October 16, 2010

Sleep Apnea and Hospitalization Part 1

If you have sleep apnea and use a positive airway pressure machine, are you aware of what to do when if you are admitted to a hospital, or if you have an outpatient surgical procedure where you will be put under? I admit I was not! So it was with great interest that I read the article here from the American Sleep Apnea Association (ASAA).

Not included as part of the above link are the procedures for those who use oral appliances. This is the reason for making sure the dentist that prescribed your oral appliance is included in the following discussion.

When using the term CPAP it will be in the generic sense meaning all types of Positive Airway Pressure devices for the treatment of sleep apnea, including CPAP, bi-level PAP, variable PAP, and auto-titrating PAP devices.

The ASAA makes several recommendations for us as patients to accomplish prior to being admitted and what to do once we are admitted. I am concerned that this is aimed only a those of us with obstructive sleep apnea (OSA). So I will mention that this might will be considered by those with mild to moderate sleep apnea. It would be wise to consult with your doctor or dentist in charge of your sleep apnea to have their input in resolving any sleep apnea issues while undergoing medical procedures.

Know you patient rights to be properly treated for OSA and mild to moderate sleep apnea during all surgical procedures whether in a hospital setting or in an outpatient surgical center. This includes any same-day procedure that requires sedation or anesthesia, including but not limited to a colonoscopy or an angiogram.

You will need to determine whether you will be able to use your own CPAP equipment that is set to your prescribed pressure or whether the hospital or facility will supply an identical mask and/or identical or better equipment. You will also need to know whether you will be allowed to have humidification if you use this and whether there are any contraindications for its use. You will need to consult with your oral appliance prescriber for how to handle oral appliances.

To supplement the above, you, as the patient are required to notify your physicians and other caregivers that you have sleep apnea and what pressure the equipment must be set at. You will need to describe the therapy required and provide the contact information for your doctor or dentist so that they can provide the diagnosis information and prescribed pressure or equipment use.

Be prepared to provide your own clean mask and, if needed, your own CPAP machine. Be ready to label your equipment with your name and required identifying information. If possible meet with the surgeon and anesthesiologist to inform them that you have sleep apnea and require therapy.

Important! Make sure that your family, and if necessary friends, know that you are a sleep apnea patient and that they know you require the equipment. They should also know the parts of the equipment and how it is used for your sleep apnea treatment. Lastly, you should make sure that you have the information as part of your medical alert jewelry and on your wallet emergency information card so that medical emergency personnel will be able to take proper action for you.

Watch for Part 2

October 13, 2010

More on Sleep Apnea

Sleep apnea is not a simple problem. There are problems that I have not covered and there is not one size fits all solution.

I have been covering obstructive sleep apnea (OSA) from mild, moderate, to severe.
OSA is the most common type of sleep apnea. It happens when the soft tissue in the back of your throat relaxes during sleep, causing a blockage of the airway (as well as loud snoring). Snoring is one of the symptoms of sleep apnea, but does not always mean that your have sleep apnea. (Don't let your non-snoring spouse see this).

Now I must add - central sleep apnea and mixed (complex) sleep apnea. Central sleep apnea, while much less common, is still serious. It involves the central nervous system, rather than an airway obstruction. It occurs when the brain fails to signal the muscles that control breathing. People with central sleep apnea seldom snore. This is what makes it so serious – it is more difficult to diagnose.

Complex sleep apnea (some use the term of mixed sleep apnea) is a combination of OSA and central sleep apnea. Be sure to read this about sleep apnea.

Unlike OSA, in which you can't breathe normally because of upper airway obstruction, central sleep apnea results when your brain doesn't send the signals to the muscles that control your breathing. Central sleep apnea is less common, accounting for less than five percent of sleep apneas.

Central sleep apnea may occur as a result of other conditions, such as heart failure and stroke. Sleeping at a high altitude also may cause central sleep apnea. Other medical conditions also cause central sleep apnea. Life-threatening problems with the brain stem is also a cause. Read this for more on other medical problems.

Treatment can include CPAP or oral appliances, but often requires oxygen being supplemented. Your physician may preform a physical exam in addition to a sleep study. Other test that may be included are lung function studies and a MRI.

Central sleep apnea patients should avoid the use of any sedative medications Some types of central sleep apnea can be treated with drugs that will stimulate breathing. If it is due to heart failure, the goal will be to treat the heart failure itself. Other symptoms may include apnea due to neurological condition. The symptoms depend on the cause of the disease and what parts of the nervous is affected, but may include difficulty in swallowing, voice changes, and weakness or numbness throughout the body.

October 10, 2010

Identifying Sleep Apnea – Part 2

Who can have sleep apnea? Anyone at any age can suffer from sleep apnea, whether they are young children to the elderly. Risk factors become important in both obstructive and central sleep apnea.

The risk factors for obstructive sleep apnea include being overweight, a male, over the age of 65, black, Hispanic or a Pacific Islander, being related to someone who has sleep apnea, and a smoker. Other factors would be having a thick neck, deviated septum, receding chin, or enlarged tonsils or adenoids. You must also include other medical factors that cause nasal congestion and blockage.

The risk factors for central sleep apnea can have many factors, but is most common in males and people over the age of 65. Central sleep apnea is often caused by serious illnesses like heart disease, stroke, neurological disease, and spinal or brain stem injury.

When diagnosed with sleep apnea, there are some things that you can do to lessen the problems with mild to moderate OSA. Lifestyle modifications are the biggest area to improve the condition. These include losing weight, quit smoking, avoid alcohol, sleeping pills, sedatives, avoid caffeine, heavy meals before going to bed, and maintaining regular sleep hours.

When going to bed, learn to sleep on your side as this will help keep your tongue from relaxing and obstructing your airway. Prevent yourself from rolling onto your back by having something at your back that is rigid enough to stop you. Some people are able to elevate their head with a foam wedge or by using a cervical pillow. If you have nasal problems, use a nasal dilator, saline spray, or breathing strips.

Many people do not use some aids that should be done. Throat exercises can be successful in reducing the severity of sleep apnea by strengthening the muscles in the airway making them less likely to collapse.

Some of the exercises you can try (I found the first the most helpful but try them for yourself) include pressing the tongue flat against the floor of mouth and brush top and sides with toothbrush. Repeat brushing movement 5 times, 3 times a day.

I found this very difficult - press length of tongue to roof of mouth and hold for 3 minutes a day. The next exercise is place finger into one side of mouth. Hold finger against cheek while pulling cheek muscle in at same time. Repeat 10 times then rest and alternate sides. Repeat sequence 3 times.

I have not tried this one - purse lips as if to kiss. Hold lips tightly together and move them up and to the right the up and to the left 10 times. Repeat sequence 3 times.

If nothing more this will strengthen your lungs, but it seems to help. Place lips on a balloon to inflate. Take a deep breath through your nose then blow out through your mouth to inflate balloon as much as possible. Repeat 5 times without removing balloon from mouth.

One exercise that also helped me is holding both hands together at the back and forming a V, take the thumbs and massage the jaw area starting at the back near the jaw hinge and pulling the thumbs forward in the soft area under the jaw. Start at the outside and work toward the center. Just use care not to depress the arteries at the side of the neck, stick to the underside of the jaw.

What ever you do, find out what works for you and give it a consistent trial and a chance to work. Even though I have severe obstructive, the most aid I have received is by sleeping on my side and using a strong back support to prevent me from turning on onto my back. I still use my VPAP machine to get the restful sleep I need.