Sleep Health FAQ

Below are some frequently asked questions about Sleep Apnea.

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Sleep Health

Yes – some of the common risk factors for sleep disorders include:

Age: While sleep problems affect all ages, they’re more common in middle and older-age adults. Children have different sleep patterns, resulting in unique pediatric sleep problems.

Gender:  Both women and men are impacted by any sleep problem. In general, women are more likely to suffer from insomnia; men are more likely to have sleep apnea.

Weight: The more you weigh, the more likely you are to develop a sleep disorder.

Anatomy: Some people have structural abnormalities in the sinuses, mouth, throat or elsewhere in the upper airway.

Drug or alcohol use: Medications, alcohol or illegal drugs can interfere with normal sleep patterns or the ability to awaken from sleep.

Other medical problems: People who suffer from high blood pressure or depression are also at higher risk.

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In severe cases, where episodes take place at least once a week for 6 months, medication may be used.

You may be able to minimize the episodes by following good sleep hygiene:

  • Getting enough sleep
  • Reduce stress
  • Exercise regularly (but not too close to bedtime)
  • Keep a regular sleep schedule
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ADD and ADHD symptoms

Lack of concentration or inability to focus

Depression

Morning headaches upon awakening

Dry mouth

Restless sleep

Frequent nighttime urination

Sexual dysfunction – Erectile dysfunction

Falling asleep while driving, working and reading

Short term memory loss

Gasping and choking during sleep

Sleepiness and fatigue during the day

General tiredness throughout the day

Snoring with pauses in breathing

Sore throat

Irritability and Anxiety

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More than 40 million Americans have a sleep disorder – and most are completely unaware of it. Many who are aware they have a diagnosable sleep disorder seek the help they need.

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You might have a sleep disorder if:

Your snoring disturbs your bed partner

You have trouble falling asleep at night more than three times a week.

You wake up often during the night.

You feel tired throughout the day.

You find yourself falling asleep while driving, at work or in class.

You have an itchy, crawly feeling in your legs.

You wake up with a headache or a dry/sore throat.

What are the most common sleep disorders?

Sleep apnea, in which breathing stops or gets very shallow during sleep. Each pause typically lasts 10-20 seconds or more, and can occur 20 to 30 times an hour.

Insomnia, which includes difficulty falling asleep, difficulty staying asleep, waking up too early and/or poor quality of sleep.

Restless Legs Syndrome (RLS), characterized by a strong, often uncontrollable urge to move your legs immediately before sleep, or other odd feelings like burning, prickling, itching or tingling.

Periodic Limb Movement Disorder (PLMD), in which patients have repetitive, uncontrollable and often imperceptive muscle spasms during non-REM sleep.

Narcolepsy, sometimes called “sleep attacks,” means falling asleep at unusual times and in awkward places.

Parasomnias, a category of undesirable physical or verbal behaviors during sleep, such as sleepwalking, bed-wetting, teeth grinding, frequent nightmares, night terrors, nocturnal seizures or sleep paralysis.

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If you suspect that you have sleep apnea, the usual first step is to discuss your suspicions with your primary care physician. If you don’t have a primary care physician, you can go directly to a clinician who is a sleep specialist. But check your health care insurance coverage first. Some policies require you to see a primary care physician first, and some policies limit the sleep centers and testing facilities whose services they will pay for. Unfortunately, you may discover that your policy offers limited or no coverage for the diagnosis and treatment of sleep apnea, in which case you may wish to switch insurers if and when you can.

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  • Mask Size, fit, and comfort are the most important considerations when choosing a PAP mask.
  • If the mask doesn’t meet your breathing needs, or if it isn’t comfortable, or doesn’t fit you, you might not stick with your PAP therapy.
  • Take the time to go over the best mask for you with your equipment provider staff
  • Don’t be afraid if you change your mind later and want to try a different mask.
  • Make sure to tell your DME therapist if you are an active sleeper so that you get the most secure mask possible
  • Make sure to tell your DME therapist if you are an active sleeper so that you get the most secure mask possible.
  • Tell your DME therapist if you are claustrophobic or if there are areas of your face that are easily irritated.

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These are some common acronyms on this site:
SA: Sleep Apnea
OSA: Obstructive Sleep Apnea
CSA: Central Sleep Apnea
AHI: Apnea-Hypopnea Index
PAP: Positive Airway Pressure
CPAP: Continuous Positive Airway Pressure
APAP: Auto-titrating Positive Airway Pressure
BiPAP: Bilevel Positive Airway Pressure

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Research has shown that the tongue is really one of the major factors contributing the blockage of the throat and airway. By gradually repositioning the lower jaw forward, the tongue also moves forward opening the airway and creating better muscle tone in the oral pharyngeal area.

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  1. The most common treatment is a CPAP machine. This is basically a machine that sits beside the bed. The patient wears a mask that fits across the face. The machine blows air into the nose all night.

