Sleep Apnea 101: Research
Sleep apnea is a common, under-diagnosed disorder whose full health implications are only now being fully understood. Research can include:
1) Studies of mechanisms of human disease, including research of disorders linked to Sleep Apnea.
2) Studies of therapies or interventions for disease
3) Clinical Trials - Clinical trials are one type of clinical research that involve CPAP users.
- What is Obstructive Sleep Apnea (OSA)?
Apnea is Greek for "without breath." Obstructive Sleep Apnea (OSA) is a condition in which a person's muscles and tissues in the throat and air passage relax while sleeping. The tissues impede the flow of air into the lungs due to the blockage of the airway. This can occur many times per night in the sleep cycle, especially during the REM sleep stages.
The scientific standard for an apneic event is when you stop breathing for at least 10 seconds. There must be an overall blood oxygen desaturation level of 3 to 4 percent along with certain potential changes in EEG frequencies and data. If a person has 5 or more of any type of event per hour of sleep, then they are clinically diagnosed with sleep apnea.
The body responds to the lack of oxygen by arousing, or waking, from sleep. This cycle leads to the person being unable to get the needed quantity of restful sleep and may result in:
- Constant Fatigue
- Difficulty Focusing
Untreated Sleep Apnea is potentially fatal and frequently results in the following serious health problems:
- Heart Attack
- High Blood Pressure
- What is Central Sleep Apnea (CSA)?
- In Central Sleep Apnea (CSA), a person stops breathing throughout the night, not due to a blocked air passage, but because the brain temporarily stops sending signals to the muscles that control breathing.
BiPAP therapy can be used to assist persons with central sleep apnea. The BiPAP machine provides air pressure in an inhale/exhale pattern helping a person to breathe.
- How do I explain sleep apnea to my partner or family?
- Understanding OSA may help friends and family offer support or lead them to an awareness of their own symptoms. This newsletter can help them learn about sleep apnea:
CPAP.com Newsletter: Educate your Family and Friends About Sleep Apnea
- What is CPAP therapy?
- CPAP stands for Continuous Positive Airway Pressure. CPAP therapy is the most commonly recommended, and the most effective, treatment for obstructive sleep apnea.
A CPAP machine provides air at a constant prescribed pressure. The air is delivered to the person through a tube and a CPAP mask. CPAP therapy provides a constant airflow which keeps the airway open so uninterrupted breathing is maintained during sleep. The air stream eliminates Sleep Apnea events and allows the person to get a restful sleep.
The level of air pressure required to maintain your airway is determined during your sleep study. Your doctor will write a prescription for a CPAP machine set at that pressure.
CPAP therapy is delivered through a nasal mask that seals around the nose or nasal pillows which seal at the nasal opening. Full face masks are available for a person who breathes through both the nose and mouth. Many innovative and comfortable options are available and advances in the delivery of CPAP therapy are continually occurring.
For instance: Some machines offer a comfort feature such as FLEX or EPR technology. It provides exhalation relief, a slight drop in pressure at the time of exhalation to help make therapy more natural. APAP, BiPAP and BiLevel machines offer various levels of pressure throughout the night.
- What are the benefits of using CPAP therapy?
- Successful CPAP users report improvements in:
- Quality of Sleep
- Quality of Life
- Energy and Motivation
- Mood & Disposition
- Job Performance
- Sexual Drive and Performance
- Alertness While Driving
A failure to use CPAP therapy to treat Sleep Apnea may increase your risk for conditions linked to untreated OSA:
- Hypertension (OSA increases your risk of hypertension by up to five times)
- Congestive Heart Failure (CHF)
- What is a Sleep Study (Polysomnography)?
- The Sleep Study (Polysomnography) is the gold standard for the diagnosis of several sleep disorders including, sleep apnea, restless leg syndrome, and narcolepsy. The results of the test are referenced as a polysomnogram which is frequently abbreviates as PSG.
Polysomnography is conducted in a sleep center, hospital or in a person's home. The test is usually performed at night to record the person's normal sleep pattern. Electrodes are placed on the scalp, the outer edge of the eyelids, and to the skin on the chin in preparation for the test.
Characteristic patterns from the electrodes are recorded during three stages: while you are awake, while your eyes are closed, and while you are asleep. Also, a computer is used to record the time it takes to fall asleep, the time it takes to enter the REM cycle, the body movement, the breathing patterns, and the sleep architecture.
The person gathering and scoring the data is called a Polysomnographic Technician.
- What is titration, as it relates to sleep studies?
- If a sleep study determines you have obstructive sleep apnea (OSA), you will need a "titration study" to determine the pressure level required to maintain your airway during sleep. A titration study may take place during the same night as your diagnosing sleep study or it may be scheduled for a later date.
