Tag: Sleep apnea

Obstructive Sleep Apnea Treatment

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Sleep Apnea, Solutions

Obstructive Sleep Apnea Treatment

If you’ve been diagnosed with obstructive sleep apnea (OSA) or think you might have the condition, you may have questions about how to treat it.

There are several treatment options; the most effective way to treat your sleep apnea depends on the severity of your condition.

Generally, mild to moderate cases can be effectively managed with the same techniques used to treat primary snoring (i.e. non-apnea). Severe cases where your AHI is over 30 are best managed with CPAP.

In extreme cases where CPAP is not tolerated and there is a clear physical obstruction, surgery can also be an option.

This article explores the various methods that can be used to manage obstructive sleep apnea.

Each category has links to other useful SnoreLab articles on the subject.

Side note: what determines sleep apnea severity?

The severity of sleep apnea is split into mild, moderate and severe. These designations are based on how many times you experience apnea or hypopnea episodes per hour – your AHI score. This is where your breathing completely stops or partially stops for 10 seconds or more.

Make sure to read our article about sleep apnea diagnosis to understand sleep studies, the AHI score and classifying the severity of obstructive sleep apnea.

Making suitable lifestyle changes

If your sleep apnea is at the milder end of the spectrum, you can treat it by making some targeted lifestyle changes.

What is most effective depends greatly on what is responsible for your sleep apnea in the first place. Generally speaking, the following lifestyle changes have the most positive impact:

1. Lose weight

Your weight has a significant influence on your likelihood of developing obstructive sleep apnea. Simply put, the heavier you are, the more likely you are to suffer from OSA.

Side note: the statistics of weight loss and sleep apnea

Some epidemiological studies indicate that 70% of patients experiencing sleep apnea are obese, and 40% of obese people are suffering from sleep apnea [1].

Promisingly, research has demonstrated that losing 10-15% of your body weight can half the severity of your sleep apnea [2], and that losing 60% of body fat can eradicate sleep apnea for around 86% of obese people [3].

There’s no shortage of advice or special diets when it comes to losing weight. It can all be a bit confusing and overwhelming. No single technique works wonders for everyone, and drastic solutions are rarely stuck at for very long.

Instead, be sure to check out SnoreLab’s SMART strategy for effective, sustainable weight loss and also have a read of our full article of the impact of weight on snoring and sleep apnea.

2. Stop smoking and reduce alcohol consumption

Smokers, and even passive smokers are more at risk of snoring and experiencing sleep disordered breathing [4][5].

Some studies have found that smokers are 2.5 times more likely to suffer from obstructive sleep apnea [6].

Quitting smoking has shown to reduce your likelihood of experiencing sleep disordered breathing [7]. This is because smoking contributes to greater inflammation and irritation in the upper airway which predisposes it to vibration and collapse [8].

Further, a nightcap is also not ideal for healthy sleep. Alcohol causes your muscles to relax – even more than they do normally when you fall asleep. It therefore increases the collapsibility of your airway and heightens the risk of experiencing apneas.

SnoreLab users amongst many others have found that reducing their alcohol consumption yields drastic reductions in their snoring and sleep apnea.

3. Alter your sleeping position

More than half of all obstructive sleep apnea cases are referred to as “position-induced” sleep apnea [9], where the severity of the condition is made worse by back-sleeping.

By sleeping on your back, your mouth has a tendency to fall open. This changes the shape of your upper airway and makes obstruction more likely.

Sleep apnea can therefore be massively reduced by switching to side-sleeping. There are many techniques you can use to make this change – be sure to check out our guide to sleeping position and snoring.

Anti-snoring mouthpieces

Whilst not recommended for severe cases of OSA, a mandibular advancement device (MAD) can be a good option for those with mild to moderate OSA, or those who do not tolerate CPAP.

MADs brings your lower jaw (mandible) forward (or advance it) to tighten the tissues in your airway that are prone to slackening and causing obstruction.

There are many different types of MAD available so finding the right one can be a bit confusing. To get the best quality we recommend getting a mouthpiece custom fitted by a dentist, though this can be quite expensive.

You can still find great quality mouthpieces without paying loads for a custom-made one. Have a read of our guide to anti-snoring mouthpieces so you know what to look out for when buying generic devices online.

If your tongue causes obstruction in your airway, a different type of mouthpiece called a “tongue retainer” can also be effective for mild to moderate OSA.