 

  1. Oral Appliance therapy involves the selection, design, fitting and use of a specially designed oral appliance that, when worn during sleep, maintains an opened, unobstructed airway in the throat. Oral appliances that treat snoring and obstructive sleep apnea are devices worn in the mouth similar to orthodontic retainers or sports mouth-guards. They have several advantages over other forms of therapy. Oral appliances are comfortable and easy to wear and care for. They are small and convenient, making them easy to carry with you when you travel. Treatment with oral appliances is reversible and non-invasive.

 

  1. There are a few different kinds of surgeries that can be performed in the attempt of resolving sleep apnea or severe snoring.
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Snoring has been long considered a warning sign or risk factor for developing OSA

We know a fellow that snored so loudly, he was evicted from his apartment building. Neighbors above, below, aside- all could hear his snore vibrating the walls. He did snore for a time and was not tested for any sleep disorder…Until he drove his truck off a steep embankment. Miraculously he was not injured, but once he had a sleep study it was revealed his apnea was severe.

Once a sleep specialist physician said, “You can bet that snoring is a cousin to sleep apnea. Once you have the snoring, its cousin is sleep apnea is eventually showing up at the family reunion!”

  • It is linked to many other health problems
  • It can ruin sleep for bed partners, roommates…and in some cases, neighbors!

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If you wear dentures to sleep, be sure to wear them when trying masks on

If you do not wear dentures to sleep, do not wear them at the mask fitting session.

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Sleep paralysis is most often associated with narcolepsy, a neurological condition in which the person has uncontrollable naps. However, there are many people who experience sleep paralysis without having signs of narcolepsy. Sometimes it runs in families. There is no known explanation why some people experience this paralysis. It is not harmful, although most people report feeling very afraid because they do not know what is happening, and within minutes they gradually or abruptly are able to move again; the episode is often terminated by a sound or a touch on the body.

In some cases, when hypnogogic hallucinations are present, people feel that someone is in the room with them, some experience the feeling that someone or something is sitting on their chest and they feel impending death and suffocation. That has been called the “Hag Phenomena” and has been happening to people over the centuries. These things cause people much anxiety and terror, but there is no physical harm.

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Disturbed and interrupted sleep can cause a wide variety of problems, from the minor to the very serious. Disturbed sleep can make a person drowsy during the day. Fatigue is the main complaint expressed by apnea sufferers.  Untreated sleep apnea is also been linked to these conditions:

Accidents

Increased Mortality

Cardiovascular Disease

Inability to Lose Weight

Diabetes

Poor Quality of Life

Hypertension

Stroke

Increased Healthcare Costs

Weight Gain, Slow Metabolism

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A complaint of inability to move the trunk or limbs at sleep onset or upon awakening

Presence of brief episodes of partial or complete skeletal muscle paralysis

Episodes can be associated with hypnagogic hallucinations or dream-like mentation (act or use of the brain)

Polysomnography (sleep recording) shows at least one of the following:

  • Suppression of skeletal muscle tone
  • A sleep onset REM period
  • Dissociated REM sleep
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Asking yourself these three questions can make all the difference for you when trying to decipher new information about health conditions.
1. What is my main problem?
2. What do I need to do?
3. Why is it important for me to do this?

Health information coming to people is sometimes very heavily laced with medical jargon. It is not surprising that sometimes people have difficulty processing their health information, so you are not alone if you find things confusing at times.

There is a simple strategy for you to use that ensures you will better understand what is being told to you so you may follow the medical advice, and be on your way to a successful treatment regimen. Asking questions helps you understand how to stay well or to get better. You don’t need to feel rushed or embarrassed if you don’t understand something. You can ask medical professionals on your health care team again. Sometimes it helps to take someone along with you to medical visits so they can take notes, and you can concentrate fully.

You become proactive in your health when you ask three good questions for the sake of your health. Asking these questions can help you take care of your health, prepare for medical tests, and take your medicines or therapies the right way.

Every time you talk with a doctor, nurse, technician, or pharmacist, use the questions to better understand your health…

#1. What is my main problem? #2. What do I need to do? And #3. Why is it important for me to do this?

SOURCE: Adapted from the National Network of Libraries of Medicine of the National Institutes of Health

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Apnea-Hypopnea Index (AHI) measures sleep apnea severity. The AHI is the sum of the number of apneas (pauses in breathing) plus the number of hypopneas (periods of shallow breathing) that occur, on average, each hour.

To count in the index apneas and hypopneas, collectively called events, must have a duration of at least 10 seconds.

The AHI, as with the separate Apnea Index and Hypopnea Index, is calculated by dividing the number of events by the number of hours of sleep.

From the AHI rating chart here, we see that an index less that 5 is considered normal. For an Apnea-Hypopnea Index (or AHI) from 5 to 15 denotes mild sleep apnea. Fifteen to 30 is moderate, while a greater than 30 AHI is considered severe.

  • AHI = sum of the number of apneas (pauses in breathing) plus the number of hypopneas (periods of shallow breathing) occurring, on average, each hour.
  • Apneas and hypopneas, collectively called events, must last at least 10 seconds to count as events.
  • The AHI is calculated by dividing the number of events by the number of hours of sleep.

