Alzheimer & Sleep Apnea

According to new research published in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine, older adults who have obstructive sleep apnea may be at increased risk of Alzheimer’s disease. They found a link between sleep apnea and high levels of the amyloid protein that is associated with Alzheimer’s disease. In fact, it is reported that biomarkers for amyloid beta, the plaque-building peptides associated with Alzheimer’s disease, increase over time in elderly adults with Obstructive Sleep Apnea (OSA) in proportion to OSA severity. Thus, individuals with more apneas per hour had greater accumulation of brain amyloid over time.00 alzheimers

The study included 208 participants, age 55 to 90. None of the participants was referred by a sleep center, used continuous positive airway pressure (CPAP) to treat sleep apnea, was depressed, or had a medical condition that might affect their brain function. The researchers performed lumbar punctures (LPs) to obtain participants’ cerebrospinal fluid (CSF) soluble amyloid levels, and then used positron emission tomography, or PET, to measure amyloid deposits directly in the brain in a subset of participants. The study found out that more than half the participants had OSA, including 36.5 percent with mild OSA and 16.8 percent with moderate to severe OSA.

The researchers concluded that addressing sleep apnea in its early stages could reduce the number of amyloid beta deposits occurring in the brain and consequently delay cognitive impairment and dementia.

If you have been diagnosed with Alzheimer’s and are wondering if you have sleep apnea, contact CanSleep to do a free diagnostic test, so that if you do have sleep apnea, there is a chance of slowing down the progression of Alzheimer’s by properly treating the sleep apnea.

By Bahareh Ezzati (RRT)


Sleep Disorders and Headache

Did you know that at least 50% of people who wake up with headaches might have sleep apnea? In general sleep apnea, sleep deprivation, and insomnia are common sleep problems that are associated with headaches.000 headaches

When you suffer from sleep apnea, your airway is partially or completely blocked during sleep. Because of this closure, the amount of oxygen in your blood being transported to your brain is reduced, which initiates the widening of blood vessels and can cause vascular headaches. These headaches are generally located in the frontal areas but can be diffuse, involving the entire head.

People who suffer from sleep apnea don’t get enough of REM, the deepest stage of sleep, since the brain kicks them out of the REM stage of sleep so they could breathe. Not getting enough of REM could trigger migraines, because of changes in the neurotransmitter or chemical systems in the brain and hormonal influences. Cluster headaches are one-sided severe headache attacks that are usually accompanied by nasal stuffiness and eye tearing, and frequently occur during nighttime, and are linked to the REM sleep cycle.

Beside sleep apnea, insomnia (difficulty falling asleep or staying asleep) is another sleep disorder that leads to headaches. Insomnia leads to irritability and ultimately stress, which is the most common migraine trigger. Teeth grinding (bruxism) which could be from stress caused by sleep apnea could also trigger headaches.  On the other hand, chronic migraines, chronic tension-type headaches, and medication overuse headaches may cause sleep disturbance and insomnia.

Sleep deprivation, which could be the result of insomnia and/or sleep apnea also triggers headaches, but sleeping longer hours is not the solution. Either too much sleep or too little sleep can aggravate headaches in any individual. Taking naps doesn’t help morning headaches either. Taking naps causes fluctuations in serotonin and other brain neurotransmitters occur during sleep, which in turn can influence the onset or aggravation of head pain. Frequent naps during the day may reduce sound sleep at night resulting in a morning headache as well. To prevent migraine headaches, you have to solve the underlying problems, which could be sleep apnea or insomnia. Contact Cansleep to discuss your options to treat sleep apnea or book an appointment with Roxanne or Alison who are our insomnia specialists.

An unfortunate connection between sleep apnea and migraines is centred on gradual brain damage. When left untreated, these two medical conditions may lead to hypertension, depression, or stroke. Each time a patient who suffers from obstructive sleep apnea experiences a breathing cessation episode that lasts longer than 10 seconds, the blood oxygen levels in the brain are impacted negatively. The cumulative effect of irregular snorts and sudden gasps may result in brain damage that is difficult to reverse. If you are experiencing more headaches, don’t wait, contact Cansleep to get tested for sleep apnea.

