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We care about your success in using your CPAP/BiPAP therapy equipment, and we're here to answer any and all of your questions about its use and care. Click on any question below to jump to its answer. If your question is not listed here, please email us or call us.
About Sleep Disorders
About Sleep Therapy
How to Establish Good Sleep Habits
CPAP Product Care
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Answers About Sleep Disorders
What general information can you tell me about sleep disorders?
Sleep is not merely "time out" from daily life. It is an active state essential for mental and physical restoration. Yet more than 100 million Americans of all ages regularly fail to get a good night's sleep.
Some 84 disorders of sleeping and waking harm personal health and quality of life, and endanger public safety by contributing to traffic and industrial accidents. These disorders include problems falling or staying asleep, difficulties staying awake or adhering to a consistent sleep/wake schedule, sleepwalking, bed-wetting, nightmares, and other problems that interfere with sleep. Some disorders are potentially fatal. Sleep disorders are diagnosed and treated by a variety of health care providers including general practitioners and specialists in neurology, pulmonary medicine, psychiatry, psychology, pediatrics and many other fields.
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What is snoring?
Although people who snore loudly are often the target of many bad jokes and the occasional victims of middle-of-the-night elbow thrusts, snoring is no laughing matter. Loud snoring may be a signal that something is seriously wrong with breathing during sleep. Snoring indicates that the airway is not fully open, and the noise of snoring comes from the efforts to force air through the narrowed passageway. An estimated 10% to 30% of adults snore, and for the most part, snoring has no serious medical consequences. For an estimated five in 100 people --typically, overweight, middle-aged men -- extremely loud, habitual snoring is the first indication of a potentially life-threatening disorder called sleep apnea.
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What is sleep apnea?
Apnea is a Greek word that means "want of breath." People with sleep apnea don't breathe properly during sleep and, as a result, don't get enough oxygen and have poor-quality sleep. Sleep apnea may contribute to excessive daytime sleepiness and may trigger high blood pressure, heart failure, heart attack and stroke. Snoring loudly, every night, warrants a visit to a healthcare provider, who may suggest a series of studies at a sleep-disorders center. Sleep specialists are now able to detect and diagnose breathing disorders in earlier and more treatable stages of the disorder. Proper treatment can prevent or reverse the potentially life-threatening consequences of sleep apnea. Most sleep apnea sufferers remain undiagnosed and untreated.
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What are the warning symptoms in adults?
The snoring may be so loud that it rivals a jackhammer and can be heard rooms away, or even by neighbors. A particular pattern of snoring interrupted by pauses, then gasps, reveals that the sleeper intermittently halts breathing. Some people do not breathe at all for three-quarters of their sleep time. Such vastly disturbed nights can produce profound daytime sleepiness that often disrupts work and personal life. People with sleep apnea fall asleep at inappropriate times such as at work or while driving. Recent studies show that people suffering from sleep apnea are two to five times more likely to have car accidents that are those who do not suffer from this disorder.
People with sleep apnea may have trouble concentrating and can become unusually forgetful, irritable, anxious, or depressed. These problems may appear suddenly or emerge over many years. The person may not notice these symptoms or may minimize their severity through heavy caffeine use. Often family members, employers, or co-workers first recognize a pattern of changes in mood or behavior and encourage a visit to a healthcare provider. Sometimes the individual seeks help for trouble sleeping. People with sleep apnea may notice that they are awakening frequently, gasping for air, and thrashing about in their sleep. They may complain about morning headaches and loss of interest in sex. Men may complain of erectile failure.
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What are the warning symptoms in children?
Sleep apnea has been linked to some cases of sudden infant death syndrome (SIDS) although the precise relationship is still unknown. Ongoing research is evaluating the possible role of sleep apnea as a factor in SIDS. Sleep apnea may be present in children who are overweight and those who have enlarged tonsils and adenoids. Children with sleep apnea may snore, squeak, have difficulty breathing, and sleep fitfully. Since it is not normal for a child to snore, parents should report their child's snoring to a healthcare provider. Older children who have sleep apnea may seem sluggish and perform poorly in school; sometimes they are labeled "slow" or "lazy."
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What causes sleep apnea?
