What is Sleep Apnoea? (Sleep Apnea) What is Sleep Apnoea? Tried everything? We can help you. What is Sleep Apnoea? (Sleep Apnea) Obstructive Sleep Apnoea (OSA) is defined as the cessation of airflow during sleep preventing air from entering the lungs caused by an obstruction. These periods of 'stopping breathing' only become clinically significant if the cessation lasts for more than 10 seconds each time and occur more than 10 times every hour. OSA only happens during sleep, as it is a lack of muscle tone in your upper airway that causes the airway to collapse. During the day we have sufficient muscle tone to keep the airway open allowing for normal breathing. When you experience an episode of apnoea during sleep your brain will automatically wake you up, usually with a very loud snore or snort, in order to breathe again. People with OSA will experience these wakening episodes many times during the night and consequently feel very sleepy during the day: they have an airway that is more likely to collapse than normal. How Do I Know I Have Sleep Apnoea?

People with sleep apnoea may complain of excessive daytime sleepiness often with irritability or restlessness. But it is normally the bed partner, family or friends who notice the symptoms first. Sufferers may experience some of the following: Extremely loud heavy snoring, often interrupted by pauses and gasps Excessive daytime sleepiness, e.g., falling asleep at work, whilst driving, during conversation or when watching TV. (This should not be confused with excessive tiredness with which we all suffer from time to time) Irritability, short temper Changes in mood or behaviour Anxiety or depression Decreased interest in sex Remember, not everyone who has these symptoms will necessarily have sleep apnoea. We possibly all suffer from these symptoms from time to time but people with sleep apnoea demonstrate some or all of these symptoms all the time. Diagnosing Sleep Apnoea OSA can range from very mild to very severe. The severity is often established using the apnoea/hypopnoea index (AHI), which is the number of apnoeas plus the number of hypopnoeas per hour of sleep - (hypopnoea being reduction in airflow).

An AHI of less than 10 is not likely to be associated with clinical problems. To determine whether you are suffering from sleep apnoea you must first undergo a specialist 'sleep study'. This will usually involve a night in hospital where equipment will be used to monitor the quality of your sleep. The results will enable a specialist to decide on your best course of treatment. The ultimate investigation is polysomnography, which will include: Electro-encephalography (EEG) - brain wave monitoring Electromyography (EMG) - muscle tone monitoring Recording thoracic-abdominal movements - chest and abdomen movements Recording oro-nasal airflow - mouth and nose airflow Pulse oximetry - heart rate and blood oxygen level monitoring Electrocardiography (ECG) - heart monitoring Sound and video recording This is a very expensive investigation, with few centres able to offer it routinely for all suspected sleep apnoea patients. A 'mini' sleep study is more usual, consisting of pulse oximetry and nursing observation. Home sleep study is becoming more popular. Treating Sleep Apnoea There are several forms of treatment for sleep apnoea. In mild and moderate cases weight loss and the use of mandibular advancement devices can be wholly successful.

In moderate and severe cases mandibular advancement device or nasal continuous positive airway pressure (CPAP) are normally prescribed. CPAP is the gold standard treatment for OSA. Central & Mixed Sleep Apnoea OSA is the commonest form of sleep apnoea, (about 4% of men and 2% of women) but there is also a condition called Central Sleep Apnoea (CSA). This is a condition when the brain does not send the right signals to tell you to breathe when you are asleep. In other words the brain 'forgets' to make you breathe. It can also be associated with weakness of the breathing muscles. The assessment for CSA is often more complicated than for OSA and the treatment has to be carefully matched to the patient's requirements. There is also a condition called Mixed Sleep Apnoea that is a combination of both obstructive and central sleep apnoea. Receive our most current information & exclusive product offers. Sign up now to receive a monthly email from us.

Featured Product Review By Karen Bray, 5 days ago Rated “I guess it's unusual for the woman to be the snorer in a partnership, but my husband has suffered many years of sleepless nights with my heavy continuous snoring, a lot of times retreating to the spare room, which always made me feel terribly guilty! Then on top of this, a few years back I started getting sleep apnea, and went to a sleep clinic where they advised an MAD device. I never got around to doing anything about it, until recently, as we moved abroad to Spain and the bedroom walls are quite thin and Im certain our neighbours would hear me. So I done a bit of research, found this site and after taking the on line test/questionaire, was advised of the most suitable device, so I went ahead and ordered and made it my new year resolution to try it out. WHY DIDNT I DO THIS BEFORE! I'm not even 2 weeks in, and the effect was immediate! First night it felt very strange in my mouth, but I actually kept it in all night.

I had an ok nights sleep, and woke up to a dumb struck husband, who's first words to me were "it actually works, you didn't snore once!" I was so pleased 😆 My problem is that I have an over bite and my airwaves were getting blocked in any position while sleeping. I had set the device with the bottom jaw quite forward and needed to adjust it back slightly, as first morning I had jaw ache on left side. So the second night was much better. I do experience a little jaw ache on that left side while eating, but this seems to be gradually easing each day. I can put up with that! So it's not even 2 weeks and I am already used to having the device in my mouth at night and both me and my husband are getting such a good night's sleep. I feel refreshed, and dont feel tired in the day. I couldnt be happier!” The Forum View as a guest or register today (3269 members) Subject / Topic Obstructive Sleep Apnoea. What is sleep apnoea?

Information | Patient 1254 If you have obstructive sleep apnoea syndrome you have many periods when your breathing stops for 10 seconds or more when you sleep. You wake up briefly after each episode of stopped breathing to start breathing again. You do not usually remember the times you briefly wake up but you have a disturbed night's sleep. As a result, you feel sleepy during the day. A typical person with this condition is overweight, male and middle-aged, and snores loudly. However, it can affect anyone. Treatment usually works well. What is obstructive sleep apnoea syndrome (OSAS)? OSAS is a condition where your breathing stops for short spells when you are asleep. The word apnoea means without breath - that is, the breathing stops. In the case of OSAS, the breathing stops because of an obstruction to the flow of air down your airway. The obstruction to the airflow occurs in the throat at the top of the airway. You may also have episodes where your breathing becomes abnormally slow and shallow. This is called hypopnoea.

Because there can also be these episodes of hypopnoea, doctors sometimes use the term 'obstructive sleep apnoea/hypopnoea syndrome'. What happens in people with obstructive sleep apnoea syndrome (OSAS)? When we sleep, the throat muscles relax and become floppy (like other muscles). In most people, this does not affect breathing. If you have OSAS, your throat muscles become so relaxed and floppy during sleep that they cause a narrowing or even a complete blockage of your airway. When your airway is narrowed and the airflow is restricted, at first this causes snoring. If there is a complete blockage then your breathing actually stops (apnoea) for around 10 seconds. Your blood oxygen level then goes down and this is detected by your brain. Your brain then tells you to wake up and you make an extra effort to breathe. Then, you start to breathe again with a few deep breaths. You will normally go back off to sleep again quickly and will not even be aware that you have woken up. Sometimes, the airway can just partially collapse and can lead to hypopnoea. Breathing becomes abnormally slow and shallow.

If this happens, the amount of oxygen that is taken into your body can be halved. Hypopnoea episodes also usually last for around 10 seconds. If someone watches you, he or she will notice that you stop breathing for a short time and then make a loud snore and a snort. You might even sound as if you are briefly choking, briefly wake up and then get straight back off to sleep. It is quite common for many of us to have the odd episode of apnoea when we are asleep, often finishing with a snort. This is of no concern. In fact, some people when they sleep have periods of 10-20 seconds when they do not breathe. However, people with OSAS have many such episodes during the night. For the diagnosis of OSAS, you need to have at least five episodes of apnoea, hypopnoea, or both events per hour of sleep. However, there are different levels of severity of OSAS (mild, moderate or severe). People with severe OSAS can have hundreds of episodes of apnoea each night. OSAS is usually classified as: Mild OSAS - between 5-14 episodes an hour.

