Obstructive sleep apnea affects millions of adults in the United States, with the majority of those affected suffering through the disorder while undiagnosed. Obstructive sleep apnea is a sleeping disorder characterized by interrupted breathing due to an obstruction in the airways, like enlarged tonsils or tensed throat muscles, and this repeated interruption of breathing can lead to other serious health problems.

What are the signs and symptoms of obstructive sleep apnea?

Sleep apnea has a lot of warning signs in adults. If you have any one or two of these signs and symptoms, consult with a doctor immediately:

• Restless sleep
• Gasping or choking during sleep
• Headaches in the morning
• Daytime fatigue
• Dry or sore throat
• Changes in mood
• Irritability
• Loud snoring
• Silent pauses in breathing
• Waking up to pee
• Insomnia

6 things that can make sleep apnea worse

If you are diagnosed with obstructive sleep apnea or suspect that you are developing the disorder, then it’s recommended that you watch out for these things that can make the condition worse:

1. Weight gain

People who have excess weight tend to be more likely to develop obstructive sleep apnea, mainly because of the added mass in the neck which tends to close in on the airways. You would also notice that people who are obese have difficulty breathing when they are awake, but their problem can be worse when they are laying in a supine position during sleep.

If you have OSA and have a BMI indicating obesity or overweight status, it is highly recommended that you adopt lifestyle changes to achieve a normal BMI. Excess weight or further weight gain can increase the risk of the airways collapsing during sleep, as well as give way to more weight-related issues such as heart disease or diabetes.

2. Alcohol consumption

One of alcohol’s effects is the relaxation of muscles. If you are suffering from OSA and have a habit of getting a drink right before sleep, then you are putting yourself at risk to even worse episodes of sleep apnea due to alcohol’s relaxant effect on the throat muscles.

It is best to avoid alcohol altogether. Alternatively, you can wait at least an hour after drinking before going to sleep to decrease the chances of sleep apnea.

3. Deep sleep and sleep deprivation

When you are sleep deprived, your body tends to make up for it with REM sleep, otherwise known as deep sleep wherein rapid eye movement and paralysis of the muscles occur. REM sleep paralyzes the airways and causes drops in oxygen during sleep, often causing gasping or pauses in breathing during the night.

REM sleep cannot be avoided since it’s an important part of quality sleep, but it’s recommended that you don’t deprive yourself of sleep too much. A good sleep cycle can help ensure that your body will not sleep so deeply to the point that you are already experiencing sleep apnea.

4. Cigarette smoking

Cigarette causes multitudes of respiratory problems which can indirectly cause sleep apnea. For one, smoking can make the area near the airways swell due to the irritant effect of cigarettes, which can lead to sleep apnea over time. Furthermore, chronic obstructive pulmonary disease or COPD is a consequence of smoking, which can also narrow and inflame the airways. Hence, another reason to quit cigarettes!

5. Sleeping on your back

Sleeping position is a pretty hard factor to modify, but with enough help from a partner or family member, you can start getting used to sleeping on the side. Sleeping in the supine position increases the tendency of snoring and worsen sleep apnea. On the other hand, people who suffer from OSA were found to have reduced sleep apnea episodes when they sleep on their side. This is also true for people who don’t suffer from OSA but are loud snorers.

6. Other respiratory problems

Respiratory problems such as adult asthma, seasonal allergies, or nasal congestion can make sleep apnea ten times worse for sufferers of OSA due to the accumulation of mucus, inflammation of the airways, and the reduction of airflow during attacks. If you have any of these comorbidities along with obstructive sleep apnea, it is highly recommended that you treat the respiratory problem immediately. Chances are, it would be easier to treat nasal congestion and allergies than to suffer through a heightened state of sleep apnea during sleep.

Conclusion

Patients who suffer from obstructive sleep apnea can limit the instances of this disorder if they put effort to control modifiable risk factors as discussed above. Weight gain, alcohol consumption, sleep patterns, smoking, sleeping position, and treatable respiratory problems are things that can make sleep apnea worse–but with lifestyle changes and appropriate treatment, you can prevent sleep apnea from getting worse and possibly reduce nocturnal episodes as well.

References

• https://www.webmd.com/sleep-disorders/sleep-apnea/sleep-apnea-conditions
• https://health.usnews.com/health-care/patient-advice/articles/2018-07-05/sleep-apnea-8-things-that-make-it-worse
• https://www.simplesleepservices.com/8-things-that-could-make-sleep-apnea-worse/
• https://www.usa.philips.com/c-m-hs/better-sleep-breathing-blog/better-sleep/side-back-or-stomach

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Obstructive sleep apnea (OSA) refers to interruption in the normal breathing pattern by partial or complete obstruction of the air passage during sleep. It is characterized by snoring, oxygen desaturations, hypopneas, episodes of apnea and excessive daytime sleepiness. According to National Healthy Sleep Awareness Project, OSA now affects 25 million adults in the US alone. This increased prevalence is a major public health concern since untreated OSA can have serious short-term and long-term consequences. Untreated OSA carries an increased risk of hypertension, stroke, depression, and headaches, to name a few. Hence, it is imperative to diagnose and prevent OSA for deep, restful sleep. Recently, there has been an increased importance of early sleep apnea detection. Early detection of OSA means prompt treatment and therefore facilitates reduction in mortality and morbidity usually associated with OSA. This can be especially important in commercial vehicle drivers or heavy machine operators since symptoms such as daytime fatigue and sleepiness, can be dealt with sooner than later.