Titration is a scientific lab term, meaning to slowly add a little bit more of something until you reach a desired effect. During your titration study, a skilled technician will monitor your sleep and slowly increase the air pressure on a CPAP machine until you are able to sleep without or with few sleep events (apneas and hypopneas). Your pressure needs vary throughout the night, so an overnight sleep study is required to prescribe you the correct pressure.
Your prescribed CPAP single pressure setting will be set to the highest level you needed during the night. By prescribing the highest pressure, your doctor hopes to prevent as many sleep events as possible. The downside of this approach is that you will have the highest pressure at all times even when it's only necessary for part of the night.
APAPs offer technologies which allow the pressure to be adjusted on a breath by breath basis, which you may find helps your therapy.
- Where can I get a sleep study close to where I live?
- We provide a CPAPtalk.com tool to help you find sleep labs in your area. Simply click the link and enter your address or zipcode to find one near you.
Locate Sleep Apnea Services
- What questions should I ask at my sleep study?
- Did I have any central apneas? How many?
- Were there any comorbidities? What were they?
- Did I breathe or leak through my mouth? How often? What do you recommend to prevent it?
- Did I exhibit positional sleep apnea (PSA)? Was my apnea more severe in one sleeping position as compared to others? Is my pressure requirement higher in one position as compared to others? (Often sleep apnea is more severe when sleeping on the back.)
- Is there anything else unusual about the results?
- How will I know my therapy is preventing apneas?
- I would like to own a data-capable machine and software to monitor apneas, hypopneas and mask leak. Will you help me with the appropriate prescription?
In addition to the questions:
- Get a copy of your PSG. It is your legal right to have one.
- Get a copy of your CPAP prescription. It is your legal right to have one.
- Make sure the prescription calls for a humidifier with the machine.
- What terms should I be familiar with before my Sleep Study?
- You can check out our Learning Center Definitions Page to become familiar with some common sleep apnea terms.
- If I lose weight, will I cure my OSA?
- The answer to this question depends on the person. Some people report experiencing less severe or cured sleep apnea after losing weight. Others report no change in their sleep apnea with weight lose. Most experience other benefits by losing weight healthily. Losing weight is good for your overall health when done properly.
- What are the symptoms of Sleep Apnea?
- The following symptoms go hand and hand with Sleep Apnea:
- Loud and frequent snoring
- Periods of not breathing during sleep
- Snorting, gasping or choking during sleep
- Need to urinate during the night
- High blood pressure
- Morning headaches
- Awakening tired in the morning
- Daytime or evening lethargy
- GERD (Gastroesophageal reflux disease)
- Drowsy driving, limited attention, memory loss and poor judgment
- Personality changes
- Weight gain, severe leg swelling, body mass index of 25 or more
- Hyperactive behavior, especially in children
- Decreased size of airways and large neck
- What are the health risks of untreated Sleep Apnea?
- Untreated Sleep Apnea can lead to:
- High Blood Pressure
- Heart Attack
- Congestive Heart Failure
- Cardiac Arrhythmia
- Chronic Fatigue
- Morning Headache
- What Surgery or Surgical Treatments are available for Sleep Apnea?
- There are several different types of surgeries available for Sleep Apnea, depending on the person, but any surgery comes with inherent risks or possible complications, and it can be painful. CPAP machines are still the most effective treatment for Sleep Apnea with very minimal risk to the end-user. Often the surgery success rate is relatively low and many people report being back on a CPAP machine, or the like, within a year, albeit often at a lower pressure.
Here are some of the more common surgeries available, although doctors are always innovating and coming up with new procedures. Not all are covered here. Talk to a sleep doctor to find out more about the newest and best options specifically chosen for you.
Tonsillectomy or Adenoidectomy
This is performed to increase the size or opening of the air passage in the case of Sleep Apnea treatment.
UPPP is performed to reduce or remove or reshape parts of the soft palate and the uvula. It may also involve removal of part of the soft tissue from the pharyngeal areas.
LAUP is similar to the above description of Uvulopalatopharyngoplasty however it uses lasers or radiofrequency waves to remove and shape the tissue.
MMA, also known as (MMO) Maxillomandibular Osteotomy or (Bi-Max) Bimaxillary Advancement, is usually reserved for severe cases which have not responded to other surgeries or a CPAP machine or where craniofacial syndromes or structures are suspected as the cause of the problem. It is more invasive and involves removing the top and bottom jaw and moving them forward or restructuring the chin, maxilla or mandible. Often it is performed in conjunction with Genioglossus Advancement.
This procedure, commonly known as tongue advancement, is designed to move or pull the tongue forward to increase the size of the airway. It is sometimes performed along with Maxillomandibular Advancement (see description above).
This procedure involves pulling forward the hyoid bone in the neck to place it in front of the larynx. The hyoid bone is one of the attachment points for the tongue.
