Is CPAP a real treatment for snoring?
I’ve recently been diagnosed with sleep apnea by a sleep clinic, and they’ve recommended that I start CPAP treatment. I’m extremely uncomfortable with this diagnosis because I didn’t GO to the sleep clinic for apnea–I was having trouble with snoring. In fact, in all our years of marriage, my wife says she has NEVER heard me stop breathing. I understand that it is just about impossible to snore while using a CPAP, but it also seems like a fairly serious solution for a relatively minor problem. In other words, I recognize that this treatment will WORK for me, but it seems like the cure is worse than the disease.
I’m getting the impression that these sleep pulmonologists might not be exactly the brightest kids right out of medical school. Does anyone know if this is a real treatment for snoring?
Tagged with: diagnosis • marriage • medical school • sleep • sleep apnea • sleep clinic
Filed under: Sleep Apnea Solutions
For starters, this is a more complicated question than you probably realized, so I’ll do my best…
The reason you are snoring is because when you are asleep, the muscles of your upper airway are relaxing to the point that it requires a significant amount of effort to get air past them and they are "flopping" around each time you breathe. You don’t have to completely stop breathing to have obstructive sleep apnea — you merely have to have airflow decreased enough to cause a dip in your blood oxygen levels sufficient to wake your brain up. The snoring is a symptom of a much more serious problem, not the problem in and of itself. Your doctor recognized this and that’s why he/she sent you for a sleep study.
If you’ve had a polysomnogram (a "sleep study") then several areas have been monitored all at the same time to come to the diagnosis. A polysomnogram monitors brain activity (to tell what stage of sleep you are in), air flow at the upper airway (to see whether and how much airflow has decreased) inspiratory effort (to compare the number of efforts made to the airflow acheived), oxygen saturation (to compare oxygen level to the state of wakefulness, airflow, and inspiratory effort), and heart rate and rhythm (to measure stress levels on the heart and by extension the rest of the body). All of these measurements combine to paint a picture of how hard you are working to breathe, whether your breathing is sufficient while you’re asleep, and whether your breathing is interrupting your brain’s ability to get to deep sleep and stay there.
If you’ve had a sleep study and been prescribed a CPAP machine you are having apneic episodes. This means that at several times during the night (in some people hundreds and even thousands of times) you made inspiratory efforts, the airflow across your upper airway dropped below where it had been while you were awake, your oxygen level dropped, and your brain came out of deep sleep. Your airway then opened up, you took a few normal breaths, your oxygen level increased, and your brain continued back down into deep sleep. Then the process started all over again. Again, you don’t have to "stop breathing" for you to have obstructive apnea. Your breathing merely needs to be insufficient to meet your oxygen needs and result in your brain coming out of deep sleep.
CPAP works by stenting open the upper airway with air pressure. This prevents the muscles from collapsing the upper airway when your brain gets to deep sleep. That will indeed treat your snoring but again, snoring is a symptom of a much more serious underlying condition. Sleep apnea kills people. If you have untreated apnea you are 15 times more likely to die in an automobile accident, you are at significantly increased risk for both stroke and heart attack (especially if you have other risk factors), and a whole host of other complications and comorbidities.
As an aside, a sleep pulmonologist has to have a real dedication to the job. Aside from four years of medical school, four years of residency, and another three years of fellowship to specialize in pulmonary medicine followed by one of the most difficult board exams in all of medicine; he/she has also had to undergo a fellowship in sleep medicine and take a second board exam in sleep disorders. The dumb kids don’t get to be sleep medicine specialists.