Sleep Apnea 101

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, 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

What is Central Sleep Apnea (CSA)?

In Central Sleep Apnea 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 sends air in an inhale/exhale pattern helping a person to breath.

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 love 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 bring with you to your physician visit that 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, you will need to treat it. 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.

Are there Sleep Apnea Assessment Quizzes I can take?

Sleep Apnea is a serious and potentially fatal medical condition. If you or a love 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 bring with you to your physician visit that evaluates you for the most common symptoms of sleep apnea.
  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.

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.

• CPAP Users Share their Success Stories
• Specific Helpful Hints for CPAP Users
• Initial Diagnosis, Signs Symptoms

• Apnea in Greek, literally translates "without breath"
• It is estimated eighteen million Americans have Sleep Apnea. That's one in eleven!

CPAPtalk.com Wiki Articles

• Sleep Apnea: What CPAP users want you to know
• Sleep Apnea: Symptoms and Risk Factors
• Creating a good Sleep Environment
• Questions to Ask your Doctor

Research Articles

• Sleep Apnea
• Obstructive sleep apnea - Treatment
• Snoring is More Than Loud
• Epidemiology of obstructive sleep apnea: a population health perspective.
• Reducing motor-vehicle collisions, costs, and fatalities by treating obstructive sleep apnea syndrome.
• The occurrence of sleep-disordered breathing among middle-aged adults.
• Increased incidence of cardiovascular disease in middle-aged men with obstructive sleep apnea: a 7-year follow-up.
• Continuous positive airway pressure for treatment of postoperative hypoxemia: a randomized controlled trial.
• Reduction in motor vehicle collisions following treatment of sleep apnoea with nasal CPAP.
• Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study.
• Sleep Apnea, Depression Linked in Stanford Study.
• Sleep, Stress, and Worry