- G'day everyone,
Nick here again from CPAP Reviews.
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Now, in today's educational video,
I'm gonna be talking to you about sleep apnea.
What it is, what causes it
and lastly, how do we treat it?
Alright, let's get to it.
(upbeat music)
All right, firstly, what is sleep apnea?
Well, apnea literally means stopping breathing.
So if you suffer from sleep apnea,
when you're sleeping,
air stops flowing to your lungs
for 10 seconds or more.
Now, when you stop breathing,
your blood oxygen levels drop,
and this triggers your brain
to just wake up out of sleep for a microsecond,
just so you can take a breath
and then you fall back asleep again
and this cycle continues throughout the night.
Now this stopping of your breathing
can happen many times an hour,
night after night,
and it can not only affect the quality of your sleep
and your sleep cycle,
but it also puts your body
in a very stressful environment
at a time when it's supposed to be resting, relaxing
and recovering from the day's activities.
Left untreated, sleep apnea can cause
some pretty severe health consequences
and these include stroke, heart disease,
so heart attacks, high blood pressure,
diabetes, depression, car accidents,
as well as a list of other things
including my all time nightmare,
which is erectile dysfunction and loss of libido.
So it's very important
that we do get tested for sleep apnea
if we do think there might be something going on
with our sleep.
Now there's three main types of sleep apnea.
There's obstructive sleep apnea,
central sleep apnea,
and mixed sleep apnea,
and I'll go through these with you now.
So obstructive sleep apnea is the most common by far,
and if you suffer from OSA,
basically what's happening is,
those muscles are in your upper airway,
your tongue, your throat, your mouth,
when you're falling asleep and you're relaxing,
they're just relaxing a bit too much
and they're falling back
and just obstructing your upper airway there.
So they're basically closing off your trachea,
where the air comes in.
And causes of obstructive sleep apnea include,
the number one is probably being overweight.
So if you are carrying a bit more weight,
you're more prone to having sleep apnea,
there's no doubt about that.
We carry a lot of weight in our neck here.
And so the more weight you got
when you lie there,
it's putting more pressure on those muscles,
more weight on those muscles,
so when they relax,
it's more likely to just close over.
Sinus issues,
so, if you've got nasal polyps
or if you've got a deviated septum, sinusitis,
a lot of congestion, those sorts of things,
if you get a lot of hay fever
that can cause sleep apnea as well,
just your general anatomy.
So just your makeup of the structure of your neck
and your jaw and your throat.
So, a lot of Asians have really narrow airway.
So that's just your general anatomy makeup.
Sleeping tablets, smoking, alcohol consumption,
all the good things (chuckles)
and simply sleeping on your back
can also cause it as well.
Now, central sleep apnea is far less common.
So with central sleep apnea,
there's not an actual obstruction.
What there is,
there's a bit of a fault happening
between the signal that's sent from our brain
to our lungs.
So normally your brain is telling your lungs to breathe.
And with central sleep apnea,
there's a bit of a signal fault happening there.
And so, your lungs just aren't getting told to breathe.
So your airway can be open,
but you're just not getting,
that signal down to your lungs to breathe.
And central sleep apnea
can actually go undiagnosed quite often
because they can sometimes be no snoring
associated with it, with obstructive sleep apnea.
There's normally a lot of noises
and snoring that goes along with it
'cause of the restriction.
So generally people are a bit more aware
that there's something going on,
but with central sleep apnea,
you might not get those noises.
And then the last one is mixed sleep apnea,
and mixed is just a combination,
so you've got a combination
of both obstructive sleep apnea
and central sleep apnea happening in the one person.
So it can be a little bit more complex,
but there are your three types of sleep apnea.
Now without treatment,
you'll most likely have sleep apnea for life, unfortunately.
So it is important that we treat it.
And the older we get,
the more severe the sleep apnea tends to become.
So if we have mild sleep apnea when we're younger
and we don't do anything about it, as we get older,
it generally gets a bit worse
because we tend to put a bit more weight on,
become a bit heavier,
everything becomes a bit more loose,
a little bit, less firm,
the muscles in our throat
and neck relax a little bit.
So it does get a little bit worse.
And there's a number of ways we treat sleep apnea,
and sometimes we use a combination approach.
So we use a combination of treatments
to really help reduce the severity of that sleep apnea.
And let's go through them.
So, one, weight loss and lifestyle changes.
So, weight loss is a big one.
