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«SLEEP APNEA HANDBOOK Foreword The first version was a wonderful resource for patients and the revised version builds on that solid ...»

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The first version was a wonderful resource for patients and the

revised version builds on that solid foundation. This new booklet is

full of excellent practical advice for patients with sleep apnea,

including trouble-shooting tips for CPAP users and simple ways that

patients with sleep apnea can reduce their cardiovascular risk. I

wholeheartedly endorse this excellent booklet and will be directing

my patients to obtain a copy.

Dr. Michael Fitzpatrick MD, FRCPI, FRCPC, D.ABSM Chair, Division of Respiratory & Critical Care Medicine Queen's University, Kingston, Ontario This handbook is designed to meet the educational needs of those newly diagnosed with sleep apnea. Sleep apnea is a common disorder which requires accurate diagnosis and effective treatment.

The recent Canadian Thoracic Society Sleep Apnea guidelines recognise the importance of providing education to people with sleep apnea. This handbook provides people living with sleep apnea and their families a good base of information to help them understand and manage their disease.

Dr. John Fleetham, MD, FRCPC Canadian Thoracic Society Sleep Apnea Committee Member, Canadian Lung Association Chronic Lung Disease Working Group 8th Edition copyright 2011. All rights reserved.

Contents What is Sleep Apnea? …………………. 2 …………………. 4 Signs and Symptoms …………………. 6 How is Sleep Apnea Diagnosed?

How is Sleep Apnea Treated? …………………. 8 CPAP Masks …………………. 10 Common Problems with CPAP …………………. 14 CPAP Equipment Care …………………. 16 Insurance Coverage for CPAP Equipment …………………. 17 Traveling with CPAP Equipment …………………. 17 Other Sleep Apnea Treatments …………………. 18 What if I Choose to do Nothing? …………………. 20 A Word to the Partner …………………. 20 Living with Sleep Apnea …………………. 21 Eating Healthy and Losing Weight …………………. 21 Surgery for Weight Loss …………………. 22 Exercise …………………. 22 Medications …………………. 23 Alcohol and Caffeine …………………. 23 Smoking …………………. 23 Sleep Apnea and Driving …………………. 24 Commonly Asked Questions …………………. 25 Glossary …………………. 26 …………………. 29 CPAP Equipment Checklist Sleep Apnea Handbook ~1~ What is Sleep Apnea?

The word apnea means no breathing. Sleep apnea refers to pauses in breathing that occur while you sleep. These pauses in breathing last for 10 to 30 seconds, possibly longer, until the body reacts with a bigger breathing effort to overcome the problem. These pauses are termed events by sleep specialists. This cycle happens over and over throughout the night, interfering with the normal sleep pattern. People with sleep apnea do not feel rested and refreshed in the morning.

There are four main types of sleep apnea.

1. Obstructive sleep apnea (OSA) occurs when the upper airway collapses; even though you are still trying to breathe, there is very little or no air getting into your lungs. OSA is the most common form of sleep apnea.

2. Central sleep apnea happens when the brain fails to signal the muscles needed to breathe. It is not as common as obstructive sleep apnea.

3. Mixed or complex sleep apnea is a blend of both central and obstructive sleep apnea. Each episode usually begins with no breathing effort (central sleep apnea). The breathing effort then starts, but the airway is blocked (obstructive sleep apnea).

4. Sleep Hypoventilation is linked to obesity. Low blood oxygen levels and high carbon dioxide levels during sleep, as well as during the day, distinguish this type of sleep disordered breathing from others.

Is Sleep Apnea Common? Yes  1 of every 5 adults has at least mild sleep apnea (20%).

 1 of every 15 adults has at least moderate sleep apnea (6.6%).

 2 to 3% of children are likely to have sleep apnea.

 Over 1 in 4 (26%) Canadian adults have a high risk of having or developing obstructive sleep apnea.

What is Meant by Mild, Moderate or Severe Sleep Apnea?

