Family support increases CPAP therapy in patients, new study says

Posted by David O. Volpi, MD, PC, FACS

Attention families of people with obstructive sleep apnea (OSA): you can make a positive difference when it comes to your family member’s use of a Continuous Positive Airway Pressure (CPAP) machine to treat their OSA.

According to new research published in May in the American Academy of Sleep Medicine’s journal, Sleep,    married people with OSA, or those living with a partner, showed better use of their CPAP machine after the first three months of treatment than OSA sufferers who were single.
Additionally, those who rated their family relationship quality as higher also showed better adherence to CPAP therapy.  The results were adjusted for potential confounding factors including age, gender, and body mass index.

Here’s a refresher on what OSA is, and how CPAP therapy can help: When you fall asleep, your muscles relax, and the soft palate at the back of the throat can sag. When this happens, the upper airway can become obstructed, causing the soft palate and uvula to vibrate, causing snoring.

When the airway is completely obstructed, breathing stops for a period of time, until the body is jerked awake in reaction. This is obstructive sleep apnea. OSA can cause interrupted breathing hundreds of times a night, usually around 20 seconds per pause.

This paused breathing causes waking through the night, preventing deep, restorative sleep. This often leads to a host of problems, from daytime sleepiness and reduced job performance, to hypertension, heart disease, mood, and memory problems.

A CPAP machine helps this condition by pumping a continuous flow of air into the nasal passages — via a mask worn at night — keeping the airway open, and preventing or greatly reducing snoring and paused breathing.

In addition to improving paused breathing and reducing snoring, CPAP treatment also reduces systemic inflammation, a common side effect of OSA. Systemic inflammation is inflammation of blood vessel tissues caused by foreign elements, such as pathogens or damaged cells.

Despite its effectiveness, the problem with CPAP therapy is that the patient has to wear an oxygen mask while they sleep at night. Many people find this uncomfortable, so they don’t wear it and subsequently don’t get the benefits of OSA treatment they need.

In an effort to increase CPAP therapy adherence, this study is great news. Family support from loved ones can increase a patient’s treatment and benefits.

If you or someone you know is considering or struggling with CPAP treatment, a qualified sleep specialist can recommend the correct CPAP machine, or one of the many non-surgical in-office treatments. Visit the eOs sleep apnea treatments page for more information.

Read the full study,  “Family support may improve adherence to CPAP therapy for sleep apnea.”

Say Hello to the Neurostimulator—an Alternative to CPAP Machines

I’ve been a practicing ear, nose, and throat specialist for more than 20 years, and one thing I know for certain about my obstructive sleep apnea (OSA) patients is—they have to do the treatments in order to get better.

The problem is that some OSA patients who would benefit from Continuous Positive Airway Pressure (CPAP) machines can’t or won’t use it because they find it uncomfortable, even though CPAPs have proven to be very effective in increasing oxygen flow and reducing apneic events that result in snoring.

But thankfully, medical advances are happening almost weekly, and so it is with sleep apnea diagnosis and treatment. One study that has me particularly excited recently appeared in the New England Journal of Medicine.  It was also written about in The New York Times by Catherine Saint Louis.

Inspire Medical Systems, based in Minneapolis, Minnesota, has developed a something called the neurostimulator to treat OSA. The pacemaker-like device is surgically implanted in the chest, and at night, the device sends regular electric impulses to a nerve inside the jaw. These electric impulses cause the tongue to move forward during inhalation, opening up the airway, improving air flow and reducing breathing pauses. 

Inspire Medical Systems funded a study to test the neurostimulator. Doctors surgically implanted remote-controlled neurostimulators in 126 patients, and activated them at night as the patients slept. After one year, patients experienced a marked decline in breathing pauses—from 29.3 episodes per hour to nine per hour, on average. Dangerous drops in blood oxygen levels also declined, from 25.4 per hour to 7.4 per hour, on average. At one year, 86 percent of patients said they use the neurostimulator on a daily basis, and two of the 126 patients stopped using in at night. Sleep apnea worsened in about 20 patients using the device, but doctors are not yet sure why.

