HYANNIS – Sleep apnea, a chronic condition that results in brief periods when breathing stops during sleep, leaves the patient exhausted and can affect everything from their health to their domestic relations.
CPAP, a breathing assistance device often prescribed for people with sleep apnea, can be a lifesaver, but a large number of patients give up on the treatment before it can effectively do its job.
“It’s said that between 30 and 80 percent are not successful,” said otolaryngologist and plastic surgeon J. Nicholas Vandemoer, MD of Hyannis Ear, Nose and Throat Associates.
Most of the problems patients experience with a CPAP machine can be solved, if the patient wants the treatment to work and their supplier makes the effort to properly fit the patient and stays in contact to address issues, he said.
For the treatment to work a patient needs the support of his doctor, his CPAP supplier and his family, Dr. Vandemoer added.
Personal and Social Costs
A person with sleep apnea stops breathing for many short periods during sleep. This triggers the body to wake up, which restores breathing, but the interrupted sleep leaves the person fatigued and can result in high blood pressure, contribute to obesity, or even death.
Some of the people who die in their sleep may have succumbed while in a sleep apnea state, said Dr. Vandemoer said.
“He died in his sleep because his oxygen level got so severe that he had a fatal sinus arrhythmia. Patients can have a stroke because of lack of oxygen,” he said.
However, those who already have cardiovascular disease may not avoid a heart attack or stroke, even if they are using a CPAP device. A recent international study published in the New England Journal of Medicine found that CPAP did not prevent severe cardiovascular events — including death, heart attacks and stroke — in patients with moderate to severe obstructive sleep apnea who already had heart disease. The study’s 2,717 participants were mainly men with moderate to severe obstructive sleep apnea and minimal daytime sleepiness who used CPAP for about 3.3 hours a night.
The study did find that CPAP significantly improved mood and lessened daytime sleepiness.
Symptoms of sleep apnea include:
- Snoring
- Daytime drowsiness
- Heartburn
- Obesity
The exhaustion caused by sleep apnea has personal and social costs.
“The person that has sleep apnea, they’re dangerous if they’re driving or if they’re using mechanical equipment,” Dr. Vandemoer said.
Sleep apnea can be treated with dental devices that force the jaw and tongue forward, electrical devices that stimulate the tongue from blocking the windpipe and surgery to remove obstructions, but CPAP “is the gold standard,” he said.
A Supportive Sleep Partner Helps
A CPAP machine consists of a mask that fits over the nose and mouth, just the nose, or only the nostrils, and is held in place by straps and connected by an air hose to the machine that controls and monitors the air pressure.
The key to success with a CPAP is whether a patient comes in with a determination to solve the problem, Dr. Vandemoer said.
“Are they referred by their doctor because they’re overweight, hypertensive, have diabetes, stroke? That’s maybe the patient who won’t do so well.”
The people who seek help due to an insistent partner tend to be more motivated, Dr. Vandemoer said. The snoring caused by apnea in the one partner results in lost sleep in the other, and many end up sleeping apart.
How It’s Diagnosed
Sleep apnea is diagnosed after a doctor orders a sleep study. According to Dr. Vandemoer, most insurance companies won’t pay for a study in a lab with trained staff and monitoring equipment, but instead opt for a home study, in which a machine is mailed to the patient, who then must follow directions on how to proceed. A sleep doctor later analyzes the machine’s recording of its performance.
But home studies aren’t of the same caliber as those done in a sleep lab, he said.
“There’s no tech to make sure you know how to use it,” he said.
Trained doctors and technicians at sleep labs, like the one Cape Cod Healthcare operates at Falmouth Hospital use an EEG report, which monitors brain waves while the patient is sleeping, in order to see what stage of sleep the patient is in. The ones that have serious sleep apnea never reach an important stage of sleep known as the REM, or Rapid Eye Movement stage, Dr. Vandemoer said.
If sleep apnea is diagnosed, the patient selects a CPAP supplier.
“The first week is most important,” Dr. Vandemoer said.
Gary Sheehan, president and CEO of Cape Medical Supply, agreed with Dr. Vandemoer that it’s “very much a team effort” of doctor, supplier and patient to make use of CPAP successful. He said the national average of patient compliance with CPAP is 55 percent, but estimated his company’s success rate at 75-80 percent. This number has been reached through both advances in technology that allow patient use of the machine to be monitored remotely and by hiring trained staff that works closely with patients to educate them about sleep apnea and use of their machines, he said.
Often these initial discussions include the patient’s bedmate, who may be more aware than the patient of how he or she snores or gasps during sleep.
Sheehan’s staff quickly responds if the data they receive from a patient’s machine indicates problems.
It Takes Time to Adjust
Patients need time to adjust to sleeping with a mask and to learn how to operate their machine. A patient might only use the mask two hours the first night, with the goal to gradually get up to four hours, then six, Dr. Vandemoer said.
Proper treatment also requires patients to be honest about the medications or illegal drugs they take, and how much alcohol they drink. If they typically have several drinks at night before sleeping, that affects the amount of air pressure a CPAP machine would have to deliver to be effective.
“Alcohol is deadly because it messes up that (tongue) muscle,” Dr. Vandemoer said.
Once fitted, a patient’s CPAP use is tracked.
“Medicare mandates we see a patient within three months with a download from that machine saying how many days and how many hours they did use it,” he said. “If they’re not compliant, if they’re not seeing six hours, they take the machine away.”
Using a CPAP machine is typically a lifelong commitment.
“If you miss a night, it makes a big difference,” Dr. Vandemoer said. “Benefits you’ve gained are rapidly lost. You have to use it every single night.”
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