Overnight polysomnography or a sleep study is the gold standard test to detect OSA. Since sleep studies are elaborate, expensive and time-consuming, a number of screening tools have been developed.

Screening for OSA

Early detection of OSA is facilitated by the development of several clinically tested screening tools. These screening measures if used by a family doctor at regular medical checkups can screen for severe or moderately severe OSA. A history of loud snoring and excessive daytime fatigue is suggestive of some sort of sleep apnea. These symptoms coupled with obesity and family history of OSA can put one at a higher risk. Such individuals would be ideal candidates for the screening tools to diagnose OSA and get appropriate treatment.

According to an expert analysis by the American College of Cardiology, there are a number of screening tools that are sensitive and highly specific and at the same time are relatively easy to administer in a clinical setting. STOP, STOP-BANG, Epworth Sleepiness Scale and Berlin Questionnaire are a few of the most specific and sensitive tools available currently. STOP and STOP-BANG questionnaires have been reported much more in research and tested clinically far more times than the others, due to their simplicity in administering.

STOP Questionnaire

This screening tool is one of the most commonly used questionnaires due to its easy administration. STOP consists of four yes or no questions. It assesses snoring (S), tiredness (T), observed apneas (O) and high blood pressure (P).

A yes answer on any two questions indicates high risk for sleep apnea.

STOP-BANG Questionnaire

This screening tool consists of eight yes or no questions. It assesses snoring (S), tiredness (T), observed apneas (O) and high blood pressure (P), similar to the STOP questionnaire. The BANG part of this tool includes BMI > 35 kg/m² (B), age > 50 years (A), neck circumference > 40 cm (N) and male gender (G).

A yes answer on any three questions indicates high risk for sleep apnea. STOP-BANG demonstrates high sensitivity in individuals with moderate to severe OSA.

Epworth Sleepiness Scale

Murray Johns created the Epworth Sleepiness screening tool in 1990. It assesses daytime somnolence or sleepiness due to inadequate sleep the night before. It is a self-report questionnaire consisting of eight questions of common scenarios, like reading a book, for instance. The answers range from zero (indicates no chances of dozing off) to three (always dozing).

The score of 10 or more on the Epworth Sleepiness Scale indicates excessive daytime sleepiness. This screening tool shows highest specificity in patients with moderate to severe OSA.

Berlin Questionnaire

Developed in 1996, Berlin Questionnaire is a screening tool that consists of three categories of questions: snoring, daytime sleepiness and hypertension and BMI.

In the first and the second categories, a response of frequent symptoms (>3-4 times/week) for snoring and daytime sleepiness is considered positive. The third category is considered positive if there is positive history of hypertension or a BMI of greater than 30 kg/m². Individuals are considered high risk for OSA if they are positive in two or more categories.

Conclusion

Untreated OSA greatly impacts the quality of life and can have serious implications. Needless to say, early detection by a simple way of a screening tool is hopeful in prompt diagnosis. Perhaps, general physicians could incorporate one of these screening tools during routine physical examinations for their patients. This could help in highlighting suspected OSA and such patients can receive treatment far earlier and avoid complications.

However, it must be emphasized that these questionnaires, though highly specific and sensitive are only suggestive of OSA. A positive on one or two screening tools is not a conclusive diagnosis of OSA. Further monitoring by polysomnography and assessment by a clinician may be required to confirm diagnosis of OSA.

References

• https://aasm.org/rising-prevalence-of-sleep-apnea-in-u-s-threatens-public-health/
• Colvin, L. J., & Collop, N. A. (2016). Commercial motor vehicle driver obstructive sleep apnea screening and treatment in the United States: an update and recommendation overview. Journal of clinical sleep medicine, 12(01), 113-125.
• https://www.acc.org/latest-in-cardiology/articles/2015/07/14/11/04/screeing-tools-for-the-obstructive-sleep-apnea-for-the-cardiovascular-clinician
• El-Sayed, I. H. (2012). Comparison of four sleep questionnaires for screening obstructive sleep apnea. Egyptian Journal of Chest Diseases and Tuberculosis, 61(4), 433-441.
• https://www.sciencedirect.com/science/article/pii/S0422763812000453
• https://medlineplus.gov/ency/article/003932.htm

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Obstructive sleep apnea is a medical condition that is characterized by interrupted breathing during sleep due to an obstruction of the airways. Recent studies have shown that people who have this nocturnal disorder are two times more likely to develop gout than people who don’t. Gout, on the other hand, is a form of arthritis that is caused by an accumulation of uric acid in the joints, and it can be very, very painful.

These two disorders seem completely unrelated, but recent research has shown significant results proving otherwise. In this article, let’s explore the relationship between these two diseases and find out what are the ways to prevent them.

What is obstructive sleep apnea?

Obstructive sleep apnea can be caused by a number of reasons; such as blockage or narrowing of the airways, thickening of tissue or fat in the airways, or an underlying medical condition that causes the neurologic controls for breathing to malfunction.

When a person has sleep apnea, he or she may manifest the following symptoms:

• Snoring
• Restless sleep (sometimes mistaken to be insomnia)
• Repeated interrupted breathing
• Frequent night urination
• Daytime fatigue or headache
• Gasping or grunting during sleep
• Heartburn
• Dry mouth
• A sore throat

People who are at risk for developing sleep apnea are those who have chronic sinusitis, obesity, enlarged tonsils, menopause, Down syndrome, and large neck circumference among other risk factors.

