Sleep Bytes & Blog

Looking for Science-Backed Information about Sleep Apnea? Hi there and welcome. I'm Kimberly MD, and I'm here to help you get a great night's sleep in today's session. I'm gonna help you understand some of the fundamentals of sleep apnea. I recently learned how to play pickleball. It's a fun and social sport, and I was anxious to get started and I wanted to win, but I wasn't really winning until I slowed down and really started paying attention to the fundamentals. The forehand, the backhand, and the game strategy. Once I spent time on these fundamentals and practiced, I really improved. Now I'm killing it. Like pickleball, learning the basics of sleep apnea and CPAP treatment will greatly improve your chances of success. I'm here to help you learn the fundamentals of sleep apnea. And I hope that you will take the time to understand them so that you can be more successful on your journey to better sleep. What you'll learn in today's lesson is one, what is sleep apnea? Two, what are the health consequences of untreated sleep apnea? And three, what the heck is an AHI? And why is it important? Let's get started. What is sleep AP apnea? Well, apnea means stopping breathing. So, sleep apnea just means stopping breathing during sleep. And the most common form of sleep apnea is obstructive sleep apnea, which is when the back of the throat blocks your breathing while sleeping. If you think of your airway, like a balloon, the skinny part that you blow into, it's very collapsible and can close off. And so when you relax at night to sleep and your body relaxes the back of your throat also relaxes, and it can close down, then you don't get any air in that causes your oxygen levels to drop. Then that message gets back to your brain and it causes you to do one of these and wake up... sound familiar? This arousal to wake up and breathe can happen. Hundreds of times, each night, really fragmenting your sleep so that you're not able to get into and stay in some of the deeper stages of sleep that we know are needed in order to feel and function our best during the day. Also, each time this happens, our body goes through a stress response. We tend to panic because we're not breathing. Our blood pressure goes up. Our heart rate goes up, and it puts our body under stress. So cumulatively over time, this can cause a lot of problems. Stay tuned to later in this recording, where I'll give you a peek behind the curtain to see what this sleep apnea really looks like in your sleep test. And let me tell you it ain't pretty. You're probably already aware that sleep apnea makes you feel bad, but did you know that untreated sleep apnea is associated with a number of short and long-term health consequences? Let's use your teeth as an example. If you decide that brushing your teeth is a waste of time, you may develop bad breath and some yellowing of your teeth in the short term, but over the long term, not brushing your teeth will lead to cavities, tooth pain, and probably having to have your teeth pulled. So it seems like a good idea to go ahead and brush your teeth. Well, sleep apnea is similar. It can negatively affect you now and make you feel bad. But the cumulative effect of untreated sleep apnea over time can lead to many more serious medical issues. Let's start with the short-term effects of untreated sleep apnea. These can be broken down into daytime and nighttime symptoms. One of the most common symptoms of sleep apnea is snoring. And your bed partner may notice pauses in your breathing. These are the apnea. Your sleep may be very restless, or you may feel that you wake up a lot during the night. Apnea can even cause you to wake up to go to the bathroom. During the day, you may feel groggy and notice morning headaches. You may feel excessively sleepy and may even doze off during routine activities, such as in a meeting, or maybe during this video, you can also feel more irritable and have trouble concentrating. When we don't sleep well, we just don't function well in the long term. Untreated sleep apnea has been associated with a number of serious medical problems, and we are learning more every year. Most notably, sleep apnea increases blood pressure. Every time you have an apnea at night, your body responds by increasing your heart rate and your blood pressure. When this happens many times an hour, night after night, year after year, it takes a toll on your body, which further leads to more heart attacks, strokes, and even problems with sexual function. There are also studies showing an increased risk for weight gain, diabetes, and dementia with untreated sleep apnea, pretty scary, huh? A lot can go wrong. When our bodies are put through the stress of untreated obstructive sleep apnea, which leads me to our third and final topic of the session, the AHI or the apnea OFIA index. The AHI is a number that tells you how severe your sleep apnea is with higher numbers indicating more severe sleep apnea. Your apnea severity is directly correlated to your health risks associated with untreated sleep apnea, as well as what treatments are available to you. Let's go back to our teeth brushing example. If you skip brushing your teeth, occasionally, say one to two times per week, it's gonna take a lot longer for your teeth to rot and fall out than it will. If you skip brushing, say five times a week, or if you decide to never brush your teeth again. Well, if you have mild sleep apnea, which is stopping breathing just a few times per hour, it will take a lot longer for you to develop heart disease or dementia. For example, then it will, if you stop breathing 30 or 60 times per hour, which suggests more severe sleep apnea, and that's why AHI, or the measure of severity of your sleep apnea, is important. Take a look at this sleep study data. This is from