By Bahareh Ezzati (RRT)

Effects of noise and white noise on Sleep

If you feel as though you’ve slept 7-9 hours and you don’t have any sleep disorders or it is under control but still drowsy the next day, sound could be a possible reason.

While you sleep, your brain continues to register and process sounds on a basic level. Noise causes you to wake up, move, shift between stages of sleep, or experience a change in heart rate and blood pressure so briefly that you don’t remember the next morning. Noises are more likely to wake you from a light sleep (stages 1 and 2), than from a deep sleep (stages 3 and 4), and tend to be more disruptive in the second half of the night.00 WHITE NOSE

A few interesting facts are:

  • “sound sleepers” have characteristic brain activity that may make them more impervious to noise
  • Whether or not a sound bothers your sleep depends in part on that sound’s personal meaning; that’s why mothers wake up easier to a baby’s noise but may sleep through a fire truck siren.
  • Studies have suggested that long-term exposure to intense noise pollution could be associated with hypertension.

The solution is to use a white noise machine, fan, or air purifier to create a background hum and block unwanted outside noise. Earplugs also work well for some people.

White noise works by reducing the difference between background sounds and a “peak” sound, like a fire truck siren, giving you a better chance to sleep through it undisturbed. If someone has difficulty falling asleep or staying asleep and doesn’t have insomnia, creating a constant ambient sound could help mask activity from inside and outside the house. There is a white noise machine that is made for this purpose. Nevertheless, the sound from TV is not considered white noise, since unlike white noise, TV sounds are constantly changing in tone, volume, and so forth. TV can be especially bothersome if you need to wake up to turn it off and resettle into bed.

For our CanSleep CPAP users, remember as Clete A. Kushida, director of the Stanford Center for Human Sleep Research, puts it “This is why the majority of bed partners prefer the constant white noise of a CPAP machine rather than their spouse’s crescendo-decrescendo snoring sound.”

By Bahareh Ezzati (RRT)


Asthma & Sleep Apnea

Did you know that studies show asthma patients faced an almost 40 percent greater risk for sleep apnea than asthma-free people?00 asthma

Recent data suggest that obstructive sleep apnea is an independent risk factor for nocturnal (at night) asthma attacks. Nocturnal airway narrowing in asthma is often associated with episodes of nocturnal and early morning awakening, difficulty in maintaining sleep, and daytime sleepiness. But, besides the impairing of sleep quality by nocturnal asthma itself, an association has been documented between nocturnal sleep-disordered breathing and asthma or bronchial hyperreactivity. One of the symptoms of sleep apnea is snoring. In asthmatic patients, snoring triggers neural reflexes (vagal tone) causing bronchoconstriction, which results in asthma exacerbation. In general hypoxia (low oxygen level in bloodstream) as a result of OSA, increases bronchial and airway responsiveness and worsens nocturnal asthma.

On the other hand, reduced airway cross-sectional area, as a result of increased airway mucosal inflammation in asthma, may worsen OSA. Rhinitis associated with asthma/allergy may worsen obstructive sleep apnea syndrome as well. OSA has been shown to be associated with inflammation of both the upper and lower respiratory tracts, asthma patients’ airway is inflamed, which causes narrowing of the airway locally. Then again OSA could cause both local airway inflammation and systemic inflammation. OSA in adults is associated with elevated levels of C-reactive protein CRP, a marker of inflammation and of cardiovascular risk. Previous studies have shown that the severity of OSAS is proportional to the CRP level, and that 1 month of effective treatment for OSA with continuous positive airway pressure treatment led to a considerable decrease in CRP level. If you suffer from asthma and experience nocturnal asthma exacerbation, contact Cansleep to do a diagnostic test to find out if you have sleep apnea or not.