What is gout?

Gout is a form of arthritis that is caused by accumulation and crystallization of uric acid in the joints. This happens when uric acid is not excreted enough, or the body produces too much of it, which causes a buildup in the joints of the body (like in the hands, knees, toes, or wrists). People who have gout suffer from flare-ups that are accompanied by pain, inflammation, redness, and swelling.

The risk of developing gout is increased if a person is obese, consumes alcohol constantly, has a family history of gout, or has renal insufficiency which decreases the kidney’s ability to process uric acid.

What is the relationship between obstructive sleep apnea and gout?

Research shows that people who have obstructive sleep apnea have increased the risk of developing gout in both short-term and long-term. Researchers also found out that sleep apnea and gout share many risk factors; such as obesity and increased alcohol consumption, as well as comorbidities like hypertension and diabetes.

Moreover, it has been found out that people with a normal Body Mass Index (BMI) are most at risk of developing gout compared to other BMI groups, wherein gout likely occurs two to five years after the diagnosis of sleep apnea. This implies that all patients with sleep apnea should be assessed for gout risk, regardless of BMI.

Researchers of this study hypothesized that the relationship between sleep apnea and gout is influenced by intermittent hypoxia (lack of oxygen during episodes of sleep apnea) which increases nucleotide turnover in the body that, in turn, increases the production of endogenous uric acid.

Another possible explanation for the association of sleep apnea with gout is the shared risk factor for both diseases, which is obesity or being overweight. People who are overweight or obese are more likely to develop sleep apnea and gout, possibly being a result of an underlying weight-related condition. However, there is still not enough scientific evidence to show a direct link between sleep apnea and gout.

How to prevent sleep apnea and gout

Since sleep apnea and gout share many common risk factors and comorbidities, correcting modifiable risk factors may decrease the chances of developing either or both of the two diseases. Here are a few tips on how to prevent sleep apnea and gout:

• If you have a family history of sleep apnea or gout, consult with a doctor to assess your risk of developing the disease
• Cut down on alcohol consumption; the recommended amount is two drinks per day for men and one drink per day for women
• Maintain a normal BMI to prevent the development of sleep apnea, gout, and other obesity-related conditions
• If you have gout, avoid red meats, seafood, and other foods that have a high uric acid content
• Take care of your kidneys to avoid renal insufficiency; avoid excessive sodium, saturated fat, cholesterol, and processed food in the diet

Conclusion

Despite lack of evidence to show that sleep apnea is directly related to gout, there are reliable studies that strongly suggest the contribution of sleep apnea to the development of gout (due to hypoxia which increases production of uric acid). A more plausible explanation is that the risk factors for sleep apnea are almost the same as that of gout. Thus, a patient who has risk factors for both diseases is most likely to develop both in the long run.

References

Sources and further reading.

• https://www.health.harvard.edu/blog/gout-sleep-apnea-may-raise-your-risk-201511178633
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4549693/
• https://www.medicalnewstoday.com/articles/144827.php
• https://www.medpagetoday.com/rheumatology/generalrheumatology/74825
• Complications of Sleep Apnea

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The treatment of mild to severe sleep apnea often requires the use of a medical device that the sufferer wears while sleeping. What sometimes used to be a cumbersome, embarrassing mask is now more discrete and comfortable for the wearer. Sleep apnea devices have come a long way as new advances have been made in the design and comfort, as well as in other alternative methods.

Advanced CPAP Devices

The Rio by 3B Medical is a CPAP with a sleek, ultralight design. The device weighs 2.6 oz. so it is virtually non-existent to the sleeper and is the lightest mask on the market. It also offers soft silicone nasal cushions for ultimate comfort, and a rotating ball in socket movement.

The F&P Eson 2 was designed for comfort in such ways as an adjustable head wrap that can be slipped over the head, as well as performance. This advanced design is made to aid not only patients but professionals as well throughout each phase from titration to adherence. Usability is also a key feature of this model, promoting less hassle and fuss so the wearer can get to sleep quicker.

Since the CPAP is the most recommended, along with being the first method of treatment for sleep apnea, a lightweight, moveable, design that does not further interrupt sleep, is best.

Nasal Device

An alternative to the CPAP is the EPAP, or expiratory positive airway pressure, device. This is a disposable adhesive valve that is worn on the nose. The intention is to keep the airway open when both inhaling and exhaling. When breathing in, the valves open. When breathing out, your breath is channeled through the valves creating pressure that keeps the airway open.

Oral Treatment Devices

If you are not tolerant to the CPAP or EPAP devices for any reason, the alternative solution is to consider the use of a mouthpiece. However, over-the-counter mouthpieces may have more detrimental effects on your teeth and jaw, and it is recommended to consult a dental professional.

FDA Approved Advancements

With that said, there has been the development of the first FDA approved intra-oral device. The device is made by Oravan and is designed with a truly open anterior. Its made of two separate pieces, custom made to your teeth and jaw from acrylic for durability and longevity. The benefit is the ability of the wearer to have full function of their mouth, with freedom of movement.

Oravan’s uniqueness lies in the dorsal fin design. These two dorsal fins reside on the lower piece and engage with the titration mechanisms located on the top piece. This allows for a more natural protrusion of the tongue and better airflow.