Obviously, if you can, bring that weight down,
it's gonna go a long way
to helping reduce the severity
of your obstructive sleep apnea.
But it ain't always easy,
especially if you do have sleep apnea,
because if you have sleep apnea,
your generally pretty tired during the day,
you don't feel very energetic.
So it's very hard to then go and do exercise
and do the right things to get your weight down.
So it can be quite a challenge.
Which is why we sort of tend to do CPAP therapy
with weight loss
but I'll talk about that in a bit.
Also lifestyle changes,
so, (chuckles) stopping smoking
and avoiding alcohol consumption of an evening.
Alcohol is very enjoyable
because it's a muscle relaxant
and makes us very relaxed
but what we want to avoid when we're sleeping
is excessive muscle relaxing,
cause that's what's causing the obstruction to happen.
So you want (chuckles),
you really want to avoid that glass of wine before bed
and obviously, yeah, quit smoking,
which is just a general rule of thumb
for a healthy life in general.
The next one is positional therapy.
So, what that means is just staying off your back
when you're sleeping.
So just sleeping on your side,
this doesn't work for everyone obviously,
but these are just some of the treatment options.
There's a number of devices,
but obviously the easiest one is to,
get a tennis ball and put it in a stocking
or something like that
and wrap it round you,
'cause it's not too enjoyable sleeping on a tennis ball,
but there's a number of other positional adjustment devices
that you can buy as well.
Mandibular therapy.
Now what this is,
these are like the mouth guards
that you might have seen.
There's a lot of cheap knockoff ones
that you'll wanna avoid.
You know, those $30 ones on eBay that don't do anything.
I'm talking about proper mandibular advancement splints
or devices,
they keep your bottom jaw from falling back.
So they're generally made by a mold
like a dentist will make a mold for you,
and then it'll get shipped off
and made up for your specific mouth and jaw shape.
So they do some measurements and things like that,
but basically they've got little adjustments on them.
So you can move the bottom part
of the mouth guard forward
and you can retract your bottom of your jaw.
So it keeps your jaw forward,
and that in turn sort of stretches out everything
and keeps it sort of from relaxing
and falling back in your throat.
These sort of devices are mainly used
for more mildish cases.
So your snoring to your mild sleep apnea.
The more severe the sleep apnea gets,
the more you need a bit more heavier therapy.
And just on that note,
I think I'll quickly just touch on severity of sleep apnea.
So the severity of sleep apnea
is based on how many apneas you're having per hour.
We call this the apnea-hypopnea index.
So to give you an idea, if you're less than five,
so you're having less than five apneas per hour,
so you stop breathing less than five times an hour,
you're in a healthy category, which is great.
If you stop breathing between five and 14 times,
you're considered mild severity,
15 to 29, moderate severity.
And once you crack 30,
we just put you in the group of severe, okay.
So you're in the severe,
whether you're 30, 40, 50, 60, 100,
and I've seen plenty of people
that stop breathing 100 times an hour.
And you normally get that number from a sleep test,
but we won't go into that just in this episode.
Okay, now going back to treatment,
once we've sort of exhausted our noninvasive treatments,
then the last resort,
we can go to sort of more invasive treatments
like surgery options.
There's a number of different surgeries
that they do,
some will be sort of like sinus surgery,
where you might get a deviated septum fixed up
or remove some nasal polyps,
make it easy to breathe through your nose.
So an ENT does this sort of stuff,
Somnoplasty, which is where they remove
sort of some of the soft tissue
at the back of your throat there.
There's some laser surgery which does some scarring,
which sort of,
firms up everything at the back of the throat,
as well as removing your tonsils, adenoids.
So there's a number of surgical options out there,
but it's important that we sort of first exhaust
our noninvasive treatment options,
which are a lot more enjoyable and far less painful
than jumping down the surgical road there.
So now we'll talk about my favorite of the therapies,
the stuff that I do all the time,
which is positive airway pressure therapy, okay.
So this is the gold standard.
This is the most common form of treating sleep apnea.
And for those of you that know nothing about it,
it's basically you have a little device, a machine,
with some tubing and a little,
you wear a little mask when you go to bed
and this device creates basically air pressure
at the end of the day.
It creates positive airway pressure.
Now, positive airway pressure, to put it simply,
is when the pressure on the outside of your body
is higher than the pressure in your lungs, okay.
And what that does is,
it forces air into your lungs, okay.
It forces air in
because the air just travels down the pressure differential,
from being high pressure to low pressure,
air just comes in
and it forces the air into your lungs.