By Bahareh Ezzati (RRT)

Dry Mouth

One of the most common CPAP side effects is dry mouth. In this blog I am going to focus on causes and solutions for dry mouth.00 Dry-Mouth_Main-Image

Small leaks or short leak spikes for brief periods of time are common in CPAP users, and they are not a big issue. A mask leak rate over 24L/min for a long period of time, or air leaks from mouth breathing are enough to impact your therapy and also cause severe dry mouth. Keep in mind the side effect of many medications is also dry mouth. So if there has been a change in your medication and suddenly you are experiencing dry mouth, you need to talk to your physician or pharmacist.

In general when you sleep with your mouth open, the pressurized air from CPAP enters in the open mouth and causing the unpleasant feeling of drying in mouth. However if only your throat is dry, not your mouth, it could be due to low humidity level.

To eliminate dry mouth, find the cause of it first.  For example if you are mouth breathing, it could be because something is blocking your nose, like a deviated septum or nasal congestion. For people who have a deviated septum and can’t breathe through their nostrils, a full face mask or using a chin strap along with nasal mask could resolve it.  If you have sinusitis or nasal congestion, increasing the humidity level or using nasal decongestants would help.

Some people still experience dry mouth, despite using a full face mask and using higher humidity level, in this case keep yourself hydrated keeping a glass of water by the bedside is a good idea. It’s good practice to take a few sips of water in the middle of the night, avoid drinking large amounts of water, it may disturb your sleep from bladder tension. You could also look into dry mouth medications. For example Biotene is a common medication that helps with dry mouth, which comes in as a mouth spray, but the gel is the most effective.

If you are experiencing dry mouth, contact your therapist at Cansleep to start looking into the cause of it and troubleshooting it.

By Bahareh Ezzati (RRT)

Sleep Apnea in Children

In general, since Obstructive Sleep Apnea (OSA) caused lack of restful sleep, kids might have a hard time waking in the morning, be tired throughout the day, and have attention or other behavior problems. As a result, sleep apnea can hurt school performance. Teachers and others may think a child has attention deficit hyperactivity or learning difficulties; therefore, children generally are underdiagnosed or misdiagnosed.  Watch your children for other common sing and symptoms of OSA such as:

  • bedwetting (especially if a child previously stayed dry at night)sleep-apnea-300x238
  • very restless sleep and sleeping in unusual positions
  • snoring, often accompanied with pauses, snorts, or gasps
  • heavy breathing while sleeping

Enlarged tonsils and adenoids are the most common cause of OSA in kids. Other factors include:

  • family history of sleep apnea
  • being overweight and having large neck size
  • medical conditions, such as down syndrome or cerebral palsy
  • defects in the structures of the mouth, jaw, or throat (narrow airway)
  • large tongue (blocking the airway)

If enlarged tonsils or adenoids are causing the apnea, the doctor usually refer the child to an ear, nose, and throat specialist (ENT). The ENT might decide on performing an operation. Surgeries to improve upper airway patency in children are Tonsillectomy (removing tonsil) and/or Adenoidectomy (removing adenoid), which has a success rate of 80-90%; however, 13% of those cured will relapse in adolescence. 

If tonsils and adenoids are not the cause of OSA or if symptoms of OSA remain after the surgery, patient would require continuous positive airway pressure (CPAP) therapy.

When excess weight is a factor in OSA, it is important to work with a doctor or dietitians on diet changes, exercise, and other safe weight-loss methods. Call CanSleep to book a half hour free consultation appointment with our Registered Holistic Nutritionist (RHN) for nutritional support, meal plans, lifestyle recommendation and sleep hygiene techniques for your child if being overweight is the cause of your child’s OSA.

