Pharmacotherapy Options In The Treatment Of Obstructive Sleep Apnea
Kimberly L. Tackett, PharmD, BCPS, CDEAssociate ProfessorSouth University School of PharmacySavannah, Georgia
South University School of PharmacySavannah, Georgia
Obstructive sleep apnea is a form ofsleep-disordered breathing that is characterized by frequent episodes ofsnoring and a cessation in breathing for greater than 10 seconds,resulting in disrupted sleep.1 It has an estimated prevalenceof 3% to 7% in males, 2% to 5% in females, and up to 78% in morbidlyobese patients. OSA results from decreased motor tone of either thetongue or airway dilator muscles, causing complete or partialobstruction of the upper airway during sleep.1,2 Patientswith OSA frequently suffer from daytime sleepiness and reduced qualityof life, as well as cardiac, metabolic, and psychiatric disorders. OSAaffects people of all ages and is most prominent in middle-aged obesemales, with a higher incidence as age increases. Obesity is the primaryrisk factor and contributes to the other disorders commonly diagnosed inthis population.3
Anesthesia And Pain Medicine
The presence of sleep apnea presents special challenges to the administration of anesthesia and pain medications that may affect respiration or relax muscles. Since most people who have sleep apnea dont know it, the anesthesiologist or pain clinician is well advised to screen the patient for OSA before proceeding. Should it be determined there is a likelihood that OSA is present, the next move is to order a sleep study to make sure or, at a minimum, to take the precautionary steps that should be taken with a patient whose sleep apnea has been diagnosed. These procedures are laid out in greater detail here. See also this article from two Mayo Clinic physicians
This summary of obstructivesleep apnea treatments is adapted from an article written by John Sotos, M.D., a member of the American Sleep Apnea Associations board of directors, and appears here by permission. The original may be viewed at . Obstructive sleep apnea and snoring respond to several types of treatment.
What Are The Symptoms Of Central Sleep Apnea
Most people with central sleep apnea present with disturbed sleep, such as excessive daytime sleepiness, fragmented sleep, waking up feeling unrefreshed, or having morning headaches. As you can imagine, these symptoms are quite non-specific, and one should seek a healthcare professional for further evaluation if these symptoms are present.
Tips To Improve Health And Comfort
Choose a CPAP device with a built-in humidifier. Most devices now include a built-in humidifier, which helps prevent the dryness and skin irritation that can sometimes occur.
If youre experiencing nasal congestion, you may prefer a full-face mask over a nasal or nasal pillow mask. Also be sure to keep your humidifier tank full, keep your tubing and mask clean, and make sure your filter is clean. Nasal sprays and antihistamines also help.
Keep your device clean. Its very important to clean your CPAP hose, nosepiece or mask, and humidifier tub regularly, as a dirty CPAP device can cause infections and even pneumonia. Your sleep doctor and device manufacturer will give you detailed cleaning instructions.
To ensure maximum comfort, ask your doctor about soft pads to reduce skin irritation, nasal pillows for nose discomfort, and chinstraps to keep your mouth closed and reduce throat irritation and dry mouth.
Mask the sound of the CPAP machine. Most new CPAP devices are quiet, but if the sound of your CPAP machine bothers you, try placing it beneath the bed and using a sound machine to muffle the noise.
Treating Sleep Apnea With Patient Education And Lifestyle Changes
An initial component of treatment for obstructive sleep apnea is informing the patient about the condition and how it may be helped by specific lifestyle changes.
Obstructive sleep apnea can cause significant daytime drowsiness, and its important for people with OSA to be aware of this issue, especially if they spend significant time driving or operating heavy machinery.
Patient education also involves explaining the factors that contribute to OSA. Making lifestyle changes described in the following sections losing weight, exercising regularly, limiting use of alcohol and sedatives, avoiding cigarette smoking, and adjusting sleeping position can reduce the severity of OSA.While these changes can play an important part in obstructive sleep apnea treatment, they may not resolve the condition completely and often need to be combined with other therapies to reduce symptoms of OSA.
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How Is Central Sleep Apnea Different From Obstructive Sleep Apnea
In obstructive sleep apnea, a person makes a notable effort to breathe, but the airway in the back of the throat is blocked. The blockage in the back of the throat causes an obstruction to our windpipe, which leads to sleep fragmentation and a disturbed oxygen balance in the body.
In central sleep apnea, the problem isnt a blocked airway. Instead, pauses in breathing occur because the brain and the muscles that control breathing arent functioning properly. As a result, there is no normal respiratory effort, which is in clear contrast to OSA.
While OSA and CSA are separate conditions, they can arise at the same time in what is known as mixed sleep apnea. In addition, treatment of OSA with continuous positive airway pressure , can induce central sleep apnea, and this is called treatment-emergent central sleep apnea.
Continuous Positive Airway Pressure
With continuous positive airway pressure , you wear a mask over your nose or mouth while you sleep. The mask is hooked up to a machine that delivers a constant flow of air into your nose. This airflow helps keep your airways open so you can breathe the way you should. CPAP is the most common treatment for sleep apnea.
