Sleep apnea
In Canada, in addition to those who reported having a diagnosis of sleep apnea, more than one in four adults (26%) reported symptoms and risk factors associated with a high risk of developing or developing Obstructive sleep apnea. Sleep apnea can affect men, women and children of all ages and most people do not know that they suffer from sleep apnea. It is a serious problem, but easily identifiable and treatable, when diagnosed.
Sleep apnea has four types of respiratory sleep abnormalities:
- Obstructive sleep apnea (OSA)
- Central Sleep Apnea (ASC)
- Sleep apnea complex
- Hypoventilation of sleep
It is important for the physician to distinguish between different types of sleep apnea, as the treatment differs in each case.
Causes
Sleep apnea can be caused by several factors, including:
- Shape of the face and neck: wide neck, receding chin, thin face
- Size of the upper respiratory tract
- Narrow pharynx – long soft palate
- Size of adenoids and tonsils
- Nasal obstruction/breathing by the mouth
- Age
- Sex (men being more at risk)
- Obesity
- Respiratory allergies
- Alcohol and/or medication consumption/use
- Smoking
Persons at risk
If you are affected by the following medical conditions, you also have an increased risk of suffering from sleep apnea:
- Hypertension (high pressure)
- Angina and arrhythmia
- Depression
- Heart attack
- Atrial fibrillation (heart rhythm disorder)
- Paralysis
- Diabetes
- High cholesterol
- Hypothyroidism
Signs and symptoms
It is important to note that someone suffering from sleep apnea rarely has all of these symptoms, and can in fact present very few symptoms.
- Repetitive night awakenings
- Frequent trips to the bathroom during the night
- Non-restorative sleep
- Morning headaches
- Snoring
- Respiratory pauses observed by the spouse
- Fatigue, excessive sleepiness during daytime
- Reduced energy level
- Lack of concentration/alteration of judgement
- Decreased alertness
- Choking or gasping during sleep
- Excessive perspiration during sleep
- Loss of memory
- Irritability, mood swings and nervousness
- Depression/anxiety
- Hypertension (high blood pressure)
- Decreased sex drive – impotence
Some comorbidities may be present in people suffering from sleep apnea:
- 30% also suffer from type 2 diabetes
- 30% of people have heart failure, angina or infarction, high blood pressure
- 50% have depressive symptoms that can be interpreted as depression (people with sleep apnea are twice as likely to suffer from depression as healthy people)
Diagnostic
Sleep apnea is diagnosed using a specialized test called polysomnography or overnight sleep study. This test is conducted under medical prescription only. To determine the necessity for a polysomnography test, your doctor will question you about your sleep and awakenings, inquire about your medical history and conduct a physical examination to establish, among other things, the size of your adenoids and your tonsils. He will also do a complete revision of all your medication. On occasion, certain drugs like tranquilizers/sedatives or muscle relaxants can worsen sleep apnea. In children and teenagers, the diagnostic test is the same as that for adults. However, surgery is more often used for children than for adults.
Polysomnography (Overnight sleep study)
According to the Canadian Thoracic Society as well as the American Academy of Sleep Medicine, the polysomnography test is the benchmark for studying sleep disorders. This test can confirm the sleep disorder diagnosis, identify any associated conditions and orient therapeutic decisions.
This test is conducted in a sleep laboratory. It consists of recording various parameters during sleep. You will be required to sleep with many electrodes or sensors positioned on various body parts:
- Head, side of the face, chin: these sensors identify the various stages of sleep.
- Around the thorax and the abdomen, two elastic bands measure your breathing efforts.
- The level of oxygen in the blood is also measured by a small sensor installed on the tip of the finger.
- Wires on the legs measure the contractions of the muscles.
- A video-camera records the session to identify the position and abnormal movements during sleep.
Finally, all the collected data is compiled, treated by software, analyzed by a sleep technologist and then reviewed by a sleep specialist in order to establish the diagnosis.
