OBSTRUCTIVE SLEEP APNEA


Reading this page can drastically change your life for the better if you have Obstructive Sleep Apnea (OSA). You have high odds to have that syndrome if you:

  • Snore.
  • Are obese.
  • Feel tired and sleepy; have sleepiness and impaired alertness while driving, sitting in business meetings or watching TV.
  • Live with chronic fatigue and lassitude.
  • Have "brain fog", decreased attention and difficulty with concentration.
  • Oscitate and have lack of energy and decreased performance at work.
  • Have high blood pressure.
  • Have heart conditions.
  • Had stroke.
  • Have bad mood, irritability and depression.
  • Drink alcohol or sedatives (especially in the second half of the day).
  • Suffer from headaches (especially in mornings).
  • Have type 2 diabetes.
  • Sweat at night even when it is not hot.
  • Go to washroom (to urinate) at least once per night (sometimes more times).
  • Have large neck size, especially with fat folds on the back of the head (a "beer lover's neck").
  • Have lower jaw sitting too close to the neck (so the lower teeth are behind the upper ones). Check when you are lying in bed: your lower and upper teeth should be coplanar; if your lower jaw is "falling down", it's a "red light"!!!
  • Is very tall. Firstly, this bullet didn't exist in the list. I knew a few slim, but really tall guys with OSA, but I didn't jump to conclusions - the sample was not too representative. One day, I found the topic How many of you tall guys/girls snore or have sleep apnea? on Reddit and decided to add this bullet even though I don't see any logical link between height and OSA.
Many people suffer from OSA for many years, but do not even know about their illness!

WHAT IS THAT?


If you never heard about obstructive sleep apnea, the information, provided below, can shock you. So, I want to let you know in advance, that the problem can be solved quickly and easily - you will read about that on this page later, in the section "HOW TO GET RID OF OSA?".

When you are sleeping at night, your brain goes into deep sleep and loses control over internal tissues of your mouth. They collapse under their own weight and block the airway:


Each suffocation event can last as long as 1 and even 2 minutes! When the blood oxygen saturation decreases critically, the brain, bombed with SOS signals, slightly wakes up and saves the situation, raising the collapsed tissues. Air passage is restored, oxygen level in the blood returns to its normal level, the brain falls back into a deep sleep, and... the story repeats itself in an endless loop:


The person spends half a night (or even more - for example, my own sleep test revealed 5 hours of 8!) not breathing - in heavy asphyxia - but, after waking up in the morning, remembers nothing and has no clue what happens at nights and why he/she is suffering many years from sleepiness, fatigue, obesity and other problems, listed in the beginning of this page! More explanation of OSA can be found in these videos: 1, 2, 3, 4, 5.

BTW, now you understand why people with OSA "sweat at night even when it is not hot"? When the airway is blocked, the chest is repeatedly, but unsuccessfully, trying to breathe. So, the body is working very hard physically throughout the whole night.

OSA CAN KILL. LITERALLY!


Have you ever heard the phrase that someone died in a dream, although he/she seemed to be healthy? Chances are great that it happened because of apnea. I mean death not from diseases that are the consequences of apnea (for example, related to the heart, blood pressure or oncology). I'm talking about death directly from the apnea itself. People are just strangled while sleeping.

The normal level of saturation (oxygen concentration in the arterial blood) is 95-98%. The reduction to 93% is considered clinically insignificant. If the level drops to 90%, it is considered as hypoxemia, and it can lead to hypoxia. The level of oxygen in the blood below 80% can disrupt the functioning of the brain and heart. 70% can lead to cardiac arrest. A decrease in saturation of less than 50% within 2 minutes leads to the onset of necrosis (death) of neurons in the cerebral cortex.

A catastrophic decrease in saturation is clearly seen on a fragment of a cardiorespiratory monitoring recording during sleep in a patient with obstructive sleep apnea:

The following video shows how OCA leads to a drop in the oxygen level in the blood to 53%. The brain at the last moment woke up and saved the situation, but not everyone was so lucky:

HOW TO KNOW WHETHER OR NOT I HAVE OCA?


