Devices for dealing with Sleep Apnea 
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 Devices for dealing with Sleep Apnea

I am interested in devices for use with Sleep Apnea.  I am
generally familiar with the CPAP machine.  But I have heard
there is a plastic mouthpiece now being used.

Are there any mailing lists related to Sleep Apnea.



Sun, 07 Sep 1997 15:40:25 GMT
 Devices for dealing with Sleep Apnea

Quote:

> I am interested in devices for use with Sleep Apnea.  I am
> generally familiar with the CPAP machine.  But I have heard
> there is a plastic mouthpiece now being used.


When we sleep, muscles in the throat relax, narrowing the air passages.
If this narrowing is enough that the walls touch, the air passing
through makes them vibrate together, producing snoring.  If the walls
collapse further so that no air gets through, obstructive sleep apnea
(OSA) results.  The spouse hears the loud snoring of a patient with OSA
broken by pauses which are followed by a gasp.  During the pause, the
airway is completely sealed.  The inability to breath rouses the patient
to lighter levels of sleep whereupon muscle tone increases and the
airway opens again.  Simplistically, these patients can either sleep or
breathe but not both.  The result is that they are constantly tired
during the day, falling asleep at unwanted times.  They have an
increased risk of accidental injury and death, particularly when
driving, as well as headaches, weight gain, hypertension, heart disease
and stroke.  OSA is a life-threatening disorder but the patient and
sometimes even a sound-sleeping spouse may have no idea that the
problem exists.

Snoring without apneas is not associated with daytime sleepiness, has
less risk, and is mainly a problem for the snorer's family, particularly
the spouse, although the familial disruption can be enough to break up a
marriage.  Both snoring and sleep apnea are easily treatable.  If you
have OSA you should consult a sleep disorders specialist without delay.
For snoring without apneas, there are some simple things you can try
first which may be helpful.

{*filter*} is a potent muscle relaxant and is often the sole cause of a
patient's OSA or snoring problem.  Patients with OSA should probably
abstain completely from {*filter*}, or at least limit themselves to one
before-dinner drink.  Some medications taken at night can cause similar
problems, for example some antidepressants and seizure medications.  If
you suspect one of these, ask your doctor about taking the medication at
a different time.

Weight loss will often cure snoring in the overweight.  If the snorer
suffers from chronic nasal congestion, perhaps from a deviated septum,
nasal polyps, or allergies, treating these problems can sometimes
eliminate snoring and apneas (see an otolaryngologist or allergist).  If
the snorer snores only when lying on his back and you are tired of
giving or receiving "elbow therapy", try putting a tennis or whiffle
ball in a sock and safety-pinning it to the back of the pajamas so the
ball pokes the patient between the shoulder blades if he rolls on his
back.  There are snore pillows sold which tip the chin up and head
backward to better open the airway.  The spouse can wear earplugs (this
is one of the cheapest and most effective solutions to snoring without
apneas).

For OSA, or for snoring if the above measures don't work as they often
don't, see a sleep disorders specialist for help.  If OSA is suspected,
a polysomnogram (overnight recording of your sleep) will be scheduled,
measuring brain waves (for sleep stages), breathing patterns, oxygen
saturation, muscle activity, and other parameters.  If OSA is confirmed,
Nasal Continuous Positive Airway Pressure (CPAP) can be administered
through a mask over your nose, either that night or on a second night,
and the pressure adjusted until the snoring and apneas are gone.  If it
works, you get a unit to use at home.  Breathing against a little
pressure keeps the airway from collapsing and eliminates both snoring
and obstructive apneas.  This works better than anything else in
resistant cases of snoring and is standard treatment for obstructive
sleep apnea.  Recent improvements in the technique have made acceptance
very good.  BiPAP (Bilevel Positive Airway Pressure) senses when you are
breathing out and cuts the pressure, and may be well tolerated when CPAP
is not.  Plugs placed into the nostrils are an alternative to the CPAP
mask and may be preferred by some patients.

A few patients can't tolerate CPAP or aren't controlled even at high
pressures.  For them, surgery is an option.  The oldest and most
effective operation for OSA is tracheostomy, but this is rarely done now
because of cosmetic and other long-term problems.  Laser-assisted
uvulopalatoplasty (LAUP) can be done in the doctor's office over several
visits.  It is less clear that it is helpful for OSA than for snoring,
and most insurance companies will not pay for treatment of snoring
without obstructive sleep apnea, so if you want a LAUP for snoring you
are probably stuck paying for it out of pocket.  Personally I'd rather
spend about the same amount and get a CPAP machine.  There are several
other surgical procedures which may be best for certain patients.  In
general surgery is less effective than CPAP, but sometimes surgery
followed by CPAP will work when CPAP alone doesn't.  Success has been
reported with training patients to pass a tube through their nose into
their throat every night to keep the airway open (no thanks).

There are other less invasive treatments that help an occasional
patient.  If the point of greatest upper airway resistance is in the
nose, an adhesive-backed leaf spring applied to the outside of the nose
to hold it open at night may help.  These can be found in most drug
stores.  You may have noticed some professional atheletes wearing them
during games.  A dentist or {*filter*}surgeon can make you a mandibular
advancement prosthesis, a piece of plastic worn in the mouth which has
the impressions for the lower row of teeth forward from the upper row to
pull the jaw forward.  A tongue-retaining device worn in the mouth at
night can sometimes help by holding the tongue forward.  I haven't found
any of these appliances to work in more than a small percentage of
patients with snoring, fewer with true with sleep apnea.


For all but the elite, work holds less promise, less purpose, less
security and less dignity than a generation ago -- Peter T. Kilborn



Mon, 08 Sep 1997 13:20:07 GMT
 
 [ 2 post ] 

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