A Sleep Tech’s Guide to Sleep Apnea
Sleep apnea is a condition that affects nearly 18 million Americans. Left untreated, the condition can lead to a wide range of health problems, including: heart failure, stroke, diabetes, weight gain, impotence, headaches, depression, memory problems, and hypertension. Of course, this is in addition to the constant sleepiness patients often experience due to continuously interrupted sleep.
The better you understand sleep apnea, as a sleep technologist, the better prepared you will be to treat patients who have this condition. This condition primarily affects people who are over the age of 40, overweight, and male – particularly men of African-American and Hispanic descent, though anyone can develop it.
Sleep apnea can only be diagnosed through a sleep study. This guide will help you properly identify various types of sleep apnea in order to understand the most appropriate course of treatment for your patients.
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What is Sleep Apnea?
Sleep apnea is a sleep disorder in which a person’s breathing is interrupted while they sleep. Untreated sleep apnea can result in an individual stopping breathing hundreds of times during the course of a single night.
The result is a body that is deprived of restful sleep and a brain and body that are not receiving an adequate amount of oxygen. Over time, sleep apnea can contribute to poor work performance, automobile accidents, and an overall reduced quality of life from feeling tired all the time.
There are three primary types of sleep apnea, each with its own unique symptoms, risk factors, and treatment options. As a sleep technologist, you need to understand the ins and outs of each type of sleep apnea so you can properly treat your patients.
Types of Sleep Apnea
As mentioned, there are three main types of sleep apnea. Initiating the wrong treatment for a specific type of sleep apnea will not benefit patients and may do more harm than good. Your sleep technologist role to identify the differences between the three types of apnea events so you can understand the appropriate treatment for your patients.
The more thoroughly you understand the differences in sleep apnea types, the better able you will be to treat all your patients’ conditions – using the most up-to-date solutions available in sleep technology.
Let’s delve into the three main types of sleep apnea: Obstructive Sleep Apnea, Central Sleep Apnea, and Mixed Sleep Apnea.
Obstructive Sleep Apnea
The most frequently diagnosed form of sleep apnea, obstructive sleep apnea, or OSA, affects nearly four percent of men and two percent of women. Unfortunately, it is believed that only about 10 percent of the people who have obstructive sleep apnea have been diagnosed and are receiving treatment for their condition.
OSA is caused by an airway blockage, either partial or complete, resulting from relaxed throat muscles. The relaxed muscles in the throat allow the tongue or other fatty tissues in the throat to fall back, effectively blocking the flow of air.
When the brain receives the signal that the airway has been obstructed or that it isn’t receiving the adequate amount of oxygen it needs, the patient wakes briefly from their sound sleep.
In many instances, this event is notable by the gasping, choking, or snorting sounds the patient makes as his or her body attempts to recover and breathe. Once the patient begins breathing again, the brain returns to sleep until the process repeats.
There are three levels of OSA:
Mild OSA in which there are between five and 14 events within a typical hour.
Moderate OSA where there are between 15 and 30 events in an hour.
Severe OSA when patients experience 30 or more events within in an hour.
Common OSA Symptoms and Risk Factors
Patients who have OSA may experience any or all of the following symptoms:
Excessive daytime fatigue
Headaches upon waking – resulting from loss of oxygen throughout the night
In addition to age, with most people diagnosed with obstructive sleep apnea being over the age of 40, there are other risk factors to consider, including:
Frequent alcohol use
Of course, there are exceptions to all of these, and some patients simply win the genetic lottery making them better candidates for sleep apnea for no other reason than their family history.
Treatment for Options for OSA
One of the most universal treatments for obstructive sleep apnea is positive airway pressure, or PAP, therapy. There are three primary devices available for this therapy including Continuous Positive Airway Pressure, or CPAP, Bilevel Positive Airway Pressure (BPAP), and Automatic Positive Airway Pressure (APAP).
Oral appliances are also used to treat OSA, and there are several surgeries that are available to assist with this condition. CPAP is often highly effective as it eliminates breathing interruptions that commonly disrupt sleep and greatly improves the overall quality of sleep – with regular use.