Lastly, there is also a new futuristic like mouthpiece available from Australia called the O2 Vent. This device is a sleek design with a titanium core that is inserted into silicone mouth guards for ultra-comfort. The mouthpiece also boasts a weight of only 1.23 oz. The advantage of the O2 vent is that you will not suffer from a dry sore throat in the morning, as the device has a built-in airway the size of a nostril. When you breathe the air is taken to the back of the throat, through the device, all while your mouth remains sealed tight.

New and Upcoming Oral Device

Another take on oral devices is provided through a dentist out of Hudson, NY who recently patented a mouth guard, unlike other mouthpieces. This dentist’s design joins the upper and lower jaws, but also holds the lower jaw forward to prevent the tongue from slipping and causing an obstruction of the airway. This design has yet to be approved by the FDA, as it is still pending, but is available through the dentist’s practice. The benefit is a more comfortable and natural feel while asleep.

Implant Alternatives

Patients who may not be interested in an external device now have the option to implant a small device into their chest.

Approved by the FDA in 2014, the device does not require the use of a wearable mask and is available for patients who suffer from severe cases of sleep apnea. It is called hypoglossus nerve stimulation. This is a small device that is implanted surgically into the chest. The device monitors the breathing of the sufferer and stimulates the nerve responsible for keeping the upper airway open. Another feature is that the wearer can turn the device on before sleep, and off when awake.

This may be a more invasive approach to treating obstructive sleep apnea, yet it may be a great solution for those who do not tolerate masks, nasal pieces, or mouth guards well.

Treating Positional OSA

For those who suffer from mild sleep apnea, where adjusting sleeping positions relieve symptoms, there has been an advancement in devices that can monitor your movements without disrupting your sleep in an effort to select proper treatment.

The Technology

The latest development is the software ABM, Advanced Brain Monitoring. It works by submitting data brought in by a device known as the night shift and a wrist oxygen transmitter. The advantage is the capabilities to home assess positional therapy, a treatment that used to require patients to visit a sleep center that often yields imperfect results.

Now, the night shift has been on the market for sleep apnea sufferers and is a wearable vibration transmitter that is worn on the back of the neck. It sends increasingly strong vibrations until the sleepers position changes, initiated when the sleeper turns to their back.

Finding the Solution for You

Choosing the right solution and treatment for your sleep apnea should always be consulted with a medical professional and in some cases a dentist. The use of over-the-counter devices and home remedies may put you at increased risk or may alter the position of your teeth when utilizing a mouthpiece. With proper recommendation, these latest developments can ease relieve the symptoms of sleep apnea with comfort and ease.

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Feeling tired after a full night’s rest? Hearing your significant other gasp for breath or snore unusually loud in the middle of the night? These can all be warning signs of a deadly disorder if left untreated; sleep apnea.

About 18 million U.S. adults suffer from sleep apnea, with that majority being men. The condition is a potential silent killer as it is typically undiagnosed. Sufferers are not aware of the occurrence as it happens while sleeping.

This condition is the result of a relaxation of the muscles in your airway that temporarily obstructs or limits the passage of oxygen. Occurrences can happen up to 30 times within one hour. In severe cases, it can result in death.

Types of Sleep Apnea

There are two types of sleep apnea, obstructive and central. They can occur individually, or they can coexist. Each type has differing signs and symptoms.

What is obstructive sleep apnea?

Obstructive sleep apnea is the most common form of sleep apnea. It is the collapse or blockage of the airway resulting in shallow breathing or breathing pauses.

The lack of oxygen to the body temporarily wakes the sleeper resulting in tiredness. Each pause can last about ten seconds.

Signs and Symptoms of Obstructive Sleep Apnea

The most common sign of obstructive sleep apnea is loud snoring and drowsiness during daylight hours. Sufferers may also experience insomnia, awakening at night from gasping for air, waking with dry mouth or a sore throat, morning headaches, depression or high irritability, decreased libido, high blood pressure, and nighttime sweating.

What is central sleep apnea?

Central sleep apnea, like obstructive sleep apnea, is when shallow breathing or complete failure to breathe occurs while sleeping. However, rather than being a mechanical condition like OSA, central sleep apnea is the deprivation of a signal from the brain telling the body to breathe.

It is most common in individuals who suffer from prior neurological conditions, who have suffered brain trauma, or those who take certain medicines.

Signs and Symptoms of Central Sleep Apnea

Central sleep apnea carries the same symptoms as OSA such as moodiness, insomnia, hypersomnia, morning headaches, and snoring. Though there are a few variations to distinguish the two. CSA symptoms may also include shortness of breath only relieved by sitting up, abrupt awakenings, irregular breathing periods where the sleeper fails to breathe, as well as chest pains at night.

Treatments

Depending on the type of sleep apnea that is occurring, treatment options can vary. The options available can range from home remedies such as lifestyle changes to medical devices, or surgery in more severe cases.

Treating Obstructive Sleep Apnea

When suffering from mild obstructive sleep apnea lifestyle changes can have a very positive effect on the symptoms of this condition. These changes include, weight loss, quitting smoking and/or drinking, and even changing sleep position from lying on your back to your side.

Other simple, less invasive treatments are available as well. The use of nasal aspirators or custom made mouthpieces can also relieve symptoms.

