Posted by Nancy Healey
It seems that I have been getting a lot of my medical information recently from TV commercials — for better or worse. Kareem Abdul Jabbar’s promotional message about atrial fibrillation made me aware that it could be the cause of my shortness of breath, which made me quickly call my cardiologist. He diagnosed my AFib and referred me to an electrophysiologist for an ablation. That was the positive part of getting my medical information from television.
The cardiologist advised that approximately half the people who have AFib also have Obstructive Sleep Apnea and recommended I test for it. The not-so-positive part of getting my medical information from commercials was that for years I have seen ads describing the difficulties of sleeping with a CPAP machine, so I was very hesitant to even take the test for it, and so I put it off. I have always been a good sleeper and could not see myself tangled in a mask that covered my mouth and nose with a tube connected to a machine every night.
I have been seeing my cardiologist for more than 15 years and realized that I should again take his advice and have the test. In the past you had to spend the night in a sleep lab hooked to machines to determine if you had sleep apnea. Now it is very simple. I wore a regular size watch for one night. The results were transmitted to a central computer, and I received the results the next morning. The diagnosis was moderate sleep apnea.
Now I needed to understand what sleep apnea is and my options for treatment. It is a condition that causes you to stop breathing while you are sleeping. The word apnea comes from the Greek word for breathless. This happens either because of a blockage of your airway in obstructive sleep apnea or because your brain doesn’t correctly control your breathing in central apnea. This results in a lack of oxygen which activates a survival reflex that wakes you up just enough to resume breathing. This reflex does keep you alive but interrupts your sleep cycle preventing restful sleep. It can also put stress on your heart that can potentially have deadly consequences.
Sleep apnea is estimated to affect about 5-10% of people worldwide. Obstructive sleep apnea is more common in men before age 50 and more common in women after age 50. People who are older, heavier, or of Black, Hispanic or Asian descent are more likely to experience obstructive sleep apnea. Smoking, use of alcohol, sedatives, and a history of family sleep apnea increase the chances of having sleep apnea. Some medical conditions, such as type 2 diabetes, congestive heart failure, Parkinson’s, high blood pressure, a prior stroke or chronic lung diseases also can make it more likely to occur.
Central sleep apnea is more frequent in people taking opioid pain medications, people with heart conditions such as atrial fibrillation or congestive heart failure, and some people living in high altitudes.
Sleep apnea testing tracks how often your breathing stops or slows down as you sleep. Based on how many of these episodes you have per hour, your doctor can diagnose you with the following:
- Mild Sleep Apnea – 5 to 15 breathing events an hour.
- Moderate Sleep Apnea – 15-30 breathing events an hour
- Severe Sleep Apnea – 30+ breathing events an hour
There is no cure for sleep apnea, but there are many ways to reduce your symptoms. If you have mild sleep apnea, your doctor may suggest lifestyle changes like weight loss, stopping smoking and treating nasal allergies.
If lifestyle changes do not relieve your symptoms or if you have moderate to severe sleep apnea, there are several other treatments that may be recommended. A CPAP (Continuous Positive Airway Pressure) is the best-known type of device. The machine blows air into your airways through a mask that can cover your nose and mouth. Because many people are not comfortable with the full mask, it is also available with only a flexible piece that fits below your nasal passages. This is the CPAP model I chose with my doctor’s advice. There are other machines with similar functions and your doctor can advise which is better for your condition.
There is also an oral appliance like a sleep mouth guard or tongue retaining device to help keep your throat open. While positive airway machines are generally more effective, oral appliances may be easier to use. Your dentist would be the one to help you with this choice.
If other treatments don’t help, your doctor may suggest surgery. This is usually only recommended if you have tried another form for over three months or if you have a jaw structure problem.
You have probably seen one of the many ads touting the advantages of the Inspire Sleep therapy system. It is an FDA-approved treatment for obstructive sleep apnea. It is designed to provide relief for individuals who are unable to use or benefit from CPAP machines. This involves implanting a small device under the skin in the upper chest area. It monitors your breathing patterns during sleep and delivers mild stimulation to key airway muscles, keeping them open and allowing for uninterrupted breathing.
The National Council on Aging says one study showed 94% of Inspire patients feel it is better than CPAP and would recommend the device. They report that the two downsides of Inspire are its cost and the need for the device to be surgically implanted. Candidates for Inspire must have moderate to severe obstructive sleep apnea, have tried CPAP without success, have a body mass index below 35, and be 18 or older.
According to the Cleveland Clinic, sleep apnea is a condition that can severely disrupt your life and put you at risk for life-threatening complications and events. Because of this, you should not try to self-diagnose or self-treat it. If you suspect that you or a loved one has sleep apnea, it is important to schedule an appointment with a sleep specialist or ask your primary care provider to refer you to one.
The CPAP machine is the most common and most effective treatment available. The best outcomes from these treatments are most likely to happen when you stick to them and make them part of your life every day without exception. I had completely convinced myself that I would never sleep again if I had to wear an ugly mask and be connected to a loud annoying machine every night. I may have had a little difficulty getting it on properly the first night but by night two I was unaware of having it on. I had somehow expected that the CPAP would sound like a small lawnmower; mine is completely silent. Much to my surprise, I now see the CPAP as my invitation to sleep, which allows me to close my eyes and fall asleep even more quickly than before.