are caused by the facial structure of the patient. In these cases surgery to move the tongue and/or jaw forward to open the airway. Nasal surgery is also beneficial to some patients. However, these cases are rare.

Problems

Like any surgical procedure, there is risk involved with surgical sleep apnea treatments. There can be damage to the speech, infections, and other side effects from all of these surgeries. The laser and RF treatments are the least invasive and are usually performed on an outpatient basis, but there are still risks.

The other problem is that they do not guarantee to eliminate sleep apnea. Even if they do, it may not be permanent.

You will need to talk to your doctor about surgical options and make an informed decision.

Lifestyle Changes

Probably one of the most important areas of sleep apnea treatment is your lifestyle. This will have a tremendous impact on the success of the other treatment options. It is also the most important factor in achieving the second goal of treatment — less fatigue and sleep deprivation symptoms.

While lifestyle changes alone is often not enough to eliminate sleep apnea, they will increase the effectiveness of other treatments and are a benefit for your life in general.

Weight Loss

Obesity is one of the most common risk factors associated with sleep apnea. While the jury seems to be out on whether it is a cause or not, there is pretty solid evidence that it is an aggravating factor. Losing weight and building your cardiovascular health will help reduce the severity of your apnea and you’ll get more quality sleep as well.

Dieting alone is not the best way to lose weight. Regular exercise and healthy, balanced diet are your best bets here. I write about what I’m learning about weight loss at Heathy Weight Loss if you want to read more about that.

Substance Abuse

Two of the biggest contributors to sleep apnea are smoking and drinking (sorry guys). Many studies have shown an increase in snoring and apnea among smokers (2.5 times more for men, 4 times more for women). Alcohol consumption, especially just before bed, increases snoring and apnea affects as well. So the less you do of these two things, the better.

Sleep Patterns

It is also important to have regular sleep patterns. A consistent sleep and wake time is beneficial if you can make it happen. You also need to get enough sleep. Most North Americans are sleep deprived whether they have a sleep disorder or not.

A calming pre-sleep routine and comfortable sleeping arrangements are also important. Light, temperature, noise and comfort all affect the quality of your sleep.

Stress

Do we even need to talk about this one? Stress is probably one of the biggest problems we face in our culture today. It affects us physically, emotionally, mentally and spiritually. It is particularly disruptive for sleep. So do whatever you can to reduce and deal with stress.

Some of the lifestyle changes mentioned above can be helpful with this — exercise is a great stress reliever. Talk to your health providers about ways you can reduce stress to manageable and healthy levels.

Natural Treatments

When we get into the arena of natural sleep apnea treatments, there is a lot of conflicting information. Not to mention name calling and back stabbing. But this is true in any area where Western medicine and Natural medicine collide. There are many claims for products that cure or treat sleep apnea naturally but it is up to you and your medical professionals to find out what works or doesn’t for you.

My naturopath has not recommended any cure for me. But he does recommend herbal and other natural treatments that help me to improve my sleep quality. And as we work to improve my overall health I’m sure that there will be some improvement in my apnea symptoms as well.

If you are comfortable with different natural medicine then talk with your health professional about what is available. They can help you to make lifestyle changes and sleep patterns that, in conjunction with the other treatments, will help you achieve the two treatment goals.

What is a Multiple Sleep Latency Test?

Posted on September 29, 2011 by Bill (LoneWolf) Nickerson

When you visit a sleep clinic for a sleep study, your doctor may arrange for you to have a Multiple Sleep Latency Test (MSLT) the following day.

This test is used to measure the level of sleepiness you are experiencing.

What to Expect

A MSLT is usually done following a normal sleep study. This is convenient since you will already be at the clinic, wired up and ready to go. The same measurements that are taken during a sleep study are also recorded during the latency test.

This test will take a good part of the day since you will have 4 or 5 naps at 2 hour intervals during the day. When you are not in the nap period you are disconnected from the computer and can wander about, read, watch TV, etc.

