How Do You Know If You Have Sleep Apnea and What is CPAP Therapy?

I have sleep apnea. I have it pretty severe.

Before I started receiving the treatment I snored quite loudly. Have you ever heard a chainsaw? I don’t think I was that loud but I was close!

But the worst part was when the silence started. The silent pauses while my throat closed and choked off my breath. My own body was strangling itself.

What is Sleep Apnea Anyway?

You may not know much about sleep apnea, but chances are that you’ve heard of it. This is a very serious sleep disorder that robs you of the deep, valuable REM sleep that your body (especially your brain) requires.

The word apnea comes from the Greek and literally means no breath. Patients stop breathing in their sleep from one of two causes (or even a combination).

Obstructive sleep apnea results when the muscles holding your airway open or your tongue in place don’t respond properly. The suction created when you inhale causes the passages to narrow to the point that they cut off your air supply.

Central sleep apnea is caused by the diaphragm failing to respond to signals from the brain. In this case, your body just simply fails to breathe. Snoring is not usually associated with this form of sleep apnea.

Regardless of the cause of the apnea, the end result is that your brain detects a fall in the oxygen rate and startles your body from sleep. Maybe not all the way awake, but enough that you don’t get into a deep, restful phase of sleep. You may gasp or snort as your body pulls in air and you will usually go back to sleep.

These breathing pauses can last as long as 60 seconds in some cases and patients have been known to have as many as 60 apnea events per hour. My last test showed that I had 52 events per hour when treatment was not in place.

Sleep apnea is a problem described as hesitations of breathing while sleeping. These hesitations are known as Apneas(meaning, “without breath”). These apnea events occur throughout the night and can be numerous enough to cause significant health problems. An overnight sleep study (polysomnogram) determines the severity and number of occurrences as well as finding the pressure (measured in cm/H20) that is needed to eliminate the apnea events. Treatable levels of sleep apnea are defined as 5 events of any type or greater per hour of sleep. During Obstructive Sleep Apnea, breathing is interrupted by a physical block to airflow despite effort.

A person with Obstructive Sleep Apnea is rarely aware of having breathing issues, even upon awakening, although many people report that they suddenly wake up gasping for air, and some hear themselves recover with a loud snore sound. Sleep apnea is usually observed by others or is suspected because of its effects on the body (sequelae). The effects may be present for many years, without selfdiagnosis, and the person may get accustomed to daytime sleepiness and fatigue caused by the sleep disturbances.

Obstructive sleep apnea (OSA) is the most common type of sleep-disordered breathing. The muscles of the body, especially in the throat, relax during sleep. The airway is made up of collapsible soft tissue which can obstruct the airway and limit breathing during sleep. This problem can be exacerbated by obesity and the presence of large tonsils and tongue tissue. The result is a lack of oxygen in the blood that causes a response from the brain, causing an interruption of the normal sleep cycle. [Source: WikiPedia]

The CPAP machine eliminates these interruptions of sleep by delivering a stream of compressed air through flexible tubing to a nasal pillow, nose mask or full-face mask, splinting the airway (keeping it open under air pressure) so that unobstructed breathing becomes possible, reducing and/or preventing apneas and hypopneas. This has the additional benefit of reducing or eliminating snoring.

Well, What Does It Matter?

Good question.

Aside from the fact that it annoys your spouse, children in the next room, and neighbors down the street, there are some serious repercussions.

The most obvious result is general fatigue. Since your body isn’t getting proper sleep cycles you never really get the sleep you need. You may sleep 10 or more hours a night yet you’re constantly drowsy. I was able to fall asleep within 10 seconds of lying down, night or day. In fact, when I was put in a darkened room with nothing to do or look at, the longest time I could stay awake was about 2 minutes.

When you are fatigued like this you’ll make mistakes. Driving and operating heavy machinery becomes dangerous. I had to stop riding my motorcycle since I didn’t feel that I could be attentive enough to stay safe.

You will often wake up with a headache, sore throat and a good case of the grumps. It can even lead to clinical depression or sexual dysfunction (and no one wants that.

