(Correction: In my previous column on sexually transmitted diseases, I inadvertently equated Human Papilloma Virus (HPV) to genital herpes virus. HPV is an entirely different virus than genital herpes virus.)
What is CPAP?
CPAP stands for Continuous Positive Airway Pressure, the best treatment, the accepted evidence-based standard of care, for persons with confirmed Obstructive Sleep Apnea (OSA).
What is OSA?
OSA is a condition where the individual takes very shallow (ineffective breaths during sleep, or even holds his/her breaths for an abnormally prolonged period of time (apnea) for dozens of times during the night, depriving the person of oxygen, which could lead to arrhythmias (heart irregularity) and in some cases, heart attack and even death. Unfortunately, not every healthcare provider, even today in the United States, recognizes OSA as a significant factor in the causation of metabolic (diabetes-T2 and other endocrine) illnesses, cardiovascular and respiratory diseases, and alarmingly, even of various cancers.
What causes OSA?
There are some individuals whose anatomy of the throat allows the soft palate (roof of mouth at the back) to fall back and block the upper airway passage while asleep. This obstruction is commonly seen among those who snore, but not all who snore has OSA. This obstruction makes the diaphragm and the chest muscles work a lot harder to bring air into the lungs, momentarily waking up the person, on and off, jerking, choking, and gasping for breath several times during sleep.
What are the dangers of OSA?
Besides the arrhythmias and possible heart attack, OSA also deprives the person of a restful, satisfying sleep. As alluded to above, OSA has been linked to increased risk for metabolic and cardiovascular diseases and to elevated risk for cancer. Lack of sleep also decreases the sense of well-being, mental acuity, concentration, work performance, and all these expose other people, society in general, to the danger of driving accidents. Those with untreated OSA are also less efficient, more forgetful, and cranky members of the work force. They are always tired, have excessive daytime sleepiness (EDS), and doze off frequently. They lack stamina and their sex life is also affected. Almost all of these individuals do not realize OSA is the cause of their problem. Actually, even among physicians, OSA, while common, is still an under-recognized and under diagnosed medical entity.
How common is OSA?
One in five Americans, or about 60 million, have obstructive sleep apnea, 4 percent among males and 2 percent among females. Extrapolated figure for the Philippines would place the incidence at about 4-5 million Filipinos suffering from OSA. In Hong Kong, the prevalence is about 7 percent, in India, 13.7 percent. Its only in the past 2 decades or so that physicians have been more aware of OSA and CPAP therapy and have been referring more and more patients to Pulmonologists for Sleep Studies. The “epidemic” of OSA is more common than we think.
What are the associated predictors?
The typical associated predictors for those who are prone to develop OSA are: male more than female, older age group, usually above 40, greater BMI (Body Mass Index, obesity), larger neck circumference and waist to hip ration, smoking, snoring, high blood pressure, longer time to fall asleep, and higher Epworth Sleepiness Scale score. To some extent, family history of OSA.
How is the diagnosis confirmed?
When the physician suspects a person to have OSA, the diagnosis is confirmed by a Sleep Study (Polysomnography). This study, which requires sleeping overnight in a sleep clinic or hospital, where the person is connected to various devices to monitor, among others, the brain activity, oxygen level, EKG, heart rate and breathing rate, while a video records movements and snoring, etc., while asleep. When positive for OSA, the diagnosis is confirmed, and a second night needs to be spent in the sleep clinic to titrate the CPAP parameters needed for actual CPAP therapy, like how much pressure is needed to keep the airway open (which differs per person), etc. These parameters are used when prescribing the CPAP therapy. The machine will be calibrated and set according to the person’s needs for an effective use every sleeping hour each day.
How comfortable is CPAP use?
Contrary to what might think as “obvious,” the use of CPAP mask or nasal pillows (depending on the user’s preference after trying them) at bedtime is surprisingly comfortable. After getting used to it within a week or so, the user might even miss it or might not feel secure without it. The CPAP machine has a controlled water heater reservoir which provides warm humidified air. Using it religiously provides a sense of safety from lack of oxygen and from developing a heart attack. CPAP use among those with OSA assures them a more restful and satisfying sleep every day. Many prefer the nasal pillow, but if one is a mouth-breather, the mask is recommended.
Is CPAP use for life?
Yes, since OSA is only treatable but not curable, one has to use CPAP for life. But as I have alluded to, once one is used to it, CPAP use could be “addicting” (reassuring is the more appropriate term) because of its life-saver reputation and all the benefits CPAP provides, including a satisfying restful sleep.
Are other gadgets any good?
Countless “non-CPAP” gadgets advertised on various media are useless and not scientifically based. They market the items to stop snoring, but snoring is not the cause of OSA. The CPAP stops snoring also. Snoring is only a symptom. Even if you stop snoring, the blocked airway is still there. The treatment should be directed to the collapsing airway passage, by “filling it up” with continuous high pressure (enough to keep the airway open for effective respiration) so oxygen can get into the lungs. Without exception, all those “non-CPAP” marketed items are useless and a waste of money. They are also dangerous because they provide a false sense of security, which could delay or preclude proper and prompt medical consultation and avoid a medical disaster.
More and more physicians, other healthcare providers, and the public are becoming aware and acutely conscious about OSA, its diagnosis, and the wonderful CPAP treatment. This trend is gratifying because the earlier the diagnosis is confirmed and the CPAP therapy is instituted, the sooner the incidence of all OSA-linked diseases listed above will be minimized through prevention around the world.