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Sleep Apnea 101: Research

Sleep Apnea Research

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 with 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.

4) Product Trials - Product trials are hosted by CPAP.com through our Product Challenge. With Product Challenge we send products to CPAP users to use, keep, and compare to their current equipment in exchange for their feedback. You can review the results of past Product Challenges here. You can sign up to receive notifications of future Product Challenges to enroll into or find out results here.

Research FAQs

What is obstructive sleep apnea (OSA)?

Obstructive sleep apnea (OSA) is a condition in which a patient's muscles and tissues in the throat and air passage relax while sleeping which impedes 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 and especially during the REM sleep stages. Apnea is Greek for "without breath."

The scientific standard of an apneic event is the patient must stop breathing for at least 10 seconds per event. 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 events 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 patient being unable to get the needed quantity of restful sleep and may result in:

  • Constant Fatigue
  • Difficulty Focusing
  • Irritability

Untreated sleep apnea is potentially fatal and frequently results in the following serious health problems:

  • Heart Attack
  • Stroke
  • High Blood Pressure
  • Diabetes

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 recommended and the most effective treatment for obstructive sleep apnea.

A CPAP machine provides air at a constant prescribed pressure through a tube, using a CPAP mask to deliver the air pressure to the person with obstructive sleep apnea. CPAP therapy provides a constant airflow which maintains the airway open so that uninterrupted breathing is maintained during sleep. This eliminates sleep apnea events and allows the patient to get a restful sleep.

The pressure of the air is determined during your sleep study and your doctor will prescribe you a CPAP machine at that pressure.

CPAP therapy is traditionally provided through a nasal mask that seals around the nose. However, more innovative and comfortable options are available and advances in the delivery of CPAP therapy are continually occurring.

For instance: CPAPs which offer FLEX or EPR technology provide exhalation relief, a slight drop in pressure at the time of exhalation. APAP, BiPAP and BiLevel machines offer various levels of pressure throughout the night.

What are the benefits of using CPAP?

Successful CPAP users report improvements in:

  • Quality of Sleep
  • Quality of Life
  • Energy and Motivation
  • Mood
  • Job Performance
  • Sexual Drive and Performance
  • Alertness While Driving

A failure to use CPAP therapy may increase your risk for conditions linked to untreated OSA:

  • Hypertension (OSA increases your risk of hypertension by up to five times)
  • Stroke
  • Congestive Heart Failure (CHF)

What is a Sleep Study (Polysomnogram)?

The Sleep Study (Polysomnogram) is the gold standard for the diagnosis or several sleep disorders including, sleep apnea, restless leg syndrome, and narcolepsy.

Polysomnograms are conducted in a sleep center, hospital or in a patient's home. The test usually performed at night to record the patient'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 while you are awake with your eyes closed and during sleep. The time taken to fall asleep, time to enter REM sleep, movement, breathing pattern, and sleep architecture are all recorded using a computer.

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
  • Stroke
  • Heart Attack
  • Congestive Heart Failure
  • Cardiac Arrhythmia
  • Depression
  • Glaucoma
  • Obesity
  • Diabetes
  • Chronic Fatigue

What Surgery or Surgical Treatments are available for Sleep Apnea?

There are several different types of surgeries available for Sleep Apnea, depending on the patient, but any surgery comes with inherent risks or possible complications, and 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 what the newest and best options are in your own case.

Tonsillectomy or Adenoidectomy

This is performed to increase the size or opening of the air passage in the case of Sleep Apnea treatment.

Uvulopalatopharyngoplasty

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.

Laser-assisted Uvulopalatoplasty

LAUP is similar to the above description of Uvulopalatopharyngoplasty however it uses lasers or radiofrequency waves to remove and shape the tissue.

Maxillomandibular Advancement

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 an CPAP machine well 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.

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).

Hyoid Suspension

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 of 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 and improved the number of apnea 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 affective in treating Sleep Apnea.