Category Archives: CPAP

Spare Your Brain – Wear Your CPAP

Over the last several years, we have had an explosion of studies demonstrating the damage sleep apnea can do to the human brain. The most recent one from New York University was published in the journal Neurology. In this study, 2,400 people were followed over a period of years for the development of either Alzheimer’s or MCI (minimal cognitive impairment). The results were fascinating and informative. People with untreated sleep apnea developed MCI on average ten years sooner than those without sleep apnea did. They also developed Alzheimer’s five years earlier. Even more striking was the fact that those who chose to treat their sleep apnea did not experience any acceleration in developing these neurological disorders.

This is another study that demonstrates the havoc that sleep apnea can inflict on the brain. We have additional studies demonstrating the deterioration of both gray and white matter in untreated sleep apnea. Gray matter is where the body of neurons is found and makes up most of our cerebral cortex and memory processing structures such as the hippocampus. White matter contains the tracts that connect these neurons to each other and allows communication between them in the form of nerve impulses.

What is it about sleep apnea that causes this destruction? In my book Sleep Soundly Every Night, Feel Fantastic Every Day, I delve into this. One theory called oxidative stress posits that repeated drops in oxygen brought about by an obstructed airway cause the damage. Another is that inflammatory mediators released in excessive amounts, as is seen in sleep apnea, cause the damage. Finally, another theory is that fragmented sleep, because of sleep apnea, inhibits the normal housecleaning chores of eliminating neurotoxins that require deep uninterrupted sleep.

The bottom line is that untreated sleep apnea can lead to severe brain damage. Unfortunately, if untreated, it can be very subtle and frequently overlooked until it is too late. The good news is that this and other studies have repeatedly demonstrated that with treatment this can be avoided and in some cases reversed. Therefore, the take home message is that if you have sleep apnea or manifests symptoms such as snoring, poor quality sleep, excessive fatigue, or sleepiness, get it checked out. Moreover, if you have a CPAP, wear it whenever you are sleeping. Remember, we have only one brain and it cannot be replaced.

10 Ways to Overcome Your Problems with CPAP

Over 18 million Americans have sleep apnea. The gold standard of treatment is the application of positive airway pressure called CPAP. Unfortunately, after one year on average, only 50% of patients are using it regularly.

1. “My nose is always dry and irritated”

The new machines have heated humidification, which can be adjusted to your comfort. If this fails, nasal saline solutions and Neti pots can be helpful at bedtime.

2. “The mask leaves a mark on the bridge of my nose”

There are pads called the Gecko Nasal Pad that can be placed on the bridge of the nose to prevent this. These have been manufactured in such a way as to maintain a tight seal that will not leak. In addition, several masks go under the nose like an oxygen cannula.

3. “The pressure is too high and I feel like I can’t breathe”

There are several solutions to this problem. First, there are autotitratable machines. These CPAP machines vary the pressure they generate depending on the amount of airway obstruction at a given moment. As a result, these machines operate at a lower average pressure during the night than straight CPAP machines.

4. “I wear a nasal mask and I wake up with a dry mouth during the night”

You are probably leaking air out of your mouth. The solution is to either wear a chinstrap or be fitted for a mask that goes over your nose and mouth, called a full face mask.

5. “I’m claustrophobic and could never wear one of those masks”

There are several very successful behavioral interventions available in order to desensitize people with claustrophobia and anxiety. You should enquire as to whether a sleep center in your area offers this.

6. “I have insomnia–so how am I supposed to sleep with one of those contraptions?”

Many sleep centers are successfully utilizing sleep medications while the patient is getting acclimated to CPAP. This can be followed by CBT (Cognitive Behavioral Therapy).

7. “My mask leaves red marks on my face that makes me feel embarrassed”

There is a new product out called the RemZzzs Mask Liners. It is a fibrous material that is placed between your mask and skin. It is quite effective in preventing skin marks and also decreases leaks around the mask.

8. “My nose is completely blocked so how can I use one of these masks?”

There are several options for you. First, a referral to an otolaryngologist may be helpful. If the blockage is due to enlargement of nasal structures called turbinates, or septal deviation, surgery or a procedure called radiofrequency ablation (RFA) may be an option. Additionally, there is a mask called the Oracle that allows the pressure to be applied through the mouth only.

9. “I wake up bloated and full of gas”

This usually subsides in a few weeks. However, if it persists, avoid eating within two hours of bedtime. Try elevating the head of your bed by 30 degrees. Finally, a switch to an autotitratable machine may eliminate this.

10. “I’ve tried it all and still can’t wear it”

Look into alternative treatments. Oral appliances fashioned by dentists who specialize in this can be effective. There are also new surgical procedures available.