TAP Implant (Pillar Procedure)
The Pillar system is different from other treatments. It is specifically designed to produce a lasting reduction in snoring after a single office procedure. Unlike other procedures, the Pillar procedure does not require heating or removing tissue, or the use of any sclerosing agents, which means the procedure causes minimal discomfort and recovery time is short. In fact, most patients resume a normal diet and activities the same day.
During the Pillar procedure, no tissue is removed. Instead, three tiny inserts are placed in your soft palate during a brief office visit using local anesthetic. The inserts support and stiffen the palate, which has been shown to reduce snoring in individuals with very moderate sleep apnea. In addition, the inserts are made of a polyester material that causes a stiffening response in the palate tissue itself. This supporting and stiffening of the soft palate will last as long as the inserts are in place.
Unfortunately, this is not a solution for those with more than mild sleep apnea. If the obstruction occurs in a place other than the site of the implants, this procedure will be ineffective.
- What Medications or Pharmaceuticals are available for Sleep Apnea?
- Currently there are no drugs on the market that are effective for the treatment of Obstructive Sleep Apnea.
Methylxanthine Theophylline is often used to treat those afflicted with Central Sleep Apnea and sometimes children or infants with Sleep Apnea but is not indicated for adults with OSA.
If normal treatments are not effective, sometimes a doctor may prescribe drugs that usually are reserved for narcolepsy or to help combat somnolence, such a stimulants or amphetamines. Modafinil, an anti-narcoleptic medication or wakefulness promoting drug, is sometimes used in this capacity.
Protriptiline, a tricyclic antidepressant, is helpful for a small number of Sleep Apnea patients. Sometimes acetazolamide and Medroxyprogesterone are prescribed to stimulate normal breathing. Prescription steroids or nasal decongestants can be useful in some cases to assist in widening the upper air passage.
- What Orthodontic Treatment and Dental Appliances are available for Sleep Apnea?
- Dental Devices or Oral Devices are sometimes used to treat Obstructive Sleep Apnea. There are several dental devices or procedures available and approved for use in treating Sleep Apnea. Usually one must go to a dentist to discuss which one would be the best choice based on the individual and to have the device custom made or fitted. They are often relatively expensive and have a moderate success rate, but could be a good option for some individuals. In general it seems the dental devices have an overall higher success rate than surgery but still lower than CPAP therapy. There are often some side effects that could be uncomfortable or cause other problems. Talk to a qualified dentist about these potential issues. Here are just a few of the dental devices available:
- The most popular treatment is MAD or the Mandibular Advancement Device. It forces the lower jaw down and forward which can help keep the air passage open and it looks like a mouth or tooth guard used commonly in sports.
- Sometimes Sleep Splints are used that hold the tongue in a certain position increasing the size of the airway.
- There is a functional magnetic system as well that places two magnets opposite each other on the sides of the jaws to help keep the airway open.
- Rapid Maxillary Expansion is an orthodontic procedure that involves inserting a temporary screw device which is applied to the upper teeth and then turned or tightened periodically over a 3 to 4 week period. It can help reduce nasal pressure and is a non-surgical procedure that may improve breathing in people with a narrow upper jaw.
- What Alternative Treatments and Lifestyle Changes can Affect Sleep Apnea?
- Usually these are things to be tried in conjunction with traditional treatments. Always consult with your doctor about any alternative treatment methods before trying them.
Some people have reported that playing a didgeridoo has helped strengthen the muscles in the pharynx and upper air passage. Also, it has improved the user's number of apnic events or allowed them to lower their pressure.
In obese or overweight individuals, losing weight can have an effect on their Sleep Apnea and pressure needs for the CPAP machine. Eating a healthy diet combined with exercise, can promote loss of weight and with weight loss can lead to the need for a lower pressure on the CPAP machine.
It is recommended to avoid alcohol or other depressants or drugs that can adversely affect those with Sleep Apnea. Avoiding cigarette smoke or quitting smoking and avoiding other pollutants can help with irritation of the mucous membranes in the nose and air passage that may cause swelling.
Trying different sleeping positions can help in some cases, especially sleeping in a somewhat upright position if one is not using a CPAP machine.
Breathe Right strips might reduce snoring which is a symptom of Sleep Apnea. However, no medical research shows that these strips are effective in treating Sleep Apnea.
- Intro to BiPAP: Part 1
- Intro to BiPAP: Part 2
- What is an Auto-CPAP?
