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)

Travelling with CPAP

It’s the time of year again when many people are making travel plans. Below you’ll find a checklist that’s useful no matter what your travel plans may be.

  • Know your rights. A CPAP machine is considered a medical device, which means you’re permitted to bring it with you into the plane cabin and it does not count as a carry-on item. We advise you to not pack your CPAP in your checked luggage, since this is risky in the event that your luggage is lost or delayed and it also may get damaged during handling.
  • Make pre-flight arrangements if necessary. If you’re taking an overnight flight, at least two weeks prior to traveling, get clearance from the airline to use your device on a flight. Arrange to sit near a power source on the aircraft. Confirm the type of power cord or adapter used by the aircraft. Remember, you cannot use your humidifier on the plate, as aircraft 000 travelturbulence increases the risk of water spillage and damage to the device.
  • Prepare documents from your doctor or CPAP supplier. Most airports especially international ones are familiar with CPAP and don’t question it, but it can help you get through security more easily if you carry a copy of your prescription and a letter from your provider explaining what CPAP is.
  • Pack CPAP and supplies
    • Pack the correct adapter for the country you’re traveling to because power outlets differ in each country. It is wise to take spare supplies especially an extra mask.
    • Check the electrical specification sticker on the machine, or check the specs in your owner’s manual to see if you have a CPAP with a universal power supply supporting a voltage range of 100V to 240V. If it indicates 100V – 240V, then you know you have a universal power supply. Some old CPAPs requires voltage converters and it doesn’t run with a different power supply. Note that some really old CPAP machines have a switch for manually changing from 120V to 240V.
    • Check if your CPAP has a direct 12V DC input. If so, you can run your CPAP with free-standing 12V battery.
    • Anticipate Hard-to-Reach Outlets. Consider taking back-up batteries.
    • Remember H2 Remember you can’t take water on the plane with you. Some people choose to pack distilled water in their luggage, other don’t take their humidifier with them. Alternative to distilled water is boiled water. Keep in mind if you are going on a cruise you can ask in advance that they place distilled water in your cabin.
  • At the airport:  Make sure you have emptied out the humidifier and packed your CPAP in its carrying case. If you have a back-up battery you can take it with you on the plane to use. The x-ray scanners will not harm your device, and it is required that you take your CPAP out of the bag and place it on the scanner’s belt.

Contact Cansleep if you are traveling and require a copy of your prescription and a travel letter. If you want to travel light or if you are worried about power cord access and want to use a back-up battery contact us so we can go over travel units and back-up batteries options with you.

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)

SoClean 2

CPAP therapy is SC_Cleaning_Process.gifthe most effective treatments for obstructive sleep apnea. However, if you aren’t committed to maintaining a clean CPAP machine, you’re putting yourself at high risk for exposure to germs and bacteria that nests in your equipment. This is why regular CPAP cleaning is an essential part of CPAP therapy. The soap and water method can be time-consuming and it’s almost impossible to reach every inch and corners of the equipment by hand, so your CPAP equipment is unlikely to be completely clean. If you’re looking for the best way to clean CPAP equipment consider SoClean, which quickly and effectively destroys 99.9% of common CPAP germs in your mask, hose and reservoir. It is completely automated, you don’t need to take CPAP equipment apart and no water or chemicals are used. Keep in mind that because SoClean uses a natural gas to clean, even the hard-to-reach spots are thoroughly disinfected. After a simple one-time setup, place your mask inside the SoClean chamber, close the lid and let SoClean’s automated CPAP cleaning cycle do the rest.                                                                                                                                                                                                                                          (click on the picture to see how SoClean works)

SoClean uses ozone (also known as activated oxygen or O3) to clean CPAP equipment. The generator inside the SoClean breaks down the chemical bond of common oxygen (O2) and allows it to recombine into a new molecule that has three atoms of oxygen instead of two. Activated oxygen has a short life cycle. After being generated it automatically decomposes back to oxygen within two hours. Activated oxygen exits the chamber through a special filter, which needs to be replaced every 6months.This filter converts any excess activated oxygen back into the oxygen that we breathe (O2). Ozone is a 100% safe, naturally occurring gas that has been used to purify water and hospital sanitizing for centuries. To get more information about SoClean2 and SoClean 2 go (travel size) contact Cansleep services at 1-844-753-sleep40.

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)

ASV

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)

BiPAP

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)

Steps to take to get used to CPAP therapy

First try CPAP during the day

Before you try to fall asleep with a new CPAP try to get used to the mask by itself.hcnoctn452-u1p-global-001

  1. Hold the mask in front of your face (with no headgear or tubing) and breathe normally for 1 minute.
  2. Then connect the mask to your CPAP machine, turn the air on and hold it in front of your face for 1–2 minutes (still with no headgear). Focus on breathing normally. If the air pressure is uncomfortable, remove the mask from your face and try again after a few minutes.
  3. Now put your headgear on, sit and practice breathing through the mask and air pressure for 2 minutes at a time.
  4. Try reading or watching TV with your mask, headgear and air pressure on for 30 minutes at a time (but not in your bedroom).

Then take CPAP to bed

  1. Have everything set up. Therapy can be a hassle to set up when you’re tired. It’s best to have everything set up when you’re ready for sleep.
  2.  It’s ok to use it for just 30–60 minutes on your first attempt. Try to add 30 minutes each time you use it to stay motivated. Remind yourself that CPAP takes patience and perseverance. Remember your body needs time to adjust to the therapy and may not feel better right away.
  3. Keep a diary of your efforts and challenges. This helps patients see how far they’ve come, notice when issues become trends that need addressing and accept the idea that CPAP therapy is a process.
  4. Have your bed partner and family members help motivate you and keep you on track.

If you ever feel discomfort or that something’s not right, talk to your clinical therapist at CanSleep services; don’t forget we are also here to support you and share our experiences with you.

By Bahareh Ezzati (RRT)