The official diagnosis can only be established by a sleep test - the details will be provided soon, keep reading. That will take weeks, but there is something you can do this night, so you have a chance to know the answer tomorrow morning: record a video of your sleep using your smartphone (Struggling to Breathe? Film Yourself Sleeping). That requires some light in your bedroom. If it's a problem, then only record the sound using a voice recorder app. If you discover the pattern "snore - snore - snore - silence when snore was expected - sharp, loud gasp" (watch the first 30 sec of this video), then you definitely have OCA. If you cannot hear that pattern, that is not a guarantee that you don't have OCA in a mild form (that's why I wrote "you have a chance to know the answer tomorrow morning" rather than "you will know").

OBESITY CAUSES OSA...


Please get familiar with the statistics of OSA prevalence in groups of people with different body mass index (source):

  • BMI 35-39.9 - 71%
  • BMI 40-49.9 - 74%
  • BMI 50-59.9 - 77%
  • BMI 60 or more - 95%

How exactly does obesity cause apnea? There are 3 factors:

  1. When most people gain weight, they gain it everywhere - including their neck and intraoral organs ("visceral fat"). Fatty tissues in this area can narrow your airway when you lie down. Compare the throats of a slim and a fat person:



  2. The visceral fat makes the internal tissues, joined with the tongue and lower jaw, heavier and, therefore, more prone to collapse under the action of the terrestrial gravitation.

  3. The fat behind the neck (remember the "beer lover's neck"?) arches the backbone forward. This narrows the airway as well:

While the weight is increasing, the clearance between the collapsing internal tissues and the neck continues to decrease, and one night the airway is completely blocked...

...AND OSA PREVENTS WEIGHT LOSS!


How exactly? There are 6 (!) factors:

  1. When the sleeping brain finally discovers that the level of oxygen in the blood has fallen to a critical level, it switches to an "emergency mode" and throws into the blood an extra dose of adrenaline and other special biochemistry to save the situation and raise the fallen nasopharyngeal organs. In such an emergency, the body (thanks to evolution!) prepares the body for the worst scenario (perhaps, prolonged hunger) and launches the mechanism for storing fat as a reserve (to survive the hungry period).

  2. Intermittent sleep in apnea causes a disruption in the production of growth hormone (testosterone) responsible for transforming fat stores to energy, necessary for the normal functioning of the body. As you could read in the page HOW TO START, growth hormone "plays an important role in weight loss - it "opens the fat depot" i.e. enables the use of fat deposits as a source of energy". The sleep of a healthy person consists of two alternating stages: shallow ("fast sleep", or "fast eye movement" phase) and deep ("slow sleep"). Growth hormone is produced mostly in the deep stages of sleep. But as soon as the brain goes into it, apnea occurs and the brain returns to the shallow stage. The lack of growth hormone causes the body to require more and more food to get energy from it, since the stored fat is "locked".

  3. Sleep apnea causes us to over produce ghrelin. The job of that hormone is to tell us when we need to eat - it stimulates food intake by making us physically feel hunger. So, the link between increased secretion of ghrelin and wight gain is very straightforward. In patients with obesity, after eating, the level of ghrelin does not decrease, for this reason there is no feeling of satiety after eating. Interesting fact: ghrelin is produced in the area of ??the stomach, which is removed with most bariatric surgeries - this is one of the mechanisms of action (but not the main) of these surgeries, which turn obese into slim. While bariatric surgeries almost stops the production of ghrelin, obstructive sleep apnea - on the contrary, greatly increases.

  4. Sleep apnea causes us to under produce leptin, and reduces sensitivity to it. Leptin is the hormone which regulates appetite (it tells us to stop eating). Because of the developed resistance to leptin, the body thinks that a person is hungry, even when in fact there is no physical need for food at the moment. That causes two effects: more frequent meals, and overeating during one meal.

  5. Sleep apnea reduces the production of serotonin. Serotonin is a natural suppressant of appetite: that hormone suppresses the feeling of hunger and gives a feeling of saturation, even if the stomach is not full. Thanks to serotonin, the amount of food consumed decreases, and as a consequence, the weight decreases.

  6. Sleep apnea reduces sensitivity to insulin. High levels of insulin (hyperinsulinemia), which are caused by insulin resistance, are associated with central obesity (a massive accumulation of fat in the abdomen): the person can look not very fat in front, but have a large, overhanging belly.