- ThermoSmart CPAP Heated Humidifier Hose Technology
- Benefits and Features - Activa Nasal CPAP Mask
- Benefits and Features - Breeze Nasal CPAP Mask
- Introduction to M Series CPAP Humidifier
- Adjusting M Series CPAP Humidifier Settings
- Fix and Prevent CPAP Mask Leaks
- Choosing Which CPAP mask is Right for You
- Get Rid of Claustrophobic Feelings and Anxiety While Using CPAP
- How to Stop Air from Entering Your Stomach While Using CPAP
- Obstructive Sleep Apnea information - DeVilbiss products
- Heart Disease Link with Sleep Apnea
CPAP Users Say
CPAPtalk.com CPAP User Discussions
Did You Know, Research
- Apnea in Greek, literally translates to "without breath."
- It is estimated eighteen million Americans have Sleep Apnea. That's one in eleven!
- CPAP therapy is the most common way to treat Sleep Apnea.
- Cherries or oatmeal are great bedtime snacks because they contain melatonin, a mineral that naturally helps set our body clock.
CPAPtalk.com Wiki Articles
- Learn From Others' Experiences: CPAP User Diaries
- Diary of Two Hoseheads
- Thoughts on Improvement
- Your First Night
- CPAP Improves Sleeping Glucose Levels In Type 2 Diabetes Patients With Obstructive Sleep Apnea
- Sleep Apnea
- Sleep Apnea and Cardiovascular Disease
- Mechanisms of Cardiovascular Disease in Obstructive Sleep Apnea
- Relationship Between Sleep Apnea and Cardiovascular Disease
- Continuous Positive Airway Pressure Improves Sleep and Daytime Sleepiness in Patients with Parkinson Disease and Sleep Apnea
- Link Between Sleep Apnea, Alzheimer's Disease Under Study
- Auto-Adjusting Versus Fixed Positive Pressure Therapy in Mild to Moderate Obstructive Sleep Apnoea
- Diagnosis and Initial Management of Obstructive Sleep Apnea Without Polysomnography: A Randomized Validation Study.
- Continuous Positive Airway Pressure for Treatment of Postoperative Hypoxemia: A Randomized Controlled Trial.
- Obstructive Sleep Apnea: Implications for Cardiac and Vascular Disease
- Epidemiology of Obstructive Sleep Apnea: A Population Health Perspective.
- Reducing Motor-Vehicle Collisions, Costs, and Fatalities by Treating Obstructive Sleep Apnea Syndrome.
- Refractory Hypertension and Sleep Apnea: Effect of CPAP on Blood Pressure and Baroreflex.
- Obstructive Sleep Apnea and the Recurrence of Atrial Fibrillation.
- Controlled Trial of Continuous Positive Airway Pressure in Obstructive Sleep Apnea and Heart Failure.
- Evaluation of a Portable Device for Diagnosing the Sleep Apnoea/Hypopnoea Syndrome.
- Home Diagnosis of the Obstructive Sleep Apnoea/Hypopnoea Syndrome.
- Effect of Nasal Continuous Positive Airway Pressure Treatment on Blood Pressure in Patients With Obstructive Sleep Apnea.
- Ambulatory Blood Pressure After Therapeutic and Subtherapeutic Nasal Continuous Positive Airway Pressure for Obstructive Sleep Apnoea: A Randomised Parallel Trial.
- Increased Incidence of Cardiovascular Disease in Middle-Aged Men With Obstructive Sleep Apnea: A 7-Year Follow-Up.
- High Prevalence of Unrecognized Sleep Apnoea in Drug-Resistant Hypertension.
- Reduction in Motor Vehicle Collisions Following Treatment of Sleep Apnoea With Nasal CPAP.
- Prospective Study of the Association Between Sleep-Disordered Breathing and Hypertension.
- Association of Sleep-Disordered Breathing, Sleep Apnea, and Hypertension in a Large Community-Based Study.
- Obstructive Sleep Apnoea Syndrome as a Risk Factor for Hypertension: Population Study.
- Snoring and Risk of Cardiovascular Disease in Women.
- Reduced Hospitalization With Cardiovascular and Pulmonary Disease in Obstructive Sleep Apnea Patients on Nasal CPAP Treatment.
- The Occurrence of Sleep-Disordered Breathing Among Middle-Aged Adults.
- Get Down To Size: Success at a Heavy Price
- Snoring is More Than Loud
- Sleep Apnea, Depression Linked in Stanford Study.
- Lung Disease Linked to the Use of Contaminated Well Water in a CPAP Machine.
- Sleep Apnea Tied to Increased Cancer Risk
- Severity of OSA is Related to Aldosterone Status in Subjects with Resistant Hypertension
- Cardiovascular Effects of Continuous Positive Airway Pressure in Patients With Heart Failure and Obstructive Sleep Apnea.
- Sleep Apnea and Heart Disease
- Role of Nocturnal Rostral Fluid Shift in the Pathogenesis of Obstructive and Central Sleep Apnea
- OSA and Risk of Cardiovascular Events