Muscles relax more during sleep than they do during waking hours, including the muscles that are necessary for breathing. In most people, this normal process doesn't cause problems; however, for still-unknown reasons, some people's throat muscles relax too much. This relaxation compromises breathing and makes sleep a time of increased risk. In other people, the muscles relax to a normal degree during sleep but because the throat passage is narrower than normal, closure occurs. In some cases, the trouble lies in the part of the brain that controls breathing during sleep. The brain appears to forget to send out the necessary instructions to the muscles that control breathing. Other possible causes are extra tissue in the back of the airway, such as large tonsils or the tongue falling back and closing off the airway.
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What are the types of sleep apnea?
There are two types -- obstructive sleep apnea, and central sleep apnea:
- Obstructive Sleep Apnea: This is the most common and severe form of sleep apnea. The muscles of the soft palate located at the base of the tongue and uvula (the fleshy tissue that hangs from the center of the soft palate), relax and sag, obstructing the airway and making breathing labored and noisy. Collapse of the airway walls blocks breathing entirely. When breathing periodically stops, a listener hears the snoring broken by pauses. As pressure to breathe builds, muscles of the diaphragm and chest work harder. Sleep is then temporarily interrupted. This interruption activates the throat muscles and "uncorks" the airway. A listener hears deep gasps as breathing starts and each gasp awakens the sleeper. Awakenings are generally so brief and incomplete that the sleeper does not remember them in the morning. Someone with obstructive sleep apnea may stop breathing for 10 seconds or longer, dozens, even hundreds of times each night. Each time breathing stops, the level of oxygen in the bloodstream falls and the heart must work harder to circulate blood. Blood pressure rises and may stay elevated after breathing restarts. The heart sometimes beats irregularly and may even pause for several seconds. These irregularities of the heart may account for some deaths during sleep of people who went to bed in apparent good health. Alcohol, sleeping pills, and tranquilizers, taken at bedtime further reduce muscle tone and may the airway more susceptible to collapse. While most people with obstructive sleep apnea have no obvious physical abnormality that interferes with their breathing during sleep, some conditions may play a contributing role. Some people have smaller-than-normal jaw, large tongues, enlarged tonsils, or tissues that partially block the entrance to the airway. Several of these conditions may exist in the same person. Obstructive sleep apnea primarily strikes overweight men. Female hormones and a different throat anatomy may protect women until menopause. In later years, the gap between the sexes narrows although it never disappears entirely.
Central Sleep Apnea: In this form of sleep apnea, the airway may stay open, but the diaphragm and chest muscles stop working. Falling levels of oxygen signal the brain causing the sleeper to awaken and resume breathing. Central sleep apnea becomes more common as people grow older, and perhaps one in four people age 60 or over experience disturbed breathing during sleep. For most, the problem is mild. It becomes more frequent and severe in people who have congestive heart failure or neurologic disorders. People with central sleep apnea may be more aware of frequent awakenings than those individuals with obstructive sleep apnea.
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What happens if sleep apnea is left untreated?
If left untreated, sleep apnea can contribute to possible increased risk for high blood pressure, heart problems, and stroke; fatigue-related motor vehicle and work accidents; and overall decreased quality of life.
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Answers About Sleep Therapy
How would my doctor find out whether or not I have sleep apnea?
A healthcare provider will want to obtain a medical history and may wish to talk with the bed partner or other members of the household about the patient's sleeping and waking behavior. A provider who suspects sleep apnea will probably refer the patient to a sleep-disorders center for further testing. Experts there will evaluate the problem, and the patient will need to spend a night in the sleep-evaluation laboratory to monitor various aspects of sleep. Evaluation by a doctor specializing in sleep disorders is recommended but not necessary.
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What is a sleep study?
A nighttime sleep study will show whether the patient suffers from sleep apnea, what type of apnea the patient has, how severe it is, and how to best proceed with treatment. On the night of the sleep study, patients are asked to go to the laboratory about one hour before their usual bedtime. Technicians will position dime-sized sensors at various points on the body to continuously record brain waves, muscle activity, leg and arm movements, heart rhythms. A monitor may be placed under the nose and mouth to monitor airflow. Stretch bands with small gauges may be placed around the chest and abdomen to show the effort needed to breathe, and a device clipped to the earlobe or finger charts the fall in the level of oxygen with each apnea.
Sleep may be studied during the day as well through a series of naps offered at two-hour intervals. This study, known as the "multiple sleep latency test," documents daytime sleepiness, which is often extreme when sleep apnea is severe. The test may also be used to differentiate sleep apnea from other causes of daytime sleepiness, such as narcolepsy, which is a neurological disorder.
