CCF Sleep

What it is, and why you should care

Obstructive sleep apnea (OSA), is a serious sleep disorder that occurs when a person’s breathing is interrupted during sleep. People with untreated sleep apnea stop breathing repeatedly during sleep, sometimes hundreds of times during the night.

What happens during an OSA episode?

During an apnea episode, the airway may close or the sleeping person may just stop breathing, causing the diaphragm and chest muscles to work harder as the pressure increases to open the airway. Breathing usually resumes with a loud gasp or body jerk, and you may wake up or feel like you were choking. These episodes can interfere with sound sleep and reduce the flow of oxygen to vital organs.

Because of the lack of deep, consolidated sleep, common symptoms of OSA are daytime sleepiness and fatigue. This can affect your mood, productivity, and safety on the road. Also, lack of oxygen flow can cause all sorts of health issues, from high blood pressure and heart disease to depression and cognitive impairment. Sleep apnea also interferes with the management of other conditions, like diabetes and cancer.

What are some of the signs of OSA?

OSA has both daytime and nighttime symptoms, which include:

• Snoring
• Restlessness during sleep or frequent nighttime awakenings
• Sudden awakening s with a sensation of gasping or choking
• Dry mouth or sore throat upon awakening
• Daytime sleepiness or fatigue
• Trouble concentrating, forgetfulness, or irritability
• Depression or anxiety

What can you do to treat OSA?

Currently there are many treatment options available for sleep apnea, and when used correctly, yield stunning results. Some of these treatments are Positive Airway Pressure (PAP) therapy, positional therapy, lifestyle changes, oral appliances and hypoglossal nerve stimulation which you can learn more about here.

Click through the app to learn more about sleep apnea, how you can get tested, and the benefits that come from treating sleep apnea.

What do I need to know about sleep apnea and how it affects my brain?

Sleep apnea robs you of a good night’s rest, making you tired, cranky, and less sharp throughout the day. But those aren’t the only things sleep apnea does to your brain. A recent study found a link between abnormal breathing patterns during sleep – like heavy snoring and apnea – and cognitive decline at an early age.

Researchers from New York University studied data from nearly 2,500 people between the ages of 55 and 90 with Alzheimer’s disease. “People with sleep apnea had an earlier onset of mild cognitive impairment compared to those without sleep apnea,” sleep specialist Harneet Walia, MD, says.

Mild cognitive impairment is when your memory is affected to the point that it is noticeable to others, but not enough to pose significant issues with one’s daily functioning, and is one of the first signs of Alzheimer’s disease. People with mild cognitive impairment are usually forgetful and may not remember recent events very well. They often need to write notes to remind themselves to do things that they would otherwise forget. The study also linked sleep breathing problems to an earlier onset of Alzheimer’s disease.

The researchers found that even though some people who sought treatment for sleep apnea still developed memory impairments, cognitive issues showed up about 10 years later than they did in people with untreated sleep apnea. So, it’s never too late to address longstanding sleep disorders. Your brain will thank you.

If you work a non-traditional shift like the night shift or rotating shifts, you may be missing out on more than daylight. You could be missing out on quality, uninterrupted sleep and better health. Night shift workers who have trouble sleeping may have a condition known as shift work sleep disorder (SWSD).

Working non-traditional shifts interferes with the body’s circadian rhythms: most of us are awake during the day because our body’s internal clock is keeping us awake. So no matter how tired you are after working all night, your awakening signals will conflict with your desire to sleep.

This results in significant problems with falling asleep, staying asleep, and sleeping when you want to. Up to one third of shift workers do not achieve circadian adjustment to their schedules and therefore report persistent insomnia or sleepiness.

The negative impact of SWSD

The effects of SWSD aren’t just limited to insomnia or sleepiness. SWD also leads to an increased likelihood of the following:

• Accidents and work-related errors
• Irritability or mood problems
• Poor coping skills and impaired social functioning
• Health related complaints — including gastrointestinal, cardiovascular, and metabolic problems
• Drug and alcohol dependency
• Infertility
• Cancer (shift work resulting in circadian disruption has been noted to be a probable carcinogen by the World Health Organization)

And from a quality of life perspective, working alternate shifts can make it difficult to lead a balanced life, since others may not share the same schedule you do.

Treating SWSD is possible and effective!

Fortunately, once you figure out if you have SWSD, there are ways to effectively treat it so you can feel your best and preserve your health. Click here to figure out if you have SWSD and how you can treat it.

6 proven ways to treat obstructive sleep apnea

Most medical treatments aren’t one-size-fits-all, and neither are treatments for obstructive sleep apnea (OSA). If you have sleep apnea and want to rest better, there are several options that you can try:

1. Continuous Positive Airway Pressure (CPAP): This is the treatment of choice, and involves wearing a mask over your nose and/or mouth while you’re sleeping. A machine gently pushes air through the mask to keep the airway from closing and, as a result, prevents lapses in breathing.

