Sleep Treatment Disorders
 

During the last three months, LacamasLife Magazine has profiled the various sleep disorders that affect adults, children, and seniors. The data that has been extracted and analyzed from various sleep disorder organizations, as well as from local sleep clinics, has found many of the root causes of the disorders, and has developed various treatments to address and resolve these various health issues.

Once a patient with a sleep disorder, such as sleep apnea, is analyzed and diagnosed, a treatment program is recommended.

Primary disorders may include insomnia, sleep apnea, narcolepsy, sleepwalking, sleep terrors or restless legs. Research has shown these primary disorders can lead to secondary disorders, such as bedwetting or an eating disorder, which may be overcome with the proper treatment program.

“We’re very careful, and thorough with our analysis,” says Christy Westphal, Lead Sleep Technician at The Vancouver Clinic’s Pacific Sleep Center in Vancouver. “We want to make sure each patient is provided with the best possible treatment options.”

The purpose of this article is to review these treatment options, which can be separated into three major categories: 1) Lifestyle changes; 2) Medical treatment, including devices such as CPAP (which is non-invasive) and surgery; and 3) Medications.

Lifestyle changes can be recommended as a treatment to combat various sleep disorders. Sometimes during analysis, weight loss may be recommended as a treatment or solution.

“Sometimes, it’s as simple as losing those extra pounds, which can contribute to blocked airways, and result in obstructive sleep apnea, or OSA,” says Westphal.

Weight loss programs are abundant, and Westphal recommends there be close communication with a patient’s primary health care provider when reviewing those programs.

Other lifestyle changes may include reducing or eliminating alcohol intake, and a smoke cessation program.

Support Groups

As sleep disorders continue to be treated, support groups have become more readily available. One such group, called AWAKE, which stands for Alert Well And Keeping Energetic, is a support group that is organized by patients. The group provides support for patients to maintain sleep disorder treatment programs, such as CPAP, which is discussed in this article.

The American Sleep Apnea Association (ASAA) has the AWAKE Network, which is composed of hundreds of mutual-help support groups in nearly all 50 states for people affected by sleep apnea. The network, founded in 1988, is an integral part of the ASAA and since 1990, the two have been partners in assisting patients, their families, and the healthcare community concerned with OSA. They believe the support groups must be patient-centered, and that local AWAKE members plan and implement each group’s activities so that they meet the needs of each individual group. Topics may include advice on complying with CPAP therapy, legal issues affecting those with sleep apnea, weight loss, and new research findings.

“The group,” says Westphal, “works with patients to help them progress and lose weight, (if that’s the treatment program they’re on) and stay on track with CPAP and other remedies. Questions are answered and speakers routinely attend to help the patients. There’s a lot of comfort in these groups, and usually about 20 people attend each month.”

To find out about your local support group, visit www.sleepapnea.org, click the Support Group link and then click on Washington.

CPAP: A common treatment (good alternative to surgery)

According to Westphal, CPAP stands for Continuous Positive Airway Pressure. It keeps your airway open as you sleep by providing you with a steady stream of air. This will prevent sleep apnea from disturbing your sleep. Most CPAP units are about the size of a small tissue box. Today’s units are smaller, lighter and quieter than when they were first used to treat sleep apnea. Some units are as small as six or seven inches in length and weigh only two or three pounds.

The unit is powered by electricity. The box has a fan that pushes air through a tube. The tube is connected to a mask that you wear as you sleep. The mask allows the air to gently blow into the back of your throat. This keeps the airway open and prevents pauses in breathing as you sleep.

The amount of air pressure needed is different for each person, and will be determined by the results from your overnight sleep study at the Pacific Sleep Center.

According to Westphal and www.sleepapnea.org, CPAP units come with a variety of features. Most units now have a pressure “ramp” setting. This timed setting starts the machine at a very low level of air pressure. It slowly raises the pressure until it reaches the right level.

Humidifiers are a common accessory for CPAP units. They provide cool or heated moisture to the air coming from the CPAP unit. This can reduce side effects and make it easier for you to breathe through your mask. Some CPAP units now come with an integrated humidifier that is connected to the machine.

No matter what type of mask you use, it is most important that it fits you well, says Westphal. First, the health care provider will work with you to select the right size for your mask. The mask should fit snugly enough to prevent leaks without causing discomfort. You may need to make small adjustments to the mask, tubing, straps and headgear until you get the right fit.

CPAP is the most common and effective treatment for OSA, she says. It may also be used to help people who have other breathing problems when they sleep. The steady flow of air from a CPAP machine keeps your airway open and restores normal oxygen levels as you sleep. This helps you maintain a steady, healthy level of breathing through the night.

For many people, the positive results of using CPAP are quick and dramatic, says the researchers at ASAA. Their initial night of using CPAP may feel like the first good night of sleep they have had in years. Others may not notice improvements right away. It may take time for them to adjust to this new way of sleeping.