a home apnea test and shows what normal breathing looks like. This person is having stable breathing. Their oxygenation is also remaining stable and is in the normal range in the mid-nineties. Now, look at this sleep study data. These flat lines are apneas or periods when breathing stops and are marked by the red areas, then breathing starts again for several breaths, then stops again. This person is having severe sleep apnea, with one apnea after another, it's during this time when breathing restarts that the blood pressure and heart rate go up as their body goes through a stress response. When we calculate your AHI or apnea hypopnea index, we're counting how many of these apnea or red-shaded areas you have over the entire night and divide it by the amount of time that you are asleep. This gives us an average, which is your AHI. Your AHI is reported on your sleep study and it's used by your healthcare team to make treatment decisions. In reality, there are times when sleep apnea is better or worse during a single night, for example, it tends to be worse when you're sleeping on your back or when you're in dream or REM sleep. If you dig deeper into your sleep study report, you can often find what's called a supine AHI or a REM AHI, which will give you the specific AHI for those particular sleep conditions. However, for the sake of this session, and for a general understanding the overall AHI is an average over the entire night. This gives us a uniform guide that everyone can understand. There are other important measures in your sleep study, such as your lowest oxygen level or the time that you spent with an oxygen level below normal, which is typically 90%, but for simplicity in today's session, I am simply focusing on the AHI. Do you know what your AHI is? If your AHI is less than five, that is generally considered within normal limits for an adult, and you would not be diagnosed with sleep apnea, at least not based on that night, an AHI between five and 15 is considered mild sleep apnea. And between 15 and 30 moderate sleep apnea, an AHI above 30 is considered severe apnea. And the numbers only go up from there. I have had patients over the years within AHI over a hundred, which basically means they aren't having any normal breathing during their sleep at night. Having untreated severe sleep apnea is like having a mouthful of cavities and still refusing to brush your teeth. Wow. You all have learned a lot. Thanks for sticking with me. In summary, today, we talked about three topics. Number one, what sleep apnea is, which is periods of stopping breathing during sleep, most often due to blockage at the back of your throat. Number two, what some of the health consequences are of untreated apnea, such as feeling groggy, irritable, and having trouble concentrating in the short term and high blood pressure, strokes, and even dementia in the long term, just to name a few. And lastly, number three, we talked about the apnea hypoapnea index or the AHI and how that number is the average number of breathing events you had per hour during your sleep study, and how this number gives you an idea of how severe your sleep apnea truly is with higher numbers, equaling more severe sleep apnea. Thanks for joining me. And I hope to see you again, as I continue on my journey for making a bigger difference in the lives of patients with sleep disorders.

How Long Does a CPAP Machine Really Last? Hey Sleep Warrior, In our quest for restful nights and bright days, our trusty CPAP machine stands as a silent guardian. But have you ever wondered, "How long will my CPAP machine really last?" Let's unravel this mystery together. A Sturdy Companion for Restful Nights The lifespan of a CPAP machine is a testament to modern engineering and our commitment to maintaining it. Even with regular use, most CPAP machines can last between 8 to 10 years, and I've witnessed many that surpass this with flying colors. This durability, of course, assumes no recalls have been issued for your specific model (don’t get me started!). Beyond the Insurance Timeline It's a common misconception that the need for a new CPAP machine aligns with insurance coverage cycles, typically every five years. After all, it’s usually the CPAP manufacturer or supplier that is making this recommendation. The truth is, this timeframe doesn't necessarily signal the end of your machine's useful life.  As responsible CPAP and healthcare stewards, we should aim to maximize the lifespan of our equipment without compromising our health or comfort. When to Consider a Replacement If your machine has been your nightly companion for over 8 years, it might be wise to start considering a replacement. Talk to your sleep provider and let them know you may need a new prescription soon. If you have been a faithful user, you don’t necessarily need a new sleep study. If you have checked in with your provider and your machine unexpectedly fails, don't worry—a new prescription can be sent over as soon as possible. Some medical equipment companies even offer loaners while you await insurance approval for a new one. Prolonging Your CPAP's Lifespan The secret to extending your CPAP machine's life lies in regular maintenance. Simple actions like cleaning your machine, replacing filters, and using distilled water can make a significant difference. These steps not only prolong the life of your CPAP but also ensure it provides the best possible support for your sleep apnea therapy.Embrace Each Night with Confidence So, continue to use your machine nightly, keep up with your provider visits, and rest easy knowing you're supported by a robust and reliable device. Your CPAP is more than just a machine; it's a key to restful sleep and energetic mornings. So stay diligent, Sleep Warrior!  Thanks for being here. I’ll see you next week.  