CPAP

CPAP stands for continuous positive airway pressure and is a treatment suitable for moderate to severe sleep apnea sufferers. It is the primary method for managing OSA and has a wealth of evidence to support its efficacy.

In most countries, it is only available with a prescription after confirmed diagnosis of sleep apnea.

A CPAP device uses a mask to force air into your nose and throat to keep your airways open.
CPAP does not give you more oxygen. Instead, it introduces a current of normal air that creates positive pressure; this props open your airway to stop it from collapsing.

Many people are fearful of CPAP. Users can also struggle with their devices, experiencing discomfort, claustrophobia and air leakage.

Despite its scary reputation, it’s important to know that CPAP can be a life-saving tool. There are measures you can take to get the most out of it and cope with any difficulties you may have.

 

SnoreLab’s guide to dealing with CPAP issues

Check out

Performing mouth exercises

Research has shown that exercising the muscles in your airway can have a positive impact on mild to moderate sleep apnea.

These techniques are adapted from speech and language therapy and consist of repeated movements in the tongue, cheeks, jaw and soft palate in order to increase muscular tone.

Several studies demonstrate that patients with sleep apnea can reduce their AHI scores and sleepiness by performing these exercises regularly [10] [11] [12] [13].

You can read about all of the evidence and also learn the 5 exercises we recommend.

Surgery

Surgery is usually a last resort only when other techniques to manage your sleep apnea have failed.

Whilst there is some research to show that surgery can produce positive outcomes for OSA, there isn’t enough evidence for surgery to be routinely recommended ahead of alternatives like CPAP.

Usually, to be considered for surgery, there are several requirements that will be assessed by an ENT (ear, nose and throat) specialist first:

  • A diagnosis of severe obstructive sleep apnea, confirmed by a sleep study
  • A clear physical obstruction that can be rectified by surgery
  • Failed treatment with alternative methods such as CPAP and mouthpieces
  • Evidence that the condition is severely affecting your quality of life

There are many types of surgery for snoring and not all are recommended for OSA sufferers.

To get an overview of the surgical interventions available and the important considerations when exploring surgical options, be sure to read our article on surgery for snoring and sleep apnea.

Conclusion

Obstructive sleep apnea can be managed via a number of different means. What is most effective depends on the causes of your condition and its severity.

Regardless of which treatment route you take, many countries have support groups for people with OSA.

These organisations aim to educate and provide support with all facets of OSA.

They give helpful information on living with the condition, provide practical support with CPAP and other treatments, fund and publish the latest research into sleep apnea as well as organising support meetings in person.

What is Sleep Apnea?

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Science, Sleep Apnea

What is Sleep Apnea?

It is normal for a snorer to wonder what sleep apnea is and if they are at risk.

Apnea simply means “no breathing”. Sleep apnea is a serious condition where your airway repeatedly closes during sleep, depriving you of oxygen until you gasp awake.

It is a common misconception that all loud snorers have sleep apnea, but if you think you do, ask yourself or your partner if you have any of the following:

  • Loud snoring with periodic silence and choking/gasping
  • Sore throat or headaches in the morning
  • Excessive sleepiness in the daytime
  • Lack of concentration
  • Behavioural changes and mood swings

Snoring, especially loud snoring, puts you at risk of developing sleep apnea later on – as good a reason as any to address your snoring now.

Side note: obstructive vs. central sleep apnea

Sleep apnea comes in two forms; the obstructive condition is linked to snoring as there is an airway blockage. The other type, central sleep apnea, is due to a fault in the brain’s regulation of breathing – this type is not linked to snoring. All subsequent references to sleep apnea refer to the obstructive form.

How does sleep apnea differ from normal snoring?

The key difference between snoring and sleep apnea is whether or not you are breathing.

When you produce a snoring sound, you are breathing; air must be travelling through your airways and into your lungs, albeit a bit bumpily. Noise from snoring is bothersome but the more worrying event is when the sound suddenly stops – now you aren’t breathing.

Here, snoring has made the serious transition to obstructive sleep apnea.

 

“Is it snoring or sleep apnea?”

Read the full article

Thankfully your body has a mechanism to kick-start breathing again. When it stops for too long, the amount of oxygen in the blood drops and carbon dioxide rises; your brain recognizes this dangerous situation. A fizz of brain activity briefly wakes your body up, often with a gasp or snort. Muscles in your neck open the airways so air can get back into the lungs.

Sadly, when you go back to sleep, this process of obstruction, low oxygen and awakening repeats itself again and again.

