We have covered the diagnosis of obstructive sleep apnea (OSA) using polysomnogram and reviewed some of the controversy regarding use of home sleep testing for OSA. Now it is time to discuss some of the treatments. We will spend most of the time talking about the most common and by far most effective treatment- continuous positive airway pressure, better known as CPAP.
What is CPAP and what does it do?
CPAP is a device that is attached to a hose and a mask that the patient with OSA sleeps with. The mask typically covers either the nose alone or both the nose and the mouth. It forces air through the mask while you are sleeping. Many people mistakenly think that it is oxygen- it isn't- it is simply forced air. The mask needs to be fairly snug fitting, in order to keep the pressure in the airway, where it is needed, as opposed to leaking out around the mask.
We explained in a previous blog that OSA is caused by collapse of the throat muscles and tissue during sleep. CPAP is a machine that works as an "air splint" to stop that airway collapse from happening. This eliminates the constant cycle of arousals caused by the lack of breathing and the effort needed to reopen the airway and restores the ability to sleep through the night without the breathing obstruction.
What if I sleep apnea doesn't cause me to wake up?
The most obvious and immediate effect from OSA is daytime sleepiness and disrupted sleep (occasionally even causing insomnia). CPAP will help the sleep be maintained. But, even if you don't wake up from sleep apnea there is still obstruction occurring. One study showed that untreated patients with OSA who stopped or decreased their breathing an average of 20 times per hour had a higher risk of death. This risk returned to normal when OSA was treated effectively (almost always with CPAP). OSA has been shown to increase the risk of many other diseases. So far most of the available evidence suggests that CPAP usage can bring these risks back to normal. These include lowering the risk of heart disease and stroke, decreasing high blood pressure, improving cardiac function in congestive heart failure, helping to lower the blood sugar in diabetes and even improving erectile dysfunction. (Erectile dysfunction is a known consequence of OSA.)
By the way, spouses and significant others of sleep apnea patients take note- effective CPAP use improved the quality of life in bed partners of patients with sleep apnea and increased their sleep time by almost an hour!
Sounds great- so why doesn't everyone with OSA use CPAP?
First of all, despite some of the complaints you might have heard, many, if not most patients adapt very well and quickly to using CPAP. They improve so much, so quickly, are finally awake and full of vitality that they wouldn't give up their CPAP for anything. However, the use of CPAP can be uncomfortable. One of my patients famously described the sensation of sleeping with CPAP to driving his car at 40 MPH with his face out window.