Medical devices such as CPAP, continuous positive airway pressure, can also be worn. The devices are masks that cover your mouth and nose, or nose alone and push air through your passageways. The pressure of the forced air allows your throat canal to remain open.

Treating Central Sleep Apnea

Because central sleep apnea is a failure of the brain to signal the body to inhale, this form is much more difficult to treat in other ways other than the use of an assisted breathing apparatus. As such, CPAP machines are also effective in treating CSA.

Another option involves surgery in severe cases. The type of surgery performed will also vary depending on the cause of the condition. This could mean the removal of excess tissue in the throat such as tonsils, placement of stiff plastics to stiffen tissue causing the blockage, or readjusting the lower jaw.

Overview

Sleep apnea left untreated, as it is in many cases, is a silent killer. Those who suffer from the condition are more likely to suffer other serious health issues such as heart disease and stroke. Each year there are on average 38,000 cardiac distress deaths directly related to sleep apnea. If you suspect that you or your bed partner have any of the symptoms seek medical advice. The condition is treatable with proper diagnosis.

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For patients with obstructive sleep apnea (OSA), CPAP therapy is nothing short of life support. While loud snoring is probably the most noticeable effect of OSA, the truly dangerous consequences of untreated OSA happen inside the body. Untreated OSA causes high blood pressure, damages the heart, and an increased risk of strokes.

CPAP machines are life-saving technology.

The adjustment period may be uncomfortable, but once OSA patients adapt to the CPAP lifestyle they will become dependent on their machine. This dependency is a good thing because the machine is literally saving their lives. The alternative, resisting treatment, results in a slow death from lack of sleep.

In June 2017, famous actress Carrie Fisher died in her sleep. Although the media chose to focus on trace amounts of drugs in her system, the official coroner’s report focused on obstructive sleep apnea. It is unclear if Fisher was even aware that she had OSA. Although the coroner’s documented cause of death was “undetermined,” it has widely been attributed to OSA.

There has also been speculation that Justice Scalia’s sudden death was connected to skipping CPAP.

2009 Study: Sleep apnea raises death risk 46%

Researchers at Johns Hopkins University published a study finding that severe sleep apnea raises the risk of dying early by 46 percent. Other studies have found there is an 86% likelyhood of dying prematurely.

Suffocation without CPAP

In layman’s terms, sleep apnea is literally when a person stops breathing during their sleep. In response, the brain to experiences repeated moments of suffocating. The person’s sleep must be interrupted for air, either through a snort or a full “wake up.”

“In severe sleep apnea, a patient’s airway is blocked while the patient suffers for 20 to 30 seconds and wakes up. When it becomes this frequent — 30 times per hour — about every two minutes it is severe sleep apnea and can become a problem. [The] most successful treatment can be a nasal CPAP (continuous positive airway pressure) mask that applies pressure to help keep the airways of a patient open while they sleep, allowing normal breathing.”

Untreated OSA causes people to wake up frequently, gasping for air on the verge of suffocating. Without a CPAP “life support” machine, there is the risk of never waking up again.

CPAP machines as emergency life support

CPAP machines aren’t limited to treating sleep apnea. They are commonly used as life support devices in medical emergencies. One of the most compelling pieces of evidence that CPAP therapy truly is “life support,” is found in the lesser-known applications.

Art Hsieh, MA, NRP, writes that CPAP isn’t just one possible way of managing congestive heart failure and other respiratory emergencies, it is “the standard of care.”

CPAP machines are primarily used “for the management of heart failure secondary to pulmonary hypertension.” Hsieh said that CPAP machines are used for treating bronchoconstriction, toxic inhalation, drowning, flail chest, and lung infections (like pneumonia).

Conclusion

In closing, two areas deserve some further clarification. First, this article does not intent to suggest that the “quality of life” of an individual living with untreated sleep apnea is the same as that of a patient in a state of unconsciousness. Secondly, even the most severe OSA patients can most likely survive a night without their CPAP machine.

For further reading on the “quality of life”:

• Quality of life among untreated sleep apnea patients compared to the general population and changes after treatment with positive airway pressure
• Obstructive sleep apnea syndrome and the quality of life
• Quality of Life and Obstructive Sleep Apnea Symptoms After Pediatric Adenotonsillectomy
• Obstructive sleep apnea and the quality of life

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Continuous Positive Airway Pressure

CPAP (Continuous Positive Airway Pressure), as the name implies, is the maintenance of a positive pressure in the airways throughout the complete respiratory cycle (inspiration and expiration), when breathing spontaneously.

Increased inspiratory pressure also increases the size and surface area of the alveoli providing greater opportunity for gas exchange to occur and improving oxygenation in the bloodstream. During the expiratory phase, breathing against a threshold of resistance holds the airway open, preventing air trapping.

This was originally used in pulmonary and cardiovascular conditioning of racehorses and competition animals.

CPAP therapy

CPAP therapy uses machines and devices specifically designed to deliver a constant flow of pressure. CPAP devices use airflow to create a positive pressure in the oropharynx and laryngopharynx. The flow may be constant or varying based on the design, and most CPAP systems have an intentional outlet to vent the excess flow.

Types of CPAP

There are two main types of CPAP units based on the functionality.

Fixed CPAP units deliver a constant air flow whereas variable (auto adjusting) units titrate the flow throughout the night to optimize the pressure. Various devices are available for this purpose, and each device uses its own algorithm to set the flow.