The second phase also showed indications that the neurostimulator is effective in OSA treatment. In 46 patients who showed that the treatment was helping their OSA after one year, some were told to continue with the therapy or have it withdrawn for one week. Not surprisingly, those who continued the neurostimulator therapy showed little change in the number of breathing pauses per hour or drops in blood oxygen levels. But in the patients no longer using the therapy, the number of breathing pauses increased sharply, from 7.6 per hour to 25.8 per hour, on average. And the episodes of blood oxygen level drops rose from 6 per hour to 23 per hour, on average.

While more research and study is needed, the results are truly encouraging that upper airway neurostimulator therapy may soon be an effective and welcome alternative for OSA treatment, especially for those patients who have difficulty with CPAP masks and machines.

Read the full article entitled, “Upper-Airway Stimulation for Obstructive Sleep Apnea” in The New England Journal of Medicine.

Women with Sleep Apnea Show Higher Brain Damage, Anxiety than Men

An estimated 18 million Americans have obstructive sleep apnea (OSA), including one in four women over 65, according to the National Sleep Foundation.

And several recent studies have linked OSA to health disorders specifically in women. Sleep apnea has been linked to dementia in older women,  and another observational study found that women with untreated severe OSA are 3.5 times more likely to die from cardiovascular disease than women without OSA.

Here’s another reason for women to take sleep apnea seriously: A first-of-its-kind study out of the UCLA School of Nursing discovered that women with sleep apnea are more likely to suffer a higher degree of brain damage than men with sleep apnea.

What is obstructive sleep apnea? OSA is a disorder that occurs when a person's breathing is repeatedly interrupted during sleep, sometimes hundreds of times a night. During each obstruction, the oxygen level in the blood drops, which over time, causes myriad health problems. For people with sleep apnea, the combination of disturbed sleep and oxygen starvation may lead to hypertension, heart disease and mood and memory problems, among other disorders.

The new UCLA study

UCLA has been on the cutting edge of sleep apnea research. About 10 years ago, the same UCLA research team that conducted the new study was the first to show that men with OSA have damage to their brain cells.

For the latest multi-year study, entitled "Sex Differences in White Matter Alterations Accompanying Obstructive Sleep Apnea,” the researchers studied patients diagnosed with OSA at the UCLA Sleep Laboratory. They compared the nerve fibers in the patients' brains, known as “white matter,” to the nerve fibers of people without OSA or other sleep problems. The goal was to find the differences in brain damage, if any, between men and women with OSA.

Results of the study

The researchers found that women are actually more affected by sleep apnea than men. Additionally, women with OSA have more severe brain damage than men suffering from a similar condition. The women with sleep apnea also showed higher levels of depression and anxiety symptoms.

Specifically, the study found that women were impacted in the cingulum bundle and the anterior cingulate cortex areas in the front of the brain involved in decision-making and mood regulation.

Based on the results, chief investigator Paul Macey said, “Doctors should consider that OSA in women may be more problematic and therefore need earlier treatment in women than men.”

With the results of this study as a foundation, the next step is for the researchers to find out if treating sleep apnea can help the brain.

In a “chicken or egg” scenario, did the OSA cause the brain damage, or did the brain damage cause the OSA?  Or did the common conditions, such as depression, dementia or cardiovascular issues cause the brain damage, which in turn leads to sleep apnea?

The study and resulting questions are fascinating, and one thing is for sure: both men and women who are having trouble sleeping should get checked for obstructive sleep apnea and other sleep disorders.

Researchers estimate that up to 85 percent of people with severe sleep apnea have not been diagnosed yet.

Many times, sleep apnea can be misdiagnosed as chronic fatigue, insomnia, depression, or some other non-specific condition, so be specific about the symptoms you are experiencing.

Don't wait to get checked—it could save your life, or someone you love.

For more information, read the article, “Women with sleep apnea have higher degree of brain damage than men, UCLA study shows.”

