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Sleep Apnea Education

If you are a candidate who has felt excessively tiredness and sleepy even after a full night's sleep, you must see the doctor to check if you are affected by sleep apnea. Your doctor may reccommend a sleep study. This test may be done in the hospital or at home.

 

What is Sleep Apnea?

Sleep apnea is defined as a temporary process of breathing that lasts 10 seconds during sleep (Wilkins, Dexter, 1998). 

 

Types of Sleep Apnea

Sleep apnea may be due to the following:

  • Obstructive sleep apnea (caused by air flow obstruction)

  • Center sleep apnea (caused by miscommunication between the brain and muscles for breathing)

  • Mixed sleep apnea (combinations of the above)

Whatever form of sleep apnea you may be suffering from, the bottomline is that you need immediate medical attention.  As we look into the severity of sleep apnea, we need to define the following terms: These are the cornerstone when your doctor evaluating sleep study test.

  • Respiratory Disturbance Index/ Apnea Hypopnea Index: average number of apnea in each hour of sleep during the sleep test. For instance, if the patient slept for 7 hours during the test and had 280 apneas, the RDI is 40. It indicates severe sleep apnea.

  • Desaturation Index: average number of oxygen desaturation of 4% or more from baseline in each hour of sleep during the test (Mooe et. at, 2000). During the sleep test , it can also be identified the defiency of oxygen  in your body system  .And if you need supplementary oxygen during your sleep, you need to use oxygen concentrator . Your  Home Respiratory Therapist  will hook up this machine with your sleep apnea machine if the study identify that you have both sleep apnea and oxygen deficeiny. 

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What are the Warning Signs of Sleep Apnea?

 If sleep apnea is not taken care of, it can lead to the following risks, but not limited to:

  • excessive tiredness

  • excessive daytime sleep

  • lack of concentration

  • hypertension

  • heart attack

  • stroke

  • sexual dysfunction

Risk factors associated with obstruct sleep apnea include history of snoring, apneas, obesity, increased neck circumference, hypertention and family history of obstruct sleep apnea (Skomro, Kryger, 1999).

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Managing Sleep Apnea

Sleep apnea can be mild, moderate, or severe. Your doctor can inform you on the intesity of your sleep apnea based on diagnosis and tests. 

Losing weight and quitting smoking  will have a positive impact on sleep apnea. However, depending on the diagnosis tests, your doctor may recommend the following breathing devices along with other measures 

  • Continuous positive airway pressure (CPAP): In order to keep your aiway open open during sleep, your doctor can prescribe CPAP machine, which is only assigned at fixed pressure

  • Bilevel positive airway pressure (Bi-pap): It has two levels of pressure.  It consists of both Intransporatory Positive Airway Pressure (IPAP) and Exporatory Positive Airway Pressure. It is generally recommended for its patients who failed CPAP therapy, diagonise  central sleep apnea, and  carbon diooxide retention or improper gas exchange during sleep.

  • Bipap Spontaneous Time: The most important difference between Bipap and Bipap ST.  is that Bipap ST comes up with breathing rate. Bipap/ST setting   includes  setting of respiatory rate  usually between 12 and 20 , if  the patient failed to provide  expected respiratory rate.  Respiratory rate  can easily be  counted   simply watching  the chest rise and falls per minute. All  these information can be available in your sleep study report.

  • Auto-pap: In the case of autopap, the pressure varies during your sleep. For example, in the case of 4-20 CmH2O settings, the lower pressure would be 4 cm H2O and upper pressure would be 20 cm H2O. In  other  words  ,a variable pressure  is  delivered  as per AHI  Idex.

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Oral Appliances

In this case, your dentist will find an appropriate piece that will go into your mouth, which will keep your mouth open. 

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Surgery

The last option is surgery, only if all treatments failed to produce positive impact. It includes you tonsil to be removed, nasal surgery for nasal deviation spetum, tracheostomy, etc.

Masks

There are different types of masks available in the market. Generally, it comes with full face mask, nasal mask, and nasal pillows mask. The selection of the mask depends on patient's conditions, comforts, setup pressures, etc.  For example, a claustrophobic patient is not a good candidate for the full face mask. 

1. Full face mask: covers the patient's nose and mouth

  • Drawbacks: If the patient suffers from claustrophobia, he/she may prefer nasal masks or nasal pillows

  • Benefits: It is ideal for patients with higher-pressure needs. If the patient has nasal deviation septum or frequent congestion, full face masks is the answer.

2. Nasal masks: In simple words, masks sitting on top of the nose and seals it

3. Nasal pillows: This mask consists of two small cushions that fit under the nose

  • Drawbacks of Nasal and Nasal Pillow Masks: If the patient opens the mouth during sleep (mouth-breathes), nasal masks are not ideal because a portion of setup pressure can leak through the mouth and therapy may not be effective, unless patient wears chinstrap along with nasal mask. Another problem associated with these masks is that all patients setup pressure is delivered directly through nasal airways, so workload is high and it may not be comfortable to some patients.