As you see, Obstructive Sleep Apnea causes fat to be stored MORE, then necessarily, and consumed (utilized for energy production) LESS, then necessarily, so nor diets (even the best ones in the world!) nor Intermittent Fasting will help to lose weight seriously and constantly because the fat storage mechanism of OCA has nothing to do with WHAT, HOW MUCH and HOW OFTEN you eat. People can think that you are a lazy glutton who don't want to do sport, but it's not your fault that you are obese - you have a problem (which, fortunately, can be quickly and easily solved - keep reading!).

So, all the just listed reasons cause further weight gain and make weight loss unrealistic. Because the person gets fatter, the degree of apnea becomes even stronger, which leads to an even greater weight gain... and so on, and so on - we have a vicious circle:



Detailed explanation of how OCA prevents weight loss can be found in these videos:









HEART PROBLEMS AND SLEEP APNEA


The heart begins to suffer and be damaged from lack of oxygen quicker than many other organs including the brain. Please google.

HIGH BLOOD PRESSURE AND SLEEP APNEA


OSA contributes to the risk of developing hypertension, which can lead to adverse consequences like a heart attack or stroke. The repeated episodes of disrupted breathing during sleep leads to drops in blood oxygen levels, spikes in the heart rate, and increased blood pressure. In simple words: when the brain discovers lack of oxygen, it instructs the heart to pump blood harder in order to transport more oxygen. The heart does its best, the blood pressure dramatically increases, but, of course, that cannot solve the problem The resulting inflammation affects the whole body. When blood pressure is difficult to control with lifestyle changes or medication, sleep apnea should be investigated as a potential cause with a sleep study. When a man requires three blood pressure medications and still cannot keep his hypertension under control, there is a 96% chance that he has sleep apnea! If you know somebody with hypertension, advise them to go to a sleep disorder specialist NOW!!!

DIABETES AND SLEEP APNEA


For diabetes and sleep apnea, glucose intolerance and insulin resistance are two terms you should become familiar with. Insulin is a hormone released by your pancreas (a gland in your abdomen behind your stomach that plays a role in hormone production and digestion) to help you store and use the sugar and fat from the food you eat.

When you suffer from sleep apnea, you periodically stop breathing many times a night — as many as hundreds of times a night if your sleep apnea is severe. When your body is deprived of oxygen, your fat cells become resistant to insulin and your glucose levels rise. This is referred to as insulin resistance and glucose intolerance. When this happens, your body may not respond to insulin. For more details, read this article.

HOW TO GET RID OF OSA?


The treatment is very quick and easy - CPAP (continuous positive airway pressure) device, or "sleeping machine", a high-tech computerized compressor that supplies air under pressure through the face mask:


A modern Automatic CPAP (aka APAP) has a smart algorithm which tries to keep the pressure lower for your convenience, but increases it in real time when detects airflow limitation or airway blockage, so each time the problem is resolved in seconds, before blood saturation starts dropping.

The upper graph shows how pressure is being increased when flow limitation (the lower graph) is detected, and drops when flow limitation has been successfully removed (i.e. the falling internal tissues have been returned to their place). The flow limitation range is from 0 (airway absolutely open) to 1 (completely blocked). As you see, the worst scenario is an about 50% blockage for a very short period of time, so no blood oxygen drop occurs:



It's so easy to begin new life without all the problems, listed in the beginning of this article! Believe or not, but CPAP-therapy removes sleep apnea (but not it's reason) immediately, not after a few months or even days, so you will start feeling much-much-much better (I would say, begin your new life) next morning after the first night of the therapy. In fact, it will be your first night with good sleep and no suffocation for many years! The next day will be your first day without sleepiness, lassitude and depression for, maybe, decades! It's like a fairy tale, but there are no miracles - physics only: the air pressure, produced by the "sleeping machine", mechanically keeps the tissues from collapsing and closing the airway. Voilà - no suffocation and its terrible effects anymore! Of course, it takes time to get used to the face mask (for example, I stopped feeling discomfort after 1.5 weeks, and stopped paying attention at all after 1.5 months), and you will not lose weight after just a few nights with CPAP, but the obstacle, which didn't allow you to lose weight, is removed literally immediately!