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What Are The Health Risks Of Sleep Apnea
Sleep apnea can lead to sleep deprivation from constant nightly interruptions and shallower overall sleep. Lack of sleep is associated with far-reaching health consequences that affect a person physically, mentally, and emotionally, and as a result, it comes as no surprise that sleep apnea has been tied to diverse health problems.
Because of how it affects oxygen balance in the body, untreated sleep apnea raises dangers for various types of cardiovascular issues including high blood pressure, heart attack, heart disease, and stroke.
Stick To A Regular Sleep Schedule
Going to bed and waking up at roughly the same times every day helps you to get the right kind of sleep. You need to experience the full cycle of deep- and lighter-stage sleep to feel well rested. A regular sleeping schedule also prevents you from getting overtired, which can make sleep apnea symptoms worse.
How To Get Rid Of Sleep Apnea
If youve been diagnosed with sleep apnea or even suspect you may have it, you probably know that its important to have it treated before it leads to other, more serious health conditions. The good news is that most cases of sleep apnea can be easily treated. The even better news is that many cases of obstructive sleep apnea can be completely cured. If you arent sure how to get rid of sleep apnea, dont stress because we have provided information on how to cure sleep apnea, as well as sleep apnea treatments without CPAP equipment.
What Is Positional Therapy
Positional therapy is a behavioral strategy to treat positional sleep apnea. Some people have sleep apnea primarily when sleeping on their back. This is called the supine position. Their breathing returns to normal when they sleep on their side.
Positional therapy may involve wearing a special device around your waist or back. It keeps you sleeping in the side position.
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Natural Remedies For Sleep Apnea
Caitilin Kelly, MD, is a clinical physician at Indiana University Health Bloomington Hospital and is board-certified in internal medicine.
Sleep apnea is a serious and common condition marked by pauses in breathing while you sleep. Occurring up to five times per hour, breathing pauses may last 10 to 20 seconds or longer. Sleep apnea often disrupts sleep, resulting in poor sleep quality and daytime sleepiness.
How Is Sleep Apnea Diagnosed
If your doctor determines that you have symptoms suggestive of sleep apnea, you may be asked to have a sleep evaluation with a sleep specialist or may order an overnight sleep study to objectively evaluate for sleep apnea.
- Testing includes an overnight sleep study called a polysomnogram . A PSG is performed in a sleep laboratory under the direct supervision of a trained technologist. During the test, a variety of body functions, such as the electrical activity of the brain, eye movements, muscle activity, heart rate, breathing patterns, air flow, and blood oxygen levels are recorded at night during sleep. After the study is completed, the number of times breathing is impaired during sleep is tallied and the severity of the sleep apnea is graded.
- For adults, a Home Sleep Test can sometimes be performed instead. This is a modified type of sleep study that can be done in the comfort of home. It records fewer body functions than PSG, including airflow, breathing effort, blood oxygen levels and snoring to confirm a diagnosis of moderate to severe obstructive sleep apnea.
An HST is not appropriate to be used as a screening tool for patients without symptoms. Its not used for patients with significant medical problems . Its also not used for patients who have other sleep disorders in addition to the suspected obstructive sleep apnea.
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Benzodiazepines Opiates And Barbiturates Can All Impact Breathing
Sanja Jelic, MD, is board-certified in sleep medicine, critical care medicine, pulmonary disease, and internal medicine.
If you use certain prescription medicationssuch as benzodiazepines, opiates or opioids, and barbituratesyou may wonder how these can affect your risk of sleep apnea. As these medications can have impacts on both sleep architecture, muscle tone, and breathing, the consequences can be important.
Mouthguards And Oral Devices
Mandibular advancing devices are oral devices that resemble sports mouth guards and work in the same way as snoring mouthpieces. They are specially adjusted by sleep apnea dentists to move the lower jaw forward and open the airway wider during sleep. Many of these devices are adjustable as they are often made of plastic or silicone. Some are hinged, meaning that you can open your mouth with the device still in place.
Although sleep apnea oral appliances can be a simple and cost-effective CPAP alternative, they may cause tooth shifting and temporal mandibular joint pain.
Treating Sleep Apnea At Home
You may be able to treat mild sleep apnea with some lifestyle changes. Your doctor may recommend that you:
- Lose weight. About half of people with sleep apnea are overweight. If you have some extra weight, you might also have extra tissue in your throat that makes it harder to breathe. Losing weight — even a few pounds — can often improve your symptoms.
- Donât use alcohol and sleeping pills. They decrease the muscle tone in the back of your throat, which can interfere with air flow.
- Change sleep positions. You may breathe more easily if you stay off your back. Hereâs a trick to keep from rolling over: Put two tennis balls into a tube sock and pin it to the back of your pajamas.
- Stop smoking. Smoking can increase swelling in your upper airway, which may make both snoring and apnea worse.
