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.


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.