In the following two videos, people share their impressions in the first day after beginning CPAP therapy:



Finding Out I Had Sleep Apnea Was The Best Thing That Ever Happened To Me. Sometimes a diagnosis isn't the end of the world. It's just the beginning of a better one.

CPAP THERAPY CAUSES WEIGHT LOSS


Do you know how I was diagnosed with OSA? I went through preparation to a bariatric (weight loss surgery). Sleep test is one of the important pre-surgical steps. If OSA is found, then the patient must go through half a year CPAP therapy to lose some weight before the surgery. That will decrease the amount if the internal fat and facilitate the work of the surgeon, who needs access to the organs to be cut. Fortunately, I cancelled my surgery before it was too late (since I found a much better way to lose weight - intermittent fasting + LCHF), but I write about that here to demonstrate one more time, that OCA prevents weight loss, and CPAP therapy - oppositely, causes.

WHAT SHOULD YOU DO TO BE DIAGNOSED?


Ask your family doctor to write a referral to a sleep disorder specialist ("sleep doctor") which will send you to a sleep test (polysomnography) to define if you have OSA. If you do, the sleep doctor will prescribe a CPAP. In many places it's covered by insurance. For example, SunLife insurance in Canada covers 90% of the CPAP-related costs (including masks). If you live in Ontario and have no extended insurance: Assistive Devices Program covers 75% of the basic device price (you pay the rest; but don't buy a basic one, buy only a modern AUTOMATIC CPAP, or APAP!!!). Google similar programs in other provinces/states/countries.

IF YOU ARE SURE THAT YOU HAVE SEVERE SLEEP APNEA...


...BUT YOU WILL SEE A SLEEP DISORDER SPECIALIST (AND HAVE A CPAP) ONLY AFTER A WHILE, YOU CAN PERFORM SOME STEPS RIGHT NOW TO PARTIALLY SAVE THE SITUATION:

  1. Do not drink alcohol and do not take sedatives or sleeping pills, especially in the second half of the day! They all contribute to obstruction events by relaxing the muscles of your upper airway and making it more prone to collapse, so the tissues tend to block the airway quicker and more frequently. After the collapse, they increase the reaction time of the brain when it gets signals about low level of oxygen in the blood, so suffocation lasts longer and is more dangerous (the lower blood saturation - the more chances to die). Narcotic pain medications can act in the similar way.

  2. Try sleep sitting up in an armchair. If the backrest is low, put your pillow ON it. Use an airplane neck pillow (buy it in a tourism/travelling store or department). Sleeping up will not totally remove OSA, but can improve the situation (maybe, you will even say: "It was my best sleep in years!" - even though sleeping in an armchair is pretty inconvenient). Also try the anti-snore/anti-apnea oral device (a.k.a. sleep apnea mouth guard). It slightly moves your lower jaw ahead, thus opening the airway (and prevents it from falling down while sleeping). You can buy it in any pharmacy. Usually, it's useless at all with severe apnea, but who knows - it may help in combination with sleeping up.

  3. If you fail to sleep sitting up, buy a bed wedge. By elevating the person's upper body, the position helps keep the upper airway open and prevent weak tongue muscles from collapsing to block the airway, hence promotes better air-flow and prevents snoring as well as mild sleep apnea:



    Buy a wedge with height at least 9 inch (that info always appears on the product or in the description if you buy online). Also, watch this video (it's an ad, but explains the principle).

  4. Stop smoking.

MIRACLES HAPPEN IN REALITY!


People answer the question "How much of a difference does using a cpap make for you?" in Reddit (just to remind: I don't sell cpap devices or anything else, related to health; the quotes are provided for those who are unsure whether or not they will be able to sleep with mask):

My business and personal and social life turned 180 degrees. Feeling fresher, younger and happier :)

Huge difference. I can sleep at night and my wife doesn't hear anything at all. I actually have no problem sleeping with my CPAP and keep it on all night.