Home surveillance methods
A sleep technologist will explain how to install the device so that you can use it at home. There are various types of portable devices that can be used to identify respiratory anomalies and measure their severity, to adjust the treatment, or to check the treatment adjustment. Information related to your sleep will be recorded by one of these computerized devices that can be used at home for one night. When you bring the device back, an evaluation of your condition will be done. A sleep specialist will interpret the results.
Following the home monitoring test, the doctor might require a laboratory analysis in order to proceed with a more complete study of the data collected and to be able to give a more precise diagnosis, or to adjust the treatment more precisely.
Apnea-Hypopnea Index
The apnea index represents the number of apneas or hypopneas per hour of sleep, as demonstrated by a sleep study. The index is a framework for evaluating the degree and severity of the respiratory anomalies and thus helps determine the most appropriate treat-ment (also called AHI).
Mild: 5 to 15 respiratory anomalies/hour*
Moderate: 15 to 30 respiratory anomalies/ hour*
Severe: more than 30 respiratory anomalies/ hour*
*According the criteria established by the AASM
To know the Centers specialized in the diagnosis of sleep apnea, visit our section Patient Resources
Treatments
Continuous positive airway pressure (PF) is the best treatment for patients with obstructive sleep apnea. Continuous positive pressure or CPAP Means that air is pushed by continuous positive pressure on the airways so as to keep them open. This pressure must be adjusted by means of a titration test. “Titration” is the adjustment of the device to CPAP. Of the patient so that it delivers the treatment pressure to an adequate level. Unlike drugs with a relatively standard dosage, treatment with CPAP Requires a specific titration to the patient. The treatment pressure varies from one individual to another, as well as obstructions, and it can also vary throughout the life of a person.
There are several types of PKD devices, so your doctor will prescribe the most appropriate type of device according to your diagnosis, taking into account, if necessary, the other illnesses you are suffering from. The apparatus for CPAP Keeps the upper airways open at all stages of the respiratory cycle, snoring and apnea are controlled. It is a treatment and not a cure. If you stop using the device, you will start again. Appropriate treatment pressure, a comfortable mask and device, good training and support from your loved ones will often make the difference between success and failure for a large number of people using CPAP
The use of the device CPAP a minimum of 4 hours per night allows observation of clinical improvement. We must give ourselves a time of adaptation. Success means better sleep and wake up and can also be accompanied by a reduction in blood pressure and the disappearance of symptoms associated with sleep apnea. In addition, the effects of using the device are cumulative! The more you use it, the bigger the benefits! When all goes well, the people who use the device at P.P.C. Say they feel improvements at several levels:
- Greater vitality
- More energy and a more satisfying sex life
- Best mood
- Increased alertness at the wheel
- Better job performance
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Purchase of a device CPAP
A CPAP unit and a mask, including the required coaching and training, can cost between $1,500 and $2,200. This is currently not reimbursed by the Quebec Health Insurance Plan, but the related costs for the treatment are eligible for the medical expense tax credit. Consult the Canada Revenue Agency, Revenu Québec or a tax consultant for more information. Check also with your private insurance plan to know if the purchase of such equipment is covered. Another option is to ask your distributor if a rental program with a purchase option or a financing plan is available.
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Warning: purchase of a used device
Caution is advised for the following reasons:
- Danger that a person is treated without diagnosis.
- The adjustment of the pressure differs from the medical prescription.
- The appliance may have been spilled inside. Danger of mold.
- The origin of the appliance (eg smoker’s environment, unhealthy, bug infestation)
The Quebec Pulmonary Association prohibits this practice.
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Other treatments
Dental device
Your doctor can prescribe a dental device (for example, mandibular advancement device) moulded by a dentist. This cap splint worn in the mouth during the night maintains the lower jaw and the tongue in a forward position, which results in keeping the upper respiratory tract open. However, this type of device does not suit all patients, nor does it offer results as good as those with CPAP therapy. The dental device, used mostly for light to moderate apnea, can also cause jaw, teeth and gum problems. When it works, some patients prefer it to the CPAP.
