The Greek word "apnea" literally means "without breath." There are three types of apnea: obstructive, central, and mixed; of the three, obstructive is the most common. Obstructive sleep apnea (OSA) is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep. Despite the difference in the root cause of each type, in all three, people with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for a minute or longer.

Sleep apnea is very common, as common as adult diabetes and affects more than twelve million Americans, according to the National Institutes of Health. Risk factors include being overweight, and over the age of forty, but sleep apnea can strike anyone at any age, even children. Yet still because of the lack of awareness by the public and healthcare professionals, the vast majority remain undiagnosed and therefore untreated, despite the fact that this serious disorder can have significant consequences.

Untreated, sleep apnea can cause high blood pressure and other cardiovascular disease, memory problems, weight gain, impotency, and headaches. Moreover, untreated sleep apnea may be responsible for job impairment and motor vehicle crashes. Fortunately, sleep apnea can be diagnosed and treated. Several treatment options exist, and research into additional options continues.

Read Our Sleep Apnea & CPAP Guide (pdf)

TREATMENT OPTIONS FOR ADULTS WITH OBSTRUCTIVE SLEEP APNEA

There are different treatment options for obstructive sleep apnea (OSA). Which option is right for you depends upon the severity of your sleep apnea (which is determined from a sleep study), the physical structure of your upper airway, and other aspects of your medical history.
The various options are listed below so that you can discuss them with your doctor. Only your doctor or sleep specialist can tell you which treatment option is best for you.

• Positional therapy: Apneas tend to be worse when sleeping on the back (the supine position) hence not sleeping on the back may reduce the number of apneas. To avoid the supine position, some people use homemade remedies, such as putting tennis balls in a tube sock and pinning the sock to the back of the nightshirt. However, they may disrupt sleep so much that the subsequent sleep fragmentation causes a concern.

• Weight loss: Sleep apnea can be weight-related. Additional fat around the neck may make the airway narrower, making obstructions more likely to occur. For some overweight people, especially those with mild cases, losing weight can be an effective treatment. Remember that sleep apnea occurs in thin people as well; the airway can close during sleep for a number of reasons, not just excess weight.

• Avoiding alcohol and other CNS depressants: Alcohol and medications that act as central nervous system (CNS) depressants-such as pain killers, sedatives, and muscle relaxants-can worsen sleep apnea by relaxing the airway muscles further and/or by reducing the respiratory drive and causing more apneas to occur. Hence avoiding alcohol and CNS depressants close to bedtime may be helpful.

• Oral appliances: Oral appliances, sometimes called dental appliances, are intended to treat apnea by keeping the airway open in one of three ways: by pushing the lower jaw forward (a mandibular advancement device or MAD), by preventing the tongue from falling back over the airway (a tongue-retaining device), or by combining both mechanisms.

• Surgery: The intention of surgery is to create a more open airway so obstructions are less likely to occur. There are several different surgical procedures with different effectiveness rates, and surgery can also sometimes worsen the apnea.

• Continuous Positive Airway Pressure (CPAP): CPAP works by gently blowing pressurized room air through the airway at a pressure high enough to keep the throat open. This pressurized air acts as a "splint." The pressure is set according to the patient's needs at a level that eliminates the apneas and hypopneas that cause awakenings and sleep fragmentation. 

CPAP is the most effective method for treating obstructive sleep apnea. It can sometimes be hard to use, but any complaints about the comfort of the machine or mask can usually be addressed easily. Talk to your doctor or Care Medical representative about any discomfort you may have.

Care Medical offers a wide range of heated humidification systems for use during the treatment of respiratory conditions by ventilation or oxygen therapy. These Humidification systems are designed to overcome many of the challenges of effectively creating, controlling and delivering gases to a patient's airway at close to physiologically normal levels of temperature and humidity.

CHOOSING A MASK AND HEADGEAR

Once you have been prescribed Continuous Positive Airway Pressure (CPAP) therapy, you will need to be fitted for a connection to your nose and/or mouth, tubing and headgear - "an interface". The mask is attached to tubing that, when connected to the CPAP machine, delivers the pressurized air that prevents apneas from occurring. It is very important that the mask is comfortable and provides a proper seal for the airflow; the proper air pressure level cannot be established unless the fit is correct. Moreover, a comfortable mask that fits well will make using CPAP easier.  Your Care Medical representative will help you choose mask that is right for you.

Most masks are triangular in shape and are worn over your nose (or the nose and mouth, with a full-face mask for mouth breathers) while the adjustable straps of the headgear hold the mask in place. Straps that are too loose permit air to leak. Straps that are too tight can break the seal and create leaks; any strap pulled too tightly can cause discomfort. If you breathe through your mouth, you may also want to consider using a chin strap to help keep your mouth closed or a mask designed for mouth breathers.

Many masks have a hard plastic body and softer silicone seal that touches the face and may have varying features. For example, a mask may include an adjustable pad that rests on the forehead. The seal may inflate once the machine is turned on so the straps do not need to be as tight. If the mask has a lower profile and does not sit too high at the nose's bridge, it can typically accommodate eyeglasses better.

Several masks on the market now are made out of gel-like material. They are intended to mold to each person's face in order to alleviate pressure points and to be more comfortable. However, because some of these masks are larger and heavier than traditional types, some people find them less comfortable. A variation of the gel-type masks is one that can be boiled, cooled slightly, and then pressed against the face in order to fit the individual.

Nasal pillows are another option. Instead of wearing a triangular mask, the user inserts into the nostrils two small flexible pieces (shaped somewhat like mushroom caps) that are attached to a plastic adapter that is in turn attached to the tubing. However, people with higher pressures sometimes experience discomfort with the pillows. The pillows do not rest on the nose, upper lip, or cheeks, may solve the problem of allergies to mask material as well as complaints of claustrophobia. Some people, especially people with a beard or moustache, simply prefer nasal pillows to a mask.

Just as there are several CPAP manufacturers that offer different types of machines with different features, there are different masks and headgear styles within manufacturers' lines. Your mask may be manufactured by one company and the CPAP machine by another. Virtually any mask will fit the standard air hose.

Some insurance carriers resist paying for more than one CPAP mask in a specific time period (such as six months or a year), so additional masks may be an out-of-pocket expense for you. Before selecting a mask, try using it with the CPAP on and under realistic conditions (for example, lying down moving from side to side). You, the wearer, should be happy with it. If you have discomfort with any mask, try other ones; though keep in mind any restrictions on cost and/or provider your insurance company may impose.

Nebulizer - A nebulizer changes medication from a liquid to a mist, so that it can be more easily inhaled into the lungs to treat diseases such as Asthma, Chronic Obstructive Pulmonary Disease (COPD) and Emphysema.

Home nebulizer therapy is particularly effective in delivering medications to infants and small children and to anyone who is unable to use inhalers with spacers.

To obtain a nebulizer, you need a prescription from your physician. Home nebulizers are usually covered under the durable medical equipment portion of health insurance policies. For more information about using a nebulizer contact Care Medical.