Stop Sleep Meds for A Sleep Study? Hey Sleep Warrior, Today I’m addressing a common question that puzzles patients as they prepare for a sleep study: "Should I take my usual sleep aid the night of my sleep study?" Whether it be Melatonin, Tylenol PM, cannabis, or an alcoholic drink, sleep clinics don’t always do a great job at informing patients on this topic.  So, let's dive into why the answer is generally "Yes" and how it impacts your sleep study results. When you're scheduled for a sleep study - whether it be in the lab or at home, the goal is to capture an accurate snapshot of your typical night's sleep. This means your sleep patterns, any sleep disturbances, and you guessed it - any remedies you usually rely on, like Melatonin, Tylenol PM, cannabis, alcohol, or prescription sleep aids.  Your sleep study aims to observe how you normally sleep. If taking something is part of your nightly routine, discontinuing it could alter your sleep patterns, leading to a less accurate assessment. Plus, if you suddenly stop taking something that helps you relax and fall asleep - you may experience rebound insomnia, and this lying awake can add to the inaccuracy of the test.   Taking your sleep aids allows the sleep clinic to see the full picture of your sleep health, including how these aids affect your sleep architecture and quality. And this is crucial for developing an effective treatment plan. So let your sleep specialist know what you are taking so this can be considered in your sleep study analysis. Interestingly, over-the-counter sleep aids typically have minimal effect on sleep apnea. However, alcohol can exacerbate sleep apnea symptoms, however it’s still important that your sleep study reflects your usual habits, including any regular alcohol consumption. For many, the thought of a sleep study is daunting. Continuing your usual regimen can help ease anxiety, making it easier to sleep with all that fun equipment on. The key is to communicate openly with your sleep clinic about your routine so they have all the information needed to make your sleep study as effective as possible. Thanks for being here. I’ll see you next week! 

Is Your CPAP Working? Hey Sleep Warrior,  Do you ever feel curious about whether your CPAP machine is really working? Well, you have the tools to find out right at your fingertips. And this, my friends, is with something called the AHI - or apnea hypopnea index. One of my patients calls this his ‘tuna’ score - since AHI spells out ‘ahi’.  Let's dive in. First, let's clarify what AHI is. The AHI measures the severity of sleep apnea by counting the number of apneas (complete stoppages of airflow) and hypopneas (partial reductions in airflow) you experience per hour of sleep. These are important because they affect how restful your sleep is and can impact your overall health. AHI categories are: Normal: Less than 5 events per hour Mild: 5 to 14 events per hour Moderate: 15 to 29 events per hour Severe: 30 or more events per hour Knowing your AHI is crucial for diagnosing sleep apnea and is the first step in managing it effectively. The higher the AHI, the more severe your sleep apnea is, and the greater the association with long-term health problems if left untreated.  So when my patients come in for a CPAP follow-up, there are a couple of primary things I need to know. First, how their symptoms are doing—whether they feel more rested and alert during the day, and if they are comfortable on their machine. Second, I need to ensure that their CPAP machine is effectively treating their sleep apnea. The machine AHI gives us this vital information. I want to see that their residual AHI is less than 5. A fun exercise that you can do is to compare the AHI from your initial sleep study to the AHI on your CPAP machine. It's not only about feeling better; it’s about seeing the tangible proof right there in the numbers. For anyone using CPAP, seeing a lower AHI on your machine compared to your initial diagnosis can be incredibly motivating. It's a clear, numerical reminder that your treatment is working and that your sleep—and subsequently, your health—is on a better path. Thanks for being here. I’ll see you next week!