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Some people with disrupted sleep schedules or circadian rhythm disturbances experience sleep paralysis

A study found that 35% of subjects with isolated sleep paralysis also reported a history of wake panic attacks unrelated to the experience of paralysis

Sixteen percent of these persons with isolated sleep paralysis met the criteria for panic disorder

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Unlike CPAP machines that deliver a constant airway pressure for the duration of treatments, BiPAP or BPAP machines deliver two prescribed pressure settings. The dual flow settings allow for more air to enter and leave your lungs.

Another difference between CPAP and BiPAP machines is the ability to set a breath timing feature, or ST Mode, in BiPAP

A BiPAP machine’s breath timing feature measures the number of breaths per minute you should be taking. In the event that the time between breaths exceeds your set limit, the device will force you to breathe by temporarily increasing the delivered airway pressure.

A BiPAP machine will benefit you If:

  • You Have a High Pressure Setting
  • Low Oxygen Levels
  • CPAP has Failed to Provide Adequate Treatment
  • If You are Diagnosed with a Lung Disorder such as COPD
  • If you have certain Neuromuscular Disorders
  • If You have a Cardiopulmonary Disorder such as Congestive Heart Failure

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Simply put, it’s just a blower in a box !

CPAP provides an “air splint” that overcomes challenges to your airway as you sleep. It doesn’t breathe for you, it simply helps you to breathe better on your own as you sleep. Most PAP machines offer a ramp feature that starts off with a reduced pressure setting and gradually builds to your prescribed pressure.

It is important to remember that any form of positive airway pressure (PAP) is not oxygen.

Imagine this quandary.  An individual goes to the ER for emergency care and is asked if he takes any medicines or uses any treatments. The patient says he wears oxygen at night, when in fact he is wearing PAP. This may cause the ER staff to make mistakes based on bad information supplied to them by the patient.

PAP is not oxygen–it is merely pressurized room air. It only causes your airway to open, it does not deliver air for you to breathe. It is not a ventilator.

It’s easy to see why people confuse the two. When sleep apnea occurs, a person’s oxygen level drops. However, the first line of defense for sleep apnea is not oxygen it is PAP.

In rare cases, such as with sleep apnea patients who also have COPD, something known as supplemental oxygen is given along with PAP, usually through the PAP mask by way of extra tubing.

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“a” + “pnea” = apnea
Means no breath

“hypo” + “pnea” = hypopnea
Means little breath

In Latin, “pnea” means breath. Translated, “a” is no and “hypo” means little. Put that all together and you have apnea (no breath) and hypopnea (little breath).

While it makes a lot of sense that apneas are more critical and can result in bigger negative changes to the body and general health, hypopneas also result in changes. this means that both are important to understand, measure and track for your therapy

So, we know that apneic events mean there is no breath that occurs for at least 10 seconds.

Hypopneic events are counted as a reduction in airflow by ≥30%, and the drop in the airflow lasts greater than 10 seconds.  There is a ≥3% oxygen desaturation or the event is associated with an arousal. An arousal from sleep means a brief awakening. People may or may not be aware of the arousals and simply drift back into sleep—until the next event occurs!

Think about this happening HUNDREDS of times a night! It would make anyone have excessive daytime sleepiness the following day! Not to mention organs being oxygen deprived from breathing events!

Alarming thoughts, don’t you agree?

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All PAP devices work on a similar principle: To deliver a prescribed air pressure into a patient’s airways that acts as a splint by keeping the airways from collapsing.

The air delivered is just enough to push past any potential obstructions while maintaining a level of air flow that feels as close to natural breathing as possible.

APAP stands for Automatic Positive Airway Pressure and is similar in function and design to the more traditional PAP device.

Auto titration machines will ‘self-adjust’ to deliver the least amount of pressure required to keep the airway open, or ‘patent’.

An APAP device is set using a maximum and minimum pressure ‘window’. The machine will operate within these given parameters using an algorithm to deliver the least amount of pressure needed with any given breath.

CPAP machines can only be set to a single pressure that remains throughout the entire night. For some with a higher-prescribed pressure setting, the constant singular pressure might make makes it difficult to exhale against.

Most PAP machines offer a ramp feature that starts off with a reduced pressure setting and gradually builds to your prescribed pressure.

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Sleep Apnea is a medical condition that causes a person to actually stop breathing while asleep. These interruptions of oxygen cause a wide variety of symptoms and is linked to some serious conditions.

Apnea sufferers can stop breathing as many as 40 times per minute. They awaken feeling as though they had little or no sleep, which is actually true as they’ve been fighting for oxygen all night.

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Sleep paralysis consists of a period of inability to perform voluntary movements either at sleep onset (called hypnogogic or predormital form) or upon awakening (called hypnopompic or postdormtal form).

Sleep paralysis may also be referred to as isolated sleep paralysis, familial sleep paralysis, hynogogic or hypnopompic paralysis, predormital or postdormital paralysis

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About half of people with sleep apnea are overweight. The condition is more likely among men than women and in older people than younger people — although children with enlarged tonsils are at risk.

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