But when nap time comes you are reconnected to the recording computer and settle in for a 20 minute nap.

You will also be asked to fill out a survey before and after the nap period to describe how you feel.

What is Sleep Latency?

A mulitple sleep latency test is measuring sleep onset latency (or sleep latency). This is a measure of the time between lying down to sleep and actually falling asleep. The lower this time is, the higher your fatigue level.

A sleep latency of more than 15 minutes is considered excellent (20 minutes is fully alert). If your latency is under 10 then you are considered to be fatigued. Under 5 minutes is severe.

When I had my first MSLT I was asleep in under 1 minute for all 4 rest periods. It was a confirmation of how I had been feeling for years.

Variation of the Test

The sleep clinic where I was originally diagnosed had a variation of the multiple sleep latency test that I also underwent. This was on a second day following a second sleep study.

In this variation rather than lying in bed and trying to nap, I was sitting in a chair while trying to stay awake. The room was darkened and no distractions were allowed. Once again, there were 4 tests of 20 minutes each that were spaced every 2 hours. It should be no problem to stay awake for the 20 minutes for a person who is not fatigued.

The idea of this test was to see how well I could stay awake without any stimulation. You probably won’t be surprised to hear that I managed to stay awake for almost 5 minutes on the last test (it was under 2 for the other 3 tests).

Not all sleep clinics will use this variation, but it can be useful to test how well you are able to keep yourself awake in a low stimulus situation. That is also a good indication of your fatigue level.

Test Yourself

If you want to get an idea of your fatigue level, you can try this at home. Obviously you won’t be able to monitor the activity of your brain, heart, etc. like a sleep lab could. But you can determine your sleep onset latency.

Set yourself up in bed comfortably where you can see a clock. Hold a spoon or similar object in your hand and dangle it over the side of the bed. You can put something under the spoon so that it will make a loud noise when it falls (a pot would be good).

Note the time that you start trying to sleep. When you do sleep the spoon should fall from your hand and wake you up. Look at the clock and see how much time has elapsed.

Once again, this is not a substitute for a proper sleep study and MSLT, but it allows you to assess your fatigue levels.

What is a Sleep Study for Sleep Apnea?

Posted on September 28, 2011 by Bill (LoneWolf) Nickerson

So you think you may have sleep apnea — what are you going to do now?

Well, I’m assuming that you’ve had a chat with your doctor already. If not, stop reading and make an appointment. This is important.

Okay, you’re back. After talking to your doctor he or she will have referred you to a sleep clinic for a sleep study. So your big question now is “What exactly is a sleep study for sleep apnea?”

Well, the official term is Polysomnography but you can just call it a sleep study.

The entire process can seem a little intimidating the first time, but I can promise you that it isn’t really all that bad. You’ll be hooked up to a computer that monitors different things during your sleep. In some cases you may have 2 nights of study along with a couple of daytime studies.

Arriving at the Sleep Clinic

A sleep study is performed at night since this is the time when most people normally sleep. As much as possible, the clinic will want to stay on or close to your normal sleep rhythm.

You will arrive at the clinic in the evening, usually around 7:00 pm. The technicians who work at the clinic will typically have to deal with 2 or 3 patients per session and the usually start with the patient that normally goes to sleep the earliest. It takes about 1/2 an hour to set up all the monitoring leads although it can take longer.

There will be a survey for you to fill out describing how you feel before heading to sleep. You may have an interview to ask about some of your sleep habits. The questions can seem a little personal, but they are very helpful in determining whether you have sleep apnea or another sleep disorder.

Getting Wired

Head

Once you are dressed for bed (lose fitting pajamas are recommended) you need to get hooked up for the monitors.

There will be leads that attach to various points around your head and face. These measure brain activity as you sleep (an eletroencephalogram or EEG). Some leads may be attached to your chin to detect muscle tension in your jaw (an eletromyogram) and near your eyes to track eye movement (an electrooculogram).

