Patient Health

Overnight stay
The established way to provide accurate diagnosis of apneas and flow-limited breathing is by a single overnight stay called a polysomography in a clinic, with specialists monitoring your sleep throughout the night to provide the best diagnosis and prescribe the best treatment options for you.
At home
Recently, another way to accurately diagnose apneas and flow limited breathing has been developed and proven effective. A study that can be conducted at home, using a scaled down portable system that takes measurement during the night’s sleep. These results are then shared with your sleep specialist to determine and prescribe the best treatment options for you.

Snoring & Sleep Apnea are common Sleep-Disordered Breathing (SDB) problems that can affect your sleep, health & quality of life. Snoring and sleep apnea often occur together. Your airway may:
• Narrow, limiting airflow as you breathe
• Vibrate, commonly heard as snoring
• Collapse, so you stop breathing
This third type of change is called obstructive sleep apnea (OSA). It is the most common type of SDB and may last for 10 seconds or longer.
Causes
Causes and risk factors of obstructive sleep apnea (OSA)
• Obesity (the heavier a person gets, the greater the risk of OSA)
• Snoring
• Family history of OSA or snoring
• Small upper airway(large tongue, large uvula, recessed chin, excess tissue in the throat and/or soft palate)
• Shape of head and neck – may create a smaller than normal airway
• Large tonsils or adenoids or other anatomical differences.(difficulties breathing during sleep can be created by a conditions such as deviated septum, enlarged tongue or receding chin)
• Throat muscles and tongue relax more than normal during sleep.(may sometimes be due to alcohol or sedative use before bedtime)
• Snoring – can cause the soft palate to lengthen, which in turn can obstruct the airway.
• Smoking or exposure to secondhand smoke
• Nasal congestion, nasal blockages, and nasal irritants
• Family history of sleep apnea
no specific genetic marker for sleep apnea has been discovered, but obstructive sleep apnea seems to run in families. This may be a result of anatomic abnormalities that run in the family.
• Other medical disorders or syndromes
such as hypothyroidism, acromegaly, amyloidosis, vocal cord paralysis, post-polio syndrome, neuromuscular disorders, Marfan’s syndrome, Down’s Syndrome
• Other conditions
such as immune system abnormalities, severe heartburn or acid reflux, high blood pressure. It isn’t clear whether these conditions are the cause or the result of OSA.
Symptoms
• Do you sleep poorly?
• Do you wake feeling tired?
• Are you sleepy during the day?
• Do you snore?
• Do you wake with headaches?
If you answer “yes” to any of these questions, you may be affected. Visit your Doctor for further advice on diagnosis and treatment.
Types
There are three types of sleep apnea:
1. Obstructive sleep apnea (OSA)
• The most common type of sleep apnea
• Present in up to 5% adults
• Occurs when your upper airway closes but your efforts to breathe continue
• Is more common in those older than 50 years
• Is more common in men than women
2. Central sleep apnea (CSA)
• Is uncommon. (only 5-10% of sleep apnea population)
• Occurs when your breathing stops but your airway stays open
• This stopping of breathing results from the body’s failure to breathe automatically. It is a central nervous system disorder
• Can be caused by disease or injury involving the brainstem, such as a stroke, a brain tumor, a viral brain infection, or a chronic respiratory disease
• People with CSA seldom snore, which makes it even harder to diagnose as they do not fit the “normal” profile of a sleep apnea sufferer
3. Mixed sleep apnea
• Is even less common
• A mixture of both OSA and CSA
• A person with mixed sleep apnea will often snore, but finds that treatments which only help obstructions in the airways do not completely stop apnea episodes
• Treatment usually includes a combination of the treatments used for OSA and CSA
Risk Factors
Research shows that snoring and sleep apnea are associated with many serious conditions. Left untreated, your sleep apnea can be a contributing risk factor to:
• High blood pressure:
More than 35% of people with sleep apnea suffer from high blood pressure, increasing their risk of heart disease1
More than 80% of people who continue to suffer from high blood pressure despite taking three or more drugs, also have sleep apnea2
• Stroke – Almost 70% of people who have had a stroke have sleep apnea3
• Traffic Accidents – A person with sleep apnea is 7 times more likely to have a car accident4
• Type 2 diabetes
• Depression
References
1 Worsnop et al. Am J Respir Crit Care Med. 1998
2 Logan et al. J. Hypertension. 2001
3 Bassetti et al. Sleep. 1999
4 Young T, Blustein J, et al. Sleep. 1997

