CPAPS:  (Continuous Positive Airway Pressure)

What is Sleep Apnea?   Sleep apnea is a condition in which breathing stops and starts during sleep. It is usually associated with snoring. The sleep apnea syndrome (sleep apnea plus daytime somnolence) is believed to affect 2% and 4% of adult females and males respectively. This makes it one of the most common medical disorders that the adult population suffers from. What are the symptoms of sleep apnea?     Sleep apnea symptoms are obesity, feeling unrefreshed despite having enough hours of sleep at night, waking up often during the night time for no reason. Snorting or gasping for air, at night. Heart failure. Memory problems and concentration issues. and daytime sleepiness. Very often CPAPS can help prevent these problems from happening. What is CPAPS?     In 1981 Drs. Sullivan, Berthon-Jones, Issa and Eves from Australia published the first account of treating sleep apnea patients with continuous positive airway pressure (CPAP) thus initiating the most common and successful treatment, currently known, for this disorder.   How can CPAPS treatment help?     CPAPS treatment is used with the majority patients who suffer from obstructive sleep apnea. With CPAPS treatment, the patient wears a snugly fit nasal mask connected to a cpap machine. The cpap allows the patience to breath freely by blowing air into the nostrils to keep the airway passages open during sleep.   Where can I get a Cpap machine?     Before using any type of treatment for sleep apnea, such as cpap treatment, you should consult your doctor. Your doctor will inform you as to what is the best treatment for your condition and may recommend using a cpap machine.

There are four levels of sleep. In level 4 most of the muscles totally relax, including those of the throat. Sleep Apnea is caused by the throat totally closing on the transition from level 3 to level 4. It is normal for the throat to close some, but abnormal for it to close totally. In order not to suffocate, the body goes back to level 3, but as soon as the oxygen deficit is caught up it goes back to level 4. A person with sleep apnea (PWSA) can go back and forth hundreds of times an hour.

My pulmonologist tells me that there are some other minor disturbances to the sleep cycle for PWSAs.

Most PWSAs don't totally wake up or restart at level 1. In fact most PWSAs, when asked, think they are getting a good night's sleep.

A PWSA has a throat that is either too narrow and/or too flabby. The later is why people who are seriously overweight are much more likely to have sleep apnea. People who are extremely overweight (in the 500 lb range or more) can and have died of sleep apnea. At some point their throat don't reopen and they suffocate.

Snoring and thrashing while asleep are both indicators that sleep apnea might exist.

There are four therapies for Sleep Apnea:

• for those very overweight: lose a lot of weight. This is the best alternative, but can take a while. It has many other health benefits. When the weight has been lost, and has been stable for a long time, it is necessary to go back to the sleep lab and get retested to see if the sleep apnea is gone.
• a CPAP ventilator (Continuous Positive Airway Pressure) - 7 years ago about 50% of those who tried, successfully adjusted to the CPAP - I suspect it is more now.
• 2nd best alternative.
• surgery to open the throat - 7 years ago about 50% of those operated on had their sleep apnea cured, but it was hard to know before surgery, if it would be successful. It is surgery and can have complications. And there is a recovery period. One of the risks is damage to the vocal cords. All the standard advice about surgery applies, including finding a surgeon who has done a lot of the operation.
• drugs - the worst alternative. The body adjusts to each drug, and the drug becomes ineffective. So another has to be tried. For any particular drug, it may or may not work for each PWSA. Each drug can also produce side effects which can vary from PWSA to PWSA.

CPAPs work by pressuring the throat and keeping it open during level 4 sleep, allowing a normal night's rest. A ventilator forces air that is a constant amount over ambient air pressure through a hose to a nasal mask. The mouth naturally stays shut while the mask is delivering the pressurized air. It is possible though difficult to talk with the mask/ventilator on. There are carefully sized openings in the mask where exhaled air and the pressurized air exit.

Exactly what pressure is needed to keep the throat open is determined in the sleep lab, with a CPAP in place. They try a range of pressures over that part of the night. If one loses or gains a significant amount of weight, it necessary to go back to the sleep lab, and find out what pressure is now needed. It's wise to use no more pressure then is necessary to keep the throat open.

It's also possible, that a heater/humidifier will be needed in the winter. Not all PWSA need one, but if CPAP use becomes difficult in dry and/or cold weather, ask for one.

The goal in CPAP use is to adjust to wearing one all night, while getting a comfortable night's sleep.

If you can't use it all night, use early in night is better then late in the night. Why? One naturally has more level 4 sleep earlier in the night.

Sleep occurs in cycles that are roughly 90 minutes long. Level 1 is REM sleep where dreaming occurs. Normal sleep has little time spent in levels 2 and 3. The first cycle is mostly spent in level 4. The last cycle mostly in level 1. With level 4 tapering off and level 1 increasing over the intervening cycles.

It's important to stay in touch with one's sleep therapist during the adjustment period. A number of things can happen, beyond getting the right mask and head gear, that should be reviewed with the sleep therapist - that can indicate a successful adjustment to the CPAP, or that further equipment changes are needed.

It's also important to give a CPAP a good long trial. It can take weeks to months to really get use to wearing one.

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