Moderate OSAS - between 15-30 episodes an hour. Severe OSAS - more than 30 episodes an hour. So, if you have OSAS, you wake up many times during the night. You will not remember most of these times but your sleep will have been greatly disturbed. As a consequence, you will usually feel sleepy during the day. Daytime sleepiness in someone who is a loud snorer at night is the classic hallmark of someone who has OSAS. Who gets obstructive sleep apnoea syndrome (OSAS)? OSAS can occur at any age, including in children. However, it most commonly develops in middle-aged men who are overweight or obese. It is thought that as many as 4 in 100 middle-aged men and 2 in 100 middle-aged women develop OSAS. Factors that increase the risk of developing OSAS or can make it worse include the following. They all increase the tendency of the narrowing in the throat at night to be worse than normal. Overweight and obesity, particularly if you have a thick neck, as the extra fat in the neck can squash your airway. Drinking alcohol in the evening.

Alcohol relaxes muscles more than usual and makes the brain less responsive to an apnoea episode. This may lead to more severe apnoea episodes in people who may otherwise have mild OSAS. Enlarged tonsils. You may also have a family history of OSAS. What are the symptoms of obstructive sleep apnoea syndrome (OSAS)? People with OSAS may not be aware that they have this problem, as they do not usually remember the waking times at night. It is often a sleeping partner or a parent of a child with OSAS that is concerned about the loud snoring and the recurring episodes of apnoea that they notice. One or more of the following also commonly occur: Daytime sleepiness. This is often different to just being tired. People with severe OSAS may fall asleep during the day, with serious consequences. For example, when driving, especially on long monotonous journeys such as on a motorway. A particular concern is the increased frequency of car crashes involving drivers with OSAS. Drivers with OSAS have a 7-12 increased risk of having a car crash compared to average. You should not drive or operate machinery if you feel sleepy. Poor concentration and mental functioning during the day.

This can lead to problems at work. Not feeling refreshed on waking. Morning headaches. Depression. Being irritable during the day. Some people with OSAS find that they get up to pass urine frequently during the night. Less common symptoms also include night sweats and reduced sex drive. People with untreated OSAS also have an increased risk of developing high blood pressure . Having high blood pressure can increase your risk of having a heart attack or stroke . People with untreated OSAS may also have an increased risk of developing problems with blood sugar regulation and type 2 diabetes . How is obstructive sleep apnoea syndrome (OSAS) diagnosed? Epworth Sleepiness Scale If you have daytime tiredness, sometimes a questionnaire is used to measure where you are on the Epworth Sleepiness Scale . This helps to gauge the level of sleepiness that you feel during the daytime. A high score indicates that you may have a sleeping disorder such as OSAS. Tests to confirm OSAS If you have symptoms that suggest OSAS, or a high score on the Epworth Sleepiness Scale, your GP may refer you to a specialist for tests. There are various types of test that can be done whilst you sleep. The ones done may be determined by local policies and availability of equipment.

For example: By using a probe placed under your nose, your airflow may be measured whilst you sleep. A sensor may record snoring volume and body movement whilst you sleep. The oxygen level in your blood can be monitored by a probe clipped on to your finger. Breathing can be monitored and recorded by the use of special belts placed around the chest and tummy (abdomen). A video of you sleeping may be undertaken. You may be asked to spend a night in hospital for the tests to be done. However, some of the tests may be done in your own home from equipment supplied by the specialist. The information gained from the tests can help a specialist to firmly diagnose or rule out OSAS. Your doctor will usually check your blood pressure. (OSAS is associated with high blood pressure.) They may also suggest other tests to exclude other causes of your sleepiness. For example, a blood test can check for an underactive thyroid gland. What is the treatment for obstructive sleep apnoea syndrome (OSAS)? General measures Sleeping on your side or in a semi-propped position. Continuous positive airway pressure (CPAP) This is the most effective treatment for moderate or severe OSAS.

It may be used to treat mild OSAS if other treatments are not successful. This treatment involves wearing a mask when you sleep. A quiet electrical pump is connected to the mask to pump room air into your nose at a slight pressure. The slightly increased air pressure keeps the throat open when you are breathing at night and so prevents the blockage of airflow. The improvement with this treatment is often very good, if not dramatic. If CPAP works (as it does in most cases) then there is an immediate improvement in sleep. Also, there is an improvement in daytime well-being, as daytime sleepiness is abolished the next day. Snoring is also reduced or stopped. The device may be cumbersome to wear at night but the benefits are usually well worth it. Comments like "I haven't slept as well for years" have been reported from some people after starting treatment with CPAP. Lifelong treatment is needed. Sometimes you can have problems with throat irritation or dryness or bleeding inside you nose. However, newer CPAP machines tend to have a humidifier fitted which helps to reduce these problems. More related content Mandibular advancement devices The mandible is the lower jaw. There are devices that you can wear inside your mouth when you sleep.

They work by pulling the mandible forward a little so that your throat may not narrow as much in the night. These devices look a bit like gum shields that sportspeople wear. Although you can buy these devices without a prescription, it is best to have one properly fitted by a dentist if one is recommended. These devices can work well in some cases. They tend to be used in mild OSAS or in people who are unable to tolerate CPAP treatment. Surgery Surgery is not often used to treat OSAS in adults. However, sometimes an operation may be helpful to increase the airflow into your airway. For example, if you have large tonsils or adenoids, it may help if these are removed. This is more commonly done in children with OSAS. If you have any nasal blockages, an operation may help to clear the blockage. New operative techniques are being developed for people with OSAS. Related Wellbeing See all Wellbeing Other treatments If you sleep mostly on your back then positional therapy can be beneficial. This works to prevent you from sleeping on your back.

There are different ways of doing this, including the simple 'tennis ball technique' (a tennis ball is strapped to your back), alarm devices and also using a number of positional pillows to help you change your sleeping position. Obstructive sleep apnoea syndrome (OSAS) - driving and operating machinery If you have OSAS and you are a driver, you only need to inform the Driver and Vehicle Licensing Agency (DVLA) if you have symptoms of excessive daytime sleepiness. For normal car drivers, you will usually be allowed to resume driving after you have had treatment so that you no longer have daytime sleepiness. However, special rules apply if you have an LGV or similar licence. However, you do not need to stop driving or inform the DVLA if you are being investigated for, or have a diagnosis of, OSAS but do not experience symptoms of daytime sleepiness that are of a severity likely to impair driving. It is also recommended that you inform the DVLA (but do not cease driving) if you are successfully using CPAP or using a mandibular advancement treatment. If your symptoms are controlled and you have no excessive daytime or awake time sleepiness then your driving licence will not be affected.

Equally, if you have daytime sleepiness, you should not operate heavy machinery, as this can also be dangerous. Further help & information Obstructive sleep apnoea - Treatment - NHS Choices Obstructive sleep apnoea - Treatment Sleep-apnoea Treatment Treating obstructive sleep apnoea Treatment for obstructive sleep apnoea (OSA) may include making lifestyle changes and using breathing apparatus while you sleep. OSA is a long-term condition and many cases require lifelong treatment. Lifestyle changes In most cases of OSA you'll be advised to make healthy lifestyle changes, such as: losing weight if you're overweight or obese stopping smoking if you smoke limiting your alcohol consumption, particularly before going to bed – the NHS recommends not regularly drinking more than 14 units of alcohol a week; if you drink as much as 14 units a week, it's best to spread this evenly over three or more days avoiding sedative medications and sleeping tablets Losing weight, reducing the amount of alcohol you drink and avoiding sedatives have all been shown to help improve the symptoms of OSA. Although it's less clear whether stopping smoking can improve the condition, you'll probably be advised to stop for general health reasons.