Automatic adjustments (ACPAP) are considered more comfortable as they can adjust the flow according to the requirement of the individual.

CPAP interfaces

There are many manufacturers of CPAP devices who use their own interface or interfaces to connect the patient to the device. Most commonly used interfaces include the nasal mask, nasal pillows or the oronasal mask.

New technology has also been developed to combine the oral mask with nasal pillows to deliver the airflow to both upper respiratory openings. A full-face mask or whole head applications (CPAP helmets) are also used with varying degrees of success.

Each interface is held in place by head gear and straps around the head. Nasal CPAP is commonly used in children despite some controversies. Studies have shown that nasal CPAP reduces ventilator time, but an increased chance of developing pneumothorax (air in the pleural cavity) is also prevalent. Oral masks and naso-oral masks are often used when nasal congestion or obstruction is present.

Other CPAP features

In addition to these, some CPAP machines have other features like heated humidifiers. CPAP devices that combine nasal pressure with Maxillary Advancement Devices (MAD) also exist.

The best part of some CPAP machines comes with the fact that they make data sharing possible and absolutely simple. You can share the data with your healthcare provider with ease in real time and with simply a phone call the machine can be remotely adjusted.

CPAP effectiveness

CPAP is found to be effective in treating sleep disorders such as obstructive sleep apnea, hypopnea and sleep disturbances. It is also useful in helping patients mobilize secretions, prevent atelectasis, reduce air trapping in COPD, reduce severe asthma attacks and cardiogenic pulmonary edema and treat hypoxemia.

Some physicians may use CPAP in premature infants with respiratory distress syndrome as well.

Downsides of using CPAP

There are some problems with CPAP devices that make the patients noncompliant. Main cause is the pressure points created on the forehead and the bridge of the nose. The discomfort caused by these pressure points on a long-term basis is significant and can, in turn, cause sleep disturbances.

Some nasal pillow systems and the oral mask/nasal pillow combination solve this issue but create a pressure point on the nares. Some patients dislike CPAP because it causes discomfort while swallowing when receiving positive pressure.

Also, if the patient opens his/her mouth while wearing a nasal mask or pillows, the flow from the CPAP constantly rushes out of the mouth. A chin strap can be used to stop this problem, but it may add to the discomfort of the patient.

CPAP Summary

All in all, CPAP is a great invention that has helped thousands of patients to overcome an array of respiratory related issues throughout the years. However, a significant number of patients have become noncompliant and missed out on the benefits of this invention owing to its minor drawbacks mentioned above.

Research and development is continuing to improve the functionality and user-friendliness of CPAP therapy to make it an invaluable, must-have asset in hospitals and at home.

References

Bill Pruitt, MBA, RRT, CPFT, AE-C. Clinical foundations; A Patient-focused Education Program for Respiratory Care Professionals.

Mercury medical. Continuous Positive Airway Pressure. 2014

Richard H. Blackmer, Jonathan W. Hedman. Method and apparatus for pulmonary and cardiovascular conditioning of racehorses and competition animals. 1988

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How to Clean a CPAP Machine

It is essential for the long life of your CPAP machine that you take proper care of it.  Everything must be kept as clean as possible to reduce the risk of bacteria or mold growth.  When you are cleaning a CPAP machine, there are several tasks you will want to perform daily as well as weekly.

Why Cleaning your CPAP Machine is Important

There are countless reasons why keeping any medical machinery clean is important.  When dealing with a CPAP machine, there are four main reasons to ensure that it is being properly cleaned on a regular basis.  They are as follows:

• CPAP supplies can degrade over time
• Cushions can lose their seal with repeated use
• Dirty filters can damage your CPAP machine
• Bacteria and mold can grow in the unit and throughout the parts

Daily CPAP Machine Cleaning Tasks

Just as you want to properly care for your own hygiene needs each day, there are several tasks you should perform on your CPAP machine daily.  Be sure you set up a daily routine where you can spend a few minutes to care for your machine.

The first thing you will want to do is wipe down your mask after you are done using it.  Make sure you reach every area that has come in contact with your skin.  You can use a damp towel with a gentle detergent and some warm water.  Then rinse the mask with a clean towel and allow to completely air-dry.  This will ensure that you’ve removed all oils, sweat and dead skin cells.  If this is not done properly, your mask may not seal the way you need it to.

If you would prefer not to use the damp towel method, you can purchase some pre-moistened towels designed to clean a CPAP machine.  Most sleep centers have these available.  While it is easier to do the cleaning this way, it will be more expensive for you in the long run.

If your CPAP machine contains a humidifier, you’ll want to empty all the leftover water in the morning.  Never allow this to sit in the unit all day.  At night, before you are ready to use your machine again, simply refill with clean, distilled water.

When you’ve been sick, it is more important than ever to clean your CPAP machine.  Wash the mask, tubing, filter, and humidifier each day during your illness.  This will help you stay clear of unnecessary germs.

Weekly CPAP Machine Cleaning Tasks

Make sure you set aside a designated time each week when you can properly care for your CPAP machine.  You’ll want to give the unit a complete cleaning to keep it free from any germs, bacteria, and dust.

Start by cleaning the CPAP tubing, headgear, and nasal mask.  You can accomplish this in your bathroom sink with some warm water and several drops of a mild dish detergent that is ammonia-free.  Mix all these elements around in the sink for approximately five minutes.  Then, be sure to rinse well with warm water and allow the elements to air dry all day.  You can choose to hang the tubing over your shower rod or on a towel rack.  This will help to ensure that all the water has thoroughly dripped out of the tubing.

