CPAP Therapy: is it really beneficial?
The short answer is yes. Many Patients tend to underestimate the consequences of obstructive sleep apnea (OSA) and merely pin this down to 'snoring'. Loud, disruptive snoring is definately a feature of sleep apnea, however there are many other facets to this common condition. 1 in 4 individuals within the Population are said to have some degree of sleep apnea, with 80% of this group still undiagnosed; this means, high prevalence and unfortunately, a very low hit-rate. Many Patients also believe that they are not tired and therefore, are not symptomatic. This is untrue as we begin to adapt to being so fatigued throughout the day, and 'not being tired' does not protect us from other secondary co-morbidities. We must bring attention to this condition and raise awareness regarding treatment as it's quite simple - CPAP is, and always has been, the gold standard treatment for OSA!
CPAP Therapy works on the principle of Positive Airway Pressure - in simple terms, air from the room we are sleeping in is drawn into the machine, filtered (not oxygenated), pressurised and delivered to our airway to maintain its muscular tone. CPAP tends to be associated with words such as 'discomfort' and 'obtrusive' for example. These devices and their technology have advanced highly in the last 5 years particularly. There are many more added comfort features and masks are a fraction of a size they once were. Our Clinicians at CPAP Victoria are also extremely skilled in assisting your experience with CPAP and rendering the whole process much easier than it used to be 10-15+ years ago. Many of our Clinicians actually use these devices themselves! The problem is, many Patients forget and disregard the benefit of CPAP due to these preconceived ideas of what therapy is when in fact, they are no longer noisy and much more comfortable with some masks that barely occupy the space around the ball of your nose!
Important benefits of CPAP Therapy
CPAP effectively eliminates all implications of OSA with ease. It is non-invasive, does not require painful recovery periods, applicable to all groups and severity ranges and retains the highest success rate among any treatment options available. Some of the consequences of OSA that CPAP reverses are listed below.
Daytime Sleepiness and Fatigue: Excessive daytime sleepiness will be eliminated and replaced by daytime alertness. The Patient will no longer nod off to sleep in the middle of daytime activities. You will be able to enjoy your life to the fullest, with vigour and energy throughout most activities.
Unrest and Affectation: The Patient will receive deeper, more restorative sleep and as such, will feel more rested and calm. Sleep deprivation, cycle problems and/or deficiencies will result in emotional problems including moodiness, irritation, easily aroused temper and in some cases, depression and anxiety. CPAP can help to avoid mood problems or disorders. Recent Studies have also shown that OSA can lead to a build-up of 'negative' proteins within our brain, which later in life, can accelerate the development of Dementia of the Alzheimer's Type (DAT).
Headache and Memory Loss: Lack of restful sleep triggers headaches, negatively impacts concentration and causes lapses in memory. Headaches or pain within the frontal part of our skull is usually a consequence of oxygen loss due to apnea. CPAP devices will control the 'morning headache' and improve all areas of cognition as our breathing is stabilised throughout the night, without any repeated episodes of apnea and oxygen desaturation.
Hypertension and Cardiac Problems: Undiagnosed and untreated sleep apnea is linked to approximately a 10 times higher risk for stroke and heart attack, with a 91% association with hypertension or high blood pressure. When we experience apnea, our heart rate and oxygen levels drop; as such, our body is triggered to release adrenaline so we can breathe again. Adrenaline causes a surge in our heart rate and activates our 'fight or flight' response; therefore, our heart is on a roller-coaster ride each and every night when we should be in 'rest and recovery' mode! A close relationship has also been found between OSA and arrythmia as well as atrial fibrillation. CPAP can often times eliminate the need for anti-hypertensive medication (high blood pressure medication) or lead to a dose reduction. Many Cardiologists refer Patients for a Sleep Study due to the profound and negative impact of OSA on overall cardiac health. CPAP truly leads to a happy, healthy heart.