Sleeping on your side, rather than on your back, may also help relieve the symptoms of OSA. Continuous positive airway pressure (CPAP) As well as the lifestyle changes mentioned above, people with moderate to severe OSA usually need to use a continuous positive airway pressure (CPAP) device. This is a small pump that delivers a continuous supply of compressed air through a mask that either covers your nose or your nose and mouth. The compressed air prevents your throat closing. CPAP can feel peculiar to start with and you may be tempted to stop using it. But people who persevere usually soon get used to it and their symptoms improve significantly. CPAP is available on the NHS and is the most effective therapy for treating severe cases of OSA. As well as reducing symptoms such as snoring and tiredness, it can also reduce the risk of complications of OSA, such as high blood pressure . Possible side effects of using a CPAP device can include: mask discomfort nasal congestion, runny nose or irritation difficulty breathing through your nose headaches and ear pain stomach pain and flatulence (wind) Earlier versions of CPAP also often caused problems such as nasal dryness and a sore throat.

However, modern versions tend to include humidifiers, a device that increases moisture, which helps reduce these side effects. If CPAP causes you discomfort, inform your treatment staff as the device can be modified to make it more comfortable. For example, you can try using a CPAP machine that starts with a low air pressure and gradually builds up to a higher air pressure as you fall asleep. Mandibular advancement device (MAD) A mandibular advancement device (MAD) is a dental appliance, similar to a gum shield, sometimes used to treat mild OSA. They're not generally recommended for more severe OSA, although they may be an option if you're unable to tolerate using a CPAP device. An MAD is worn over your teeth when you're asleep. It's designed to hold your jaw and tongue forward to increase the space at the back of your throat and reduce the narrowing of your airway that causes snoring. Off-the-shelf MADs are available from specialist websites, but most experts don't recommend them, as poor-fitting MADs can make symptoms worse. It's recommended you have an MAD made for you by a dentist with training and experience in treating sleep apnoea.

MADs aren't always available on the NHS, so you may need to pay for the device privately through a dentist or orthodontist. An MAD may not be suitable treatment for you if you don't have many – or any – teeth. If you have dental caps, crowns or bridgework, consult your dentist to ensure they won't be stressed or damaged by an MAD. Surgery for OSA Surgery to treat OSA isn't routinely recommended because evidence shows it's not as effective as CPAP at controlling the symptoms of the condition. It also carries the risk of more serious complications. Surgery is usually only considered as a last resort when all other treatment options have failed, and also if the condition is severely affecting your quality of life. A range of surgical treatments have been used to treat OSA.

These include: tonsillectomy – where the tonsils are removed if they're enlarged and blocking your airway when you sleep adenoidectomy – where the adenoids, small lumps of tissue at the back of the throat above the tonsils, are removed if they're enlarged and are blocking the airway during sleep tracheostomy – where a tube is inserted directly into your neck to allow you to breathe freely, even if the airways in your upper throat are blocked weight loss (bariatric) surgery – where the size of the stomach is reduced if you're severely obese and this is making your sleep apnoea worse Surgery to remove excess tissue in the throat to widen your airway (uvulopalatopharyngoplasty) used to be a common surgical treatment for OSA, but it's performed less often nowadays. This is because more effective treatments are available, such as CPAP. This type of surgery can mean you're unable to use a CPAP device properly in the future if you need to. Soft palate implants Soft palate implants make the soft palate, part of the roof of the mouth, stiffer and less likely to vibrate and cause an obstruction. The implants are inserted into the soft palate under local anaesthetic .

The National Institute for Health and Care Excellence (NICE) has said soft palate implants are safe, but they're not currently recommended for treating OSA as there's a lack of evidence about their effectiveness. However, this form of treatment is recommended for treating snoring associated with OSA in exceptional cases. Support groups OSA can have a significant impact on the quality of life for someone with the condition, as well as their friends and families. As well as causing physical problems such as tiredness and headaches, the condition can have a significant emotional impact and affect your relationships with others. For support and advice about living with OSA, you may find it helpful to contact a support group, such as: Could you be suffering from sleep apnoea without even knowing it? | Marriott and Hand Melbourne VIC Could you be suffering from sleep apnoea without even knowing it? March 1, 2016 You wouldn’t be alone! Despite years of self-denial, our own Dr David Marriott self-diagnosed his own sleep apnoea problem during a lecture.

“There are a high number of people who do suffer from it and either aren’t aware of it – and that probably would be most people – or just don’t see a need for the therapy to help themselves through it,” Dr Marriott said. This sparked his interest in offering these treatments at the Marriott and Hand practice and educating patients about their conditions. What is sleep apnoea? Sleep apnoea is a condition where the airway, normally around the throat region, collapses when you are asleep and therefore, air is unable to get in or out of your lungs. It doesn’t matter how hard you try. Generally, people who suffer from this condition aren’t particularly aware of it and even long-term partners may not notice, as you won’t generally wake up fully throughout the night, instead you will be brought to a semi-aroused state before falling back to sleep. Obstructive sleep apnoea vs central sleep apnoea There are two basic forms of sleep apnoea and it’s important to make a distinction between the two. The first, central sleep apnoea, cannot be treated by dentists with the provided appliance. In fact, prescribing the appliance to patients suffering from central sleep apnoea may cause further complications.

The second form is known as obstructive sleep apnoea (OSA) which can be managed by the dentists at Marriott and Hand with the use of an appliance. All patients who wish to receive treatment will first need to see a sleep specialist and have a diagnostic test to ensure we are dealing with OSA. We at Marriott and Hand will be happy talk you through the steps required. Symptoms of sleep apnoea Patients who suffer from sleep apnoea may find themselves falling asleep during the day, fatigued or drained during everyday tasks. For example; do you fall asleep whilst you’re a passenger in a car or even worse do you fall asleep while you’re at the traffic lights in your own car? You may be suffering from sleep apnoea. This will happen because your body just isn’t getting the rest it really needs and it tends to try and play catch up wherever it can. If your airways are being blocked and the oxygen is not getting into your lungs then you’re constantly fighting and almost waking up throughout the entire night. This process happens so frequently that you never really get a full night’s sleep. But again, often times you may not be fully aware of that.

Sleep apnoea treatment At Marriott and Hand, we partner with a company called SomnoMed who supply SomnoDent appliances that we are able to prescribe to patients to help treat OSA. The appliance works in a similar manner to two acrylic mouth guards (one for top jaw and one for bottom jaw) that are semi-locked together to bring the mandible (the lower jaw) forward along with the tongue. This treatment works to open your airway while you are sleeping so the oxygen is reaching your lungs to breathe comfortably and achieve a full night’s sleep. Before we are able to prescribe the appliance, we first need to make sure that the teeth are in an adequate condition to be able to support the appliance because there are some fairly heavy forces which are generated by the mandible or the muscles that control the mandible. Sleep Apnoea FAQ / Sleep Apnea FAQ New Technology Publishing, Inc. Sleep Apnoea FAQ / Sleep Apnea FAQ Written and edited by patients, and with input by others experienced in sleep apnea, this FAQ or Frequently Asked Questions page answers many concerns and issues raised by people with snoring and apnea.