It has even been linked to hypertension and heart disease.

Left untreated, sleep apnea can quite literally kill you.

Credit: American Academy of Sleep Medicine

Yikes — I Snore Like A Train! What Do I Do?

Snoring is actually related to obstructive sleep apnea. It may be a precursor to apnea itself and definitely accompanies it. So if you do snore then you should take some time to get it checked out, especially if people tell you that you pause during the night or gasp or snort.

While you may not have apnea, snoring can be severe enough to reduce the amount of air you get when you breathe. This is known as sleep hypopnea which means reduced breath. It can have similar effects to apnea.

The best way to determine if you have sleep apnea is to talk to your doctor about arranging a sleep study at a sleep clinic. A sleep study will monitor you during your sleep to see exactly what is happening with your breathing and brain patterns. It can also test you for other sleep disorders such as restless legs, grinding teeth, etc.

If you are diagnosed with either sleep apnea or sleep hypopnea your sleep doctor can discuss treatment options. At this point, there is no medical cure, but some lifestyle changes can be effective at reducing or eliminating the problem. Surgery is also a possibility, but there are risks involved without any guarantee of relief.

So most people who suffer from sleep apnea will need ongoing support such as CPAP or dental devices.

The important thing now is to find out for sure. If you suspect you might have a problem get it checked… Now!

What is CPAP and How it Works

The reduction and elimination of obstructive sleep apnea began with the invention of the CPAP (Continuous Positive Airway Pressure), first described in 1981 by Colin Sullivan in Sydney, Australia. It has evolved over time, from large noisy machines to more compact and quiet units created in the late 1980s. Effective treatment stimulated a massive surge of clinics dedicated to the diagnosis and treatment of Sleep Apnea. Many variations of sleep disorders were recognized, and most of the patients of these centers have sleep disorder breathing. Sleep Apnea became easily diagnosed, and the CPAP machine has become the method to treat this problem.

The CPAP machine creates a pressurized flow of air through a hose to a CPAP mask worn during sleep. A CPAP mask delivers the air through a nasal interface, nasal pillow delivery system, or a full face interface that allows the patient to breathe in or out from the nose or the mouth or a combination of the two.

The air pressure causes a “splinting the airway” (keeping it open under air pressure) so that free-flow breathing occurs, thus preventing apnea and hypopnea. This also creates a favorable outcome by eliminating snoring. A CPAP machine is normally used indefinitely to treat sleep apnea at the patient’s home.

The CPAP machine blows air at a preset pressure (also called the titrated pressure). The necessary pressure is prescribed by a physician after reviewing the results of an overnight sleep study (polysomnography) taken in a sleep laboratory. The titrated pressure is the pressure of air, (measured in cm/H2O), that was required to open the airway and end the Apnea events. The typical pressure for most patients is between 6 and 14 cm/H2O. A CPAP machine can produce pressures of 4 to 20 cm/H2O. More advance machines, that are needed in severe cases, can go up to 25 or 30 cmH2O.

CPAP machines may also be used to treat preterm infants whose lungs have not fully developed. For example, some doctors may use a CPAP machine to treat infants who have respiratory distress syndrome or even bronchopulmonary dysplasia.

OSA(Obstructive Sleep Apnea) treatment involves a CPAP System, which has three main parts:

1. A CPAP mask or other device that fits over your nose or your nose and mouth, some CPAP masks just touch the CPAP user’s nostrils. Headgear straps keep the mask in place.

2. A Flexible hose (Tubing) that connects the mask to the machine’s motor.

3. A CPAP machine (Flow Generator) that blows air(Positive Airway Pressure) into the tubing, delivering it to the CPAP mask.

Some CPAP machines have other features as well, such as heated humidifiers for added comfort, exhalation pressure relief (EPR™ also named C-Flex™, A-Flex™, Bi-Flex™, Smart Flex™), CPAP machines are small, lightweight, and quiet (23-30dB). The noise from a CPAP machine is usually soft and rhythmic.

