CCF Sleep

You tried positive airway pressure (PAP), but it didn’t work. What can you do now? First, it may not be time to give up on PAP just get. Have you tried the following troubleshooting steps?

• Working with a provider to find the mask that is right for you
• Discussed any concerns of feeling that the PAP pressure is too high or low
• Addressing concerns of PAP machine noise
• Making sure a stuffy nose isn’t making PAP uncomfortable
• Discussing with your healthcare provider anatomical nose blockage such as deviated nasal septum which can hinder ability to tolerate PAP
• Sleeping on your side instead of your back
• Getting any other medical issues checked out by your doctor so they won’t interfere
• Going to a Sleep Apnea Management clinic or trying a PAP Nap study

What to try next: other apnea treatments to consider

If you’ve tried all of these steps and still feel like PAP isn’t working or you can’t use PAP regularly, it might be time to check out your other options. Other apnea treatments include:

• Dietary and surgical weight loss: Designing a specific low-calorie plan with your doctor or having bariatric surgery can result in substantial weight loss, but it is best to remember that weight loss is not an immediate treatment and is best used in combination with other therapies.
• Positional therapy: If you’ve tried sleeping on your side to no avail, your healthcare provider can recommend a special pillow or device to help keep you off of your back while you sleep.
• Upper airway surgery: Many different upper airway procedures are available to apnea patients, including nasal septum straightening or turbinate reduction, tonsil removal, tongue reduction, throat tissue remodeling, and jaw adjustment. 
• Hypoglossal nerve stimulation: Implantation of a small device that stimulates the hypoglossal nerve (which moves your tongue forward in your mouth, away from your airway) can help keep your airway open during sleep and reduce sleep apnea. 
• Oral appliance therapy: These appliances are fitted by dentists and designed to bring the lower jaw (and tongue) forward.

What to do next

As always, it is best to talk to your doctor when contemplating alternative treatment options so they can let you know which strategies would work best for you and help you evaluate the pros and cons of potential treatments.

If you think you may have sleep apnea, you might be contemplating your options for sleep testing. Since home sleep apnea testing (HSAT) is a simpler, more convenient version of a lab-based sleep test, you might already be ready to jump on board. However, it is important to assess the pros and cons and see if home testing is really right for you.

Who is a good candidate for HSAT?

Firstly, HSAT is only performed to confirm the diagnosis of obstructive sleep apnea (OSA) in individuals who have shown other signs or symptoms. If your sleep apnea screening risk level is “severe,” this may be a good option for you. Home testing can be a better option than a lab study in some cases because:

• It’s less expensive
• It’s less time consuming
• You can sleep in your own bed
• There are only four sensors to worry about
• It’s so simple you can set it up yourself

If the testing confirms OSA, you’ll be ready to get the treatment you need.

Who is NOT a good candidate for HSAT?

Home testing is not for everybody because it’s not always a suitable replacement for lab testing. Here’s why HSAT may not be for you:

• • It’s not a screening tool – it can’t differentiate between mild apnea and normal sleep
• It doesn’t work well for people with certain heart, lung and neurological conditions
• It’s less precise – HST only tests four parameters, while labs test 20

Lab testing is more comfortable and home-like than ever

Many people are nervous about lab tests, but sleep centers try to mimic the home environment as much as possible, with comfortable beds and a hotel-like atmosphere. You’re encouraged to bring everything you need for your usual bedtime routine: reading materials, medications, even your favorite pillow.

Most people still won’t sleep like they do at home, but even a few hours of sleep is enough to make a diagnosis. Talk to your healthcare provider to get more information and see if you would be eligible for a home sleep apnea test.

If positive airway pressure (PAP) hasn’t worked for you, you may have heard about one of the newest alternatives to treat sleep apnea: hypoglossal nerve stimulation (HNS). But what is it and how can it help you?

Hypoglossal nerve stimulation is the newest surgical therapy for obstructive sleep apnea (OSA). Therapy consists of a device implanted under the clavicle that stimulates the hypoglossal nerve producing forward movement of the tongue that increases the size of the airway during sleep. Approved by Food and Drug Administration (FDA) in 2015, upper airway stimulation is appropriate for carefully selected patients with OSA.

Who is a good candidate for this treatment?

You might be a good candidate for this therapy if your healthcare provider can confirm that PAP treatments (such as continuous positive airway pressure [CPAP] or bi-level positive airway pressure [Bi-level PAP] machines) haven’t worked for you and you do not have complete soft palate collapse when you sleep. In order for you to be considered for HNS therapy, conservative therapies like weight loss and exercise should have been attempted, as well as non-surgical treatment approaches like PAP and dental devices.

