Obstructive Sleep Apnea (OSA)
I have Obstructive Sleep Apnea (OSA), in which the soft tissues in the
back of my throat collapse almost as soon as I fall asleep. This
obstructs my airway and I end up holding my breath while the oxygen in
my blood is
replaced by carbon dioxide. Eventually, my body reacts by waking
me
up enough to gasp (loudly) for air. I'm an overweight 60-year-old
white
male, which is a prime demographic for this condition. I'm also a
world-class snorer, which is the first indicator of possibile OSA.
(If you see
yourself or your partner in this description, listen for pauses amid
the
loud snoring and seek a medical opinion ASAP if that is what is
happening.)
OSA is diagnosed by means of an overnight sleep study that measures
respiration, oxygen saturation, pulse, blood pressure, and movements of
the eyes, arms, and legs. It also uses an electro-encephalograph
(EEG) to determine stages of sleep. Under normal circumstances,
breathing pauses 4-5 times per hour, but rarely for more than a few
seconds; in my case, my breathing stopped over 70 times per hour,
sometimes for more than a minute at a time. Sleep studies are
expensive, so my doctor first arranged for me to sleep
with an oxymeter clipped to one finger to see if my oxygen saturation
dropped
at night (it did, quite dramatically).
Normal sleep progresses from stage 1 through stage 4 and into stage
5/REM (rapid eye movement) sleep. The actual benefits of sleep
don't come until stage 4 is reached, but I rarely got that far because
my gasps for air
would intervene. The result is sleep deprivation, regardless of
the
amount of time spent in bed. Symptoms include daytime drowsiness
(I
fell asleep at the wheel once, at work a few times, and almost nightly
in
front of the TV after supper), elevated blood pressure, loss of energy,
and
dullness of thought. It's a gradual process, so one doesn't even
know
how much they've been affected until they start coming out of it.
Treatment
There are numerous products on the market to reduce snoring, but OSA is
a medical condition and it must be treated as such. Some
anti-snoring products rely upon herbs or pressure points, but their
effectiveness is unproven. For several years, I used a mouthpiece
to pull my jaw forward in order to keep the airway open. It
helped, but it wasn't enough so I started researching my options.
The surgical option is to remove enough of the soft tissue at the back
of the throat (often including the uvula) to prevent blockage. An
alternate technique is the use of microwaves to "cook" the offending
tissues
so they become firm and won't collapse. In extreme cases, a
tracheotomy
may be performed to bypass the blockage entirely. I considered
the
microwave approach, but it too is unproven. I had long resisted
the idea
of
being attached to a machine at night, but I eventually decided that
dealing
with the problem was more important.
Constant Positive Air Pressure (CPAP) Machines
The CPAP is essentially a precision air pump. It is calibrated to
provide a prescribed amount of air pressure to the user that pushes the
soft tissues open and overcomes the blockage. I use a mask that
fits
around my nose and seals to my face. Other people use a headgear
that
connects directly to their nostrils, which works better for men with
mustaches.
My prescription is for a 9mm increase in pressure (atmospheric
pressure
at sea level is 760mm of mercury; at 5000', it's about 620mm), which is
fairly typical.
My pulmonologist and I both assumed that the sleep study would confirm
OSA, so we scheduled it as a diagnostic exercise for the first half of
the
night, after which I was awakened and placed on a CPAP that the
technician
could adjust and monitor during the second half. I slept better
during
that second half than I had in years!!!
CPAPs don't work for everyone. People with certain breathing
problems find themselves unable to exhale against the pressure, which
is why a newer device called a BiPAP (Bi-level Positive Air Pressure)
is also available. The BiPAP senses the user's breathing and
provides the prescribed pressure for inhalation and a lower pressure
for exhalation. Even newer devices are adaptive instead of using
preset levels.
All that said, my CPAP works quite well for me. I have used it
since January of 2002 and I have seen rather dramatic improvements in a
number
of areas. First and foremost, I awaken refreshed in the morning
and
I'm not drowsy during the day or after supper. I have noticed the
lifting of a fog from my thought processes, which is very important to
me
as a "knowledge worker." My physical energy level is dramatically
improved.
That, in combination with some adjustments in my eating patterns and
emphasis
on regular walking, resulted in a weight loss of over thirty pounds
(alas, some has returned). My blood pressure has also dropped 30
points in conjunction
with daily medication. Dramatic (but not CPAP-related)
improvements
in my cholesterol levels have also come. (I'm still overweight,
but
less
so.)
I have taken my CPAP on business trips as distant as Singapore, which
required
me to work out a number of considerations that I have described on my CPAP Travel page. It
turned out to be far
less troublesome than I had expected.