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Obstructive Sleep Apnea

Alternative Treatment Names
Continuous positive airway pressure; CPAP; Bi-level positive airway pressure; BiPAP or Bi Level

What is Obstructive Sleep Apnea?
A common disorder, Obstructive Sleep Apnea (OSA) is characterized by pauses in breathing or shallow breaths during sleep. OSA is a chronic condition, which means it does not resolve spontaneously, and is rarely cured.

When people with OSA fall asleep, they can stop breathing for a few seconds to a minute. These interruptions happen throughout the night, at least five times an hour. Afterward, normal breathing starts again, sometimes with a loud snort or choking sound.

When breathing pauses or becomes shallow, the OSA sufferer usually moves out of deep sleep into light sleep—or has a brief awakening—which they may not remember. As a result of these disruptions, sleep quality is worsened, causing tiredness during the day. In fact, obstructive sleep apnea is one of the leading causes of daytime sleepiness.

Symptoms and Signs of Obstructive Sleep Apnea
Loud frequent snoring, increased age and obesity with increased neck size are the three best predictors of having OSA. If your partner complains about your snoring or says that you gasp for breath during the night (especially if you make a loud snorting or choking sound), this is a sign you might have obstructive sleep apnea. Other symptoms may include one or more of the following:
  • Sleepiness during the day
  • Morning headaches
  • Memory, learning, or concentration problems
  • Irritability, depression, mood swings, or personality changes
  • Needing to urinate at night
  • Waking up with a dry throat
What Causes Obstructive Sleep Apnea
People with OSA tend to have a narrower or more collapsible airway than normal, often at the base of the tongue and soft palate. During sleep, the normal relaxation of muscles in the throat can cause the tongue and palate to fall backwards, further closing the already narrowed airway. Obstructive sleep apnea can be caused (or made worse) by:
  • Obesity: Extra fat tissue in the neck can narrow the airway, which makes it harder to keep open
  • Large tongue and tonsils: These can obstruct the airway, making it harder for air to pass through
  • Getting older: For reasons not fully understood, sleep apnea tends to increase with age
  • Head and neck shape: Some people have a naturally small airway opening in the mouth and throat due the structure of their bones
Health risks of Obstructive Sleep Apnea
Left untreated, Obstructive Sleep Apnea can trigger the release of stress hormones, change how your body uses energy, and, of course, make you feel tired and sleepy during the day. But even if you don’t have daytime sleepiness, obstructive sleep apnea still puts you at higher risk for:
  • High blood pressure
  • Heart attack, heart failure
  • Stroke
  • Irregular heartbeats
  • Diabetes
  • Obesity
  • Driving or work-related accidents

Treatment for Obstructive Sleep Apnea
In addition to lifestyle changes and surgery, CPAP therapy has been an accepted treatment for OSA. A CPAP machine is a blower that connects by a tube to a mask that fits over your mouth or nose, blowing air so that a continuous pressure in the airway is maintained. This constant pressure keeps the airway from collapsing allowing normal breathing.

Who Should Use CPAP
Continuous positive airflow pressure (CPAP), sometimes referred to as nasal continuous positive airflow pressure (NCPAP) is the best treatment for obstructive sleep apnea. It is safe and effective in sleep apnea patients of all ages, including children. After using CPAP regularly many patients report the following:
  • Normal sleep patterns.
  • Feeling more alert and less sleepy during the day
  • Less anxiety and depression and better mood.
  • Improvements in work productivity.
  • Better concentration and memory.
  • Improved sleep of a patient's bed partners.

How CPAP Works
CPAP works in the following way:
  • The device itself is a machine weighing about 5 pounds that fits on a bedside table.
  • A mask fits over the nose. A tube connects the mask to the CPAP device.
  • The machine delivers a steady stream of air under slight pressure through this tube into the mask.
The doctor, nurse, or therapist will help choose the mask that fits you best. They will also help adjust the settings on the machine. The settings on the CPAP machine depend on the severity of your sleep apnea.

If you are using the CPAP machine, but your sleep apnea symptoms do not improve, the settings on the machine may need to be changed. Most patients can be trained to adjust the CPAP at home. Otherwise, you will need to make trips to the sleep center.

Getting Used to the DEVICE
It can take time to become used to a CPAP device. The first few nights of CPAP therapy are often the most difficult. Some patients may actually sleep less or not sleep well at the start of treatment.

The patients who are having problems may tend not to use it for the entire night, or even stop using the device. However, it is important to use the machine for the entire night.

Common complaints include:
  • Nasal congestion and sore or dry mouth
  • Nosebleeds
  • A feeling of feeling being closed in (claustrophobia)
  • Irritation and sores over the bridge of the nose.
  • Eye irritation
  • Upper respiratory infections
  • Chest muscle discomfort, which usually goes away after awhile
Many of these problems can be helped or eliminated by using a mask that is lightweight and cushioned. Some masks are used only around the nostrils. Chin straps, nasal salt water sprays, or humidifiers may also prevent side effects. Modern CPAP machines have many adjustments that can be made to make them more comfortable.
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