Your mask and headgear need to also be air-dried completely.  The best place to do this would be on a towel, or you could hang them on a hook.

The next step will be to clean the CPAP machine itself.  Always keep in mind that you don’t want to get the machine too damp or wet as it could end up inside the components and ruin it.  Instead, simply wipe it down with a damp cloth.

Be sure to pay careful attention to the CPAP machine’s filter.  This is where the dust and debris will settle.  You can remove it and rinse it down with some warm tap water.  Squeeze it gently to ensure that all the dust has been removed.  Then, dry the filter by blotting it carefully with a towel.

If your machine has a white filter, you will not want to wash this—they are disposable and should be replaced once a month.  If you find that it has become dirty before the month is over, you should always replace it sooner.

For CPAP machines that contain a humidifier, you’ll need to ensure a deep cleaning every week as well.  Start by emptying all the remaining water left in the tank.  Then, wash the chamber in your sink with some warm, soapy water.  Rinse this out well and be sure to drain as much of the water as possible.  You will want to allow the chamber to air-dry completely before you place it back onto the CPAP machine.

Mark your calendars that every other week, you’ll want to take a little extra care with the humidifier.  It will be important to disinfect the chamber thoroughly to reduce any risk of mold and bacteria.  Start by soaking it in a solution made up of one-part vinegar and five parts of water.  You should do this for at least 30 minutes.  Then, rinse the chamber thoroughly and place it on the top rack of your dishwasher for an added washing.  Again, don’t put the humidifier back onto the CPAP machine until it is completely dried.

It is very important if you have a humidifier with your unit, then you only ever use distilled water.  This prevents any buildup of mineral deposits that will damage your machine over time.

Conclusion

Cleaning your CPAP machine on a regular basis is an important aspect to keeping you healthy and comfortable.  It will also increase the lifespan of your CPAP machine and enable it to remain in top-notch working order.  With a little bit of your time both daily and weekly, you will be able to prolong the life of your unit.  Be sure to take the time now to maintain and clean your machine so you can remain healthy and enjoy quality sleep for many years to come.

Without a doubt, the easiest way to clean and sanitize your CPAP equipment is with the SoClean 2 CPAP cleaning unit. No water and no messy chemicals necessary. It is almost universally acclaimed as the most effective way to clean your CPAP equipment.

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A Quick Beginners Guide to CPAP Machines

If you’ve just been told that you need to start using a CPAP machine, you might be feeling a little apprehensive about the next steps. Many people who stop using their machines do so because they aren’t experienced enough to work through the problems that might arise. Here are some simple tips to help beginners use a CPAP machine.

Take Your Time Selecting a CPAP Mask

Choosing your CPAP mask is going to be a crucial step to sleeping comfortably at night. There are different masks that suit a variety of needs. It will be important to take the anatomy of your face and shape of your nose into consideration.

One size does not fit all when it comes to CPAP masks. Many people who quit treatment will do so as a result of an improper fit, so take your time and select wisely.

Practice Using Your CPAP Machine

Most people don’t find that they are immediately comfortable with their CPAP machines. The best way to get started is to practice using while you are awake. Start with slow and deep breaths. At first, you are going to notice that the air easily fills up your lungs, but that breathing back out can be a little harder. You will also take notice to the sound of the air escaping through the exhalation ports of the mask.

If you are using a nasal mask, you will feel the air rush out of your mouth if you open it. When using a full face mask, you can breathe however you wish and still receive the benefits. Spend time for a few minutes or hours, whatever is comfortable, finding a pattern of breathing that feels right to you. If you need some distraction during this practice time, feel free to take your mind off the exercise. Watch some TV or read a book. Whatever keeps you on the machine longer will help you achieve your goal of feeling comfortable enough to sleep with the mask on.

Sometimes the Air Might Feel Too Strong

This is actually a common complaint but you’ll never want to adjust the CPAP air pressure without speaking to a doctor. Doing so could lower your oxygen intake and eventually cause unwanted health issues. Your best course of action is to go back to practicing with your machine during the daytime hours so it will become more comfortable at night.

Stuffy Noses are Common with CPAP Users

If you are one of the many people that suffer from a stuffy nose while using your CPAP machine, there are some steps you can take.

• Use a saline nasal spray up to 6-8 times per nostril before using your CPAP machine.
• Ask your doctor about using a CPAP machine that comes with a humidifier. This will add moisture to the forced air and can reduce nasal congestion.
• Thoroughly clean your mask and tubing daily. This is an important step toward protecting you from germs and bacteria that can lead to sickness.

Fighting a Sore Throat When Using a CPAP Machine

It is also quite common to wake up with a sore throat after your CPAP usage. You might have been breathing through your mouth while sleeping which is a common cause. You can apply a simple chin strap to your mask to keep it closed all night. Another option would be to purchase a full face mask so you can breathe through your mouth. Once you switch to the full face mask, you’ll want to have a humidifier on your CPAP machine to keep the air moist. If all else fails, be sure that the filters on your CPAP machine are clean.

Troubleshooting a Poor Fitting Mask

Nothing makes a CPAP experience worse than wearing a mask that isn’t fitting properly. It causes air to leak out of the mask resulting in red eyes, snoring and even a stop in breathing. Try some of these solutions to see if they relieve the issues for you.

