MySleepApnea.Org

Archive for April 2008

  At first glance there is very little physical difference among CPAP, autoCPAP and Bi-level systems. All basic RAD systems consist of the same basic components.

  • The unit (often referred to as “the box”)
  • Interface ( a mask or nasal pillows) and headgear
  • Tubing and connectors

The Unit: In addition to a smaller blower and electronic components inside the box, most respiratory assist units will feature an On/Off button, and LCD display, a keypad to adjust the particular pressure setting for the patient, a power supply and a port to connect the tubing. Positive airway pressure units generally weigh less than 5 pounds and some less then 2 pounds. The major difference among the three positive airway pressure devices is in the functions they are designed to preform.

  • CPAP is designed to provide continuous, fixed positive air pressure
  • autoCPAP is designed to change the CPAP pressure based on the patient’s needs
  • Bi-level is designed to provide different levels of pressure (IPAP and EPAP)

 The Interface and Headgear: There are three basic types of RAD interfaces, full facemask (covers entire face), nore and mouth mask, and nasal mask. Within each type of interface are a variety of styles. The particular interface selected depends on the patient’s preference. The key to selecting the proper interface is patient comfort. The more comfortable the patient, the more likely the patient will remain compliant with his or her positive airway pressure therapy.  Headgear is used to keep the interface securely on the patient’s face. Generally, headgear consists of a sense of straps secured about the patient’s head by Velcro tabs. As with interfaces, there are a variety of styles of headgear, and selecting a particular headgear depends on patient preference.

Tubing and Connectors: Flexible, lightweight tubing and specially-designed connectors are used to connect the positive airway pressure unit to the interface. Because each patient has unique needs, a host of accessories are available for RADsystems.

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  Moderate to severe cases of OSA (obstructive sleep apnea) significantly increases the risk of suffering a stroke. The study of 1,475 people found that those with moderate to sever sleep apnea at beginning of the study were 3 to 4 times more likely to have a stroke than a comparable group of patients without sleep apnea during the next four years. The study did not find any significant increase in the odds of having a stroke for people with mild sleep apnea compared with people without sleep apnea. The stroke risk we found for people with moderate to severe sleep apnea is quite significant- double the risk of other well -known risk factors for stroke, such as hypertension or diabetes. It was even found that the risk of stroke was significant even after other risk factors for stroke, such as high blood pressure and obesity, were taken into account.

   The patients in the study were defined as having moderate to sever obstruction sleep apnea in their breathing stopped or slowed at least 20 times per hour of sleep. People whose breathing stopped or slowed between 5 and 20 times per hour of sleep were considered to have mild sleep apnea. One reason obstructive sleep apnea may increase stroke risk is that it has been shown to cause high blood pressure, with this, it is the most common risk factor for stroke. Another possible reason is that when a person stops breathing, the lack of oxygen kick in the body’s “fight or flight” response. Part of that reaction is to make the blood more clottable, and blood clots in the brain can cause a stroke.    

    This study provides yet another reason why it’s so important to treat sleep apnea with all caution as possible. It also raises the question of weather people with sleep apnea should be put on aspirin therapy or given other anti-clotting drugs/medications, which is what is done for other people with stroke risk, but this is an issue that needs further research.

Sleep apnea increases risk of heart attack and/or death up by 30%.

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 But what does weight have to do with sleep? Plenty, enough. First, there are now a number of studies that suggest there is a link between sleep loss and weight gain. Some of these studies (in adults) have looked at how sleep deprivation changes the body’s normal metabolism and hormone function, and the results are not good. Not getting enough sleep seems to affect not only how in-efficiently you metabolize calories, but also how hungry you feel (by altering the level of a number of hormones-serotonin, leptin, perhaps others- in the body and mind). Think about how many times you’ve to keep yourself awake at 2:00AM by eating doughnuts or pizza. Or how you’ve used a “carb fix” as a pick-me-up when feeling drowsy in the middle of the day (maybe this does more to explain the typical ten-pound weight gain of the sleep-deprived college-freshman than dining hall food). This hormonal imbalance may eventually place people at greater risk for diabetes as well.

graduation-to-obesity.jpg Other research has also found a negative relationship between weight and sleep in children (the less you sleep, the more likely you are to be obese). One study in Japan found a link in six- and seven-years-olds’ between obesity and later bedtimes and fewer hours of sleep. Children who got less than eight hours of sleep had an almost three times greater risk of being obese compared to children who got ten or more hours. In addition, some of these studies suggest this relationship may also go in the other direction. In other words, the risk of being obese decreases with each additional hour that your child sleeps! This may well be the single greatest argument you’ll ever have in getting your teenage daughter to go to bed at reasonable hour!

 In addition, being overweight or obese can greatly increase your child’s chances of having a serious sleep disorder. Obstructive sleep apnea is a breathing disorder that occurs during sleep and affects about 1-3 percent of  children in the United States. It often leads to problems with attention, behavior, and academics. The most common cause in children related to being overweight or obese (the best predictor of sleep apnea in adults is having a neck size of seventeen inches or above.) Overall, the risk of sleep apnea in obese children is four to five times that of a normal weight children. Yet fewer than 50 percent of pediatricians state that they ask questions about sleep problems, “most of the time or often” in their obese patients. So it is very important that parents of overweight children be aware of this possible link with sleep apnea. You should also be aware of the most common symptoms of sleep apnea (loud snoring, breathing pauses, restless sleep, daytime tiredness), so that these can be brought to the attention of your child’s doctor for further evaluation.

 Finally, the relationship between sleep and obesity may involve other issues. For example, in obese adolescents decreased physical activity and more disturbed sleep go hand in hand. This suggests that one possible factor in adolescent obesity might be poor quality sleep. Obesity leads to daytime fatigue, which makes teens less likely to exercise, which eventually leads to more weight gain, and so on. As already mentioned, children who watch a lot of television and spend most of their time in sedentary activities are more likely to be overweight. They are also more likely to have sleep problems, which in turn, may result in their being less attractive, gaining more weight, and then developing more sleep problems.

What Parents Can Do:

  • Limit fatty foods and foods high in calories.  Junk the junk food. Discourage between-meal snacks.
  • Encourage outdoor and physical activity.  Schedule time for your child to be outdoors and to spend at least thirty minutes a day being physically active.
  • Limit television viewing, computer time, and video games. Cut back on all the electronics!
  • Watch out for school lunches. Often the biggest culprits in the high- calorie, high-fat sweep-steaks are the school cafeteria and vending machines. You probably have some handle on what your kids eat at home, but much less control over what they eat when they’re out of your sight. This requires some combination of teaching your kids about healthy food choices and making sure the bad choices they do have are as limited as possible.
  • Be aware of the sleep and weight connection. If your child is overweight, look for signs of obstructive sleep apnea, and let your pediatrician know if you see any of them. Make sure the lack of sleep doesn’t play a role in causing the weight problem. Keep track of when and under what circumstances your child is most likely to overeat and not if these are times when he seems sleepy or tired.

Make healthy eating, like healthy sleep, an important priority for your whole family!


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