The most effective and widely accepted treatment for Sleep Apnea is positive airway pressure therapy. It does not involve drugs or surgery. A bedside device gently delivers pressurized air via a mask to keep your upper airway open.
Treatment options:
Continuous Positive Airway Pressure (CPAP) provides one constant air pressure all through the night
Automatic Positive Airway Pressure (APAP) therapy automatically varies the pressure all through the night and from night to night. It actively responds to the continuous changes in your upper airway
Bi-level therapy provides a higher pressure when you breathe in, and a lower pressure when you breathe out

Bi-level devices can provide therapy:
• For people with Obstructive Sleep Apnea (OSA) if they have found continuous positive airway pressure (CPAP) therapy too difficult
• Provide noninvasive positive pressure ventilation (NPPV) for people with respiratory disorders or other forms of Sleep-Disordered Breathing (SDB)
Bi-level therapy works by delivering two different levels of positive air pressure:
• A higher level of pressure when you breathe in
• A lower level of pressure when you breathe out
Although both are non-invasive, Bi-level and CPAP therapy differ in two significant ways:
1. Bi-level devices deliver two levels of air pressure that are set to coincide with the patient’s inspiratory and expiratory efforts
2. Bi-level therapy can be used to treat conditions other than sleep apnea (OSA) and is the first line of treatment for a wide-range of respiratory disorders
Frequently Treated Conditions
Physicians may use bi-level therapy to treat a broad range of conditions, including:
• Nocturnal hypoventilation
• Respiratory insufficiency
• Neuromuscular disease
• Respiratory failure
• Chest wall deformity
• Chronic obstructive pulmonary disease (COPD)
• ALS or Lou Gehrig’s disease
• OSA*
Bilevel therapy is not typically prescribed for OSA patients; however, OSA patients who require high treatment pressures or have another respiratory condition are often candidates for bi-level therapy.

Automatic Positive Airway Pressure (AutoCPAP) devices
• Are positive airway pressure devices used in the treatment of Obstructive Sleep Apnea (OSA)
• Automatically adjust, on a breath by breath basis, to blow the minimum pressure needed to keep your airway open during sleep, allowing your machine to provide you with your ideal pressure over the entire night
• Tend to be more advanced, more feature rich and more expensive than CPAP machines
• May also be known as:
• Auto Adjusting CPAP
• Auto Titrating CPAP
• Self Adjusting CPAP
• Auto PAP
• Automatic CPAP

How does CPAP therapy work?
Air is pushed from the flow generator through the tubing and mask, the air then passes through the nose and into the throat, where the slight pressure keeps the upper airway open.
The low air pressure does not interfere with breathing – though some people need a few nights to get used to the sensation of positive airflow.
Beginning CPAP Treatment
The proper treatment pressure, a comfortable system, and good education often mean the difference between success and failure for CPAP users.
Treatment success means sleeping better and getting more enjoyment out of waking hours. It can also mean lowering blood pressure and resolving OSA symptoms.
Successful CPAP users report improvements in:
• Vitality and motivation
• Job performance
• Mood
• Sexual drive and performance
• Alertness while driving
• Quality of life
• Quality of sleep
A failure to use CPAP therapy may increase one’s risk for conditions linked to untreated OSA:
• Hypertension (OSA increases your risk of hypertension by five times)
• Stroke
• Congestive heart failure (CHF)