So: You've been told you have sleep apnea.
You've taken the sleep test, probably overnight at a sleep study center. You are starting to understand that you need to take some steps to get your sleep apnea under control. Your first step before you jump in to treat the condition is to learn more about it. This brief article is meant to tell you just a little bit about this breathing disorder that affects sleep, how it can be treated, and how to be successful in your treatment.
How important is it to treat sleep apnea?
You've probably lived with snoring and daytime sleepiness for years, and if you're like most people your spouse has probably come to expect a noisy experience trying to sleep next to you. You may not even see the point of treating your sleep apnea.
But what happens if you don't treat it? The consequences can be severe. First of all, daytime sleepiness isn't just inconvenient -- it can be dangerous. You know it's a problem if you're trying to drive or operate machinery. You may think you can live with that. But how do you feel about heart trouble? Dementia? Cancer? It turns out all of these can be worsened or even brought on by poor sleep.
Chances are if you're visiting this site, you've already decided to go ahead with treatment and have a prescription in hand for a machine. Good for you!
Is "sleep apnea" a new phenomenon?
It may seem like sleep apnea is something you've only heard about in the last decade or so, but it's been around for a very long time. The only thing that's (relatively) new is the term "sleep apnea". Recognition of the symptoms goes all the way back to Classical Greek times, but the phenomenon only gained a name in the 1950s.
Back then, what we now call sleep apnea was associated with "Pickwickian" syndrome, named for an overweight character in Charles Dickens' The Pickwick Papers who was known to fall asleep unexpectedly during daylight hours.
As often happens with medical conditions, naming it seems to have given the study of the syndrome greater legitimacy. Doctors soon determined that Pickwickian syndrome -- more properly known as "obesity hypoventilation" syndrome -- was actually a separate problem. But awareness of sleep apnea among patients and doctors alike has greatly increased only in the past few decades. The number of diagnoses increased from only 420,000 in 1993 to 6.7 million in 20101. Researchers found this growth in cases was associated with both trends toward obesity and coverage of sleep apnea by health insurance. No wonder it seems as if sleep apnea is a "new" thing!
How is sleep apnea treated?
There are various options for treating sleep apnea, including surgery. But by far the most popular and well-known treatments for sleep apnea involve artificial assistance with breathing through the use of Continuous Positive Airway Pressure devices -- CPAP. These provide a steady gentle stream of air while sleeping, via a mask and tube connected to a machine. The more basic and uncomfortable early CPAP machines and breathing masks have given way in recent years to machines that offer much greater comfort, heated and moisturized air, and very lightweight masks. The increase in comfort and tolerability of CPAP therapy has resulted in better compliance by patients. Research shows that patients are more likely to use their CPAP systems consistently when the CPAP is comfortable and not felt to be too intrusive.2
Making sure your sleep apnea treatment is successful
Successfully treating sleep apnea with CPAP involves more than just choosing the most comfortable mask and a machine that provides moisturized, heated air for the greatest comfort. Using these types of machines and masks can certainly improve adherence to CPAP therapy, but what can you do to help ensure that your treatment is successful? Studies conducted over the past decade suggest that three things -- a consistent bedtime, spousal involvement and social support, and honest communication with your medical team -- are key factors in the success of CPAP treatment.
1. Keep to a consistent sleep schedule
A study conducted by researchers at Penn State found that going to sleep at the same time each night helped patients using CPAP to maintain a consistent use of their CPAP machine.3 The study defined adherence as utilizing CPAP for at least four hours each night. The researchers found that if the patient's bedtime varied by more than an hour and five minutes from one night to the next, they were less likely to adhere to the CPAP treatment routinely. If they stayed consistent within 45 minutes from one night to the next they were more likely to keep to a stable CPAP routine. This research suggests that if you can set a consistent bedtime routine for yourself and go to sleep at the same time each night, you are more likely to be successful in your sleep apnea treatment.
2. Make sure your family is on board
Research has shown that family support, especially observations of improvement with the use of CPAP therapy, is key to maintaining consistent use of CPAP assistance with breathing. This type of social support is so important that researchers recommend setting up telecommunication with the patient to provide similar support if spousal support is not available!2 Talk with your spouse before you begin treatment and let him or her know that adherence to your CPAP therapy is an important part of improving your health. Ask them for their support and make sure they are able to provide you with feedback about how well the therapy is going for you.
3. Talk honestly with your doctor about how you feel
If your CPAP machine doesn't feel comfortable or if wearing it makes you feel trapped or claustrophobic, chances are you will be reluctant to wear it. That can lead to less compliance,2 which means you won't be getting the benefit out of your machine that you need to feel better. Talk to your prescribing physician about how the CPAP machine and mask you are using feel to you. And be honest with them. There are so many options in CPAP masks, breathing tubes, and machines, and they are getting more comfortable and wearable all the time. Your doctor can help you find a combination that is the most comfortable for you. This level of honest communication will go a long way toward ensuring your success with CPAP therapy.
(1) AM Namen, A Chatterjee, KE Huang, SR Feldman, and EF Haponik. "Recognition of Sleep Apnea Is Increasing: An Analysis of Trends in Two Large, Representative Databases of Outpatient Practice." Annals of the American Thoracic Society, Sept 1, 2016. DOI: 10.1513/10.1513/AnnalsATS.201603-152OC
(2) AM Sawyer, N Gooneratne, CL Marcus, D Ofer, KC Richards, and TE Weaver. "A Systematic Review of CPAP Adherence Across Age Groups: Clinical and Empiric Insights for Developing CPAP Adherence". Sleep Medicine Reviews, December 2011. DOI: 10.1016/j.smrv.2011.01.003.
(3) VM Indivero. "Stable Bedtime Helps Sleep Apnea Sufferers Adhere to Treatment." Penn State, June 2013. [Story link]
Image courtesy of the American College of Cardiology and ResMed.