Doug Linder Current editing by Jerry Halberstadt Frequently-Asked Questions file v 3.1 My name is Doug Linder. I'm just some guy with apnoea. It's easier to tell you what I am not: Most importantly, I am NOT a doctor. I do not keep lists of doctors, specialists, equipment companys, or anything like that. I can't recommend doctors or brands of CPAP machines. Sorry. I don't have a folderful of secret "cures" for apnoea that I keep away from everyone else just out of spite. The minute I hear of a new potential treatment, I put it up here. I'm not highly connected to the field of sleep medicine. Yes, I have met a few nice folks in the industry, and some of them are indeed doctors. But they don't give free, anonymous, undiagnosed medical advice over the internet, either. I (Doug Linder) wrote much of this FAQ, and I am neither a doctor nor a sleep technician. I have no official involvement with the sleep medicine community. DO NOT TAKE ANYTHING IN THIS FILE AS MEDICAL ADVICE. As with any health matter, consult a qualified health professional before seeking treatment of any kind.

NB: Yes, I am well aware that "apnoea" is the British spelling, and in America it's usally spelled "apnea", but I like the first way better, I consider it more proper (in that it's closer to its Latin root), it's a perfectly valid spelling. Many thanks to Sally Warren Soest for her invaluable assistance in completing large chunks of this FAQ, and also Jerry Halberstadt and Rick Bonato. Please don't write me to ask about the benefits of surgery, or if your friend should have some kind of medical procedure, or similar questions. Even if I were a doctor, I wouldn't give medical advice via email with no diagnosis. So, again, please - no medical questions. Ask your doctor. I'm telling you - really! - that I'm just a layman who happens to have gathered a little information about this in one place. For the most part, *everything* I know about apnoea is in this document or somewhere in the SNORE pages. I don't have secret files, or piles of medical studies about the relative effectiveness of the various treatments.

If you want more information, and you can't find a local source, I suggest you contact one of the sleep-disorder-related organizations . I don't keep track of sleep-related literature. You may find useful references in a Bibliography on Sleep If you are a doctor, researcher, sleep technician, or other medical-type, welcome. I'm afraid I don't keep up on the medical journals and so on. If you want to converse and trade information with others of your professions, I suggest the sci.med.* newsgroup hierarchy, the newsgroup alt.support.sleep-disorder , the very technical mailing list SLEEP-L (contact: [email protected] , and especially Dr. Michael Thorpy's excellent sleep disorders home page ~thorpy , which has lot more links and general sleep information than I do here. Yet another superb site for more information about snoring and sleep apnoea is Jerry Halberstadt's Phantom Sleep Page. ( Highly recommended. What is sleep apnea? Sleep apnea is defined as the cessation of breathing during sleep. Apnea specialists generally agree that there are three different types of sleep apnea: obstructive, central, and mixed.

Of these three, obstructive sleep apnea (OSA) is the most common; central sleep apnoea is rare; mixed sleep apnea is a combination of the previous two with treatment being the same as OSA. Obstructive sleep apnea Obstructive sleep apnea is characterized by repetitive pauses in breathing during sleep due to the obstruction and/or collapse of the upper airway (throat), usually accompanied by a reduction in blood oxygen saturation, and followed by an awakening to breathe. This is called an apnea event. Respiratory effort continues during the episodes of apnoea. An analogy might be helpful: OSA is like putting your hand over your vacuum cleaner intake nozzle. Your hand blocks all air from getting through (upper airway collapse) even though the vacuum cleaner is still applying suction (respiratory effort continues). The vacuum cleaner is usually straining somewhat at this time, and so does the human body. Central Sleep Apnea Central Sleep Apnea is defined as a neurological condition causing cessation of all respiratory effort during sleep, usually with decreases in blood oxygen saturation. To return to the vacuum cleaner analogy: central sleep apnoea would be like pulling the plug on the vacuum cleaner.

No power, no suction: if the brainstem center controlling breathing shuts down there's no respiratory effort and no breathing. The person is aroused from sleep by an automatic breathing reflex, so may end up getting very little sleep at all. Note that CSA, which is a neurogical disorder, is very different in cause than OSA, which is a physical blockage - though the effects are highly similar. Mixed apnoea Mixed sleep apnoea, as the name suggests, is a combination of the previous two. An episode of mixed sleep apnoea usually starts with a central component and then becomes obstructive in nature. Generally the central component of the apnoea becomes less troublesome once the obstructive apnoea is treated. How Severe Must apnoea Be To Require Treatment? Note that for any type of apnoea to even be considered of importance it must be at least 10 seconds in duration or longer. Specialists usually consider 5 or more of such apnoeas per hour to be of possible clinical significance (less than 5 per hour is normal). However, another important factor is whether the person is excessively tired during the day. One of the best people to help you answer this question is your bed partner.

People with sleep apnoea generally have the following symptoms: Loud, frequent snoring The pattern of snoring is associated with episodes of silence that may last from 10 seconds to as long as a minute or more. The end of an apnoea episode is often associated with loud snores, gasps, moans, and mumblings. Not everyone who snores has apnoea, by any means, and not everyone with apnoea necessarily snores (though most do). This is probably the best and most obvious indicator. Your bedmate indicates that you periodically stop breathing during your sleep, or gasp for breath Excessive daytime sleepiness/fatigue: Falling asleep when you don't intend to. This could be almost anytime you are sitting down, such as during a lecture, while watching TV, while sitting at a desk, and even while driving a car. Ask yourself, "Did I used to be able to (read, drive, watch TV) for longer periods of time without falling asleep?" If the answer is yes, you may have sleep apnoea or another sleep disorder.

Even if you don't literally fall asleep, excessive fatigue (that is, you got plenty of sleep and you're still really tired) could be an indicator. Unrefreshing sleep with feelings of grogginess, dullness, morning headaches, severe dryness of the mouth. Body movements often accompany the awakenings at the end of each apnoea episode, and this, together with the loud snoring, will disrupt the bed partner's sleep and often cause her/him to move to a separate bed or room. For another questionnaire designed to help identify possible sleep apnea, and based on a handbook on sleep apnea, please click to: Phantom sleep questionnaire Also available in Spanish or Portuguese translation. If I were awakening in the night and having all these symptoms, wouldn't I be aware of it? Probably not. Most people with sleep apnea do not realize that they are awakening to breathe many times during the night. The arousal is slight, and people become accustomed to this, but it is enough to disrupt the pattern of sleep so that they get very little deep sleep or REM sleep, and awaken feeling sleepy. A great many (probably most) apnoea sufferers go through a large part (or ALL) of their lives unaware of their condition.

Likewise regarding daytime sleepiness: people with sleep apnoea often are not aware of feeling tired or unusually sleepy. The disorder develops over a number of years, and they are not aware of the increasing symptoms and believe they feel "normal". Only after treatment do they realize how much more alert and energetic "normal" feels! What should I do if I think I may have sleep apnoea? As with most medical questions, if you have any doubt, the best thing to do is see your doctor. Unfortunately, many doctors are not highly knowledgeable about sleep disorders. You might want to contact one of the sleep disorder foundations to find out your nearest accredited sleep specialist or sleep disorders center. The only definite way to diagnose OSA is to spend a night in a sleep lab undergoing a "polysomnogram," (or "PSG" - a sleep study). This is probably what your doctor will recommend. Many doctors are not familiar with sleep disorders. Your doctor may refer you to an Otolaryngologist (ENT - "Ear, Nose, & Throat" doctor), pulmonologist, or sleep disorders expert or you may even suggest it.

