Sleep apnea is a chronic condition, but fortunately it can be controlled well with proper treatment. Dr. Jonathan Marcus, a sleep specialist, shares the questions his patients ask most about living with and treating sleep apnea. 1.Q: How does sleep apnea affect the body? A: Sleep apnea is a condition in which you stop and start breathing repeatedly throughout the night. There are three types of sleep apnea: central sleep apnea occurs when the brain doesn’t send the right signals to control breathing, obstructive sleep apnea occurs when the airways become blocked so breathing stops, and complex sleep apnea occurs when both these problems are at fault. Obstructive sleep apnea is the most common type, affecting about 8 to 10% of adults in the United States. When we sleep, our anatomy changes a little bit and the muscles that line the breathing tube relax, so there’s less space for the air to go through. If you have sleep apnea, though, those muscles relax too much, so you’ll get short periods of time where you’re not getting enough air (called a hypopnea) or you’re not getting any air at all (called an apnea). When you don’t take in enough fresh air, your brain will sense this—it’s kind of like your check engine light comes on and alerts you to a problem. The brain will trigger a big surge in adrenaline, which flows throughout the body, including the tongue and throat muscles. These muscles will wake up and your throat will open, causing you to gasp or make a snorting noise. Then you’ll start breathing normally again. This action means the breathing problem is temporarily taken care of, but the adrenaline in your body disrupts your sleep, causing your heart to beat a little faster and harder. This stress on the body adds up when these apneas continue every few minutes as you sleep. Then, when you get up in the morning, you don’t feel very well rested, as your sleep was continuously disrupted over the course of the night. Sleep apnea affects everyone a little differently. Some people have frequent breathing disruptions at night but don’t feel very affected during the day, whereas others will really struggle to stay awake. This excessive daytime sleepiness impacts their safety and function and can cause problems at work and at home. 2. Q: How is sleep apnea typically treated? A: To treat obstructive sleep apnea, there are four main approaches. First, I advise my patients to make certain lifestyle changes. Overweight and obese sleep apnea patients greatly benefit by losing weight, so I encourage them to follow a healthy diet and maintain an active lifestyle. In some circumstances, we may consider weight-loss surgeries. The second approach involves the use of continuous positive airway pressure (CPAP) devices. A CPAP machine sits next to your bed and plugs into the wall. It attaches to a hose with a mask at the end that you place over your face when you sleep. CPAPs gently pressurize the air and direct it straight into your airways to keep them open. CPAP masks are made out of soft materials that make a seal under or over the nose, and on occasion around the nose and the mouth; there are many different types of CPAP masks, so it’s important for patients to find the right fit for them. In some cases, we’ll treat sleep apnea with dental appliances that pull the jawbone forward to open the airways. The final treatment approach for sleep apnea is surgical intervention. Although surgery for sleep apnea was common 20 years ago, today it’s not performed as often, as CPAPs are much more effective and less invasive options. 3. Q: What’s new in the world of sleep apnea? A: Medicine is always changing, and sleep medicine is no different. One of the things that has changed the most with sleep apnea is how we implement new technologies and how those improve the lives of our patients. Traditionally, patients seeking a sleep apnea diagnosis would be required to do an overnight sleep study at a medical clinic. They’d sleep in a little bedroom and clinicians would connect them to a number of different monitors, including a heart rate monitor, an oxygen sensor, and a brain wave detector. This is still considered to be the gold standard of how to evaluate sleep disorders, but in many ways, it can be an awkward and somewhat artificial experience. However, a few years ago, new at-home sleep apnea tests began to achieve widespread acceptance. These small kits with special sensors are provided by the doctor, and patients bring them home and put them on at bedtime. About 90% of the time, we’re able to get a clear evaluation of possible sleep apnea from this home test. They represent a major change from the old methods, and patients are always typically happier to use the kits at home rather than come into a facility for a night. The treatment for sleep apnea has also greatly improved in recent years. CPAP machines are much more technologically advanced and have helpful features, like sleep tracking and air pressure sensors. And, masks have become more comfortable and easy to wear, which means patients are more likely to wear them consistently, improving outcomes. 4. Q: What’s the relationship between snoring and sleep apnea? A: Many people think all people who snore must have sleep apnea. This is probably because snoring is often the reason a person seeks out a sleep apnea diagnosis. Patients often tell me their spouses insisted they see a sleep specialist because their snoring is unbearable—colloquially, we call that sleep apnea by proxy. The spouse wakes up repeatedly throughout the night because of the sleep apnea patient’s snoring. However, while roughly 90% of sleep apnea patients do snore, only 1 in 4 chronic snorers have sleep apnea. 5. Q: What should people with sleep apnea keep in mind when traveling? A: It’s important for people with sleep apnea to always bring their CPAP with them when they travel. If you had high blood pressure, you wouldn’t leave your medication at home while on vacation, and it’s the same with a CPAP for sleep apnea. In the United States, the Federal Aviation Administration prevents airlines from charging passengers for bringing their CPAPs on the plane; it’s considered medical equipment and it’s always free to bring with you. I generally recommend carrying your CPAP onto the plane with you because patients have had to deal with damaged CPAP units after luggage gets thrown around. If you’re staying in a hotel or on a cruise ship, it’s helpful to let them know ahead of time that you’ll be bringing along a CPAP. These are common customer requests, and the hotel or cruise can usually make sure there’s an outlet available near the bed or provide you with an extension cord if no outlet is close by. Often, hotels and cruises will offer sleep apnea patients a bottle of distilled water to use in your CPAP, as well, just like they’d offer a toothbrush or a comb to travelers who forgot those necessities. Traveling with a CPAP has gotten much easier in recent years, so it’s important patients always take their CPAPs with them whenever they’re going to sleep in a new location.