If you’ve tried other therapies to no avail, talk to your healthcare provider about what HNS can do for you.

Understanding sleep apnea and heart health

If you suffer from untreated sleep apnea, you could be causing serious damage to your heart. When you stop breathing during sleep, your involuntary reflexes cause you to startle awake, accelerating your heart rate and increasing your blood pressure. As your blood pressure rises, your heart walls thicken and become stiffer due to increased workload. These structural changes make the heart less efficient at pumping blood and more susceptible to arrhythmias. When you stop breathing more than 30 times per hour, you have increased risk of cardiovascular damage, but there is likely risk even at lower frequencies.

Take it from the sleep disorder experts

Sleep disorder specialist Harneet Walia, MD, found in her research that those with serious apnea were 4x more likely to have elevated blood pressure – even though they were taking three or more medications. All these patients either had or were at risk for cardiovascular disease, despite being under the close care of heart specialists. The study suggests that treating sleep apnea can improve blood pressure control and, in turn, patients’ heart health.

Sleep apnea and heart failure

Sleep apnea occurs in about 50% of people with heart failure or atrial fibrillation, the most common sustained abnormal heart rhythm. Sleep disorders research director Reena Mehra, MD, says that episodes of upper airway collapse in sleep apnea may trigger arrhythmia events. Other ways sleep apnea can increase risk of arrhythmias and heart failure include:

• Repeated episodes of oxygen lowering (what doctors call hypoxia)
• Changes in carbon dioxide levels
• Direct effects on the heart due to pressure changes within the chest
• Increased levels of markers of inflammation

With the high prevalence of sleep apnea in hypertension, cardiac arrhythmias, and heart failure, experts recommend that you don’t delay in seeking the advice of your physician.

You already have diabetes or pre-diabetes, and now you might have sleep apnea. It’s already hard enough to manage one chronic condition, so why should you worry about trying to manage another?

Impact of sleep apnea on diabetes

Untreated sleep apnea can make diabetes much worse. This is because sleep apnea pauses your breathing while you sleep, reducing oxygen and increasing carbon dioxide (CO2) in your blood. This can cause a whole host of problems, such as high blood pressure, heart disease, and frequent morning headaches. But for diabetics, these changes can make matters worse by contributing to insulin resistance.

If you already have type 2 diabetes

In type 2 diabetes, you have too much sugar, also called glucose, in your blood. Food is broken down into glucose, which is then absorbed by the body’s cells and used for energy with the help of the hormone insulin. For people with type 2 diabetes, their cells are not able to properly use insulin, and therefore must use more insulin to get glucose into their cells. So, if your body cannot use insulin as well as a result of sleep apnea, you can more easily get high blood sugar levels that cause damage to your nerves and organs.

If you’re at risk for type 2 diabetes

Also, for those who are only at risk for diabetes, poor sleep from sleep apnea can put you at a greater risk of developing the disease. In addition to making you crave carbohydrates and sugar-loaded foods, endocrinologist Mary Vouyiouklis Kellis, MD, says that a lack of sleep can make you less likely to want to exercise or plan meals, resulting in weight gain and higher diabetes risk.

So, if you have diabetes or are just at risk, treating sleep apnea is a win-win situation, giving you better sleep and preventing /improving your diabetes.

While it’s common knowledge that disturbed sleep can reduce energy and alertness, a recent study suggests that sleep apnea may have more serious repercussions for cancer patients than you might think.

What the research shows

Researchers from the University of Chicago and the University of Louisville disrupted the sleep of mice using a motorized brush across their bodies – a disruption that most closely resembles sleep apnea in humans. Sleep-disrupted mice developed larger, more aggressive tumors than well-rested mice. Further, immune systems of the sleep-disrupted mice were less effective at fighting the early stages of cancer than the immune systems of the well-rested mice.

What does it all mean?

These findings suggest that fragmented sleep affects how the immune system deals with cancer in a way that makes the disease more aggressive. Although human studies are limited, there is growing interest among cancer and sleep researchers on the role of sleep therapies in cancer care, particularly cancer prevention.

So, if you or a loved one are dealing with a cancer diagnosis, don’t forget how important it is to get a good night’s sleep!

Insomnia and Substance Abuse

Although they’re used commonly to help with falling asleep, alcohol and other drugs are major causes of sleep problems.

Alcohol is often thought of as a sedative or calming drug. While alcohol might help you fall asleep, it increases the number of times you awaken in the latter half of the night when its relaxing effect wears off.