By Bahareh Ezzati (RRT)

OSA Surgeries

Surgical management of obstructive sleep apnea

In OSA, CPAP is almost inevitably the preferable form of treatment, and therefore should be tried first. Exceptions may be in rare cases of severe psychological aversion, or fitting failure due to cranio-facial anomalies or claustrophobia.Surgery

Type of surgeries:

  • To improve the nasal airway

Septoplasty surgeries are often done to assist with CPAP compliance and it rarely corrects OSA without another intervention. It includes: turbinate reduction, rhinoplasty, polypectomy

  • To improve the palatal oropharyngeal airway

Uvulopharyngopalatoplasty (UPPP) involves removal of tonsils, adjacent soft palate and tightening (by sutures) the lateral and posterior pharyngeal walls. Circumferential narrowing in the airway from excessive scaring is a long-term complication of the surgery.

Laser Assisted Uvulopalatoplasty (LAUP), may be done as UPPP (but without tonsillectomy or suturing) leaving a ‘Roman Arch` palate.

Transpalatal Advancement Pharyngoplasty (TPAP) 1cm of the back of the hard palate is removed

  • To improve the Retrolingual airway

Genioglossus Advancement (GGA) Genioglossus muscle, which is the part of the tongue attaching it to the chin, is brought forward and rotated by about 1 cm.

Hyoid Suspension or Advancement (HS A), Hyoid bone is advanced over the upper thyroid cartilage which involves moderate neck dissection

Direct tongue base surgery: Very dangerous and done in a very few centers

Tongue Base Radiofrequency (TB RF) which destroys tongue base tissue by about 17%

  • To improve both the airway at both the oropharyngeal palatal level and the retrolingual level

Maxillomandibular Advancement (MMA) which pulls the whole face forward at least 1cm. Complications include airway problems with dental and occlusal changes

Most surgery improves only one area of upper airway (at a time) while most sleep apnea patients have multiple areas of airway collapse.  Therefore, multiple surgeries may be required, and despite those surgeries CPAP may still ultimately be necessary. Especially in more severe OSA, surgery is relatively ineffective in controlling the condition when compared to CPAP. Also all surgery carries serious risks, including death, and airway surgery more than many other forms. CPAP carries virtually no risks. Nevertheless, CPAP splints the whole upper airway open and it is the least invasive treatment for OSA. If you have had performed, any of the surgeries above but still have signs and symptoms of sleep apnea, call Cansleep services to book a diagnostic test to see if you still need CPAP therapy or not.

By Bahareh Ezzati (RRT)


Not all patients benefit from CPAP or BiPAP therapy. For example, patients with congestive heart failure may be candidates for a different PAP therapy. Often their apnea is more complex with Cheyne-Stokes respirations (an abnormal pattern of breathing characterized by progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in an apnea event), and advanced devices are required. Also, patients with central sleep apnea may require more advanced PAP therapy. Central sleep apnea (CSA) differs from obstructive sleep apnea in that, instead of an obstruction causing breathing to become shallow or stop periodically throughout the night, the brain fails to send signals to the respiratory system to instruct it to continue breathing during sleep. ASV machines are meant to treat central sleep apnea (CSA), mixed sleep apnea, and also Cheynes-Stokes respiration.  0000 asv

The difference between ASV therapy and other therapy is that it provides support to regular breathing. It uses an algorithm which detects significant reductions or pauses in breathing and intervenes with just enough support to maintain the patient’s breathing at 90% of what had been normal prior to decreased breathing. The algorithm is based on a set rate of breaths per minute that the patient should be taking. When the patient’s breathing dips below these rates, the ASV delivers just enough air pressure to keep the patient breathing regularly.

Nevertheless, a recent study has shown that ASV may be harmful in patients with a reduced left ventricular ejection fraction (LVEF≤ 45%). For this particular group there is a 33.5% increased risk of cardiovascular death, compared to control patients who are not on ASV therapy.  If you are on ASV therapy and have cardiac problems check with your cardiologist to find out what is your Ejection Fraction and if ASV is safe for you to use. Also, if you have obstructive sleep apnea and recently had cardiac failure contact your clinical therapist at CanSleep services to check if you are a candidate for ASV therapy.