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What are the treatment options?
General Guidelines:
- Weight loss may help in the treatment of sleep apnea. Even partial weight loss -- 20 pounds by a 200-pound man who should weigh 165 -- may improve breathing during sleep, making sleep more restful and diminish daytime sleepiness.
- Avoid alcohol within 2 hours of bedtime. Alcohol depresses breathing and makes apneas more frequent and severe. Alcohol also appears to trigger apneas in people who would otherwise merely snore.
- Avoid sleeping pills. Sleeping pills depress breathing and generally make sleep apnea worse. Exceptions may be made for people who are bothered by frequent awakenings. Seek a doctor's advice.
- Take all drugs with care. Medications prescribed for headaches, anxiety, and other common problems can affect sleep and breathing.
- Sleep on one side. Some people suffer from sleep apnea only when on their backs. Pillows placed behind the back or a tennis ball attached to the back of pajamas will encourage side-sleeping throughout the night.
Specific Treatments:
- Continuous positive airway pressure (CPAP, pronounced "see-pap"): In this highly effective therapy, a mask is worn over the nose during sleep. Pressure from an air compressor forces air through nasal passages and into the airway. This gentle pressure holds the airway open and allows the person to sleep and breathe normally and eliminate snoring. CPAP is primarily use to treat obstructive sleep apnea, although recent studies suggest it may also improve the sleep of some patients who have central apnea. Approximately 60% to 70% of patients who have tried CPAP have been able to continue in its use; the remainder have found the apparatus too cumbersome. The most common treatment of sleep apnea is the CPAP machine.
- Oral appliances: Devices that may help some apnea patients are designed to open the airway by bringing the jaw, tongue and soft palate forward. A dentist specializing in oral appliances will be able to personally fit one for the patient.
- Surgery: Surgery may correct physical abnormalities that compromise breathing during sleep. These abnormalities include enlarged tonsils or adenoids (common in children), nasal polyps or other growths, a deviated septum, and malformations of the jaw or soft palate. Using a technique known as the uvuolpalatopharyngoplasty (UPPP), a surgeon removes excess tissue at the back of the throat that may be blocking the airway during sleep. Studies show that UPPP benefits about half of those people who undergo the surgery. Some patients have reported negative side affects of the surgery such as nasal speech and the regurgitation of liquids into the nose when swallowing.
- A tracheostomy may be required for people suffering from severe cases of obstructive sleep apnea. This procedure involves making an opening in the trachea (windpipe). A tube inserted into the opening stays closed during waking hours, allowing the person to talk and breath through their normal upper airway. The tube is opened for sleep so that air bypasses the obstruction in the throat and flows directly to the lungs.
- Oxygen: Supplemental oxygen is rarely needed for the treatment of sleep apnea alone. However, oxygen may be added to the nasal CPAP system to correct for low-oxygen levels due to existing lung or heart disease.
- Medication: Medication is generally of limited benefit for sleep apnea sufferers. Certain medications may help mild cases of obstructive sleep apnea and some cases of central apnea.
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What do "CPAP" and "Bi-level" stand for?
A CPAP is a "Continuous Positive Airway Pressure" machine. A Bi-level provides two levels of positive airway pressure, one for inhaling and one for exhaling, for patients who require it.
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How to Establish Good Sleep Habits
What habits can hurt healthy sleep patterns?
- Caffeine and other stimulants stimulate the brain and interfere with sleep. Coffee, tea, cola, cocoa, chocolate, and some prescription and non-prescription drugs contain caffeine and should not be taken within 3 to 4 hours of bedtime. Although mild daytime use of caffeine probably does not hinder sleep at night, heavy or regular use during the day can lead to withdrawal symptoms and sleep difficulties.
- Nicotine is another stimulating drug that interferes with sleep, and nicotine withdrawal can also disrupt sleep throughout the night. Cigarettes and some drugs contain substantial quantities of nicotine. People who quit smoking can expect to fall asleep faster and awaken less during the night, once they overcome the withdrawal effects of the drug. Nicotine should not be used near bedtime or during the night.
- Alcohol slows brain activity. When used at bedtime, alcohol may help a person fall asleep initially but will disrupt sleep later in the night. Early morning headaches, nightmares, and awakening during the night may result from having a "nightcap" before bed. Alcoholic beverages should be avoided 4 to 6 hours before bedtime.