• Take time adjusting the straps to see if you can make it fit better.
• Inspect the condition of your mask and cushions. You will want to purchase new supplies every 3-6 months or as necessary if they have excessive wear and tear.
• If you are unable to make the mask comfortable on your face, be sure to speak with your doctor. They might be able to offer additional support to help you achieve comfort.
• Try a different style of mask. There might be a better option that fits your face properly.

If you are suffering from an improperly fitting mask, you might also experience some other symptoms. Your mask may cause red, sore spots or bruises on your face. These symptoms generally mean that your mask is on too tightly.

You can loosen the straps to reduce the discomfort, but the mask will still need to be tight enough to prevent leaking. Another option you might want to consider is to cover the straps with pads which will prevent chaffing. If all else fails, you will want to try out a different style of mask.

Perform Regular Maintenance

To keep your machine running at optimal levels, you will need to ensure that it is clean and sanitary. Every day you will want to clean your mask to remove any bacteria that might be present. In addition, you should perform weekly cleanings on the entire system which will include the mask, tubing and tank. By doing this you not only keep yourself from being exposed to unnecessary germs but you are prolonging the life of your equipment. Talk to your doctor or CPAP supplier to receive a full listing of maintenance tasks that should be performed.

Conclusion

While there are many reasons a person quits using their CPAP machine, with the proper education, you don’t need to be one of them. Using your machine is a critical component to the well-being of your body. It is, therefore, necessary that you take every measure possible to make it comfortable and safe to use. If you experience any additional problems, it is always wise to speak with your healthcare professional. They will have the answers you need to provide a successful treatment plan.

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A report by the National Institute of Neurological Disorders and Strokes said at least 40 million Americans suffer from sleep disorders each year. These disorders are always present. They interfere with work, home life, driving and even social activities. They’re also the cause of an estimated $16 billion in annual medical costs.

Who knows how much they cost in lost productivity each year?

Doctors have identified more than 70 sleeping disorders. While they can affect your total health, once doctors correctly diagnose them, the uplifting news is that they can be managed. The rest of this article will cover some of the most common diseases and disorders and their ultimate effect on overall health.

The four most common sleep disorders.

Sleep apnea

This results in interrupted breathing while sleeping. It’s typically associated with a buildup of fat or declining muscle tone due to aging — two factors that allow the windpipe to collapse while sleeping. The result is sleep apnea for 18 million Americans.

Another cause of the disorder is a malfunction of the neurons in charge of controlling breathing during sleep. Taking sedatives or sleeping pills is particularly dangerous because these drugs can keep sleep apnea sufferers from awakening enough to breathe. Click here to read more about sleep apnea diagnosis.

Insomnia

Just about everybody experiences it at some point. Its causes are too numerous to detail, though stress, jet lag, and diet are common. Insomnia nearly always influences job performance and general physical condition the following day.

It affects around 40 percent of women and 30 percent of men. Sleeping pills can relieve the inability to sleep on a short-term basis. However, using them long-term can make the problem worse. Did you know that there is a very interesting correlation between insomnia and apnea?

Restless legs syndrome (RLS)

This sleep disorder tends to run in families. It generates feelings of uncomfortable crawling, tingling or prickling in the legs. The estimated 12 million Americans who suffer from it feel the urge to move their legs to make these sensations go away. They experience constant leg movement throughout the day but insomnia at night.

The condition is most prevalent among the elderly and has been associated with illnesses such as anemia and diabetes. Some RLS patients also suffer from periodic limb movement disorder (PLMD). This causes arms and legs to jerk every 20 to 40 seconds, resulting in interrupted sleep. Doctors typically prescribe medications that control the neurotransmitter dopamine.

Narcolepsy

A quarter of a million people in the United States are afflicted with this disorder. Even though they manage to get a sufficient amount of sleep at night, they nod off frequently during the day. Each episode lasts from a few seconds to more than half an hour.

Occurrences of cataplexy — losing muscle control during highly emotional events — as well as hallucinations and temporary paralysis upon awakening affect some individuals with narcolepsy. Stimulants, antidepressants and other drugs help patients avoid the dangers of falling asleep at the wrong times.

Diseases and Disorders

According to the CDC, sleep disorders can play a prominent role in the development of chronic disease and significantly affect total health.

Cardiovascular disease.

Having sleep apnea creates an increased risk for hypertension, irregular heartbeats, coronary disease and stroke. There are also some shared physiological characteristics between those who suffer from sleep apnea and those experiencing a hardening of the arteries. Some physicians consider sleep apnea a predictor of cardiovascular problems.

Obesity.

Sleep that’s too short can cause metabolic changes potentially linked to obesity. Studies have noted an association between a short duration of sleep and excess body weight in subjects of all ages, but especially striking in children. Researchers believe that lack of sleep in children might negatively impact the hypothalamus, which regulates appetite and energy expenditure.

Depression.

For many years, clinicians have considered sleep disturbance a symptom of depression. However, recent studies suggest that once sleep apnea patients have been treated and start getting enough sleep, their symptoms of depression lessen.

Anyone suffering from sleep deprivation is also prone to irritability, headaches and an overall feeling of sluggishness. Innovative technology such as brain imaging can now help scientists understand how the regions of the brain operate during sleep. It could also lead to innovative therapies to treat sleep disorders and to overcome problems such as jet lag.

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