This type of device is available in two models : a fixed one, or the more popular adjustable model. Some dentists have been specially trained to fix and adjust the dental devices.
For more information on dental devices, discuss your sleep issues with your sleep specialist so that he can arrange for consultation with a trained dental professional.
Surgery
Before considering surgery, talk about it with your doctor.
Here are the three types of surgery that could be offered to you:
- La chirurgie conventionnelle
- Uvulo-palato-pharyngo-plastie (U.P.P.P.) : It is conducted in an operating room under general anesthesia by an otorhinolaryngologist (ear-nose-and-throat specialist or ENT). Its main objective is to control snoring, but it is sometimes used for patients suffering from sleep apnea, those for whom CPAP therapy does not work.The intervention consists in removing the uvula and part of the soft palate to clear the respiratory tract. If necessary, nasal polyps or the tonsils can also be removed. This ablation can modify or reduce loud snoring, but it has limited success in curing sleep apnea. The patient may feel some pain after the surgery, but it can be relieved with drugs. It is possible that the symptom of having a dry throat may remain permanently.
- Tonsillectomy and adenoidectomy :
In children, sleep apnea is often linked to large tonsils or adenoids. These can be removed surgically to control the problem. Usually, when the swelling due to the surgery subsides, snoring and respiratory pauses stop; the child sleeps better and feels more rested and energetic. If the apnea persists despite the surgery, or if surgery is deemed not appropriate, a treatment similar to that of adults is required, for example a CPAP treatment.In some adults, either tonsillectomy or nasal surgery can be considered in order to help a patient better tolerate the positive pressure or, more rarely, in the hope of controlling sleep apnea.
- Radiofrequency procedure : This procedure consists in reducing the thickness of the throat and tongue tissues by cautery, i.e. by heating the subcutaneous tissues with a needle linked to a radiofrequency generator, thus leaving more space for the passage of air. Because it is a new treatment, it is too early to know the long-term results.
- Laser surgery : This surgery, done under local anaesthesia in many sessions, consists of reducing the throat tissues. It is important to realize that this surgery is not recommended for sleep apnea, but rather for snoring.
- La chirurgie conventionnelle
In conclusion, be aware that all types of treatments, be it a CPAP device, a dental device or surgery, must be chosen with reference to your condition. Your health care team will help you determine the most appropriate treatment. Contact your medical team if:
- You are experiencing problems with CPAP
- You have lost or gained more than 13 kg (30 lb) from the time you started using a CPAP.
- You feel that the device at CPAP Does not help you.
Tips and prevention
Following a diagnosis of chronic condition, such as sleep apnea, adopting healthy lifestyle habits will benefit you in the long run. It is advisable for anyone suffering from sleep apnea to:
Stop smoking
Smoking can worsen your symptoms of sleep apnea. Cigarette smoking promotes increased mucus production, inflammation of the respiratory tract, irritates your throat and makes you cough at night. In addition to decreasing the irritation of your throat, quitting smoking will also give you more energy for your daily physical activities.
The highly qualified staff of our 1-888-Poumon9 line of the Quebec Lung Association provides information on the tools available according to your needs to help you quit smoking and refer you to custom-cessation programs for you.
Maintaining a healthy weight
Overweight is a risk factor for sleep apnea. Adopting healthy eating and exercising regularly will help you maintain a healthy weight. A weight loss of only 10% (ie a loss of 20 pounds in a man of 200 lbs) will reduce on average by 30% the index of apnea / hypopnea. Similarly, a weight increase of 10% will increase the apnea / hypopnea index by 30% on average.