  • Benefits: The nasal masks can reduce the air leakage. It is easy to wear and remove than full face masks

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Asthma and Nebulizer Use

The patients with Asthma, COPD, or breathing difficulties use nebulizers. 

 

How to Use the Nebulizer for Treatment 

1. Wash your hands prior to preparing each treatment and clean the nebulizer.

2. Connect the air tubing from the compressor to the nebulizer base.

3. Fill the nebilizer with the correct dose of medication (ex. Albutrol) prescribed by the doctor.

4. Attach the mouthpiece or Aerosol mask to the nebulizer and to the patient's mouth/face.

5. Turn on the machine and make sure the patient is deeply breathing throughout the treatment.

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Asthma Treatment

Asthma is an obstructive airway disease that makes breathing difficult. Asthma manifests the following signs:

  • Shortness of breath

  • Wheezing

  • Tight feeling in the chest

There are different drugs available to treat Asthma, COPD and other lung disease conditions.

  •  Bronchodilators (Adrenergic)​: the first line of drug for asthmatic and COPD patients before the use of steroid inhalers. 

    • Albuterol Sulfate (Proventil): dosage of 2.5 mg, 0.63 mg, 1.25 mg

      • It is a bronchodilator that relaxes patient's muscles in the airway and increases airflow to the lungs.

    • Xopenex (Levalbuterol): dosage of 1.25 mg, 0.63mg, 0.31 mg

      • If the patient's heartrate is higher than normal, this medication is used to treat airway obstruction​. It is chemically similar to Albuterol

  • Anticholinergic: A second method of producing airway relaxation through blockage of cholinergic induced bronchoconstriction

    • Ipratropium Bromide (Atrovent): dosage of 0.5 mg/mL

    • Duoneb: A combination of Atrovent and Albuterol. For COPD patients, it works well by preventing contraction of airway and by decreasing the amount of mucus produced by the airways

  • Corticosteroids (Steroids): This inhibits inflammation and swelling inside the airways and opens the airways 

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Asthma Flow Meter

It is a hand-held device that measures patient's maximum speed of expiration or peak expiratory flow rate. If the Asthma patient regularly uses this flow meter, it can detect and monitor airway narrowing early.

 

Patient Instructions for Use of Asthma Flow Meter

1. Hold the peak flow meter and move the mark to zero

2. Stand up/ sit upright 

3. Take a deep breath

4.  Close your lips tightly around the mouthpiece between the teeth

5. Blow out as fast and hard breaths as you can into the mouthpiece

6. Check the movement of the marker and analyze it

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Incentive Spirometer

It is a medical device used to measure how well your lungs fill up with each breath.

Who Can Use it?

The patients recovering from surgeries to keep their lungs inflated and COPD patients.

Patient Instructions for Use

1. Sit up in the upright position

2. Place the mouthpiece into your mouth and tightly seal your lips around the mouthpiece 

3. Exhale normally before you begin therapy

4. Inhale (breathe in) slowly and deeply as you can. You can see the piston inside the incentive spirometer rise 

5. Hold your breath three to six seconds

6. Remove the mouthpiece from the mouth and exhale slowly and relax

7. Repeat these steps as instructed by your doctor

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Portable Pulse-Ox

It is used to spot oxygen saturation in the blood and monitor pulse rate. The normal O2-saturation rate is 95:100.

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Digital Blood Pressure Monitor 

Blood pressure is considered as a silent killer. It is one of the leading causes of strokes, heart attacks, kidney failures, etc. Therefore, checking the blood pressure is very important in our busy and stressful lives. 

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References

 

    American Academy of Sleep Medicine. International Classification of Sleep Disorders: Diagnostic and Coding Manual. 2nd ed. Westchester, IL: American Academy of Sleep Medicine; 2005. p. 51–5.

   Ebell MH, Siwek J, Weiss BD, et al. Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. Am Fam Physician 2004; 69: 549–57.

   National Institutes of Health State of the Science Conference Statement. Bethesda, MD; 2005 Aug 18.

   Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002;165(9): 1217–39.

   Young T, Shahar E, Nieto F, et al. Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study.Arch Intern Med 2002; 162(8): 893–900.

   Kapur V, Strohl K, Redline S, Iber C, Oconnor G, Nieto J. Underdiagnosis of sleep apnea syndrome in U.S. Communities. Sleep Breath 2002; 6(2):49–54.

   Quan S, Wright R, Baldwin C, et al. Obstructive sleep apnea-hypopnea and neurocognitive function in the Sleep Heart Health Study. Sleep Med2006; 7(6): 498–507.

   Shahar E, Whitney C, Redline S, et al. Sleep disordered breathing and cardiovascular disease: cross sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 2001; 163(1): 19–25.

   Punjabi N, Shahar E, Redine S, Gottlieb D, Givelber R, Resnick H. Sleep-disordered breathing, glucose intolerance and insulin resistance: the Sleep Hearth Health Study. Am J Epidemiol 2004; 160: 521–30.

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