Sleep apnea and snoring

Symptoms

It is important to note that a person with sleep apnea rarely has all these symptoms and even, on occasion, very few symptoms.

• Wake-ups repeated during the night
• Frequent trips to the bathroom during the night
• Non restorative sleep
• Headaches on waking
• Snoring
• Respiratory stops observed by the spouse
• Fatigue, excessive sleepiness during the day
• Decrease in energy level
• Lack of concentration / impairment of judgment
• Decreased vigilance
• Choking or suffocation during sleep
• Excessive perspiration during sleep
• Memory loss
• Irritability, change of mood and nervousness
• Depression / anxiety
• Hypertension (high pressure)
• Decreased libido – erectile dysfunction

Who suffers from sleep apnea?

• One in six adults has mild sleep apnea
• At least one in fifteen has moderate sleep apnea
• At least one in twenty suffers the consequences of sleep apnea during the day
• Men, women and children of all ages can be affected
• Most people do not know that they suffer from it; therefore, they are not treated

What are the factors that promote the development of sleep apnea?

• The shape of the face and neck: wide neck, receding chin, narrow face
• The size of the upper respiratory tract
• A narrow pharynx – long palate
• Size of adenoids and tonsils
• Nasal obstruction / mouth breathing
• The age
• Sex (men being more at risk)
• Overweight
• Respiratory allergies
• The consumption of alcohol and/or drugs
• Smoking

Treatments for sleep apnea

Following a diagnosis of a chronic condition, such as sleep apnea, adopting healthy lifestyle habits will benefit you in the long run. The treatment will then depend on the severity of the symptoms and their causes.

Correction of snoring by surgery

• Produced by the soft palate when it comes into vibration, snoring usually occurs during sleep or at the time of naps. It may be difficult for both those who suffer this vibrational phenomenon and those who produce it. There are both minor and painless surgeries that can effectively treat snoring.

Correction of apnea by surgery

• Often misunderstood, sleep apnea syndrome is a danger for snorers with cardio-respiratory risks, the psychological, social and professional consequences that result. It is now possible to surgically treat and cure apnea.

Treatment of sleep apnea and snoring without surgery

• Adopt healthy lifestyle habits
• Continuous Positive Airway Pressure Devices (P.P.C.)
• Oral appliance

A) Adopt healthy lifestyle habits

It is recommended for anyone with sleep apnea to:

Stop smoking

Smoking can worsen your sleep apnea symptoms. Indeed, smoking promotes increased mucus production, causes inflammation of the airways, irritates your throat and makes you cough during the night. In addition to lessening the irritation of your throat, quitting will also give you more energy for your daily physical activities. The highly qualified staff of the Quebec Lung Association’s Lung-9 line provides information on the tools available to meet your needs to help you quit smoking and refers to cessation programs that are tailor-made for you.

Maintain a healthy weight

Being overweight is a risk factor for sleep apnea. Adopting a healthy diet and exercising regularly will help you maintain a healthy weight. Weight loss of only 10% (for example, a loss of 20 lb. in a 200 lb man) will reduce the apnea/hypopnea index by an average of 30%. Similarly, a 10% increase in weight will increase the apnea/hypopnea index by an average of 30%.

Tip: If you exercise at the end of the day, it is recommended to do it three hours before going to bed. An intense activity before bedtime could disturb your sleep.

Consume alcohol in moderation and avoid taking sleeping pills or muscle relaxants:

Alcohol, sleeping pills and some painkillers can cause too much relaxation of the throat muscles. As a result, your airways can collapse and become blocked more easily. They can also make it more difficult for your brain to   » wake up  » and detect a lack of oxygen in your body. This can lead to longer and more severe breathing pauses. In addition, alcohol stimulates the brain and accentuates long-term insomnia and symptoms of sleep deprivation.

Tips:

Avoid drinking at least 6 hours before going to bed.
Always tell doctors about your condition, especially when prescribing pain medications or sleeping pills.
Treat aggressively nasal congestion and allergies

Controlling the environment and taking allergy medications (in collaboration with your medical team) should reduce your symptoms and thus promote a better tolerance to P.P.C.

Adopt a regular sleep schedule

Going to bed and getting up at about the same time every day promotes better sleep. A regular sleep schedule also helps prevent excessive sleepiness which can worsen the symptoms of sleep apnea.

Reduce caffeine consumption

Coffee, tea, colas and chocolate all contain caffeine and are therefore likely to disturb your sleep. Caffeine prolongs sleep time and can interrupt sleep during the night.