Consume alcohol in moderation and avoid taking sleeping pills or muscle relaxants
Alcohol, sleeping pills, and some pain medications can have the effect of too much relaxing the throat muscles. As a result, your airways can sag and collapse more easily. They can also make it harder for your brain to “wake up” and detect a lack of oxygen in your body. This can result in longer, more severe breathing breaks. In addition, alcohol stimulates the brain and it accentuates long-term insomnia and symptoms of lack of sleep.
Energetically treat nasal congestion and allergies
Controlling the environment and taking allergy medications (in collaboration with your medical team) should decrease your symptoms and thus promote better tolerance to P.P.C.
And to promote better sleep:
Adopt a regular sleep schedule
Going to bed and getting up at roughly the same hours every day promote better sleep. A regular sleep schedule also helps prevent “over-fatigue” which can aggravate the symptoms of sleep apnea.
Reduce caffeine intake
Coffee, tea, colas and chocolate all contain caffeine and are therefore likely to disrupt your sleep. Caffeine prolongs sleep time and can interrupt sleep overnight.
Sleep on the side
Sleeping on the side does not cure sleep apnea. Sleeping on your side rather than on the back can however reduce the severity of apnea as when you sleep on your back, gravity stretches the tissues of your throat and neck, which can narrow the airways or block completely.
It is possible to train to sleep on the side:
By placing pillows in your back to support you.
By inserting a tennis ball on the back of your pajamas to avoid turning over on your back or using a backpack without armature filled with bath towels! If you start rolling on your back during your sleep, the pressure of the tennis ball or backpack will make you return to the side.
Recommendation
The use of CPAP is required every night or nap during the day.
When traveling, you must:
- Bring your device, mask tubing as hand luggage in the plane.
- A power adapter. (Europe)
- To have with you a copy of the medical prescription.
- Have a copy of the purchase or rental invoice (customs).
During a stay in the hospital, you must bring your device.
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Driving and drowsiness
Almost everyone knows the dangers of impaired driving, but at the same time, few people realize that drowsiness while driving can have equally tragic consequences. Like alcohol, fatigue slows reflexes and reaction time, decreases attention, distorts judgment and increases the risk of an accident. A blank night is equivalent to a blood alcohol level of 0.08. A tired driver poses a danger to himself and others. People with sleep apnea who are not treated are twice as likely to be involved in a road accident.
According to a US transportation company, a study showed a 30% reduction in accidents and a 48% reduction in associated costs. According to the SAAQ (Société de l’assurance automobile du Québec), fatigue would be involved in 19% of fatal accidents and in 23% of all accidents involving bodily injuries on Québec roads. Fatigue experienced by the driver would be the determining factor in 30% to 40% of fatal accidents involving a heavy vehicle. This excess risk is corrected by the assiduous use of the apparatus at P.P.C.
Your diagnosis of sleep apnea should be reported to the SAAQ. By stating your condition as well as the treatment used, you will be in good standing, in case of an accident.
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Sleepiness test
All people who suffer from sleep apnea are not sleepy during the day. However, if you want to know your level of drowsiness, answer this test.
What are the risks of falling asleep or falling asleep in the following situations?
Associate a note with each proposal:
Epworth Scale
0 = no chance of drowsiness
1 = slight chance of drowsiness
2 = Moderate chance of drowsiness
3 = strong chance of drowsiness- Reading in sitting position
- Watching TV
- Sitting, inactive in a public place (for example, at the theater or during a meeting)
- As passenger in the car, for a period of at least one hour
- For an afternoon siesta, when circumstances allow
- During a conversation, sitting and face-to-face
- Sitting after a non-alcoholic meal
- At the wheel of your car, during the few minutes waiting at the traffic light
If your score is greater than 10, you are more somnolent than the average population. Talk to your doctor.
If your result is less than 10, but you show some symptoms or suffer from the conditions listed above, it would be good to talk to your doctor.
Did you know that
The Quebec Lung Association offers direct services to the population. For more information, visit our Patient Resources section.