2. Weight loss: Losing weight through eating a more nutritious diet, reducing caloric intake, and exercising regularly can help sleep apnea. After weight loss occurs, talk to your doctor about a repeat assessment of your sleep apnea.

3. Positional therapy: If you sleep on your back, your doctor can recommend certain comfortable pillows/devices to help you sleep on your side and keep your airway open as you sleep.

4. Oral appliances: These devices can move your jaw forward and keep your tongue from blocking your airway as you sleep.

5. Upper airway surgery: If other devices and therapies don’t work, you can have surgery to reduce airway obstruction in your nose and throat.

6. Hypoglossal nerve stimulation: If other devices and therapies don’t work, you can have a small device implanted that will stimulate the nerve that moves your tongue forward in your mouth as you sleep, keeping the airway from being blocked.

Talk to your general practitioner today

In the end, while personal research and self-help can be good places to start for apnea treatment, your healthcare provider is your best resource. Click here to find a specialist near you.

How to know if you’re at risk for sleep apnea

If you’re reading this, you’ve already completed a risk assessment for obstructive sleep apnea (OSA). But what if a loved one or friend might be at risk too? Here’s a simple way to see if you or someone you know is at risk for OSA, using “STOP-BANG” criteria:

• Do you snore loudly (louder than talking or loud enough to be heard through closed doors)?
• Do you often feel tired, fatigued or sleepy during the daytime?
• Has anyone observed you stop breathing during your sleep?
• Do you have or are you being treated for high blood pressure?
• Is your body mass index more than 35 kg/m2? Calculate your BMI here
• Is your age over 50 years old?
• Is your neck circumference more than 40 cm (15.75 inches)?
• Are you of male gender?

If you have three or more positive responses to these questions, you have a high risk of sleep apnea and should talk to your provider about getting tested.

Sleep apnea’s incredibly high prevalence

It may seem scary to get a new diagnosis or even just to think that you might have a chronic condition like sleep apnea, but you’re not alone.

Sleep apnea statistics: prevalence

At least 27% of men and 11% of women have obstructive sleep apnea (OSA) as per population-based data. It’s about as common as diabetes, but not nearly as well-recognized. And those numbers are based on older studies when obesity rates were not as high as they are today – the Center for Disease Control (CDC) estimates that obesity rates have doubled in the US over the past 30 years. As we know, obesity is a major contributor to the occurrence of OSA in individuals, so it’s likely these numbers are under-representative of reality.

Sleep apnea statistics: severity

Most of these apnea cases are not mild. Approximately 17% of middle-aged men and 9% of middle-aged women have moderate-to-severe OSA, the range of sleep apnea that can contribute to other health conditions, such as heart disease and stroke. While most people think of men as being more at risk for OSA than women, after menopause, women are just as likely as men to develop OSA. However, they tend to get a diagnosis later because they are less likely to snore and more likely to have other symptoms like fatigue, anxiety, and depressed mood.

Sleep apnea statistics: future projections

With numbers like these, it’s easy to understand that OSA affects millions of people every day, and the numbers keep rising. In just the past 15-20 years, OSA cases have increased by 10-50%. And although many people may not know about it, it is more prevalent than other well-known chronic diseases, like diabetes (which has around a 10% prevalence), Alzheimer’s disease (1-5%), and arthritis (10%). It’s even almost as common as high blood pressure, which affects one in every three adults.

However, even though so many people have documented OSA, at least 80% of cases go undiagnosed. By downloading this app, you’re already a step ahead of the game. Click here to learn more about taking control of your sleep apnea.

Getting used to your positive airway pressure therapy

If you have sleep apnea and your doctor has prescribed positive airway pressure (PAP) therapy, you might anticipate or already have difficulties getting used to the device. You know that PAP is the best way to treat your apnea and feel better during the day, but getting into using PAP regularly is a struggle. Whether you have anxiety or claustrophobia or are having difficulty with PAP for some other reason, a PAP Nap can help you with your problems.

What is a PAP Nap?

A PAP Nap is a short daytime study for people who are having problems starting or continuing their PAP therapy for their sleep breathing disorder. During the study, you’ll work one-on-one with a sleep technologist, using relaxation, deep breathing, and desensitization techniques to try to become more comfortable with PAP therapy. The study includes a cardiorespiratory recording (with minimal sensor usage) and counseling to help you overcome any fears or discomforts about PAP therapy and to become more comfortable with the mask and pressure sensations. The goal of the PAP Nap is to help you get used to using the equipment yourself so you are more likely to use PAP therapy on a nightly basis at home.

Are PAP Naps effective?