On rare occaisions, in the author's personal opinion, a doctor may not take apnoea seriously enough. It has been reported that some people have to actively prod their doctors a bit. If your doctor seems inclined to pass the potential of apnoea off as relatively unimportant, you may want to consider getting a second opinion. Insurance note: many managed health care insurance plans now require that you MUST see your "primary care" doctor (your regular doctor) before you can see a specialist. Be sure you check with your insurance company, or your firm's benefits coordinator, before beginning your diagnosis and treatment for apnoea. It's been my experience that most insurance plans cover PSGs ("sleep studys") and treatment (usually a CPAP machine), but of course plans vary - save yourself some potential aggravation and check ahead of time! I/my bedmate snore(s). Do I have apnea? It's possible, but not definite. Some people snore who do not have OSA. It's even possible, though extrememly rare, for someone who has OSA to not snore.

(However, if the person has excessive daytime sleepiness, he/she may have another type of sleep disordered breathing, such as upper airway resistance syndrome, or a different type of sleep disorder). Pay attention to the sound and pattern of snoring: is it a steady, regular snoring, or is it loud, frequent, and occurring in periodic bursts punctuated by periods of silence, normal breathing, and/or gasping for air? The latter is a very good indicator of OSA. OK, I don't have apnea. What can I do about my snoring? There are thousands of "cures" for snoring. Most of them are old wive's tales that vary from ridiculous to dangerous to both. Few of them are effective. This FAQ is not concerned with snoring, but rather with the disorder of sleep apnoea. For further information, research snoring itself. Be aware that there doesn't appear to be any guaranteed, safe "quick fix". However, if you've been through a PSG and have been diagnosed as not having sleep apnoea, there are a few things you can try: If you're overweight, lose weight.

Excess weight on the throat can contribute to snoring (and, of course, is unhealthy in general) Quit smoking. Again, this is a good idea in general, needless to say, but the decreased lung capacity could possibly have an effect on snoring, too. If you sleep on your back, try sleeping on your stomach. The new procedure Laser-assisted Uvulaplasty (LAUP) could be helpful under some circumstances. Be sure to read the section below concerning LAUP. Is obstructive sleep apnea dangerous? What are the effects? Absolutely. In rare cases, apnea can be fatal. Think about it: is something that makes you stop breathing something you consider to not be dangerous? It has also been linked to high blood pressure and to increased chances of heart disease, stroke, and irregular heart rhythms (arrhythmias). Unfortunately, not all of the long-term effects of untreated sleep apnoea are known, but specialists generally agree that the effects are harmful. If nothing else, the continual lack of quality sleep can affect your life in many ways including depression, irritability, loss of memory, lack of energy, a high risk of auto and workplace accidents, and many other problems.

This is not something to ignore or trifle with. While it isn't usually immediately dangerous, don't take it lightly. If you think it will go away by itself - don't. It won't. What treatments are available? There are only a few effective treatments for OSA. They fall into several categories: weight loss, surgery, dental appliances, and a breathing-assistance device. The most popular and most effective is the use of a device which delivers air under slight pressure to the airway by way of a nasal mask. There are several types of positive airway pressure devices including CPAP , bi-level positive airway pressure , and responsive and "smart" airway pressure devices . They are all variations on Continuous Positive Airway Pressure, or CPAP. There is no guaranteed, permanent, device-free "cure" for apnoea! The type of treatment prescribed will depend on the type and location of airway obstruction and on the person's overall health.

Obstructions can occur anywhere from the nose (deviated septum; swollen nasal passages from allergies), the upper pharynx (enlarged adenoids; long soft palate; large uvula; large tonsils), or the lower pharynx (tongue that is large or situated far back; short jaw; short, wide neck with narrow airway). The location of obstructions varies between individuals, and an individual may have more than one obstruction. Continuous Positive Airway Pressure (CPAP) "Nasal CPAP" is the treatment of choice for most people with obstructive and mixed apnoea. It is the most reliable and effective treatment in most cases. Hundreds of thousands of CPAP devices are now in use treating obstructive sleep apnoea. It involves using a small air blower device connected via a hose to a nose mask you wear while you sleep - much like a regular oxygen mask, with straps to keep it in place. Essentially, this devices blows air into your nose to keep your airway from collapsing and creating an obstruction by increasing the air pressure in your airways. It isn't as unpleasant as it sounds - most people get used to the sensation fairly quickly.

Admittedly, having to wear a face mask to bed isn't the most attractive thing in the universe. All I can say about that is: you have to live with it. Also, most bed partners are usually happy to live with that rather than snoring! And it is infintely preferable to the effects of apnoea, both the fatigue and the other physical effects (additional strain on the heart, &c.). The exact results vary, but great many people report significant changes in their lives when they start using CPAP - they feel more awake, more alive - "like a whole different person", in some cases. Bi-Level Positive Airway Pressure Bi-level positive airway pressure (BiPAP is one such device) is a variation on CPAP. Instead of providing air at a constant, steady pressure all night, the machines "senses" how much air a person needs, based on inspiration and expiration, and varies its level of pressure accordingly. On inspiration, a higher pressure is needed to prevent apneas, hypopneas, or snoring. But on expiration the patient typically requires several centimeters less of pressure. What is the purpose of this?

Well, some people find that they simply cannot sleep with regular CPAP due to the constant air pressure. Bi-level pressure helps this problem by providing less pressure when you are breathing out (exhaling) , and more when you are breathing in (inspiring). I would like to comment at this point that people probably should not view bi-level pressure devices as a cure-all if you're not happy with your current CPAP. I suggest that you spend some time getting used to regular CPAP. Don't give up on it because it feels weird for the first few nights. One gets used to it after time. Just because CPAP is annoying at first does not necessarily mean you need bi-level pressure. Give it time. Several manufacturers make bi-level airway pressure devices. BiPAP is a trademark of Respironics. Bi-level pressure devices are significantly more expensive than regular CPAP, and I've heard that most insurance companies will not pay for it unless your doctor essentially demands it.

Responsive and "smart" airway pressure devices (JH) In the belief that the reduction of total airway flow would provide greater comfort to the patient and encourage patients to use the airway pressure treatment on a regular basis, several manufacturers have begun to offer a new generation of treatment devices. These devices incorporate flow and pressure sensors and automatic regulation systems. There are three basic approaches. One approach tries to keep overall pressure requirements low by using high pressure only when there is a specific problem, but this requires a very rapid increase in pressure when a problem is detected. The second approach (Horizon AutoAdjust, Virtuoso )varies the pressure delivered, providing less when problems are absent, and raising the pressure gradually when problems appear. The third approach (Sullivan AutoSet) gradually raises and lowers the pressure as conditions require, but also changes the pressure within a specific breath if an emerging problem is detected. DPAP (demand positive airway pressure) uses a low base pressure and rapidly ramps up the pressure after an airway obstruction or flow limitation occurs. This rapid ramp-up of pressure is used for each breath in which a breathing problem is detected. This product is no longer manufactured.

In the approach taken by several other manufacturers, pressure changes are designed to be smooth and gradual, although each device has unique characteristics. These include: Horizon AutoAdjust by DeVilbiss, the Sullivan AutoSet by ResMed, and the Virtuoso Smart CPAP system by Respironics. In the Horizon AutoAdjust by DeVilbiss, pressure changes are designed to be gradual. Thus, in response to airway obstructions or flow limitation, these devices gradually increase pressure over a period of several breaths until the problem is overcome. Then the devices gradually reduce the pressure. The Virtuoso Smart CPAP system by Respironics monitors the airway for vibrations which typically preceed apneas and responds by increasing pressure to help prevent airway collapse. In the absence of such vibrations, pressure is reduced. The Sullivan AutoSet by ResMed uses flow information to increase pressures rapidly enough to pre-empt an emerging problem and thus prevent significant flow limitation, while using a history of recent breaths to gradually raise and lower overall pressures.