A Pill for Sleep Apnea? Hey, sleep warrior!  When you think about treating sleep apnea, the idea of using a drug, or a pill, might raise some eyebrows. After all, sleep apnea is primarily a mechanical problem—how can a pill help keep our airways open at night? Despite my initial skepticism, I'm genuinely excited to dive into the emerging data on AD109, a new medication that's currently under investigation. Let’s dive in. As many of you know, CPAP therapy, while effective, is not universally tolerated. And let's be honest, even among those who do tolerate it, it’s not always liked. With a significant number of people still going untreated each year, we need to do better. That's why exploring new treatment options is crucial for our field. AD109 represents a novel approach. It's an oral medication designed to stimulate the nerves that control the muscles keeping our airway open while we sleep. By activating these nerves, AD109 aims to maintain a clear airway throughout the night, potentially reducing the severity of sleep apnea. AD109 combines two medications in a nasal spray format—a decongestant and a muscle relaxant targeting the muscles that collapse the upper airway. It's designed to decrease the physical obstructions that cause sleep apnea by minimizing nasal congestion and relaxing the muscles that can block the airway during sleep. The Mariposa research study assessed the efficacy and safety of AD109 in adults with moderate to severe obstructive sleep apnea. The results were quite promising: AD109 significantly reduced the number of apnea events per hour of sleep compared to a placebo, by about 45%.  Participants also reported improved sleep quality, reduced daytime sleepiness, and an enhanced overall quality of life.  These benefits could be life-changing for those who struggle with CPAP machines. Though some did experience mild nasal discomfort and an unpleasant taste, these side effects were generally mild. For those intrigued by this new treatment and wondering about participation in ongoing research, more information is available on Apnimed's website where you can learn more about the study and how you might get involved. So, while the initial results from the Mariposa study are promising, it's important to remember that the path from research to reality can be lengthy. Clinical trials are thorough and meticulous by design, ensuring that new treatments are both effective and safe for widespread use. If AD109 continues to show promise in its subsequent trials, we are still looking at a timeline that would extend to 2026 or later before it becomes available to the public. So don’t put your CPAP away just yet. Patience is key in the development of new medical treatments, as rigorous testing is essential to bring truly beneficial therapies to our community. Thanks for being here. I’ll see you next week!

Gas with CPAP? Hey, Sleep Warrior!  Are you or a loved one experiencing excessive gas from using CPAP? Besides being uncomfortable, these issues can be downright embarrassing. No thanks.  This is called aerophagia, and it is a common issue faced by many CPAP users. It occurs when air is swallowed and enters the stomach instead of the lungs, leading to discomfort, bloating, and excessive gas.  This problem can disrupt sleep and lead to uncomfortable or embarrassing gas during the day, ultimately affecting overall therapy adherence.  But why does aerophagia happen, and what can be done about it? Listen up. The primary cause of aerophagia in CPAP users is simply high pressure settings. When the pressure is too high, it forces air into the esophagus rather than just the airway, leading to swallowed air and subsequent discomfort. One potential solution to excessive pressure is the V-Com, a device that reduces inspiratory pressure without affecting the therapeutic pressure. The V-Com can be purchased online without a prescription for about $30. You could also discuss pressure adjustments with your sleep provider – maybe your pressure can be turned down and still be effective. Lastly, you can try sleeping on your side or utilizing the ramp feature on your machine, both of which can lower the overall pressure. Another cause of aerophagia is the type of mask used. Full-face masks are more likely to direct air into the stomach as the air passes over the tongue and esophagus on it’s way to the lungs. Switching to a nasal mask can really help, and you can use a chin strap or the SomnoSeal if there are issues with mouth breathing or dry mouth. You’ll also want to be sure you have a good seal on your mask since mask leaks tend to result in your machine blowing higher pressures to compensate for the leak.  Finally, anatomical factors can play a role. The way your body was built, with the trachea going to your lungs being right behind the esophagus going to your stomach, can make it difficult to completely avoid swallowing air, especially if high pressures are necessary for treating your apnea or you are stuck using a full-face mask. In these cases, if there are no contraindications, over-the-counter gas relief products, like GasX, may provide some relief. Other options include ginger or peppermint tea, known for its natural anti-gas properties. Remember, these are general suggestions, and it’s important to discuss your specific issues with your sleep provider to find the most appropriate solution for you.  By addressing the underlying causes and implementing these strategies, I hope you can reduce the impact of aerophagia and improve your CPAP therapy experience.  Thanks for being here. I will see you next week!