Legs

There may also be leads attached to your legs to measure how much they move during your sleep.

All of these leads are attached using a paste that holds them securely yet washes off quite easily. The closest thing I can think of to describe it is lard. It feels a bit weird at first, but you’ll get used to it quickly.

Chest

Your heart rate is also measured, so ECG (electrocardiogram) leads will also be attached. These leads are attached more firmly and if you’ve ever had an ECG before then you’ll know how hard it is to take these off, especially for those of us with a hairy chest!

You will also have lycra straps (or in some cases electronic leads) around your chest and abdomen to measure how you breathe (or attempt it) during your sleep.

Other

There may be other leads attached to monitor different parts of your body as you sleep. It can vary from clinic to clinic and even patient to patient.

Connection

Now, all these leads are just dangling from various parts of your body. So the next step is to connect them to the monitoring box. This is a box that is about the size of a brick (but thankfully it isn’t as heavy). It has sockets to connect all of the leads so that the monitoring equipment will be able to record the information in the right place.

It will take a few minutes as the technician carefully ensures that each lead is plugged in correctly. While they do this, the box usually be hanging from a strap around your neck. You’ll kind of look like Iron Man — well, if you have a good imagination.

Once this is complete, you’ll be free to walk about the clinic and do things similar to what you’d do at home — read, watch TV, etc. When it is time for sleep the technician will connect the monitoring box (which is no longer around your neck) to the computer cables and hook up a blood oxygen sensor to either your finger or your ear lobe. If you’re using a CPAP mask during your test, they’ll help you get it adjusted as well.

Sleepy Time!

Now you get to sleep.

While you are sleeping the computer will be recording all the information for your doctor to review. The technician will also be monitoring you through a microphone and, in some cases, a camera to make sure that you are okay.

If you wake up during the night to go to the washroom you will have to call the technician for assistance. They will need to disconnect you from the computer and then reconnect you when you’re done. Don’t worry if you have to do this several times during the night. This is part of their job and they are used to doing it.

Rise and Shine

Wake up time is usually around 6:00 to 6:30. They will usually wake the patients in the order that they went to sleep.

You might find this a bit early (I know that I do) but remember that the technician has been up all night watching you sleep. They need to get home and get some shut eye themselves.

The tech will get you disconnected from the computer cable and you can then go to the washroom if needed.

You will be asked to fill out another survey about how you slept and how you feel. After that, the leads are removed and you can finish getting cleaned up and dressed. And that is all — for most. It is possible that your doctor may want a multiple sleep latency test that is done during the day. We’ll talk about that another time.

So, that’s what you can expect when you have a sleep study for sleep apnea. Nothing to lose sleep over 8=)

CPAP To Treat Sleep Apnea

Posted on September 16, 2011 by Bill (LoneWolf) Nickerson

One of the most common ways to treat sleep apnea is through the use of air pressure. This is known as Positive Airway Pressure. The machines are commonly referred to as CPAP machines although there are really 3 basic types of machines as you’ll see below.

They work by using air pressure to keep your airway from collapsing. The amount of pressure required to achieve this varies from patient to patient. It can also change from night to night for a given patient.

Pressure provided by the machine is measured in mm of mercury (mmHg) and ranges from 4 to 20.

Masks

The pressurized air is blown through a tube and into your airways, usually through a mask fitted over the nose (known as a nasal mask). Other forms of masks are available (oral, full face and total face) as well as devices that are inserted into your nostrils (nasal pillows and prongs).

The different styles of masks, etc. are designed to be as comfortable as possible for different people. You will need to experiment to see which is right for you and the way that you sleep. Most people use the nasal masks, but they are not the best if you move around a lot in your sleep or if you sleep on your stomach (which you shouldn’t do anyway — plug from my chiropractor 8=)

The Machines

There are 3 categories of machines that are used to provide the pressure. Once again, the variety allows for you to find a machine that is comfortable for you to use while providing relief from your apnea.

