Care for Patients with Sleep Apnea

Sleep apnea is defined as a serious sleeping disorder that can lead to serious health problems, such as high blood pressure and heart trouble, if untreated. Untreated sleep apnea causes breathing to stop repeatedly during sleep, causing loud snoring and daytime tiredness, even with a full night’s sleep.

What is Sleep Apnea?

Sleep apnea is a serious sleep disorder it happens when a person's breathing is interrupted during their sleep. People who are suffering from untreated sleep apnea their breathing repeatedly stops and starts during sleep. People with sleep apnea tend to:

• Snore much louder than those with regular snoring

• Pause while they breathe (for over 10 seconds)

• Take shallow breaths, gasp, or choke

• Be restless

Different types of sleep apnea:

Obstructive sleep apnea

Obstructive sleep apnea is the most common type of sleep apnea. It happens when your airways repeatedly become completely or partially blocked during sleep, usually because the soft tissue in the back of your throat collapses. During these episodes, your diaphragm and chest muscles work harder than normal to open your airways. You may start to breathe with loud gasps or jerk your body. This can affect your sleep, lower the flow of oxygen to your vital organs, and lead to abnormal heart rhythms.

Central sleep apnea

With this type, your airway doesn’t become blocked. Instead, your brain fails to tell your muscles to breathe because of issues in your respiratory control center. It’s related to the function of your central nervous system. Central sleep apnea happens most often in people with neuromuscular disease such as amyotrophic lateral sclerosis (ALS) or Lou Gehrig’s disease.

Complex sleep apnea syndrome

This condition happens when the patient is suffering from a combination of both obstructive sleep apnea and central sleep apnea.

Symptoms of Sleep Apnea

Following are some of the most common signs and symptoms of Sleep Apnea:

• Snoring

• Fatigue or sleepiness during the day

• Restlessness while sleeping, or regular nighttime awakenings

• Dry mouth or sore throat when you wake up

• Waking up suddenly from sleep after gasping or choking

• Trouble concentrating, forgetfulness, or crankiness

• Depression or anxiety

• Constant need to go pee at night

• Sweating during night

• Headaches

Sleep Apnea symptoms in children:

Sluggishness or sleepiness, which others may mistake as laziness in the classroom

• Poor school performance

• Trouble swallowing

• Daytime mouth breathing

• Inward movement of the rib cage when inhaling

• Sweating a lot at night

• Unusual sleeping positions, like sleeping on the hands and knees, or with the neck hyperextended

• Bedwetting

• Learning and behavioral disorders

Risk Factors for Sleep Apnea:

Risk factors for this form of sleep apnea include:

• Being older. Middle-aged and older people have a higher risk of central sleep apnea.

• Being male. Central sleep apnea is more common in men than it is in women.

• Heart disorders. Having congestive heart failure increases the risk.

• Using narcotic pain medications. Opioid medications, especially long-acting ones such as methadone, increase the risk of central sleep apnea.

• Stroke. Having had a stroke increases your risk of central sleep apnea or treatment-emergent central sleep apnea.

Treatment for Sleep Apnea

Here are a few ways in which Sleep Apnea can be treated :

• Use of PAP Machines that help to open up blocked airway passages like CPAP or BiPAP

• Lifestyle changes, including losing weight and quitting smoking

• Treatment of allergies that make it difficult to breathe at night

• Treatment of associated medical conditions that could be causing your sleep apnea

• Use of supplemental oxygen while you sleep

CPAP or BiPAP for Sleep Apnea?

CPAP and BiPAP machines are both forms of PAP therapy, which uses compressed air to open and support the airway during sleep. A PAP machine generates the pressurized air and directs it to the user’s airway via a hose and mask system. Let's have a look at - CPAP and BiPAP one by one.

CPAP Machine

A CPAP machine sends air pressure through a mask while you’re sleeping. This air pressure is greater than that of the air around you, which helps keep your upper airway passages open to stop apnea and snoring.

BiPAP Machine

BiPAP machines provide two different levels of air pressure, which makes breathing out easier than it is with a CPAP machine. For this reason, BiPAP is preferred for some people with Sleep Apnea.

CPAP machines and BiPAP machines look quite similar and might be easily confused by a beginner user.

To note - there's a quite a few differences in these machines.

CPAP machines have an adjustable pressure setting that delivers between 4 to 20 cm H2O regardless of whether the user is inhaling or exhaling.

BiPAP machines on the other hand have 2 pressure settings — inhalation positive airway pressure (IPAP) and exhalation positive airway pressure (EPAP) - this pressure allows for lower pressure levels during exhalation. Depending on the BiPAP machine’s settings, the switch between IPAP and EPAP may be timed or automatically based on the user’s breathing patterns.

BiPAP machines have two air pressure settings: one for the inhalation phase (IPAP), and one for exhalation (EPAP). The EPAP is usually significantly lighter than the IPAP, allowing users to breathe more naturally and not feel as though they are fighting against the machine when they exhale. Most machines have a range of approximately 4 - 25 cm H2O, 5 cm H2O higher on the upper end than CPAP machines.

While CPAP machines have only one setting (that is IPAP), some models now have sensors that allow for gentler air pressure on the exhale. Unlike the EPAP setting that is available on BiPAP machines, the exhalation pressure cannot be set by the user and is only slightly less than the overall pressure setting.

CPAP machines are mostly used to treat obstructive sleep apnea whereas BiPAP machines are used to treat central sleep apnea, complex sleep apnea, or COPD.

When looking at the cost, BiPAP tends to be more expensive than CPAP which makes some consumers chose the former. The comfort and liking of CPAP / BiPAP machine depends on the individual, but generally, BiPAP is often chosen when CPAP is not tolerated by the user.

A big advantage of the BiPAP machine is that the strain is decreased during expiration. This limits the amount of energy expended during exhalation. In other words, it is easier to breathe out with BiPAP than with CPAP.