Why is sleep apnea dangerous?

Sleep apnea is harmful because repeated oxygen debt and fitful sleep every night takes its toll on your body [1]. During the low oxygen events, your heart is having to work harder. This increases blood pressure which damages your arteries, thickening their walls and increasing the likelihood of:

  • Heart problems including angina, heart failure and heart attacks
  • Stroke
  • Diabetes
  • Impotence

These physical problems are only made worse by disturbed sleep. A lack of sleep also has detrimental effects on your day-to-day mental functioning. Many people experience:

  • Low energy
  • Daytime sleepiness
  • Worsened reaction times
  • Poor memory

Beyond the sufferer, sleep apnea impacts upon society too. At work, persistent tiredness shrinks productivity and means more days taken off sick [2].

On the road, studies have found that people with sleep apnea are twelve times more likely to be involved in road traffic accidents. Some countries now make it mandatory to inform the driver registration authorities if you are diagnosed with sleep apnea [3].

What can put you at risk of sleep apnea?

Snorers are not necessarily suffering from sleep apnea, but the risks associated with each are closely aligned. The things that make you more likely to develop sleep apnea mirror the risk factors for snoring:

Identifying potential sleep apnea

There are some important things to watch out for if you suspect you have sleep apnea:

  • Very loud snoring, with periodic silence and gasping
  • Headaches or a sore throat in the morning
  • Being excessively sleepy in the day
  • Lack of concentration
  • Mood swings and behavioral changes

Despite continuously waking during the night, sufferers don’t usually realize it themselves. Many people assume that the fatigue they are experiencing is a symptom of age so fail to seek help. Instead, partners of those with the condition are more likely to spot their sleep apnea.

How does sleep apnea severity vary?

The severity of your condition can be assessed by counting how many times you experience low-oxygen events. This helps to generate an AHI score, the apnea-hypopnea index. This measures the apnea or hypopnea episodes per hour of sleep:

  • Apnea episode – complete airflow blockage for at least ten seconds
  • Hypopnea episode – at least 50% reduction in airflow for at least ten seconds

Your AHI score relates to the severity of sleep apnea:

  • 0-5 events per hour – normal
  • 5-15 events per hour – mild sleep apnea
  • 15-30 events per hour – moderate sleep apnea
  • 30+ events per hour – severe sleep apnea

Your score is very important when deciding on the best way to treat your sleep apnea. Mild to moderate cases can be addressed with normal snoring reduction techniques and consumer remedies. If you have a severe case, continuous positive airway pressure devices (CPAP) are the most effective form of treatment.

Conclusion

It is important to know that relatively benign snoring can make a dangerous transition to obstructive sleep apnea. This is a serious condition where your airway repeatedly closes during sleep, briefly depriving you of oxygen until you gasp awake.

Low oxygen events and continuous poor sleep can have serious repercussions on both your physical and mental wellbeing.

The same things that cause snoring put you at risk of sleep apnea. Some people even consider loud snoring to be the first stage of “sub-clinical” sleep apnea. Importantly, up to 95% of people with sleep apnea snore [4], but not everyone who snores has the condition. Understand your risk and know how to spot the signs so you don’t make the switch.

CPAP: A Guide to the Different Types of Mask

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Sleep Apnea, Solutions

CPAP: A Guide to the Different Types of Mask

If you’ve been recommended CPAP to treat your snoring and sleep apnea, you might have a few questions:

What is CPAP?

CPAP stands for “continuous positive airway pressure”. A CPAP device uses a mask to force air into your nose or mouth to keep your airway open. It is very effective in treating sleep apnea, a condition where the airway repeatedly closes during sleep.

Contrary to popular belief, CPAP does not give you more oxygen, it simply establishes a current of normal air that props open your upper airway to prevent it from collapsing.

Normal breathing works via negative pressure, where expansion of the chest creates low pressure that then acts like a vacuum to suck in air. Conversely, by using CPAP, the constant flow of air creates high, positive pressure that forces outwards and pushes the airways open.

What makes a CPAP device?

There are three main components to any CPAP machine:

  • Flow generator
  • Hose
  • Mask

The generator pushes air through the hose, to the mask and into your airways.

Whilst the generator and tube are much the same (with some subtle variations and features unique to each product such as humidifiers), the mask is the part that varies the most. When being fitted for a CPAP device, it is important to consider the type of mask that is best for you.