- Treat allergies. Nasal allergies swell the tissues in your airways and make them narrower, so itâs harder to breathe. Ask your doctor how to get them under control.
Degrees Of Severity Of Sleep Apnoea
The full name for this condition is obstructive sleep apnoea. Another rare form of breathing disturbance during sleep is called central sleep apnoea. It is caused by a disruption to the mechanisms that control the rate and depth of breathing. The severity of sleep apnoea depends on how often the breathing is interrupted. As a guide:
- normal sleep fewer than five interruptions per hour
- mild sleep apnoea between 5 and 15 interruptions per hour
- moderate sleep apnoea between 15 and 30 interruptions per hour
- severe sleep apnoea more than 30 interruptions per hour.
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The Dangers Of Using Sleep Aids For Sleep Apnea Treatment
is one of the most common sleep disorders in the US, but according to the American Sleep Apnea Association, about 80% of people with the condition are either undiagnosed or misdiagnosed, meaning they are going completely untreated. As a result, many turn to a variety of sleep aids to help them get the rest they need. If youre suffering from OSA, could taking an over-the-counter-sleep aid serve as an effective sleep apnea treatment? Unfortunately, many common sleep aids can actually make the condition much worse, and they should be avoided if you have the slightest hint that youre suffering from sleep apnea.
Treatment For Obstructive Sleep Apnoea
OSA is a long-term condition and you may need lifelong treatment to control the symptoms. There are effective treatments and changes you can make to improve your wellbeing.
Treatment focuses on reducing the number of breathing pauses you have when youre asleep. You should feel less sleepy during the day, have a better quality of life and reduce your risk of getting health complications and having accidents.
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Maintain A Healthy Weight
Doctors commonly recommend people with sleep apnea to lose weight. Obesity, specifically in the upper body, can increase the risk of airway obstruction and narrow nasal passages. These obstructions can cause you to stop breathing suddenly or for lengths of time while sleeping.
Maintaining a healthy weight can keep your airways clear and reduce sleep apnea symptoms. Research shows that modest weight reduction in people with obesity can eliminate the need for upper airway surgery or long-term CPAP therapy.
In some cases, weight loss can eliminate sleep apnea. However, if you regain the weight, its possible for the condition to return.
What Is Sleep Apnea Symptoms Diagnosis And Treatment Options
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Sleep apnea is a serious sleep disorder in which a persons breathing is interrupted during sleep. People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night.
Left untreated, sleep apnea results in many health problems, including hypertension , stroke, cardiomyopathy , heart failure, diabetes, and heart attacks.
Untreated sleep apnea can also cause job impairment, work-related accidents, and motor vehicle crashes, as well as underachievement in school in children and adolescents.
Sleep is most crucial to both our physical and mental wellbeing and should always remain a priority in maintaining our health. However, in our modern and busy world, sleep seems to be the first thing that people are willing to sacrifice, intentionally or not, to meet other goals.
If, however, you are one of the few people who does make the effort to sleep for the recommended amount of time and still feel tired and sluggish in the mornings, you might have an underlying health condition that is diminishing the quality of your sleep.
Sleep apnea is one of the most prevalent conditions that cause this, affecting the bodys ability to intake oxygen in its slumbering state.
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Make Sure Your Mask Fits Correctly
When it comes to CPAP therapy, one size does not fit all. Its very important to get a mask that fits correctly and is comfortable for you.
There are many different types of masks available, including ones that cover the full face and ones that cover only the nose. Masks also come in a range of sizes, to accommodate different face shapes. There are also options that allow you to sleep in any position, accommodate glasses, and stay on if you toss and turn.
Be sure to discuss your options with your doctor and schedule follow-up appointments to check the fit, evaluate your treatment progress, and adjust or switch your mask if necessary.
Sleep Apnea Cardiovascular Risk And Metabolism
Several studies have shown an association between sleep apnea and problems like type 2 diabetes , strokes , heart attacks and even a shortened lifespan, says Jun. Why this connection? For one thing, obesity is common in sleep apnea patients, and obesity greatly increases risks of diabetes, stroke and heart attack, he says. In most cases, obesity is the main culprit behind both conditions, Jun explains.
Still, its important to note that not everyone with sleep apnea is obese. Furthermore, evidence suggests an independent link between sleep apnea and diabetes. Our lab and others have shown that sleep apnea is associated with higher risks of diabetes, independent of obesity, and that sleep apnea can increase blood sugar levels, says Jun.
For people who are overweight or obese, weight loss is key for treating or avoiding sleep apnea. People who accumulate fat in the neck, tongue and upper belly are especially vulnerable to getting sleep apnea. This weight reduces the diameter of the throat and pushes against the lungs, contributing to airway collapse during sleep.
Women in particular should be careful as they age. While premenopausal women tend to put on weight in the hips and in the lower body instead of the belly, this shifts with time. Weight begins to accumulate in traditionally male areas like the tummy, and this leads to a greater chance of sleep apnea.
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