Devices like the Horizon AutoAdjust, the Sullivan AutoSet, or the Virtuoso Smart CPAP system by Respironics can be used in the laboratory or home to titrate (determine) individual pressure requirements and thus be used to determine the prescription for a CPAP device. The professional doing the titration receives extensive data on the patient, equivalent to a home sleep study. The devices (sometimes in special configurations for long-term home use may also be used as an alternative to CPAP or bi-level airway pressure.) Compared to CPAP, 'smart' devices may offer greater patient comfort insofar as the overall pressure is reduced, providing that the changes in pressure reduce or eliminate apnea, snoring, or flow limitation, and also provided that the changing pressures are tolerated by the patient. They may be used for patients whose pressure requirements may vary during the course of a night, from night-to-night, and over longer periods of time. As professionals in the field of sleep disorders gain experience with these devices and their appropriate applications, they may provide an additional path to relief for selected patients.

As with any new form of treatment, physicians and patients may need to review studies of each device before selecting the one most appropriate to the needs of the specific patient. Clinical research on these devices is being presented at professional meetings. In one study of treatment , a comparison was made among three conditions: untreated; treated based on professionaly determined pressure settings applied to a manual or traditional CPAP; and pressure determined by the 'smart' CPAP. Both the manual and auto treatments reduced obstructions to breathing, with the manual being more effective in reducing apneas or hypopneas, but the auto system operated at a 35% lower average airway pressure than manual CPAP. Tongue-Restraining Devices (TRDs) This is a suction cup that is gripped with the teeth and which sucks the tongue forward, thus opening the airway behind the tongue. People who snore only when lying on their back, and whose tongue is the main source of obstruction, sometimes find this device helpful. Uvulopalatopharyngoplasty (UPPP) surgery This surgery removes the uvula and tightens up the soft tissue of the palate and upper throat (pharynx).

It can be done separately or in conjunction with other treatments, depending on where in the airway the obstructions occur. There are the usual surgical risks involved with this surgery. Notable ones are general anesthetic (depresses breathing reflex and can be risky in people with breathing problems like sleep apnoea), swelling of the airway, need for pre- and post-operative medications (may depress the breathing reflex), bleeding, and significant pain lasting up to several weeks. Is it effective? Will it free me from having to wear a CPAP machine for life? This surgery seems to have a history of being about 50% effective in about 50% of patients who have it. In other words, many of the people who have UPPP will end up having to use CPAP anyway. It is almost never a "cure-all." In the author's personal opinion (and remember: this is not medical advice!), the risks and side effects of the surgery are usually not worth it. No, I have not had it. However, I have yet to hear from a person who was happy that they had the surgery, though of course there probably are some.

This is a decision that each person has to make, but I advise you give it a great deal of thought beforehand. Surgery is not something to be undergone on a whim, and certainly not for the sole (and somewhat vain, in my opinion) reason of ridding yourself of the need for CPAP. Laser-Assisted Uvulaplasty (LAUP) LAUP is a relatively new laser surgery on the uvula and soft palate that is reported to diminish snoring, but no controlled studies have been done to show that it reduces sleep apnoea. Because it is less extensive than UPPP, it is unlikely to be any more effective than UPPP in treating obstructive apnoea. It is usually done in several steps, and is an outpatient procedure. For that reason it is less risky than UPPP. LAUP is a relatively new procedure, and there is little data as yet concerning its effectiveness. Since this procedure has been developed, it has been somewhat heavily advertised as a "cure for snoring" in magazines and newspapers. This is, in the author's personal opinion, somewhat misleading and potentially dangerous.

While the procedure may sometimes be effective in helping people who snore but do not have apnoea, the main danger from LAUP is that people may eliminate their snoring and assume that their problems are solved, when in fact they may still have untreated sleep apnoea which may continue to get worse but be ignored because its primary alarm signal (snoring) has been silenced. Potential patients should be careful that they don't see an ad in the paper, call the doctor, and rush into a LAUP procedure without research and consideration. The American Sleep Disorders Association has published standards of practice for LAUP. Their recommendations are as follows: "Because adequate peer-review objective data do not exist regarding the effectiveness of LAUP for the treatment of sleep-related breathing disorders, including OSA [sleep apnoea], LAUP is not recommended for the treatment of these disorders. [emphasis added] Surgical condidates for LAUP as a treatment for snoring should undergo preoperative clinical evaluations that include an objective measure of respiration during sleep. Asignificant number of patients who present with a symptom of snoring will have underlying, undetected, sleep-related breathing disorders. Patients should be informed that the risks, benefits and complications of LAUP have not been established.

Patients who elect to undergo LAUP for the treatment of snoring may be at risk of incurring a delay in the diagnosis of OSA, may be obviated by this surgical procedure. Patients must be specifically informed of this risk and should be evaluated on a biennial or preferably, annual basis. The perioperative use of narcotics may pose risks for patients who have undergone LAUP operations; therefore, careful clinical judgment should be used when prescribing pain medications. Patients should avoid the use of sedative medications, sleeping pills, and alcohol during the perioperative period." Reference: SLEEP Volume 17(8):pages 744-748. Also see another article on LAUP . Nasal Surgery May be done to open nasal passages, to correct a deviated septum, or to improve the ability to use CPAP. Jaw Surgeries Several procedures have been used to enlarge the lower and sometimes also the upper jaw, thereby attempting to make more room for the airway. Which patients will be helped by this type of surgery is not yet predictable except in severe cases of facial malformation, and only a few surgical teams have extensive experience and have reported their results in the medical literature. This probably should be considered semi-experimental surgery.

Is there anything I can do myself? You can try! However, if you have apnea, it is wiser and safer to get professional treatment. You can use the techniques below, in consultation with your sleep specialist/doctor, while your treatment progresses. Whle you can't "cure" your apnea, there are several things doctors suggest you do that have greatly alleviate it: Weight loss If you're overweight, do it! Excess weight contibutes to obstructive sleep apnoea in two ways: 1. Fat deposits in the neck tissue compress the airway and make it more likely to collapse. 2. Excess weight in the abdomen makes the breathing muscles operate inefficiently, which contributes to breathing difficuty when sleeping. Weight loss by itself is very difficult (as many of us know). Sometimes people are only able, or much better able, to lose their excess weight after treatment for sleep apnoea has begun, they are able to be more awake and vigorous, and increase their energy use.

Naturally, weight loss is just a generally very healthy thing (if you're overweight - if your weight is normal, don't starve yourself!) Smoking As with the loss of excess weight, this is, of course, just a good idea in general. However, quitting might also help your sleep apnoea in addition to its countless other health benefits, by returning lung capacity to normal. The author has personally found the nicotine patches now available to be of great assistance when trying toi quit smoking. But be warned - they don't do it for you - it still requires an effort on your part. They don't make it easy, but they make it easier. Alcohol Eliminate alcohol in the evening. Alcohol depresses your breathing reflexes and significantly worsens sleep apnoea. Apnoea sufferers should be very careful about excessive drunkenness. It's possible that if you depress your reflexes enough, you might not wake up at all. The same thing goes for sleeping pills, drugs, or anything that might affect your breathing. Allergies and respiratory infections: These cause nasal congestion, which narrows the airway and contributes to apnoea. Consult your physician for medications to treat these which will not interfere with sleep.