- Clock Watching is not recommended for people experiencing sleep problems, especially those suffering from insomnia. Many find it helpful to set their alarms for the time they wish to get up in the morning and then hide the clock and watches in a dresser drawer across the room. Most people experiencing sleep problems sleep best away from time pressures.
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What role does stress play?
Sleep problems are frequently brought on by stress. Once the stress is eliminated, however, changes made to help overcome the sleeplessness and daytime fatigue may cause the sleep problems to continue. These changes made to try to overcome sleepiness may include naps, excessive use of caffeine, alcoholic beverages at bedtime, working at night, and irregular sleep times. Eventually, as the person tries to fall asleep and fails, a fear of sleeplessness and tension may develop. The bedroom is no longer seen as a restful place for sleep and relaxation. The person begins to feel tension and anxiety upon entering the bedroom to sleep.
Consequently, some people suffering from sleep problems end up sleeping on a sofa or in a chair and are no longer able to sleep in the bedroom. This phenomenon is called conditioning. Relaxation exercises, meditation, biofeedback, and hypnosis have been helpful in controlling chronic sleep problems. These techniques for treating sleep problems require formal training by a psychologist, physician, or other health care professional.
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What are some good habits I should try to establish that will help support healthy sleep patterns?
- Regular exercise may help people sleep better; however, the benefits of exercise on sleep depends on what time of the day the person exercises and the overall physical fitness. People who are physically fit benefit from exercise when performed about 6 hours before bedtime. Exercise in the morning will have little effect on sleep at night, while the same amount of exercise near bedtime may disrupt sleep. It is also important to note that restricted or limited activity during the day may lead to sleeplessness at night.
- Environment: For most people, a comfortable bed in a dark, quiet room is best for a good night's sleep. Some people seem to adjust readily to changes in their sleep environment, while others (insomniacs, elderly) are easily disturbed by subtle changes in their sleep surroundings. If excessive light is a problem, spot lighting and blackout curtains may help. The use of background sound (white noise) or ear plugs may also serve to mask disruptive sounds.
- Diet: Eating before bedtime can influence the ability to fall asleep and stay asleep. Heavy meals or foods that cause indigestion may prevent sleep or cause sleeplessness during the night. However, a light snack at bedtime can serve to promote sleep. Milk and other dairy products are especially good bedtime snacks possibly because they contain the natural sleep-promoting substance tryptophan.
- Designed Time to Worry: Some people may find it helpful to designate a worry time. Worry time can be used for sorting out problems and coming up with possible solutions to those problems. Select about 30 minutes in the evening to sit alone undisturbed. On 3"x5" cards write down each worry as it comes into your mind (one worry per card). These worries can range from having to call someone in the morning or remembering an anniversary to financial concerns or problems with a relationship. Once all the worries are written down, sort them into three to five piles according to the priority of the worry. Then look at each worry card and come up with a possible solution to that worry. While other worries will not have easy solutions, even making a dent in a worry will be progress. The next morning, review and begin to carry out your plans.
Guidelines for all types of sleep disorders:
- Get up about the same time every day.
- Go to bed only when sleepy.
- Establish relaxing pre-sleep rituals such as a warm bath, light bedtime snack, or 10 minutes of reading.
- Exercise regularly. Get vigorous exercise in the late afternoon, at least 6 hours prior to bedtime, and mild exercise, such as simple stretching or walking, at least 4 hours prior to bedtime.
- Keep a regular schedule. Regular times for eating meals, taking medications, performing chores, and other activities help keep our inner clocks running smoothly.
- Avoid caffeine within 6 hours of bedtime and don't drink alcohol, especially when you are sleepy. Even a small dose of alcohol when you are tired can have a potent effect.
- Do not smoke before bedtime.
- Try to nap at the same time every day. Mid-afternoon is best for most people.
- Use sleeping pills conservatively. Most doctors seldom prescribe the use of sleeping pills for more than 3 weeks. Do not take sleeping pills after drinking alcohol.
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Who should follow these recommendations?
Good sleep hygiene improves the sleep of many people, but not all. If your sleeplessness or other sleep problems persist after 4 to 6 weeks of modifying sleep and daytime habits as described above, you should consider professional help from a healthcare provider or an expert in sleep disorders.
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