Process for starting CPAP Therapy

If a physician prescribes a CPAP system, the patient will be directed to a home equipment provider. (Home equipment providers are also referred to as durable medical equipment, or DME.) The physician will work with the patient to make sure the settings that he or she prescribed are correct. He or she usually requires the patient to complete an overnight sleep study to find the correct settings for the system pressure. The sleep study will measure how much pressure is needed to keep the airway open during sleep.

CPAP machines have variations in size, options, colors, and operation, and come from a variety of different manufacturers. CPAP masks also have a variety of sizes, colors, materials, and features, some only covering the nose, while others cover the whole face. Some are made with silicone like cushion to create a seal between the face and the mask, while others use a Gel filled cushion. Some now are even made from a cloth material that is not porous enough for the air to penetrate.

f a patient cannot tolerate the mask given, the physician may suggest switching to a different style. Many sources for replacement CPAP systems, machines, masks and accessories are available.

CPAP machines are also is used to treat preterm infants whose lungs have not fully developed. For this treatment, soft prongs are placed in an infant’s nostrils.

A CPAP has many benefits. It can:

  1. Keep the airway open during sleep
  2. Eliminate loud snoring so others in the household can sleep Improve the quality of sleep, even at a reduced sleep time
  3. Relieve sleep apnea symptoms, such as excessive daytime sleepiness, headaches, and moodiness
  4. Decrease or prevent high blood pressure Many people who use a CPAP machine report feeling better as soon as they begin treatment. They feel more attentive and better able to work during the day. They also report fewer complaints from bed partners about snoring and sleep disruption.
  5. The medical benefits are numerous. Sleep apnea has been determined to cause or increase impotence and a lowered sex drive, Obesity, Alcohol and Drug Dependencies, Lack of Exercise, Vision Problems, Diabetes and many others

Treatment 

A widely used solution and arguably the most consistently effective treatment for sleep apnea is the use of continuous positive airway pressure (CPAP) device, which ‘splints’ the airway open during sleep by means of a flow of pressurized air into the throat. However, the CPAP machine only assists during inhalation. The lungs must prompt exhalation. The exhalation is more difficult at higher CPAP pressure settings. A Bi-Level CPAP, often called BIPAP or VPAP can provide ease of exhalation by reducing the positive pressure when the start of exhalation begins, then the flow generator returns to the higher inhalation pressure. CPAP therapy is effective only for (OSA)Obstructive Sleep Apnea, not for central or mixed cases. [Source and Reference: Alaska Sleep Education Center]

Conclusion

Sleep apnea is a common disorder that causes pauses in breathing or shallow breaths while you sleep. As a result, not enough air reaches the lungs. During Apnea events the airway collapses and becomes blocked or obstructed. When inhalation is attempted, the air that pushes past the obstruction can cause loud snoring. Subsequent snoring may disturb sleep partners. The positive pressure from a CPAP machine can prevent the airway from collapsing or becoming blocked.

References:

1.Obstructive Sleep Apnea Patrick J. Strollo, Jr., M.D., and Robert M. Rogers, M.D. [Source Link]

2.Continuous Positive Airway Pressure and Breathlessness in Obese Patients with Obstructive Sleep Apnea: A Pilot Study Sichang Xiao, MSc, Johan Bastianpillai, MBBS, Culadeeban Ratneswaran, MD, Martino F. Pengo, MD, Yuanming Luo, PhD, Caroline J. Jolley, PhD, John Moxham, MD, and Joerg Steier, PhD [Source: National Center for Biotechnology Information]

3.Sleep–Related Breathing Disorders in Adults – The Report of an American Academy of Sleep Medicine Task Force [Full Report: HERE]

4.Obstructive Sleep Apnea Sean M. Caples, DO; Apoor S. Gami, MD; and Virend K. Somers, MD, PhD [Source: American Physiological Society]

Disclaimer:

Our content does not constitute a medical or psychological consultation. See a certified medical or mental health professional for diagnosis. Also, the information and statistics that we published in this article are collected from authentic medical associations and publications which sources are clearly mentioned in the article.

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