Women, Wake Up: Sleep Apnea is Not Just a Male Disorder

Earlier this year, a particularly alarming statistic came out of Valme University Hospital in Seville, Spain, where researchers found that women with untreated severe OSA are three and a half times more likely to die from cardiovascular disease than women without OSA. (Read a summary of the study here.)

Since then, more research has been published showing high rates of sleep apnea in women,  as well as increasing links between OSA and age, obesity and hypertension.

In one new study published in August, researchers from Uppsala and Umeå University in Sweden analyzed 400 women between the ages of 20 and 70 years. They found that OSA was present in 50 percent of ALL the women participants aged 20 to 70 years.

They also found that 80 percent of women with hypertension and 84 percent of obese women suffered from sleep apnea. Of the obese women, 31 percent between age 55 and 70 had severe sleep apnea.

The alarming high percentages show that this should be a wake-up call to women.  Sleep apnea is not just a male disorder. Women—especially those with hypertension and/or obesity—need to wake up to the dangers of OSA and seek treatment if diagnosed with it.

Even Dr. Karl Franklin, lead author of the Swedish study, was surprised by the findings. He said, “We were very surprised to find such a high occurrence of sleep apnea in women, as it is traditionally thought of as a male disorder. These findings suggest that clinicians should be particularly aware of the association between sleep apnea and obesity and hypertension, in order to identify patients who could also be suffering from the sleeping disorder.

I agree wholeheartedly with Dr. Franklin, and add to his point that individuals, not just doctors, also need to be aware and speak up if they suspect they may have sleep apnea and related conditions. Read a summary of the study.

A few more recent studies showing OSA’s link to women’s health issues:

A study published in the September issue of the journal Obstetrics & Gynecology out of the University of South Florida found that babies born to obese women with OSA were more likely to be admitted to the neonatal intensive care unit than babies born to women without OSA. In addition, the women with OSA were more likely to develop a high blood pressure condition during pregnancy known as preeclampsia, and to deliver their babies by cesarean section.

Read the study, entitled, “Sleep apnea in obese pregnancy women linked to poor maternal and neonatal outcomes.”

In another study also published in September, sleep apnea in women has been linked to overactive bladder syndrome.

Researchers from the Hospital del Mar in Barcelona, Spain gave 72 women a questionnaire regarding their bladder control and four specific symptoms. According to the results, 62 of the women polled were diagnosed with obstructive sleep apnea (OSA). Further, the women with OSA scored higher on the questionnaire for the prevalence of bladder control symptoms, and the discomfort related with these symptoms.

More research is needed, but clearly, evidence is mounting showing the link between women and sleep apnea, and related disease and disorders. With one in four women over age 65 suffering from sleep apnea, according to the National Sleep Foundation, every woman who believes she is suffering from a sleep disorder-related condition should learn more and get checked out by a qualified sleep doctor. Many women are selfless caretakers, and will put their own worries or needs aside to take care of the needs of others. But don’t wait: Your health is the most important thing, and the healthier you are, the more productive you’ll be and the better you can care for your loved ones.

How do you know you may have obstructive sleep apnea? Some common symptoms include snoring, paused breathing during sleep and excessive sleepiness during the day. If you or someone you know is waking during the night gasping for air, that is a signal to seek diagnosis. Increased blood pressure is another sign you may have sleep apnea. For further study, read “Women and Sleep”  on the National Sleep Foundation website.

When you go for an exam, be specific with your doctor about the symptoms you are experiencing. While sleep apnea is more common in men, OSA increases in women after age 50. Many times, obstructive sleep apnea can be misdiagnosed in women as chronic fatigue, insomnia, depression, or some other non-specific condition. Also, some doctors still associate sleep apnea more with men than women, and are too quick to prescribe a medication, rather than do a full sleep disorder work up. Be  as clear and detailed as you can about your symptoms and what you are experiencing, and don’t wait —it could save your life.

Less Than Six Hours Sleep/Night Increases Strokes

Lack of sleep and an increase in strokes. According to new research, the two conditions are very connected, even in otherwise healthy adults.