Medications: Many common medications interfere with either the breathing reflex or sleep or both. Some of the most common are "sleeping pills", tranquilizers, and short-acting beta blockers. Consult your sleep specialist about seeking alternative medications. A list of medications that affect breathing or sleep can be found in "Snoring and Sleep Apnoea: Personal and Family Guide to Diagnosis and Treatment," by Pascualy and Soest, Demos Vermande Publishing: New York, 1995. The answer to this varies, but generally there are things you can do, depending on your individual situation: First, read the darn manual to your CPAP unit! Adjustment of headgear This is probably the easiest and most effective thing you can do: spend time learning how to adjust your headgear and mask. Many people struggle with it and call it uncomfortable when they haven't really tried to adjust it properly. It's especially tough when you;re sleepy and fumbling with it in the dark. Take some time. Sit down at the table during the day with the headgear. Take it apart. See where all the straps, buckles, and velcro seams are. Figure out what each one does. Generally familiarize yourself with it.

Put it on. Adjust it so it's the most comfortable, and note what each strap has to be like to achieve this. Ask someone to help you, if necessary One thing I have found is that a lot of people mistakenly think that the solution to all problems with air leakage is to adjust the straps more tightly. That frequently doesn't help. Usually air leakage problems are due to positioning, not pressure. The author's arrangement leaks no air and is adjusted rather loosely. Naturally, there has to be enough pressure to keep a seal, but make sure you have everything positioned just right before you start tightening the straps greatly. Only you can tell what works best and you'll have to experiment a bit to find out. Some people have found that putting a hook in the wall over the bed, and hanging the hose over that helps to keep it from "tugging" on the mask and headgear by removing the weight of the hose. If you use a mask, try using nasal pillows (below). Humidifiers If you find the incoming air to be too dry, and your sinuses are drying out, many manufacturers offer a humidifier as an option.

Essentially, this is a (rather expensive, for what it is) piece of plastic which you fill with water and place in between the machine and your mask. The air flows over the water and picks up moisture, just like a regular house humidifier. A heated humidifier in line with the CPAP can make a significant difference in comfort. Noise Most CPAP machines are quite quiet. Most people don't mind it, and some even find the soft "white noise" of rushing air to be relaxing. Some, however, find the noise of the machine disturbing. The only two things you can do are 1) block the noise somehow, or 2) put the machine further away. To block the noise, try putting the machine behind something - a dresser or board, perhaps. However, DO NOT PLACE ANYTHING OVER THE CPAP UNIT OR BLOCK THE FLOW OF AIR IN ANY WAY! Remember, this machine pumps air - if you cut off the air flow, you could damage it or ever start a fire. It must have plenty of space around it so air can circulate. Appearance Unfortunately, there's really nothing you can do about this.

Even if you bought Gucci headgear and mask, there's no hiding the fact that you're wearing headgear and a mask. If you think your bed partner doesn't like it, ask them if they find snoring more attractive. Try these things at your own risk - I am not responsible for any problems that might arise from attempting any of these solutions! Waaah! I don't want to use CPAP for the rest of my life! I didn't really want to include this one, but so many "questions" boil down to this, I had to. Sorry if it sounds harsh, but some people need to hear it. If you could read my email, you'd agree. Look, as things stand right now, there just isn't a "cure" for OSA." Deal with it. No matter how much you want a quick, easy solution - there isn't one. Now, it's true that there are treatments other than CPAP, and some of them work for some people. It's true that you might be able to alleviate the severity of your apnoea by doing some things (mentioned above). In some cases, people can even reduce the severity enough to eliminate the need for CPAP. But probably not.

I wouldn't pin my hopes on it. You should probably resign yourself to the fact that, if you have moderate to severe OSA, you will have to use CPAP for the rest of your life, unless some miraculous new cure is discovered. I see many, many people running headlong to surgery in the hopes that maybe it will solve the problem. Yes, in some cases, UPPP surgery might help. But even the most optimistic estimates only put the success rate at 50%. Those odds aren't good enough for me, personally, but of course everyone has to make their own decisions. I just suggest you do some long, hard thinking first. No surgery is without risk. I'l say it again, so it's clear: UPPP surgery is not a panacea or magical cure for OSA. That doesn't mean it can never help. But if you run to surgery as a solution just because you're tired of CPAP - you're a fool. Look at it this way: many, many people suffer with physical problems much worse than yours. Would you prefer to have to have kidney dialysis? Or chemotherapy? How about a wheelchair or missing limb? All you have to do is wear a little mask at night.

Small price to pay. You got lucky. And always remember to look on the bright side: CPAP usually has tangible benefits. You probably feel more rested, more energetic, less tired. Do you want to go back to the way you were? Yeah, I know CPAP can be a pain sometimes. I know it isn't the snuggliest thing in the world when you're trying to get romantic with your bedfellow. I know sometimes you just want to rip it off and fling it across the room. If you're like me, you probably do just that once in a while. But....grow up. Deal with it. It's not that bad. Would you rather have a real defect? Stop feeling sorry for yourself. Quit whining, resign yourself, and concentrate on other things. If you're an American, try to break the inborn habit of thinking that life owes you a quick, easy fix for every problem or inconvenience. What are "nasal pillows" and "Adam circuits"? Nasal pillows ("Adam circuit" is another name for the same thing) refers to a different method of delivering air with a CPAP machine.

Basically, these are nose plugs that you use in place of a traditional mask over your nose (you still connect it to the hose to CPAP machine, like a mask). It is less bulky than a mask, and there aren't as many problems with air leaking out. The author greatly prefers this option, though of course it's a matter of personal preference. Nasal pillows are also a nice option for people who find the mask irritates their skin and/or leaves them with pressure marks or blemishes due to skin oil. To acquire nasal pillows, ask the health equipment provider where you got your CPAP. Which CPAP machine is the best? There are several different manufacturers of CPAP machines, each with different models. They all preform the same function; the major differences are in price, weight, and options. Some are "bare bones" while some have many options including such things as voltage converters (handy for people who travel to foreign countries) and even remote controls! The author is quite happy with his "Remstar Choice", but I've only used one other kind. You'd have to do some research. Unless there's some option that you really need, it probably doesn't matter.

How can I use my CPAP when I'm camping? The following is an email from Bill Gonda . I'm not an electrician. I don't know anything more about it. For related information on the use of battery backup power, see Why bother with a back-up system? Alternative and backup power supplies. "I use a CPAP device for my apnea...it changed my life. One interesting bit of experience that will probably be of use to no one else in the world is my experience using solar power to charge a battery to run my machine while we went on safari in Kenya and Tanzania in August. We did lots of camping and spent half of the time in places where there was no electricity. Big problem for me and my wife and kids (let alone the Western half of Kenya) due to the loudness of my snoring. I have a Puritan-Bennett 318 Companion (light weight compact..are there any smaller ones?). It has a plug for a 12 V DC battery . Here's what I did to use the CPAP at night: I used a car battery that I bought in Nairobi. $50.

Hooked up a Radio Shack DC power receptacle (This consists of two small clips and a lighter socket)(#270-1527A) ($5) to the PB 12V DC power cord. ($12) That plugged into the Machine to run it at night. The problem came in how to charge the battery during the day with no electricity anywhere. It is very sunny in Kenya during the summer !! So I brought with me two 5 watt MSX-lite solar panels. (made by Solarex) They are the size of a sheet of typing paper and 1/4" thick and weigh about 14 oz. each. They worked great. I could charge the battery in about 8 hours. Even in the most remote campsites I could run my CPAP machine for 8 hours straight. The 5 Watt panels are expensive ($80 each) but are fantastic, and really indestructible. It allowed me to go anywhere and still have my CPAP working. We also could have run it off the Safari van, but our tents were often far away from the parking area.

