Sleep Apnea Management

What is Sleep Apnea?


Sleep apnea” is a potentially serious medical condition where you stop breathing in your sleep. When you are awake, the muscles of your upper airway hold it open. When you are asleep, these muscles relax and the only thing holding your airway open is the elasticity of these tissues. In Obstructive Sleep Apnea (OSA) , the soft tissues of the tongue and soft palate fall back and block off your airway as you fall asleep.


This causes your oxygen levels to drop and triggers the emergency “fight or flight response” by your body to wake you up to breathe. This response also stresses your heart and increases your blood pressure, heart rate and blood sugar. Up to 50% of people with significant untreated OSA will go on to develop hypertension. Looking at it another way, 25% of people with hypertension have underlying OSA. Speeding up your heart rate increases the risk of developing cardiac arrhythmias like atrial fibrillation. Sleep apnea also increases the risk of myocardial infarction, congestive heart failure, and stroke. One-third of people with coronary artery disease or myocardial infarction, and up to 50% of patients with stroke have underlying OSA aggravating their health problems. In addition, raising your blood sugar will contribute to diabetes.


Treatment Options for Obstructive Sleep Apnea


There are a number of treatment options for Obstructive Sleep Apnea. CPAP is generally the most effective treatment. However, depending on the individual and the severity of their sleep apnea, other treatments may be as effective and sometimes easier to use or more comfortable. There are oral appliances such as a Mandibular Advancement Device or a Tongue Retaining Device (MPOWRx). For those with sleep apnea that is primarily when they sleep on their back, there are body re-positional devices .


Starting CPAP/BiPAP Therapy

At the sleep apnea clinics, patients with a diagnosis of obstructive sleep apnea who are starting CPAP/BiPAP therapy for the first time are offered a free one month trial of therapy. During this trial we will monitor your response and troubleshoot any concerns that may arise. The goal of the trial is to ensure your sleep apnea is fully controlled and to determine the most appropriate settings and most comfortable mask interface for long term use. We have a wide variety of machines and masks from all manufacturers and our expertise will help ensure your therapy is optimized.


Positive Pressure Devices

CPAP

Continuous Positive Airway Pressure (CPAP) opens up the obstruction at the back of the throat by applying positive pressure to the airway through a mask over the nose or sometimes the nose and mouth. The settings for CPAP are determined in the sleep lab or through Auto-CPAP. Auto-CPAP senses snoring or pauses in breathing and automatically increases the pressure accordingly.

BiPAP

Bi-level Positive Airway Pressure (BiPAP) provides two pressures. One pressure to breathe in and a lower pressure to breathe out. The lower pressure makes it easier to exhale for those patients requiring high CPAP pressures. The higher inspiratory pressure assists the patient in taking a bigger breath in those with chronically low oxygen levels at night. A more sophisticated BiPAP called BiPAP S/T can provide a backup rate to automatically ventilate the patients with Central Sleep Apnea. BiPAP S/T also has a setting called AVAPS (Average Volume Assured Pressure Support). This setting helps patients with obesity or neuromuscular diseases take a big enough breath to maintain their oxygen levels when they sleep.

ASV

The Adaptive Servo Ventilator (ASV) is an even more sophisticated type of BiPAP. It is essentially a type of ventilator used in patient with Central Sleep Apnea. It is particularly helpful in patients with Cheyne-Stokes type Central Sleep Apnea. It reacts more accurately to the gradual waxing and waning of Cheyne-Stokes breathing than the BiPAP S/T. This helps to stop the waxing and waning cycles that disturb the sleep in these patients generally resulting in a more restful sleep than they could obtain on BiPAP S/T.


Mask Interfaces

There are many different makes and types of masks. Any mask can be used with any machine. The technician will work with you to find the most comfortable mask option.

  • N30i Nasal Pillows
  • F30i Full Face Mask
  • Nasal Mask


Alternatives to CPAP


Dental Devices

Custom Made Dental Device

A mandibular advancement device holds the lower jaw forward during sleep. This brings the tongue forward which helps to hold the airway open at the back of the throat relieving snoring and mild to moderate obstructive sleep apnea. This device is custom fitted and adjusted by a dentist trained in sleep disorders medicine. It tends to be slimmer, more comfortable and made from much more durable materials than a "boil & bite" type of device.


Boil and Bite Dental Device

A "boil & bite" type of mandibular advancement is a less expensive dental device that you fit yourself. This brings the tongue forward which helps to hold the airway open at the back of the throat relieving snoring and mild obstructive sleep apnea. The device comes with instructions on how to heat and mold the upper and lower pieces to your teeth. The upper and lower pieces are snapped together in one of two positions and then inserted into the mouth. The first position is neutral and helps to prevent the lower jaw from sliding back especially when you turn onto your back. The second position provides 5 mm of lower jaw advancement. This device is primarily for patients with snoring or mild obstructive sleep apnea. It includes a 30 day money back guarantee.


Tongue Retaining Device

MPowRx

MPowRx is a type of "tongue retaining device". It is very useful for snoring and mild obstructive sleep apnea. It is also an alternative for patients with dentures who cannot use a dental appliance. It is made of a soft, flexible silicon that fits comfortably behind the lips in front of the teeth or denture. It has on open bulb in the middle that you stick your tongue in. The suction in the bulb holds the tongue forward. This gives you more space at the back of the throat to breath. It is very simple to use.


Body Re-positional Devices

Night Shift



The Night Shift is a rubber collar with a magnetic clasp on the front and a small, light-weight position sensor and data logger on the back. This device is for patients who have sleep apnea primarily when they sleep on their back. The device records body position and vibrates when you turn on your back. This motivates you to wake up and turn over. The device records your body position as well as how often it has to remind you to turn over. It also records snoring and body movement. Movement helps to determine how often you are awake in the night. The device comes with a USB cable that you can plug into your computer to download the information from the data logger and view in chart format. The charts will show how successful you are at avoiding sleeping on your back. They will also show if there is residual snoring and if you are spending less time awake during the night as time goes on.