Tips:

Avoid consuming a caffeinated food during the 6 hours before bedtime.
If you have difficulty falling asleep, take an herbal tea or hot milk, try reading or taking a warm bath.
Sleep on your side

Sleeping on your side does not cure sleep apnea. Sleeping on the side rather than the back can however reduce the severity of the apnea since when you sleep on the back, the gravity stretches the tissues of your throat and your neck, which can shrink the upper airways or block them completely.

Tips: 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 on your back or using a backpack without a frame filled with towels! If you start riding on your back while you sleep, the pressure of the tennis ball or backpack will make you go back to the side.
If sleep apnea is moderate to severe, more intensive treatment will be required. It is usually treated with a P.P.C. apparatus, that is, a continuous positive air pressure ventilator, also known as C.P.A.P.

B) Continuous Positive Airway Pressure Devices (CPAP)

The apparatus at P.P.C. is the best treatment for patients with obstructive sleep apnea. Continuous positive pressure or P.P.C. means that air is pushed by a continuous positive airway pressure to keep them open. This pressure must be adjusted using a titration test.

Your doctor will prescribe the most appropriate type of device according to your diagnosis, taking into account, as needed, the other diseases you have. There are several types of P.P.C.

The apparatus at P.P.C. fixed: it is the standard treatment, the most tested and the least expensive model. The device always delivers the air with the same pressure.

The apparatus at P.P.C. automatic: this is an alternative to the P.P.C. fixed. It is also effective and some people find it more comfortable since the level of pressure adapts according to respiratory events (apnea, hypopneas) or snoring.

Ventilation device with two pressure levels (also known as bipap or bi-level): the two-level device is based on the same principle as the P.P.C. fixed and automatic, except that it delivers a two-level pressure with reduced air pressure at expiration, which facilitates breathing. It is mostly used by people who require high positive pressure, improving comfort and tolerance to treatment. We are constantly creating new products. For optimal comfort, do not hesitate to try the latest ones. Find out about prices, warranties and after-sales service when you’re ready to make a purchase.

How does it work?

A mask is installed and supported by a strap on the head. A tubing connects the mask to the apparatus with P.P.C. This unit is plugged into an electrical outlet and provides constant air thrust into the mask. By keeping the upper airways open at all stages of the breathing cycle, snoring and apnea are controlled. It is a treatment and not a cure. If you stop using the unit on your P.P.C., you will start apnea again.

At the beginning of its use, unfortunately some people give up if they do not notice any rapid change. The time required to feel an improvement can be 4 to 6 weeks of sustained use, that is to say use of the device every night and throughout the night. First of all, you have to learn how to sleep with the mask on your face and then adjust the discomfort and the small adjustment problems (for example, adjustment of the mask, nasal obstruction). It is only after this period of adjustment that we begin to feel the benefits. Patients say they get used and become more comfortable with the equipment after 3 to 6 months of use. A period of adaptation is therefore necessary, one must be patient! The best way for you to adapt to this new situation is to inform yourself, ask questions and make the necessary follow-up with your medical team.

Problems or discomfort may occur during treatment. It is important to talk about it to improve or correct the situation. Once the problems are resolved, people are generally very happy to use their device, especially after discovering all the benefits of this type of treatment.

How much does this kind of treatment cost?

A P.P.C. and a mask, including the coaching and teaching you need, can cost between $ 1200 and $ 2500. For the moment, this amount is not refundable by the Quebec Health Insurance Plan, but the costs related to treatment are eligible for the medical expense tax credit. Consult the Canada Revenue Agency, Revenu Québec or a tax advisor for more information. Also check with your private insurance plan if the purchase of such a device is covered. Otherwise, check with your distributor if they have a lease option or a financing plan.

C) Oral appliance

Your doctor may prescribe an oral appliance (or jaw advancement orthosis) molded by a dentist. This gutter worn in the mouth during the night is used to hold the lower jaw and tongue forward, which has the effect of maintaining the opening of the upper airway. However, this type of device is not suitable for all patients, does not offer as good results as the device P.P.C. and can cause problems with your jaw, teeth, or gums. It is used mainly for mild or moderate apnea. When it works, some patients prefer it to the P.P.C.

This type of device is available in fixed or adjustable model. The adjustable model is more successful than the fixed model. Some dentists have special training to fix and adjust these dental appliances.

For more information on dental appliances, talk to your sleep specialist to get a consultation with a specialist dentist.