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Sleep Apnea 101

Sleep Apnea Basics

What is Obstructive Sleep Apnea?

Obstructive Sleep Apnea (OSA) is a condition in which a patient's muscles and tissues in the throat and air passage relax while sleeping, and this impedes the flow of air into the lungs due to a 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 and have 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 can be clinically diagnosed with Sleep Apnea.

The body responds to this 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 results in:

  • Constant Fatigue
  • Difficulty Focusing
  • Irritability

Untreated Sleep Apnea is potentially fatal and frequently results in the following serious health problems:

  • Heart Attacks
  • Strokes
  • High Blood Pressure
  • Diabetes

Sleep Apnea 101 FAQs

What is obstructive sleep apnea (OSA)?

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 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.

What is Mixed Sleep Apnea (MSA)?

In Mixed Sleep Apnea, the patient has a combination of both Central Sleep Apnea and Obstructive Sleep Apnea. Treatment is usually a combination of medication and CPAP use. There are now some advances in technology with some recent BiPap or BiLevel machines on the market made specifically to treat the special needs of those afflicted with MSA.

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

How is Sleep Apnea diagnosed?

An overnight sleep study is usual indicated when seeking to diagnose if a patient is suffering from Obstructive Sleep Apnea. This sleep test, usually conducted in a specialized sleep lab by a sleep doctor and a respiratory therapist, is called a polysomnogram or polysomnography test; also known as a PSG. Signs or Symptoms of Sleep Apnea

Often people are unaware that they may have Sleep Apnea or they do not realize they have difficulty breathing in their sleep at all. It is usually someone else who witnesses the person sleeping and having these events or obstructions, usually gasping for air or sudden stoppage of breathing while asleep, whereby they first become aware they may have Sleep Apnea.

Snoring is another big symptom but there are many people who snore who do not have sleep apnea. If snoring stops briefly and then resumes, that is a significant indicator of sleep apnea. Daytime tiredness or drowsiness, difficulty or lack of concentration, headaches, impotence or decreased sex drive, moodiness or irritability, lack of energy, acid reflux (gastro-esophageal reflux), restless sleep, tossing and turning, night sweats, memory problems, nighttime choking or chest pain, swelling of the legs in the obese, waking up foggy, groggy, or unrefreshed, anxiety, depression, increased urination at night; these could all be symptoms of Sleep Apnea. Some people first learn of the problem when they fall asleep at the wheel of a car, or are even involved in a car wreck or crash caused by the side effects of having untreated sleep apnea.

I suspect I have sleep apnea, what should I do?

Sleep apnea is a serious and potentially fatal medical condition. If you or a loved one suspect you have it, you should be tested as soon as possible.

  • Sleep Questionnaire. This is a simple test you can fill out and take with you to your physician visit. It evaluates you for the most common symptoms of sleep apnea.

    Sleep Apnea Screening Questionnaire

  • Sleep Study. A polysomnogram, or sleep study, measures many key metrics while you sleep. These metrics are used to determine if you have sleep apnea or a number of other sleep related conditions such as central sleep apnea or restless leg syndrome.

    To find a sleep physician or sleep lab in your area simply enter your address into our sleep services locator.

    Local Sleep Services Locator

    CPAPtalk.com has created an "Introduction To The Sleep Lab" video that explains the process of verifying, diagnosing and treating sleep apnea. If you are curious about the process or would like to know what to expect during your sleep study you can view the video in the Videos Tab of this page.

    If you have tested positive for sleep apnea, it should be treated. CPAP is the most popular and proven way to treat sleep apnea. Here is our advice on navigating the tricky process of getting effective equipment:

  • Get The Best Equipment. Watch Out! There is a significant difference between basic and high end CPAP equipment. High end equipment is generally smaller, lighter, quieter, less prone to leaks, easier to breathe against, better humidified and easier to travel with than basic CPAP Equipment. The key to CPAP treatment is comfort, choose wisely!

    Many traditional, brick and mortar CPAP providers will set you up on a CPAP and bill your insurance company. If this approach to getting your equipment is used, you will most likely be given basic equipment. This is because there is only one billing code for all CPAP Machines and very few unique codes for CPAP Masks. Due to this, the insurance company will pay your CPAP Provider the same amount if you get a high end or basic machine. Usually, the amount paid to traditional CPAP providers by insurance companies is not enough to cover the cost of high end CPAP equipment and the patient is left to make do with basic equipment.

    If you would like high end equipment, there are a variety of ways to obtain it online for equal or lesser cost than dealing with traditional CPAP dealers.

  • CPAP.com (CPAP Retailer). CPAP.com sells high end CPAP supplies and equipment direct to consumers. Many times buying with cash is less expensive than the copay and deductible charged through insurance. If you want a way around the hassle and low end equipment provided by insurance companies and local providers, this is a good choice.

Is there a sleep apnea assessment quiz?

Yes, the link below will take you to a questionnaire designed to evaluate the most common symptoms of sleep apnea. This quiz may be a useful tool for discussing your symptoms with your doctor and can be taken to your appointment.
Sleep Apnea Screening Questionnaire

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.

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 the History of Sleep Apnea?