The importance of a correct fit

Compliance is a big problem when it comes to CPAP treatment, with many users giving up after only a few nights. So whilst CPAP can be very effective in treating snoring and sleep apnea, it is only useful when it is actually being worn.

There are many reasons that make people stop their CPAP treatment, but most complain of discomfort. One study found that over a period of three years, 91% of users had abandoned their CPAP treatment [1].

Therefore, getting the right mask for you is vital to ensure you get the most out of CPAP.

 

SnoreLab’s guide to troubleshooting problems with your CPAP device.

Read

Nasal masks

This mask is dome shaped and forms a seal around the nose. Shapes vary so there are many options to suit different face shapes. Because air is not being introduced directly into the nose, the airflow feels a bit more natural. This also allows for higher pressures to be used, ideal for people with severe sleep apnea.

However, as the name suggests, nasal masks only work through the nose. Nasal masks are not effective if you breathe through your mouth whilst you sleep. Many devices address this by coming with a chin strap to prevent your mouth falling open. This option is therefore not suitable for people who suffer from allergies or have chronic sinusitis.

Air leakage is a potential problem with nasal masks; the seal formed by the padding can be compromised if you have facial hair. Some users also complain of discomfort from the straps on the head or pressure on the bridge of the nose. You can often mitigate this with proper fit and adjustment.

Nasal mask pros

  • Many different shapes for optimal fit
  • Higher pressures possible, therefore suitable for severe sleep apnea
  • Less claustrophobic than full face masks

Nasal mask cons

  • Potential air leakage with facial hair
  • Difficult to wear before bed or with glasses on
  • Not suitable for mouth breathers and people with nasal congestion

Nasal cushions

Also known as a nasal pillow, this type of mask rests on your top lip and uses two cushioned prongs that fit directly into your nostrils. This is the smallest and most simple of all CPAP masks so is popular with people who find other masks claustrophobic and uncomfortable.

Nasal cushions are less cumbersome than alternatives and cover less of your face. This is ideal if you want to wear the mask for some time before bed. With its slimmer design, you needn’t alter your nightly routine where other masks would be in your field of vision and prevent you from wearing glasses.

Nasal cushions are also beneficial for those who have more facial hair, as the seal is only formed on the nostrils.

Because the air is forced directly into your nose, high pressures can be uncomfortable. This means nasal cushion masks are less appropriate for people with severe sleep apnea. The direct airflow can cause nasal dryness and discomfort.

Again, the device only works for nasal breathers. If you have a tendency to breathe through your mouth when asleep but can still breathe properly through your nose, nasal pillows can still be effective when used with a device that holds your mouth closed.

Nasal cushion pros

  • Less claustrophobic
  • Can be worn comfortably whilst awake
  • Less prone to air leakage
  • Suitable for people with facial hair

Nasal cushion cons

  • High pressures can be uncomfortable, therefore is less suitable for severe sleep apnea
  • Can cause nasal dryness
  • Not suitable for mouth breathers

Full-face masks

These masks are larger, covering the nose and mouth, so are ideal for mouth breathers. If you have experienced discomfort with a chinstrap, or frequently have a blocked nose, full-face masks could be the answer.

Higher pressures are more tolerable with full-face masks as the air isn’t being sent directly into your airway. Being able to use high pressures makes this mask ideal for those with severe sleep apnea.

The added weight of a full-face mask means it has a tendency to loosen during the night, particularly if you are a restless sleeper. However, there are several straps that can be adjusted to get an optimum fit. This mask is ideal for people who sleep on their back.

Due to the increased area in contact with your face, there are more potential areas for air leakage, especially for those with facial hair. Leakage that occurs out of the top of the mask can sometimes dry out and irritate your eyes.

The bulk of a full-face mask makes it difficult to wear before you sleep as it interrupts your field of vision and makes it difficult to wear glasses.

Full-face mask pros

  • Ideal for mouth breathers
  • Suitable for people who sleep on their back
  • High pressures are tolerable, therefore is suitable for severe sleep apnea

Full-face mask cons

  • Potential air leakage
  • Bulky, so can move during the night
  • Difficult to wear whilst awake

How do I know which CPAP mask is right for me?

How a CPAP mask feels is different for every individual. General comfort and feelings of claustrophobia are subjective and dependent on the materials, design and fit of the mask.

When in consultation about using CPAP, it is important tell your doctor about all aspects of your sleep and nightly routine to decide on the best mask for you. Remember to try different types and make sure you get an optimum fit with the adjustments available.

Use this table to decide which CPAP mask is best for you:

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