By Bahareh Ezzati (RRT)

Comfort features on some popular CPAP machines

CPAP treatment can be highly effective in treatment of obstructive sleep apnea. For some patients, the improvement in the quality of sleep and quality of life due to CPAP treatment will be noticed after a single night’s use. Often, the patient’s sleep partner also benefits from markedly improved sleep quality, due to the amelioration of the patient’s loud snoring. The question that usually rises is what other features CPAP has to make CPAP therapy more comfortable? The topics that this blog will cover is CPAP features such as ramp, pressure release function,  and the difference between pressure release and BiPAP will be discussed.

Ramp may be used to temporarily lower the pressure if the user does not immediately sleep. The pressure gradually rises to the prescribed level over a period of time that can be adjusted by the patient and/or the provider. The Symbol for ramp is a triangle. Ramp

Breathing out against the positive pressure resistance (the expiratory positive airway pressure component, or EPAP) may also feel unpleasant to some patients. Some machines have pressure relief technologies that make sleep therapy more comfortable by reducing pressure at the beginning of exhalation and returning to therapeutic pressure just before inhalation. The level of pressure relief is varied based on the patient’s expiratory flow, making breathing out against the pressure less difficult.

The question that rises is that why not use CPAP with pressure release Instead of BiPAP?

Pressure release is similar to BiPAP therapy in that it offers pressure relief as the patient exhales so that they don’t feel like they’re fighting against the incoming airflow during expiration. However, pressure release is more of a comfort feature for CPAP machines that only offers pressure relief up to 3 cm, whereas BiPAP pressure relief starts at 4 cm and goes up. For those who need only a little pressure relief, a CPAP with pressure might be the right choice.

Another difference between BiPAP and CPAP with pressure release is that the pressure relief from pressure release is not a fixed amount, and the pressure drop can vary from breath to breath, whereas the BiPAP maintains a set, prescribed exhalation pressure. If you have difficulties breathing out against pressure, talk to your clinician at Cansleep to see if you would benefit from pressure relief feature or/and BiPAP.

By Bahareh Ezzati (RRT)


Did you know there are different types of PAP (Positive Airway Pressure) therapy? BiPAP which is also known as BiLevel is a common type of PAP therapy. This blog is going to talk about BiPAP and the difference between BiPAP and CPAP therapy.CPAP_vs_BiPAP_1

CPAP machines deliver a steady, continuous stream of pressurized air to a patient’s airways to prevent them from collapsing and causing apnea events. One of the complaints about CPAP devices is that some patients find the constant singular pressure difficult to exhale against. For patients with higher pressure strengths, exhaling against the incoming air can feel difficult, as if they’re having to force their breathing out. BiPAP machines are often prescribed to sleep apnea patients with high pressure settings or low oxygen levels as well as people with lung disorders or certain neuromuscular disorders. The main difference between BiPAP and CPAP machines is that BiPAP machines have two pressure settings: the prescribed pressure for inhalation (IPAP), and a lower pressure for exhalation (EPAP).

BiPAP generates inspiratory (IPAP) and expiratory (EPAP) pressure gradients that complement the patient’s own respiratory cycle, optimising the lungs’ efficiency and reducing the work of breathing. BiPAP has been shown to be an effective management tool for COPD (Chronic Obstructive Pulmonary Disease) and acute and chronic respiratory failure. The difference in pressures helps to eliminate extra CO2 (carbon dioxide) gas from the body. This offers relief to the user’s typically overworked muscles of breathing. On some BiPAP units exhalation time is also set. COPD patients generally have long exhalation times due to loss of lung elasticity and setting exhalation time allows them exhale fully.

 If you’ve tried CPAP and find the pressure settings too difficult to manage exhaling against, talk with your therapist at Cansleep to see if a BiPAP machine is right for you.

By Bahareh Ezzati (RRT)