Sleep specialists categorize sleep apnea by the number of events per hour:

 Mild sleep apnea – 5 to 15 events per hour  Moderate sleep apnea – 15 to 30 events per hour  Severe sleep apnea – over 30 events per hour

Other important factors are:

 How sleepy you feel  How low the oxygen level dips  How long the oxygen level stays below 90%  Other medical conditions you may have, such as heart disease

–  –  –

The two main symptoms are:

1. Excessive daytime sleepiness that cannot be explained

2. Snoring with pauses in breathing

Other frequent symptoms include:

 High blood pressure  Irritability  Gasping or choking during sleep  Fatigue  Depression  Lack of concentration  Morning headaches  Memory loss  Impotence

Any combination of the following may increase your risk of having sleep apnea:

 Obesity  Large, thick neck (greater than 17 inches for men, greater than 16 inches for women)  Family history of obstructive sleep apnea  Male  Older than 40 years of age  Recessed chin or large tonsils

–  –  –

Your age _________ Male ____ Female _____ How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you have not done some of these things recently, try to work out how they would affect you.

Use the following scale to choose the most appropriate number for each situation:

–  –  –

Situation Chance of Dozing Sitting and reading.………………………………………………………. ____________

Watching TV……………………………………………………………… ____________

Sitting, inactive in a public place (e.g. theatre or meeting)……………… ____________

As a passenger in a car for an hour without a break……………………... ____________

Lying down to rest in the afternoon when circumstances permit………... ____________

Sitting and talking to someone…………………………………………… ____________

Sitting quietly after a lunch without alcohol……………………………... ____________

In a car, while stopped for a few minutes in traffic……………………… ____________

–  –  –

If your score on this test is greater than 10, please discuss it with your doctor.

Sleep Apnea Handbook ~5~ How is Sleep Apnea Diagnosed?

The best method of diagnosing sleep apnea and other sleep problems is an overnight test in a sleep laboratory. This test is called polysomnography (PSG). You will be connected to wires that monitor breathing and sleeping. A sleep doctor will explain the results and suggest treatment.

–  –  –

Leg movement Polysomnography: an overnight test in the sleep laboratory.

Sleep Apnea Handbook ~6~ Portable Monitors As public awareness of sleep apnea grows, so does the demand to be tested. In some areas the waiting time for sleep laboratory testing is very long.

If your doctor believes that your symptoms suggest that you very likely have sleep apnea, and you have no other serious illnesses, portable machines may be used. Portable machines can be used at home and can provide information about oxygen levels, airflow through the nose and mouth, breathing patterns, and snoring. You will be shown how to hook up to the machine so you can do it at home. Testing should be done under the supervision of a physician with training in sleep medicine. If it is discovered that you have sleep apnea, follow-up is needed to decide the best treatment for you.

Portable monitors record information about you while you are sleeping at home in your own bed.

Sleep Apnea Handbook ~7~ How is Sleep Apnea Treated?

The goal of any treatment for sleep apnea is to prevent airway collapse during sleep.

Over 25 years ago Dr. Collin Sullivan successfully treated a sleep apnea patient with the use of continuous positive airway pressure (CPAP). This was delivered through a mask glued to his nose! Years later, CPAP is still the best treatment for obstructive sleep apnea.

The best treatment for obstructive sleep apnea is continuous positive airway pressure (CPAP) produced by a CPAP machine (also called a flow generator). This pressure is then delivered through tubing and a mask to your airway. The mask is held in place by a headgear.

Sleep Apnea Handbook ~8~ How Does CPAP Work?

The CPAP machine delivers a constant flow of air through tubing and a mask to the airway. This creates a ‘splint’ that supports the tissues at the back of the throat, preventing collapse. The amount of pressure developed in the airway by the CPAP machine is prescribed by your sleep specialist, usually after monitoring the effects of treatment during testing at the sleep laboratory. Once your airway is open, the obstructive apnea events and snoring are prevented from happening.

–  –  –

CPAP is a treatment, not a cure.