CPAP

The most common machines used to treat sleep apnea are CPAP (Constant Positive Airway Pressure) machines. These devices are set at a constant air pressure which your doctor will prescribe. This setting is the one that is the lowest setting that provides relief during your sleep studies.

The drawback to this is that the pressure is often higher than your body really needs. On nights where you have been drinking alcohol you body needs more pressure to keep the airways open. If you gain or lose weight this will also affect your pressure needs.

However, for people who have a relatively low pressure setting that works, these machines are the simplest and least expensive.

APAP

APAP (Automatic Positive Airway Pressure) machines function in much the same way as CPAP. The difference is that they will automatically sense and adjust the pressure you require through the night. When you are lightly sleeping the pressure will be lower. If you are having a bad night and require higher pressure, the machine automatically adjusts.

This allows the machine to determine the lowest pressure that you need to avoid apnea. A CPAP machine must be set at a level that is appropriate for your worst episodes and is often higher than necessary for most of the time you use it.

BiPAP

One problem with CPAP and APAP is that the pressure is constant, even when you are exhaling. BiPAP (BiLevel Positive Airway Pressure) are designed to help people who have trouble exhaling under the constant pressure of a CPAP, especially when the prescription is high.

There are 2 settings on a BiPAP machine. The higher pressure is applied when you inhale (IPAP setting) and the lower one when you exhale (EPAP setting). This reduces the effort required when exhaling without reducing the effectiveness of the therapy.

The Drawbacks

While CPAP, APAP and BiPAP machines are literally life savers for people who suffer from sleep apnea, they have drawbacks as well.

Comfort

The first one that you’ll encounter is that they are uncomfortable. It can be difficult to get used to wearing a mask with the straps and tubes. Working with your health professional can help you to find the most comfortable fit for you.

You may also have trouble dealing with the pressure. It does take some getting used to. For me, these two problems were somewhat mitigated since I was so sleep deprived that I was able to fall asleep instantly (I could have slept on a rock). So I was able to get used to them very easily. But I know that many people struggle with this and some cannot adjust to it at all.

Noise

Another problem is the noise. The machines are quieter than they used to be, but there is still a certain level of noise from the machine and also from the tubing and mask. You obviously will be breathing out and that air escapes through vents. The design of the vents has improved but there is still enough noise to wake a light sleeper.

My wife has adjusted to the noise level — it sure beats my snoring and snorting that she used to put up with. It has become part of the ambient noise, but she struggled with it at first. I keep my machine on the floor and that helps. It also helps to make sure that you have a tight, comfortable fit — leaks are very noisy!

Nasal Congestion

The biggest drawback for me is that a nasal mask only fits over the nose. When I am stuffed up with allergies or a cold it is impossible to use the mask properly. This requires that I take some kind of decongestant before bed on those nights. I’m not a big fan of cold medicines but they are preferable to sleep apnea.

I could switch to a full face mask, but then I’d be tempted to breathe through my mouth. I like the fact that the nasal mask forces me to breathe through the nose as it is more comfortable for my throat.

Humidity

For many people, humidity is a big problem. I don’t know why I don’t struggle with this, but many people find that their nasal passages and throat become very dry when using CPAP. If you have this problem then a humidifier will help.

Pretty much every machine sold today has an optional humidifier attachment or has one built in. They use heat and water to moisturize the air flowing through the tubing to the mask. You can adjust the heat level to create as much or as little moisture as you need to keep from getting dried out.

In the winter when the air is extra dry I sometimes use the humidifier on my machine without heat. But I rarely notice a difference if I forget to fill it.

Portability

Finally, a CPAP machine is not really portable. Sure, you can pack up the machine and mask and take it with you. But you can’t nap on the sofa or sleep on an airplane with it. At least, not easily.

There are travel machines that are smaller and easier to use if you travel a lot. But your options for sleeping are limited by where you are able to set up the machine.