Think of it kind of like a balloon.
So if we blow a balloon,
obviously the air pressure inside the balloon is higher
than the air pressure on the outside of the balloon.
There's a little more pressure inside the balloon.
And if we let go of that balloon,
the air just shoots out and it does that
because the air is just going from high pressure
to low pressure.
So we're basically just doing the opposite,
which is shooting air in to help our, lungs open up,
keep that airway nice and open,
and this treats the sleep apnea brilliantly.
It does it really well.
Now there's a few types of this form of therapy,
so positive airway pressure therapy.
And I'll just discuss them with you now
'cause it can be a little bit confusing for some,
but it's important just to understand
the different forms of the therapy.
So, the first one is just
continuous positive airway pressure,
which is CPAP.
That's a word that many of you will have heard.
Some of you might not, but many of you will.
So with continuous positive airway pressure,
that machine, your device,
is set to one preset level of therapy pressure,
one pressure level.
So when you're breathing in and out,
there's just one level of pressure.
Another form of continuous positive airway pressure
is what we call automatic positive airway pressure.
So it's still continuous,
there's still continual pressure coming in.
It's just, it's not preset to one fixed level,
automatic or APAP,
so that's what we call it, APAP.
The machine itself will monitor your breathing
and then it will regulate that pressure up and down,
minute by minute, hour after night.
So it's still continual,
the pressure is still coming in nonstop
when you're breathing in and out
but it varies depending on the severity of your sleep apnea.
So if your airway's nice and open,
the automatic's gonna say nice and low,
but if you're having snoring,
if you're having obstructive sleep apnea events,
lots of them, you roll onto your back,
that machine will pick up that information
and it'll gradually increase the pressure
to treat the sleep apnea.
All right, that's your automatic ones.
There's another form of therapy called BiPAP.
Now with BiPAP,
that's normally used to treat
either people with complex or mixed sleep apnea.
So remember that central sleep apnea
that I was talking about,
that mixed sleep apnea?
So we use generally BiPAPs to treat those people.
We do sometimes use CPAPs and APAPs as well,
so we can start with that
and if it's not working out then we'll use the BiPAPs.
They're a bit more technologically advanced
than the other forms of therapy.
And also, sometimes we use BiPAP
for people who might have obstructive sleep apnea,
but they're not coping with CPAP or APAP.
So, they're finding it too hard to breathe out
against the pressure.
They can't quite get it,
so that we can move them to a BiPAP.
And the reason we can move them to a BiPAP is,
with BiPAP therapy, we set one fixed level
for when you're breathing in
and also a different level of pressure
for when you're breathing out.
So the pressure when you're breathing in
can sometimes be a lot higher
than the pressure when you're breathing out.
What this does is, is it helps the person,
supports the person when they're breathing,
when they breathe in.
But when they exhale, instead of exhaling
and really struggling to breathe out against that pressure,
it's a lot easier for them to also breathe out.
So you get the therapy when you breathe in,
a lot easier when you breathe out.
And we call those two values, IPAP and EPAP.
So inhalation positive airway pressure,
exhalation positive airway pressure,
and we can set those different values.
Generally, your physician will sort of work out,
where best to those values.
The BiPAPs are also used to treat other conditions,
other lung conditions, COPD,
some other sort of neurological lung conditions as well.
If you are someone who has really struggled, getting used-
like you've got sleep apnea
but you're really struggling
with your CPAP and your APAP,
you've tried them both and you can't do it,
maybe speak to your health professional,
about trying a BiPAP therapy device.
They do cost a lot more,
which is generally why we sort of stick to,
steer people into these CPAP and APAPs to begin with,
but I personally believe that probably over time,
and as that technology becomes cheaper
and those machines become maybe a bit more affordable,
we might actually transition
to BiPAP being your gold standard,
your go to therapy in the future.
Because it really is a lot easier
on the person when they're breathing out,
and that's one of the downsides of that,
CPAP and APAP.
It's quite hard
because of that continual pressure coming in
all the time.
Sometimes be quite hard to breathe out.
People do always struggle with that little part,
especially in the beginning.
So, it's a little tip for you there.
Don't give up if you failed on CPAP and APAP,
there are other devices available.
Yeah, so that's basically it for today.
Thanks for watching, I hope you enjoyed it.
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and you found it somewhat useful,
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Until next time, have yourself a great day
and sleep well, see you later.