How alcohol destroys deep sleep

Not all sleep stages are equal. Rapid Eye Movement (REM) sleep and deep non-REM sleep, also known as Slow Wave sleep are the two deep sleep stages that are important for feeling rested after sleep, both physically and mentally. Recent studies report reductions in these deep sleep stages enhance the progression of neurodegenerative diseases like Alzheimer’s disease. Alcohol use is associated with reduced and fragmented deep sleep. This can lead to daytime sleepiness and fatigue, as well as increased fall-risk in the elderly.

Additionally, the following non-prescription medicines/substances can also cause sleep problems:

• Pseudoephedrine, including the brand Sudafed®
• Medicines with caffeine (including the brands Anacin®, Excedrin®, and No-Doz®, as well as cough and cold medicines) when consumed excessively or too late in the day
• Nicotine, which can disrupt sleep and reduce total sleep time (Smokers report more daytime sleepiness and minor accidents than do non-smokers, especially in younger age groups)

With all the side effects and consequences, the use of alcohol and other drugs to cope with insomnia is strongly discouraged. If you have insomnia, talk to your healthcare provider about safe treatment options with proven results to help you sleep better.

How sleep can affect your appetite

You already know that not getting enough sleep can change the way you feel, but research shows that a lack of sleep can also change the number on your scale.

Studies suggest that sleep deprivation is associate with increased hunger and cravings for high-calorie, high-carb foods, like fast-food and sweets. This is because sleep changes the levels of key hormones that regulate hunger.

3 sleep-dependent hormones that regulate hunger

1. Ghrelin: Lack of sleep increases this hunger-controlling hormone, which then causes you to eat more
2. Leptin: Sleep loss also causes your appetite-suppressing hormone to decrease
3. Cortisol: This stress hormone increases when you don’t get adequate sleep, which may stimulate your appetite

Also, new research shows that sleep deprivation increases levels of a brain chemical similar to the chemicals in marijuana, causing a craving for high-fat foods.

Many people don’t realize that being short of sleep can make a huge difference in your appetite, but getting more of that deep, restful sleep can help get you back on track.

How do you know if you’re getting the right amount of sleep?

Think of sleep like the three bears thought about porridge. Most adults 18-64 years of age require seven-to-nine hours and 65+ year olds require seven-to-eight hours of sleep for optimal performance and good health. Few require less and few require more, but most are somewhere in between.

Individual sleep needs are genetically driven and change with age, life phase and health. Your optimal sleep time is the amount of sleep your body requires to maintain normal levels of alertness and otherwise run smoothly. Aiming for a stable bedtime and wake-up time every day of the week helps to avoid too little and too much sleep.

Negative impacts of too little sleep

Insufficient sleep: Daytime sleepiness and fatigue are common signs that you’re cutting sleep short. Other symptoms of insufficient sleep are:

• Poor concentration and inattention
• Irritability and reduced motivation
• Restlessness and poor coordination
• Decreased performance behind the wheel, in school and on the job
• Repeated yawning or blinking
• Difficulty keeping eyes open or head up
• Wandering thoughts
• Lane-drifting or missing signs or exits on the road

Chronic insufficient sleep is more common in women, adults under 55 years, employed individuals, students, and those with fair or poor general health. Extending sleep time resolves the symptoms.

Negative impacts of too much sleep

Oversleeping: Oversleeping has some of the same consequences as under-sleeping. People who oversleep can wake up feeling groggy and cognitively impaired. Oversleeping is also associated with:

• Increased risk of depression
• Increased risk of cardiovascular disease
• Increased risk of diabetes
• Increased rick of obesity

How sleep troubles can get you down

Feeling down and you don’t know why? Sleep apnea or other sleep disorders could be the culprit. They’re often overlooked when diagnosing a patient’s problems because their symptoms are incredibly varied and may include symptoms that fall under the category of mood and psychiatric disorders. Beyond sleep disruptions and other bedtime symptoms, people with sleep disorders may have:

• Depression
• Trouble concentrating
• Excessive daytime sleepiness
• Fatigue
• Low motivation
• Problems with sex
• Dry mouth/sore throat
• Declining work/educational performance

Impact of sleep disorders on your life

These symptoms often take a large toll on overall quality of life, making it hard for the sufferer to do everyday tasks and connect with friends and family. Although these symptoms align with major depressive disorder, for those with sleep disorders, their symptoms generally don’t get better with treatment for depression.

Only when a sleep disorder diagnosis has been reached and treatment to improve sleep has been administered will the patient’s symptoms improve. If you’re reading this, you’ve taken our assessments for sleep disorder risk, so if you have any of these symptoms and may be at risk, talk to your healthcare provider about getting tested for sleep disorders.