You will feel better only as long as you use it.

If you stop using the CPAP, your symptoms will return. We understand that wearing CPAP can be difficult, especially if you still feel tired or cannot sleep with a mask on your face. It is important to work with your doctor and equipment supplier to solve any problems you may have.

CPAP equipment has improved over the years. Smaller machines, heated humidity, pressure relief and automatic CPAP machines are all newer options. Battery packs are also available for some machines.

Sleep Apnea Handbook ~9~ CPAP Masks CPAP equipment is usually purchased through a home oxygen company. Look in the yellow pages under oxygen for a choice of suppliers. When you try on a mask it should feel comfortable right away. Keep in mind that it may take some time to get used to wearing any type of mask. The following are only some of the masks that are available on the market. Please work with your supplier to find the best fit for you.

Nasal Masks

–  –  –

What is a good fit?

 The top of the mask should be at the bridge of your nose.

 The bottom of the mask should be about halfway between the bottom of your nose and the top of your upper lip.

 The edge of the mask should be close to the sides of your nose without actually touching it.

 The smallest mask that fits is usually best.

 A small leak is acceptable unless air is blowing into your eyes.

 The headgear should not need to be pulled tightly to control leaks.

Picking the right mask is very important.

Ask yourself these questions:

 Can I breathe through my nose or do I breathe through my mouth? If you breathe through your mouth, a full face mask or chin strap may be better.

 Am I claustrophobic? If so, nasal pillows may suit you better.

 Can I handle something inside my nose? If not, a nasal mask might be better.

Do not be in a rush at the CPAP store.

 Be sure to lay back and also on each side to see how it will feel when you are in bed.

 Try the mask with a CPAP machine attached.

 Make sure the headgear is easy for you to use.

 Ask about a trial period for a new mask or a trade-in policy in case the mask does not work out.

 Take your time when choosing a system that is right for you.

–  –  –

Nasal Stuffiness  Nasal stuffiness can happen when you begin CPAP therapy. Try adding a heated humidifier to your system.

 Nasal stuffiness may also be caused by sinusitis, allergies or rhinitis. Contact your doctor to determine the cause and an effective treatment. It is important that your nose is as clear as possible to make wearing your CPAP mask more comfortable.

 Nasal blockages can happen because of polyps or old fractures. Blockages can interfere with CPAP treatment. These problems should be treated by an ear, nose and throat specialist.

 A full face mask may be the best mask for you.

Sore or Red Areas  Any marks should disappear very shortly after removing the mask.

 Sore or red areas on the bridge of the nose are caused by either a poorly fitted mask or by over-tightening the headgear.

 Adjust your headgear until it is just tight enough to make a seal without large leaks. A small air leak that does not blow into your eyes is acceptable.

 Consider trying a different style of mask.

Skin Irritation  Wash your mask with warm, soapy water and air dry every day.

 Wash your face and dry well before putting the mask on.

 Contact your doctor if a rash develops; a prescription cream may be needed to treat the problem.

 Try a different style of mask.

–  –  –

Dry Mouth (full face mask users)  A heated humidifier will make a difference to the dryness of your mouth.

 Ask your pharmacist about artificial saliva or oral lubricant products that can help with a dry mouth.

Removing the Mask during the Night  It is normal to sometimes remove the mask in your sleep. Keep in mind that the goal of treatment is to wear it all night.

 If you move around a lot in your sleep adding a chin strap may keep the mask on your face.

 You may pull the mask off because of nasal congestion. Try adding a heated humidifier.

 Talk to your sleep specialist if you cannot use your CPAP equipment, he/she may be able to suggest some hints or test for other problems.

Treating sleep apnea is very important for your overall health. If you have experienced problems getting used to your CPAP equipment, please do not give up. It may take a few weeks, or even months to be comfortable wearing a mask. Be patient. Return to your supplier to look for ways to deal with any problems you have. Talk to your sleep doctor about any medical concerns. Do not give up.

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