By working to normalize your breathing, CPAP helps protect you from the severe health risks that are related to obstructive sleep apnea. These risks include the following: Heart Disease. Many of the risks involved with OSA are related to how your heart functions. A person with an extreme case of sleep apnea can stop breathing hundreds of times in one night. The pauses in breathing cause drastic changes in your oxygen levels. This puts an enormous strain on your heart and can lead to an increase in your heart rate.

Research shows that people with OSA have a higher rate of death due to heart disease. The link is strongest between OSA and high blood pressure. Studies also show that CPAP may reduce these high blood pressure levels in people with sleep apnea. The use of CPAP over an extended period of time may help protect you from heart problems and reduce your chance of dying from them. These problems include the following:

• Congestive heart failure
• Coronary artery disease
• Irregular heartbeat

Stroke. By normalizing your breathing, OSA patients also reduce chances of stroke, which is a sudden loss of brain function. It occurs when there is a blockage or rupture of one of the blood vessels leading to the brain. Westphal says studies show that people with OSA are two to four times more likely to have a stroke than people who do not have sleep apnea. The consistent use of CPAP, she says reduces the stroke risk dramatically.

Diabetes. OSA is also related to glucose intolerance and insulin resistance. These are the factors in Type 2 diabetes, which is a very common form of diabetes in adults. The CPAP treatment can improve insulin sensitivity in people with Type 2 diabetes and OSA.

“CPAP helps people get on the right track to change their lifestyle,” says Westphal. “When you’re not tired, your metabolism increases and you want to do more – you have more energy to do things, and you want to make changes to your lifestyle that will help you. Good sleep is so important.”

The most common problem with CPAP is when the mask does not fit well. If the mask is too big, the straps holding it to your face will need to be pulled too tight. This may cause skin irritation as the straps rub against a patient’s face. A mask that is too small will not seal properly and air will leak out. This can cause air leaks that blow into your eyes. You will need the help of your sleep doctor or technician to make sure that your mask is a good fit.

CPAP may cause some people to have more nasal congestion. This can often be relieved with a saline nasal spray, a decongestant or a humidifier.

Using CPAP may also make your throat dry or sore. A heated humidifier that fits your CPAP unit can ease this symptom. Be sure to tell your sleep doctor what is happening.

Overall, says Westphal, the CPAP option is the best way to deal with sleep apnea, that is, if you don’t want surgery.

Surgery Options

Surgery may be used to help someone with OSA. According to researchers at www.sleepeducation.com, the most common options reduce or eliminate the tissue in your throat. This tissue collapses and blocks your airway during sleep. These surgeries focus on one or more of the following three areas:

• The soft palate
• The uvula, tonsils and adenoids
• The tongue

More complex surgery can be performed to adjust other bone structures. These include the mouth, nose and facial bones.

Surgical procedures that may be used to treat obstructive sleep apnea include:

Maxillomandibular osteotomy (MMO) and advancement (MMA) Cuts are made into the bones of the jaw. The upper and lower jaws are pulled forward and soft tissue is tightened. This enlarges the entire upper airway. An overnight hospital stay is required. The jaws may be wired shut for several weeks.

Westphal says this is a very painful procedure, and is a major inconvenience for weeks. “People can’t work with their jaw wire shut,” she says. “They basically break your jaw and move it forward to help with the airways.”

Laser-assisted Uvuloplasty (LAUP) Cuts are made to scar and tighten the soft palate. The uvula is trimmed over a period of several visits. It is not as effective as UPPP and is usually done for snoring, not sleep apnea. It is less painful and has fewer side effects than UPPP.

Septoplasty and Turbinate Reduction Both of these options are used to open the nasal passage. Septoplasty straightens a bent septum that is blocking the flow of air. The septum is the bony divider between the two nostrils.

Turbinate reduction reduces or removes large turbinates and polyps. Turbinates are curved bones along the wall of the nasal passage. Polyps are growths of tissue that stick out from the mucous lining of the nose.

Medications

Sometimes, medicine is the only treatment option, or it may be used in tandem with another treatment. Medications include special nasal sprays, decongestants or oxygen.

Summary

Curing sleep disorders can help people get better sleep, which in turn can improve a child’s grades in school; improve a child’s behavior at home and in the classroom; change ADHD diagnoses in children and adults; decrease absenteeism in the workplace; increase productivity in the workplace; and even help individuals in their fight against diabetes and other ailments.

“Really, getting a good night’s sleep,” says Westphal, “changes a lot of things, and that’s what we’re here to do – help people get over their sleeping problems and onto a better, happier life.”

To learn more about sleeping disorders, call the Pacific Sleep Center at (360)397-3606.
 

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