The only real nuisance was having to carry the battery to the camp...but much better than being asleep all day." The answer to this is: I'm sorry, I don't know. All I can suggest is that maybe you try one of the big sleep-disorder-related organizations . Copyright 1995 Doug Linder. Copyright 1996 New Technology Publishing, Inc. Information about diagnostic and treatment devices is based on product sheets and promotional literature provided by the manufacturer and the claims have not been evaluated. Inclusion does not imply endorsement nor does omission imply a negative evaluation. There may be errors, omissions, or areas which need clarification in this file. If you think you have discovered one, please write to the current editor, Jerry Halberstadt Doug Linder has retired as editor and compiler of this FAQ. Thanks, Doug, for your pioneering effort! It will be maintained by Jerry Halberstadt as part of the Phantom Sleep Page . New Technology Publishing, Inc. is pleased to make available this information, as prepared by Doug Linder, by publishing it as part of the Phantom Sleep Page. Assigned to New Technology Publishing, Inc. Copyright © 1996 New Technology Publishing, Inc. All rights reserved.

Neither the publisher nor the authors of any material in this site are engaged in providing medical or professional services through the publication, distribution or sale of these materials, tests or quizzes, or books. Persons with suspected or diagnosed sleep apnea syndrome or any sleep disorder or other condition discussed in this site should consult with a physician and other qualified professionals for advice concerning their own treatment. Sleep | Phantom Sleep Apnea | Phantom of the Night: Apnea Book | Quiz | Phantom Sleep Tonight (Journal, SleepWell) | FAQ Copyright All material on this site is Copyright © 1995-2010 New Technology Publishing, Inc.&/or Jerry Halberstadt All rights reserved. For links policy, and Trademark Notices, please see: Copyright and Links In reviews or articles based on "fair use" of this copyrighted material, please reference as your source: Healthy Resources and New Technology Publishing, Inc., Privacy Policy Disclaimer Our publications (online, email, print, or any other communications or phone contacts) do not provide medical advice or a professional service.

No one including the publisher, editors, editorial advisors, or the authors of any material in this site is engaged in providing any medical or professional advice or services through the publication, distribution or sale of articles, books, materials, tests or quizzes, on this site or in communications by phone, email, or any other means. Persons with suspected or diagnosed sleep apnea syndrome or any sleep disorder or other condition including COPD discussed in this site should consult with a physician and other qualified professionals for advice concerning their own treatment. Obstructive sleep apnoea - NHS Choices Obstructive sleep apnoea Sleep-apnoea Treatment Obstructive sleep apnoea (OSA) is a relatively common condition where the walls of the throat relax and narrow during sleep, interrupting normal breathing. This may lead to regularly interrupted sleep, which can have a big impact on quality of life and increases the risk of developing certain conditions.

This topic covers: Apnoea and hypopnoea There are two types of breathing interruption characteristic of OSA: apnoea – where the muscles and soft tissues in the throat relax and collapse sufficiently to cause a total blockage of the airway; it's called an apnoea when the airflow is blocked for 10 seconds or more hypopnoea – a partial blockage of the airway that results in an airflow reduction of greater than 50% for 10 seconds or more People with OSA may experience repeated episodes of apnoea and hypopnoea throughout the night. These events may occur around once every one or two minutes in severe cases. As many people with OSA experience episodes of both apnoea and hypopnoea, doctors sometimes refer to the condition as obstructive sleep apnoea-hypopnoea syndrome, or OSAHS. The term "obstructive" distinguishes OSA from rarer forms of sleep apnoea, such as central sleep apnoea, which is caused by the brain not sending signals to the breathing muscles during sleep.

Symptoms of OSA The symptoms of OSA are often first spotted by a partner, friend or family member who notices problems while you sleep. Signs of OSA in someone sleeping can include: noisy and laboured breathing repeated short periods where breathing is interrupted by gasping or snorting Some people with OSA may also experience night sweats and may wake up frequently during the night to urinate. During an episode, the lack of oxygen triggers your brain to pull you out of deep sleep – either to a lighter sleep or to wakefulness – so your airway reopens and you can breathe normally. These repeated sleep interruptions can make you feel very tired during the day. You'll usually have no memory of your interrupted breathing, so you may be unaware you have a problem. When to seek medical advice See your GP if you think you might have OSA. They can check for other possible reasons for your symptoms and can arrange for an assessment of your sleep to be carried out through a local sleep centre. As someone with OSA may not notice they have the condition, it often goes undiagnosed. Read more about diagnosing OSA .

Causes of OSA It's normal for the muscles and soft tissues in the throat to relax and collapse to some degree while sleeping. For most people this doesn't cause breathing problems.

In people with OSA the airway has narrowed as the result of a number of factors, including: being overweight – excessive body fat increases the bulk of soft tissue in the neck, which can place a strain on the throat muscles; excess stomach fat can also lead to breathing difficulties, which can make OSA worse being male – it's not known why OSA is more common in men than in women, but it may be related to different patterns of body fat distribution being 40 years of age or more – although OSA can occur at any age, it's more common in people who are over 40 having a large neck – men with a collar size greater than around 43cm (17 inches) have an increased risk of developing OSA taking medicines with a sedative effect – such as sleeping tablets or tranquillisers having an unusual inner neck structure – such as a narrow airway, large tonsils, adenoids or tongue, or a small lower jaw alcohol – drinking alcohol, particularly before going to sleep, can make snoring and sleep apnoea worse smoking – you're more likely to develop sleep apnoea if you smoke the menopause (in women) – the changes in hormone levels during the menopause may cause the throat

 muscles to relax more than usual having a family history of OSA – there may be genes inherited from your parents that can make you more susceptible to OSA nasal congestion – OSA occurs more often in people with nasal congestion, such as a deviated septum, where the tissue in the nose that divides the two nostrils is bent to one side, or nasal polyps , which may be a result of the airways being narrowed Treating OSA OSA is a treatable condition, and there are a variety of treatment options that can reduce the symptoms.

Treatment options for OSA include: lifestyle changes – such as losing excess weight, cutting down on alcohol and sleeping on your side using a continuous positive airway pressure (CPAP) device – these devices prevent your airway closing while you sleep by delivering a continuous supply of compressed air through a mask wearing a mandibular advancement device (MAD) – this gum shield-like device fits around your teeth, holding your jaw and tongue forward to increase the space at the back of your throat while you sleep Surgery may also be an option if OSA is thought to be the result of a physical problem that can be corrected surgically, such as an unusual inner neck structure. However, for most people surgery isn't appropriate and may only be considered as a last resort if other treatments haven't helped. Read more about treating OSA . Complications of OSA The treatments mentioned above can often help control the symptoms of OSA, although treatment will need to be lifelong in most cases. If OSA is left untreated, it can have a significant impact on your quality of life, causing problems such as poor performance at work and school, and placing a strain on your relationships with others.

Poorly controlled OSA may also increase your risk of: having a stroke or heart attack developing an irregular heartbeat – such as atrial fibrillation developing type 2 diabetes – although it's unclear if this is the result of an underlying cause, such as obesity Research has shown someone who has been deprived of sleep because of OSA may be up to 12 times more likely to be involved in a car accident. If you're diagnosed with OSA, it may mean your ability to drive is affected. It's your legal obligation to inform the Driver and Vehicle Licensing Agency (DVLA) about a medical condition that could have an impact on your driving ability. Once a diagnosis of OSA has been made, you shouldn't drive until your symptoms are well controlled. The GOV.UK website has advice about how to tell the DVLA about a medical condition . Preventing OSA It's not always possible to prevent OSA, but making certain lifestyle changes may reduce your risk of developing the condition. These include:

Question: If you suffered from Apnoea, what would you be unable to do?
Answer: BREATHE