Weight Gain and Difficulties: Chronically interrupted sleep periods may cause weight gain, and more importantly, significant difficulties with weight loss. We have two hormones which control our appetite and energy expediture named leptin and ghrelin. OSA causes signalling problems and an imbalance of these hormones which results in strange appetite patterns and problems with activity (as well as sexual problems). As CPAP therapy will manage a Patient’s disrupted sleep, improved quality of life, reduction in weight and assistance of a healthy lifestyle related regime occurs.
Metabolic Problems and Diabetes: Clinical Studies have indicated that Patients diagnosed with OSA are closely linked to the development of resistance to insulin. Approximately, a 89% correlation between insulin resistance and OSA has been found which is a principal risk factor for the development of diabetes type 2. Diabetic Patients afflicted with sleep apnea may also find it hard to control diabetes if their sleep apnea remains untreated by CPAP.
Gastroesophageal reflux disease (GERD) is also associated with sleep apnea, as the ailment is caused by an increase in negative intrathoracic pressure that is the result of breathing against a closed or narrowed airway. Additionally, continuous adrenaline surge throughout the night tends to activate organs that should be 'sleeping' including the production of gastric acid. Patients with GERD will likely benefit from using a CPAP machine as their airway is kept open by the device and oxygen desaturation will not ensue.
Excessive Nightly Urination or Nocturia: As we lose our oxygen levels due to an apneic event, this resulting adrenaline response to clear our airways to breathe again will result in organ activation. Our bladder will be triggered by this adrenaline release and cause 'stimulation' which results in nocturia, or frequent nocturnal urination. The toilet visits alone are disruptive to sleep, let alone repeated airway closure! With CPAP, we receive more restful and deeper sleep and anti-diuretic hormones are secreted in bigger amounts during the deeper stages of sleep. Thus, frequent urination during the night is less likely to happen.
Survival and Quality of Life: A Study examined two groups of Patients; both groups were diagnosed with severe OSA, however only one group was treated with CPAP. The Study found the 'CPAP Treated Group' to have a 50% higher chance of overall survival compared to the untreated group; now that's an astounding figure. An apnea can be likened to waking us up as our brain releases adrenaline to wake us from our slumber and open the airways to recoup all of our lost oxygen saturation. These events also arouse us and bring us out of our deeper sleep periods back into lighter sleep, therefore missing out on crucial restoration time which results in neurotransmitter and hormone production, recovery, memory consolidation and development. CPAP aids not only in restful sleep, but our entire regeneration by controlling apnea and all negative consequences that take place following these nefarious events.
Think you may be at risk for sleep apnea? Take the simple STOP-BANG quiz below which helps to screen for potential OSA diagnostic risk*.
Count each 'Yes' as 1 point:
1. Do you snore often and loudly?
2. Do you often feel fatigued, tired or sleepy during the day?
3. Has anyone witnessed you stop breathing during sleep?
4. Do you have high blood pressure?
5. Do you have a BMI over 35 kg/m2?
6. Are you over 50 years of age?
7. Is your neck circumference over 40 cm?
8. Are you a Male?
0-2 points - low risk for OSA
2-4 points - moderate risk for OSA
5-8 points - high risk for OSA
Please contact our Team of highly trained Clinicians on 1300 750 006 to discuss any information presented in this blog post, your STOP-BANG result or answers to any questions you may have regarding CPAP Therapy. To add, we have a network of relationships with reputable Sleep Physicians across Victoria where we may point you in the right direction to improve your sleep and your health. If you are a current CPAP User, we can offer improvements to your regime and usually have a tip or two to share with you. Don't ignore it any longer; CPAP Victoria is always here to help you across all aspects of your Sleep Journey!
*Adapted from the STOP-BANG CA framework described in Chung, F., Abdullah, H. R., & Liao, P. (2016). STOP-Bang questionnaire: a practical approach to screen for obstructive sleep apnea. Chest, 149(3), 631-638.