The Cleveland Clinic has found that patients are more likely to correctly use and stick with their PAP therapy if they receive sleep technologist coaching and follow-up. So if PAP seems like a struggle, the PAP Nap might be the right next step for you.

Positive airway pressure therapy, or PAP, is the treatment of choice for moderate-to-severe obstructive sleep apnea (OSA). It’s also useful for many patients with mild OSA who experience daytime symptoms such as sleepiness, irritability and memory lapses.

What is PAP and how does it work?

When you have an apnea, your airway collapses and you stop breathing due to the lack of airflow. PAP therapy uses a mask or nose-piece to blow air into your airway. This acts as a splint of sorts to keep the airway open and keep you breathing while you sleep. 

Although PAP therapy can be delivered in different ways, Continuous PAP (CPAP) is preferred as the initial treatment for OSA. When you receive the device, you should be fitted for a mask which is best suited for you in terms of comfort and your facial anatomy. You should also receive education and instruction of how to use and clean the device.

CPAP generally requires an initial titration sleep study to figure out what pressure works best for the patient. However titration can be done at home using an Auto-PAP (APAP) device, in many cases.

What if CPAP doesn’t work for you?

If CPAP doesn’t work, your doctor may recommend Bilevel PAP (BiPAP) or Auto PAP (APAP). BiPAP provides two pressure settings instead of just one, allowing for a lower pressure when you exhale. APAP devices use sensors to adaptively change the airway pressure based on what’s needed, so a titration study in the laboratory is avoided. However, these alternative modes aren’t right for everybody, so talk to your doctor to figure out which option would be best for you.

Getting help from your healthcare provider

You’re tired every morning because you can’t sleep each night, but you don’t know if it’s really something you should see a doctor about. How can you tell?

If you notice something that’s bothering you at bedtime, like a spouse watching TV or feeling too warm, the first step would be to see if you can improve your sleep hygiene. Click here to learn about what to do and not to do to get to sleep easier.

What to do if you still can’t sleep

If you still can’t sleep and think you have insomnia, talk to your healthcare provider. An evaluation may include:

• A physical exam
• A review of your medical history
• A review of your sleep history
• An interview of your bed partner to help evaluate your sleep

You may be asked to keep a sleep diary for a week or two, which helps keep track of your sleep patterns and how you feel during the day. In some cases, you may be referred to a sleep center for testing.

Based on your diagnosis, here are some of the most common ways your provider can assist you:

• Acute insomnia (less than three months of sleep loss) may not require treatment. This typically occurs in the setting of a major stressor, like the death of a loved one or loss of a job.
• Chronic insomnia that is mild can be remedied with good sleep habits that you and your provider can identify.
• Sleeping pills may be prescribed for a limited time if you’re suffering from moderate to severe chronic insomnia and you have trouble functioning because of daytime fatigue. However, cognitive behavioral therapy for insomnia has been shown to be more effective long-term.
• Chronic insomnia treatment includes first treating any underlying health problems that are causing the insomnia and improving sleep hygiene. If insomnia continues, your healthcare provider may suggest other treatments.

…with good sleep hygiene!

Having trouble falling asleep? Waking up at three a.m. for no reason? Insomnia can rob you of energy the next day, fog your thinking and put you in harm’s way on the road. If you’re relying on common crutches for sleeplessness, they won’t help your cause. Here are the dos and don’ts from our sleep experts:

The worst ways to get to sleep:

• Having a “nightcap” before bed is the single worst remedy you can use to fall asleep. Drinking alcohol may make you feel drowsy, but it fragments the natural stages of sleep and may also worsen snoring and sleep apnea.
• Using smartphones, tablets or laptops in your bed prevents the release of melatonin from the brain’s pineal gland, preventing sleepiness and worsening your insomnia. It’s all caused by the “blue” light these devices projects.
• Antihistamines like diphenhydramine (Benadryl®) sure make you drowsy, but they’re not a long-term solution for insomnia. They may help you get to sleep, but they also accumulate in the brain over time, causing grogginess, i.e. a “hangover effect” and even cognitive impairment the next day.

The best ways to get to sleep:

• Get out of bed, go to another room, read a book (no smartphones!), take a bath or try some other relaxing activity. That way, you won’t reinforce the unhappy habit of lying awake all night.
• Reset your body clock by getting to bed and waking up the same time every day — even on weekends and days off. A consistent schedule can help prevent “social jet lag” from following a different sleep schedule on weekends.
• Write your to-do list early in the evening so you can keep your mind off of the next day’s obligations when you’re trying to fall asleep.
• Relax prior to bedtime to unwind such as listening to calming music

Try these suggestions and other sleep hygiene tips from our experts to free yourself from the insomnia trap. A new sleep routine may make all the difference for you at night and the next day.