I'm a year into BiPAP and it's made a huge difference! I sleep less and wake up feeling better. I used to wake up after sleeping 10-11 hours and literally say "I need a nap.". Now it's 7-8 hours a night and I have a little spring in my step. I don't think I'll ever be a morning person but that's just me. Cognition and mental status has by far been the biggest improvement. I feel like I'm firing on all 8 cylinders rather than driving a Cadillac with a 4 cylinder engine. I feel like I have a lot more willpower than I ever had. It has helped me loose some weight and will help me finally quit smoking. What made me talk to my doctor was having to fight sleep really hard while driving at night. It started to happen almost every time I drove at night. Regardless how much I slept or how much caffeine I consumed. This was right around the time a couple of train derailments were in the news and tentatively attributed to sleep apnea. That scared the crap out of me. I talked to my (then new to me) PCP about it. He looked at me and said you have sleep apnea as if it were a plain as day fact. TBH, it sounded a little arrogant without any testing. I was concerned it could be something worse. After the specialist referral and testing it turned out he was spot on. Good catch doc! Despite being slightly claustrophobic, ex: I cannot drive in a car with all the windows closed, I had very little trouble adjusting to the mask. After the titration study where I'd only slept 4.5 hours I noticed a little spring in my step walking out of the sleep lab. That 4.5 hours during the study felt like the best sleep I had in years. I knew I'd *have to* adjust to the mask and did so without much issue.

Amazing difference for me, the first 2 weeks were a tough adjustment period, but after that my sleep has been so much more restful, I never want to go back to sleep without it. I had no idea how tired I was before (and that it wasn't normal!).

My CPAP has changed my life. When I was first tested and prescribed a machine it took me almost 3 months to sleep through the night with it. I had severe anxiety when wearing it which was the reason it took so long. When I was first tested my AHI was 85, I was waking up to go to the washroom 4-5 times a night not to mention the countless times I would wake up. I fell asleep in meetings and pretty well any time I sat down on the couch. Now after being on the machine or a solid 10 months I sleep through the night and only wake up if one of my kids needs me. I usually fall asleep within 5 minutes of putting the mask on and I have also not even had a nap in almost as many months. My anxiety is gone, my energy level is way better and the mental cloudiness is gone as well. I know the results are different for everyone but my experience has been extremely positive.

I can focus so much better. When playing the piano I can follow the music better. I can hear and play both hands more meaningfully.

I no longer fall asleep standing. I'm still tired but not death tired.

I wake up every day not needing caffeine and can actually make it through a work day without worrying about falling asleep. Driving is much safer considering I can finally stay awake. Quality of life in general is greatly improved once you get used to wearing the mask. I feel like I can think straight again without the mind-cloudiness every day. Keep trying, and try other types of masks if you feel the one you have isn't for you. It is more than worth it to get rid of the brain fog and tiredness through the day.

It's made a huge difference for me. I used to sleep through the night, almost fall asleep driving and at work, and took long naps on the weekend. I was always tired. After using the cpap for a few nights I was able to stay awake during all those times and cut out the weekend naps. I normally sleep about 8 hours or so per night now and I also have a lot more energy. It was difficult getting used to the full face mask but I was very motivated. Now it doesn't even bother me.

USEFUL TIPS FOR A BEGINNER CPAP USER:


• Buy only an automatic device (aka APAP, or Auto CPAP).

• Buy only a device with a memory card. Analyze your nights using SleepyHead program (download for free here).

• Depending on a person and on a mask, it can be comfortable to go to sleep with the minimum pressure (4), or with a higher pressure. In the beginning of my therapy, I preferred the initial pressure 8-9, but after half a year, after purchasing the fantastic mask AirTouch F20, I decreased the start pressure to 4. EXPERIMENT to find the pressure you feel comfortable with! If you decide to go with a number, which is lower than your minimum prescribed pressure (for example, your prescribed range is 9-14 but you like 4), don't worry: when needed, the APAP will increase the pressure, depending on the conditions in the real time. That will happen when you will already be sleeping, so you will not pay attention.

• Don't use ramp (even auto) - you can feel that the pressure jumps up before you are 100% sleeping, and that will wake you up.

• Use the exhalation relief feature (make exhalation pressure 3 cm less than inhalation pressure).

• In the first days, when you go to sleep, put the mask on, lie on bed, but DON'T CONNECT THE HOSE IMMEDIATELY. Maybe, you have an easy shortness of breath which you do not notice (because of physical activity just before going to bed, superexcitation or excess weight). Allow 2-3 minutes to shortness of breath to disappear, and only after that connect the hose.

