December 12, 2016
Your snoring and sleep breathing issues have resulted in more elbows in the ribs than you care to remember. Maybe you’ve even suffered the ultimate insult and been kicked out of the bedroom. You’ve probably been reading more and more medical reports lately, showing that sleep apnea causes high blood pressure, heart attacks, stroke, and type 2 diabetes, so you know it’s a serious problem. But who wants to face spending a night in a sleep lab and then the prospect of having to use a CPAP machine every night? The good news is that there have been some recent technological innovations in the field that may make it more appealing for you to finally tackle this issue.
1) You no longer have to spend a night in a sleep lab.
“The bed was uncomfortable.” “They made me go to bed at 9 p.m. – who can sleep at that time?” “I could hear other people snoring and coughing all night.” As a sleep doctor, I’ve heard all the negative comments about in-lab polysomnograms (sleep studies), and you may have heard some less-than-stellar reviews of the experience from friends who have had one. The good news is that the vast majority of patients can now have a sleep apnea test in the comfort of their own homes. In 2007, the American Academy of Sleep Medicine (the field’s governing body) issued new clinical guidelines regarding home sleep testing. The conclusion: for patients at increased risk for obstructive sleep apnea (OSA), home sleep studies’ diagnostic accuracy was equivalent to that of in-lab studies.
A typical in-lab sleep study involves multiple electrodes placed on your head, around your eyes, on your chin, chest and legs. Application of each sensor requires scrubbing the skin with an abrasive and application of a conductive paste between your skin and the electrode. Female patients commonly complain about their hairdos being utterly destroyed during the process. If you have a weave, wig, or toupee, it will have to be removed for the study, which can be embarrassing. There are also two sensors around your nose, belts around both your chest and abdomen, and an oxygen sensor on your finger. You will be watched all night by a technologist through an infrared camera in the room; many people find this is creepy enough to be insomnia-inducing! Compare this to the most commonly used home sleep test apparatus that only involves a single belt around your chest, one sensor under your nose, and a finger oxygen probe. Home sleep testing kits are super-simple to set up and patients can easily do it themselves.
2) CPAP machines have gotten a lot more comfortable.
Since their inception, CPAP machines have undergone quite a bit of evolution. The first innovation that made a huge impact on comfort was the introduction of heated humidifiers into the machines. The earliest machines had the tendency to really dry out the throat and mouth, but most machines now come standard with a humidifier, which eliminates this problem. Another major shift in CPAP machines has been the “APAP revolution.” APAP stands for “Auto-Titrating CPAP Machine;” this newer generation of machines provides on-demand pressure and can treat OSA with less mean pressure than the older, fixed-pressure machines. CPAP machines have also had dramatic improvement in size and noise-level compared to their early versions. Most CPAP machines now are the size of a shoebox or smaller, and there are some models that can fit in the palm of your hand. Typical noise output of a modern CPAP machine ranges from about 25-30 dB, which has been equated to a whisper in a quiet library.
For people who have tried CPAP and had a bad experience with it, BiPAP machines may be a better fit. BiPAP machines are more sophisticated than CPAP; they have the capability of dropping the pressure when you switch from inhalation to exhalation. Many CPAP-intolerant people do well with BiPAP because it feels more like natural breathing. Trying to exhale against incoming air pressure can feel claustrophobic and BiPAP fixes that problem.
3) Alternative treatments are now available.
If you held off on getting a sleep apnea test because you knew that there was no way you’d ever sleep with a mask on your face, it’s time to reevaluate your position because there are several effective and unobtrusive therapies on the market. Provent is a medical device that consists of a patch that covers your nostrils. It is very small and portable and approved by the FDA for the treatment of OSA. Oral appliances for sleep apnea are another option for the CPAP-averse. You wear these retainer-like devices in your mouth at night and they push your mandible forward, helping keep your airway open when you sleep. Make sure you get a device that is FDA-approved for OSA; there are many devices on the market and some are only approved for snoring. Previously, you used to have to go to a dentist to get one of these devices but now the there is a “boil-and-bite” device that you can fashion at home called the ApneaRx. The ApneaRx is significantly less expensive than typical custom-made oral appliances.
As you can see, many of the typical patient concerns about sleep apnea testing and treatment have been put to rest. So what are you waiting for? Go get tested now!
Joseph Krainin, M.D., is the founder of Singular Sleep, the first-ever online sleep center. He is double board-certified in sleep medicine and neurology and is a Fellow of the American Academy of Sleep Medicine.