Sir William Olser in 1918 first used a term he invented, "Pickwickian", to describe patients who were both obese and hyper-somnolent. Olser was obviously a reader of Charles Dickens as the Dickens novel Pickwick Papers had a character in it that was similar to the patients he had identified with these common symptoms. Around 1956, Dr. Burwell was treating patients who often had congestive heart failure, extreme sleepiness or fatigue, as well as improper airflow to the lungs; or respiratory failure. He termed these types of patients as having Pickwickian Syndrome.

Early Diagnosis and Treatment

In 1965 a group of French and German doctors lead by Dr. Gastaut started doing research on what is now called Obstructive Sleep Apnea, and recorded breathing and sleeping patterns of a patient with Pickwickian Syndrome and discovered distinctively unique patterns of the 3 types of apneas.

Beginning in 1969 OSA (Obstructive Sleep Apnea) was often treated with a tracheostomy; bypassing the upper air passage altogether by creating an incision or opening in the trachea (windpipe) and inserting a breathing tube.

Invention of the CPAP machine

In 1981, an Australian researcher by the name of Dr. Colin Sullivan and his colleagues Berthon-Jones, Issa and Eves, introduced their findings on the treatment of OSA with something called a Continuous Positive Airway Pressure machine, or CPAP. The treatment plan started off with a reversed vacuum cleaner motor that blew air into the afflicted person's nasal passage using a Silastic tubing to keep the airway open. The initial CPAP machines were large, bulky and noisy but by the late 1980s many improvements had been made to the machine and masks and soon this became the preferred method of treatment for those who suffer from Sleep Apnea. The publishing of their research papers was a landmark development in the treatment of Sleep Apnea.

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.

I have been diagnosed with sleep apnea, what should I do?

  • Get The Best Equipment. For effective treatment, the CPAP equipment must be used nightly. Because of this, selecting the most comfortable equipment possible is advisable. Our company provides a low cost, hassle free alternative to the stress and risk of dealing with private insurance and traditional providers to obtain CPAP equipment and supplies.

  • Get Support and Information From Other CPAP Users. The prospect of adjusting to CPAP therapy can be daunting. You are not alone. The online CPAP Community cpaptalk.com is a free, no registration required resource where CPAP users from all over the world gather to ask questions, provide encouragement, review CPAP equipment and stay up to date on the latest treatment techniques and options.

    CPAPTalk.com Online Sleep Community

  • Replace Disposable Equipment Regularly. CPAP filters should be replaced following manufacturer's guidelines. In general, disposable or fine filters should be replaced once a month. Washable, or foam filters, should be rinsed with clear, running water once a week and allowed to air dry and should be replaced every 6 months. Expect a CPAP mask to remain effective for about six months. Sinus infections and nasal congestion often result from the failure to care for and replace disposable equipment regularly. Use our Replacement Part Wizard to identify your machine or mask and see all the related parts.

  • Replacement Reminder Emails. CPAP.com offers equipment replacement reminders to help you maintain healthy functional therapy. After placing an order with our company, you will be given the option to have email reminders sent to you. Select the desired time frame for the reminder email allowing you to "order it and forget about it". Edit reminder setting at Product Reminders in Your Account.

  • Stay Informed. The market for CPAP goods and services is competitive and dynamic. Manufacturers are frequently coming to market with products that make CPAP therapy more comfortable and effective. You do not want to be stuck using an inferior product or miss out on a new machine or mask that could improve your therapy and comfort! Subscribe to our CPAP newsletter and get the product and industry news that affects your therapy.

    CPAP Newsletter Archive

    CPAP Newsletter Sign Up

I'm a new user, what do I need to buy?

You will need a CPAP machine, hose (tubing), power cord, filters, and a CPAP mask for effective CPAP therapy. Every CPAP machine comes with a power cord, filter, and a hose (tubing). CPAP masks are sold separately.

During your CPAP therapy you may find that your needs require additional elements. More advanced and comfortable setups also include humidifiers, machine software, CPAP mask strap pads, chinstraps, insulated hose coverings, and extra filters.

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 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

Do I have to use CPAP every time I sleep?

Yes. Using CPAP therapy every night and during naps will increase the effectiveness of therapy, which will lead to an improvement in your mood and energy levels. Remember that even during a short rest your air passage is obstructed and being without oxygen is harmful to your health both short and long term. To avoid the side effects of untreated Sleep Apnea use your CPAP each time you sleep.

It will get easier, and become second nature to you if you stick with CPAP and surround yourself with support. CPAPtalk.com is a free sleep apnea patient forum we maintain. It is a great source of advice and support at any hour of the night or day.

What techniques will help me adjust to treatment?

To get used to CPAP, wear it every night without exception even if you end up taking it off after a few hours. Get into the habit of wearing it. CPAP therapy is necessary for your life. You need to make a commitment to a longer, healthier life.

Wear your Mask around the house when you are first starting out. Watch TV with it on, read while wearing your mask. Getting used to the feel of the mask when you are awake will help it to feel familiar at bedtime.

How long will I have to use CPAP?

Using a CPAP machine treats OSA, it is not a cure. It is very important to remember that this is therapy and therapy is continuous. CPAP therapy is still today, the most recommended and the most effective treatment for obstructive sleep apnea.

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.