• If you feel like you can't breath under pressure, then try slow breathing just after putting the mask on, i.e. sloooooow inhale and sloooooow exhale - after a few cycles, you will realize that everything is going fine!

• If you suddenly feel that there is not enough air, then take the deepest breath that you can. Whatever the pressure is, it's ALWAYS possible! When you know this fact, you know that you are not in the danger of suffocation, i.e. a certain psychological problem disappears.

• If you wake up at night and feel that you cannot breath, you are probably under high pressure at that moment. Simply turn off and turn on the device (i.e. click the button twice) - that will reset the pressure to the minimum level, so you can keep sleeping comfortably.

• Many people ask: what if there will be an electricity blackout in the night? OK, you will suffocate and die. Do you really think, that the engineers of a device as high-tech as a CPAP, didn't think about that? In fact, it's easy to check what will happen... When you are wearing a mask, unplug your device from electricity. You will see, that you keep on breathing without any problem. Of course, the effect will disappear if that happens when you are sleeping, but you will not become a victim of your CPAP!

• Peg pressure as your friend. Many beginners think: "How is it possible to breath under pressure?"... Believe me: it's even easier, than without pressure since the compressor HELPS your lungs. For beginners, it's all about psychology, not physics!

• Are you afraid that you will not be able to get used to the mask? I was afraid of that too. But after 2 weeks I was totally OK with the mask, after 1.5. months stopped paying any attention, and after a few months, I had a strange feeling if I lie in bed without mask - I am missing something! Inconvenience in the beginning is nothing compared to the benefits that will dramatically improve the quality of your life!

• Use CPAP mask leak sealer gel (buyable in the Internet - I bough this). You will forget how masks leak.

• If the mask hurts your skin, buy the mask named "AirTouch F20". It has a very soft memory foam rather than silicon (video). Mask leak sealer gel cannot be used with it (and there is no need because air doesn't leak from under AirTouch F20).

• Use humidifier! In good modern CPAP models, it is built in, but if your device doesn't have it, buy an external humidifier. The CPAP ventilation is drying on the airways. The airways are meant to be moist since it is line with mucus membranes. When it dried out, you got tiny wounds in your airways, opening you up for infection. The mucus production was your body doing its best to protect you from drying out.

• If you experience condensation in the mask, or if you use masks of different KINDS, then switch humidity level to "auto" (rather than setting an exact temperature each time you change mask KIND or the room temperature and humidity change). The "auto" setting works perfectly in my AirSense 10 Autoset! You will see, that with a nasal mask much less water is consumed that with a full face mask. If you want to get as high humidification as you can without getting condensation, then use a heated hose or an insulating cover for your tube - that helps to prevent condensation.

• Use CPAP hose holder to hang your hose above your head. Firstly, it's more convenient, especially when you are turning from side to side. Secondly, a fragment of the hose will be running uphill, so the moisture, collected within the tubing, will run back down the hose to the humidifier, rather than into your mask, dousing you in the face in the middle of the night. If you don't have a hose holder, put the CPAP machine in a lower position than where you are lying in bed (below your mattress level - even on the floor) to ensure the hose goes from the bottom upwards.

• If your nose is not absolutely clean, and you want to use a nasal mask, then, just before going to sleep, use salt water nasal rinse (you can buy it in any pharmacy).

• Don't buy a "compact" "traveler's machine". It is only a little bit smaller, but the same room will be occupied by accessories, so you will save very little room overall. With that, it will not be as good as a regular one. It is slightly lighter in weight, but that gives you no advantage travelling by an airplane: any kind of cpap does not count towards your carry on bag total since it is medical equipment. In fact, lighter weight is a disadvantage: compact machine is not stable on the bed-side table. Cases reported when user pulled the hose while turning to a side, and the device fell down to the floor. In fact, any regular device is portable and easy to travel and comes with a bag - simply travel with the device you are so familiar with.

And now - some nice selfies!

In the laboratory, just before sleep test (I smile because I don't know what a nightmare is happening to me!):



Soon after starting CPAP therapy:



After 2 years of fantastic sleeping and energetic life without constant sleepiness, chronic fatigue and seeing the world through fog:


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