In early June, the University of Alabama at Birmingham released the results of a study that regularly sleeping less than six hours a night significantly increases the risk of stroke symptoms in middle-age to older adults who are of normal weight and at low risk for obstructive sleep apnea (OSA). That’s worth repeating: Less than six hours of sleep per night increases the risk of strokes in adults of normal weight and not at risk for OSA.

It seems that under six hours of sleep per night is the critical variable, but why? Let’s take a look at the study. The University of Alabama researchersfollowed 5,666 people  for up to three years who had no history of strokes or stroke-like symptoms, transient ischemic attacks (when blood flow to the brain stops for a brief period causing stroke-like symptoms), or high risk for OSA at the start of the study.

For a period of three years, the researchers followed and studied the subjects’ first stroke symptoms, stroke risk factors, depression symptoms, demographic information and other various health behaviors. What they found was—after adjusting for body-mass index (BMI)—there was a strong association between daily sleep periods of less than six hours and a greater incidence of stroke symptoms for middle-age to older adults, even beyond other risk factors. Interestingly, the researchers did not find any link between short sleep periods and stroke symptoms in overweight and obese participants.

Still, the connection between short sleep and strokes is worthy of great attention from the medical community and general public. I agree with the Alabama study’s lead author, Megan Ruiter, PhD., who said, “The results of the Alabama study provide a strong argument for increasing physician and public awareness of the impact of sleep as a risk factor for stroke symptoms, especially among persons who appear to have few or no traditional risk factors for stroke.”

It looks like the medical community is taking this message to heart. Another study announced in late July is going on at the Alberta Health Services and the University of Calgary.  There, Dr. Patrick Hanly of the university’s Hotchkiss Brain Institute is leading a study to learn more about the physiological connection between sleep apnea and stroke—specifically, the brain’s blood flow response in people with and without sleep apnea.

For the study, participants with sleep apnea stay overnight in the sleep laboratory at Calgary’s Foothills Medical Centre, where their breathing and cardiovascular responses are continuously monitored while they sleep. The next day, their brain blood flow response to reduced oxygen levels is assessed while they are awake. Then, the participants receive supplemental oxygen during sleep for two weeks, and are tested again to see if their cerebral defense mechanisms have improved. The researchers are also studying people without sleep apnea to see if their cerebral defense mechanisms function better than in those with sleep apnea. Hanly and team’s theory is that it is the lack of oxygen, or hypoxia, that people with sleep apnea experience during sleep that impairs the body’s normal defense mechanisms in the brain. A better understanding of this connection will lead to better prevention and treatment strategies.

I applaud the work of the Alabama and Calgary researchers. It’s time we all wake up to the health benefits of more–and better—sleep.

For more information, read the University of Alabama at Birmingham study, “Under 6 Hours of Sleep Tops Risks for Stroke in a Low-risk Population.”

Ready to Treat Your Sleep Apnea? You Have Options.

This month’s blog is for anyone who has been diagnosed with obstructive sleep apnea (OSA) and is currently using or considering using a Continuous Positive Airway Pressure (CPAP) machine while sleeping.

Many patients are not happy about the prospect of sleeping with an mask on. If you do opt for CPAP therapy, realize that CPAP machines have come a long way. If you’re adamant you do not want to use a CPAP mask, thankfully, you have options.

First, I want to briefly explain what obstructive sleep apnea does to a person’s nighttime breathing. When you fall asleep, your muscles relax, and the soft palate at the back of the throat can sag. When this happens, the upper airway can become obstructed, causing the soft palate and uvula to vibrate, causing snoring.

When the airway is completely obstructed, breathing stops for a period of time, until the body is jerked awake in reaction. This is obstructive sleep apnea. OSA can cause interrupted breathing hundreds of times a night, usually around 20 seconds per pause.

This paused breathing causes waking through the night, preventing deep, restorative sleep. This often leads to a host of problems, from daytime sleepiness and reduced job performance to hypertension,heart disease, mood and memory problems.

A CPAP machine helps this condition by pumping a continuous flow of air into the nasal passages, keeping the airway open, and preventing or greatly reducing snoring and paused breathing.