APAP therapy is a variation of CPAP treatment with the difference that it can be set to provide a continuous pressure, like CPAP, or it can vary the pressure as the patients' needs change throughout the night.
BPAP therapy is recommended for patients who have trouble exhaling against a high CPAP pressure. BPAP machines can be set to two different air pressures – one for inhaling and the other for exhaling, allowing patients to more easily get air into and out of their lungs.
Central Sleep Apnea
Central Sleep Apnea, or CSA, occurs when the muscles that control breathing aren’t receiving the proper signals from the brain to breathe. This type of sleep apnea is far less prevalent than OSA, accounting for only about 20 percent of sleep apnea cases, and it is often caused by a medical problem rather than a problem in body mechanics.
Common CSA Symptoms and Risk Factors
The symptoms of CSA are often similar to OSA symptoms, but there are a few differences that make this condition a little more distinctive, including:
Difficulty concentrating – lack of mental focus.
Excessive drowsiness during the day.
Headaches in the morning.
Irregular breathing during sleep.
Poor sleep quality.
Shortness of breath causing patient to awaken.
The risk factors with CSA are a little different as well since some health conditions can lead to CSA. These conditions include: heart failure, the use of narcotic painkillers and other medications, obesity, Parkinson’s disease, and medical conditions affecting the brainstem.
Risk factors to consider when diagnosing and treating patients with CSA include:
Age (more common in adults over the age of 65)
Gender (men are more likely to have CSA than women)
Cardiac disorders (heart conditions like congestive heart failure and atrial fibrillation pose a greater risk for CSA)
Opioid medication use
PAP treatment for OSA (using PAP devices to treat OSA can cause patients to develop CSA)
CSA Treatment Options
Treating CSA almost always involves the treatment of underlying conditions as the first step in the process. It is necessary to treat heart failure, control medication usage, and treat Parkinson’s disease or tumors, etc., first. Once these conditions are treated properly, the CSA may resolve.
However, CPAP and BPAP devices can be instrumental in treating CSA just as they are with treating OSA. Adaptive-Servo Ventilation device is also sometimes used to treat CSA very effectively by continuously adjusting the airflow to match the needs of individual patients. ASV reacts quickly to make adjustments when patients aren’t breathing normally and then reverts to a low pressure once the patient regains his or her normal breathing rhythm.
In some cases, medications, like Diamox or Theo-24 may be prescribed to help stimulate breathing for patients who have CSA and aren’t responding well to PAP therapies. The key is in finding the right therapy meet the patient's needs.
Mixed Sleep Apnea
Mixed sleep apnea is a combination of both central sleep apnea and obstructive sleep apnea. Mixed sleep apnea is generally treated as obstructive sleep apnea, using a CPAP device. One study, conducted by Mayo Clinic, found that nearly 15 percent of all sleep apnea patients had mixed sleep apnea.
Common Symptoms and Risk Factors for Mixed Sleep Apnea
Mixed sleep apnea patients share symptoms with both obstructive sleep apnea patients and central sleep apnea patients. They generally are treated with CPAP. Like other sleep apnea types, mixed sleep apnea is more common in men than women.
Treatment Options for Mixed Sleep Apnea
CPAP remains the “go to” treatment for patients with mixed sleep apnea. Some patients with mixed sleep apnea may develop complex sleep apnea when placed on CPAP. BPAP and ASV therapy may be helpful for these patients. Treatment for mixed sleep apnea varies from one patient to the next with no single “best practice” for treating the condition.
Treating sleep apnea is never a one-size-fits-all philosophy. As a sleep technologist, you will need to work closely with your physicians to determine the best treatment for each patient, to assure their individual needs are met, and to assure their comfort with therapy.
Here at the American Association of Sleep Technologists, we invite new and veteran sleep technologists to learn more about sleep apnea and other topics by downloading our Sleep Technology Terms and Definitions ebook. Get your complimentary copy today.