Many people don’t like wearing the nasal mask for CPAP therapy. Some feel claustrophobic or claim it causes dry mouth, nasal congestion or skin irritations. Realize there are different machines out there, so it’s important to choose the right machine for you—choose a small, quiet machine with a comfortable mask that fits you well. A humidifier attached to the CPAP machine can reduce throat dryness.

If CPAP therapy is not for you, there are some non-surgical treatment options. One of the latest is the Pillar Procedure, a safe, non-invasive treatment for mild to moderate OSA symptoms. During the Pillar Procedure, three tiny polyester implants are placed into the soft palate through a small delivery tool without incisions or stitches. Over the following weeks, the implants, together with the body's natural fibrotic response, stiffens the upper palate and creates structural support. This reduces the tissue vibration that causes snoring and the tissue collapse that causes obstructive sleep apnea. I do the Pillar Procedure at my Eos Sleep office, and it usually takes around 20 minutes.

Another is a more comfortable alternative to CPAP, called the Provent Device. This FDA-approved treatment involves a small nasal valve that fits into the nostrils and is secured by an adhesive bandage. The valve is powered by your own breathing and creates positive airway pressure much like CPAP, but does not require a machine or mask.

Bilevel Positive Airway Pressure (BiPAP) is similar to CPAP therapy, but the machine has two air pressure levels, one for breathing in and one for breathing out. The air pressure for breathing out is usually set lower than the incoming air, and you may find it more comfortable to breathe out against a lower air pressure.

Whatever OSA treatment option you choose, you owe it to yourself to seek proper treatment and use your chosen therapy regularly.  The benefits are great—snoring and paused breathing will be reduced or eliminated, helping you—and your partner—to sleep and feel better during the day.

For Obstructive Sleep Apnea Sufferers, Throat Exercises Provide Relief

There is a simple (and free) technique that researchers from Brazil have studied, suggesting that exercising the throat muscles may improve severe obstructive sleep apnea symptoms. These throat exercises, derived from speech therapy, seem to work because they have a marked ability to strengthen and tone the muscles of the throat, even reducing the circumference of a patient’s neck.

Sleep apnea is a potentially life threatening sleep disorder that is caused when the muscles of the throat collapse during sleep. Obstructive sleep apnea (OSA) is the most common type of apnea and also the most serious because it causes the soft tissue in the palate, throat, or tongue to “obstruct” the flow of air as a person struggles to breathe while they are asleep. Apnea is particularly severe when there are more than twenty or thirty events per hour because it severely limits the amount of oxygen the person receives throughout the night. Carrying extra weight, especially around the throat area has been found to be a related cause of OSA.

According to an article last month in The New York Times, a study on the effects of specific throat exercises on obstructive sleep apnea patients was conducted by the Heart Institute’s Pulmonary Sleep Laboratory at the University of São Paulo Medical School in Brazil. Researchers split the OSA patients into two groups. One group was instructed to do simple breathing exercises every day, the other group was instructed to do 30 minutes of throat exercises a day, comparable to those that speech therapists employ. The motions included swallowing and chewing, sliding the tongue back and forth to front of the palate, and repeating particular vowel sounds quickly. This exercise technique may be an alternative for some patients to the most widely known treatment of sleep apnea today, the CPAP (Continuous Positive Airway Pressure) machine, which is attached to a mask the patient wears while asleep.

The researchers found that after three months, the group that only did the breathing exercises had almost no improvement, while those that performed the throat exercises reduced the severity of their sleep apnea by 39 percent. Although the patients’ body mass index remained consistent, also noted was that the exercises reduced the circumference of the subjects’ necks significantly. The study also stated they snored less and slept better, concluding that throat exercises “significantly reduce Obstructive Sleep Apnea severity and symptoms, and represent a promising treatment for moderate OSA.”

The report analysis can be found at PubMed.org. For more information about the available treatments of obstructive sleep apnea, including a throat exercise program, contact The Manhattan Snoring and Sleep Center. If you suspect you have sleep apnea, it is important to get the treatment you need.