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article imageSleep apnea: few treatment options for a serious condition Special

By Liz Seegert     Apr 12, 2012 in Health
Some sleep apnea suffers may finally have an alternative to the bulky machines many use nightly to treat their condition. Provent Therapy has recently gained popularity as an effective, less obtrusive, and more comfortable option for some.
An estimated 18 million adults in the United States suffer from obstructive sleep apnea (OSA). This chronic condition causes the airway to collapse while sleeping, resulting in snoring and bouts of not breathing. Sleep apnea sufferers stop breathing repeated while asleep, sometimes hundreds of times during the night. Breathing can often halt for a minute or longer, according to the American Sleep Apnea Association. The sleeper is usually unaware of these interruptions because they don't trigger a full awakening.
“Studies have shown that having untreated sleep apnea is worse than being legally drunk,” said Steven Park, MD, an otolaryngologist and sleep medicine specialist at Montefiore Medical Center in the Bronx, NY. OSA affects as many as 24 percent of men and 9 percent of women in the United States, and nearly two-thirds of the population over age 65 (64 percent) are thought to suffer from the condition. Worse, 90 percent of the people who have sleep apnea are not diagnosed. Sleep apnea is treatable, but some patients think that can be worse than the symptoms.
The National Sleep Foundation (NSF) said that untreated sleep apnea can lead to or worsen many chronic conditions like heart disease, diabetes, high blood pressure, mood and memory disorders. It also causes chronic fatigue and increases risk of car accidents. It may even shorten a person’s life span as much as 20 years.
There are only a handful of effective treatment options for sleep apnea. Most are treated with continuous positive airway pressure (CPAP), considered to be the gold standard. A small machine is hooked up to a breathing mask worn over the nose and mouth. Air is gently forced through the mask at a consistent rate to keep the airway and throat open and provide ample oxygen. However, many patients stop treatment after only a few weeks – due to the device's discomfort, bulk, noise, and awkwardness.
About 40 to 50 percent of patients are unable to use the CPAP machine, said Gregg Schneider, DDS, a nutritionally oriented dentist in Rahway, NJ. " Dentists are able to fabricate oral appliances that are worn during sleep that advance the lower jaw and help maintain the airway. They are safe and effective,” Dr. Schneider is an authority on alternative medicine and sleep apnea, and has been treating the condition fort 25 years. In addition to offering the retainer-like device, he uses nutritional supplements including melatonin and valerian to help patients sleep.
Provent is a disposable nightly-use nasal device that claims it is just as effective as CPAP, while being less intrusive, quieter, and more comfortable. Provent Therapy works by using a patient’s own breathing to create Expiratory Positive Airway Pressure (EPAP), which helps keep the airway open while sleeping. The device uses a valve design that attaches over the nostrils and is secured in place with hypoallergenic adhesive.
During inhalation, the valve opens, allowing the user to breathe in freely. When exhaling, the valve closes and air passing through the nose is directed through two small air channels. A proprietary design increases pressure upon exhalation to keep the airway open. Since the device is small and disposable, Provent is more discreet and convenient compared with CPAP or other treatments. The device is approved by the U.S. Food and Drug Administration (FDA) and was proved to be effective in clinical studies. Like CPAP, Provent isn’t for everyone, but many users said they were highly satisfied with the device.
Dr. Park said that Provent Therapy costs about $2 per day and is not covered by most insurance plans. That makes it an expensive option, but for some people, “a good night’s sleep is worth the price.”
Heidi Barron, Marketing Manager for It’s the Journey, the Atlanta 2-day walk for Breast Cancer, found out she suffered from moderate to severe sleep apnea, after undergoing a sleep study. “I was tired all the time, and I snored sometimes,” she said. “My husband told me I would make all these strange noises in the middle of the night and that sounded like I was choking.” Heidi has used a CPAP device for the past three years “and hates it - it’s bulky, it’s obtrusive, it’s unattractive,” she said. “But it works.” She said she completely resisted using it at first. “but when I finally tried it, I woke up feeling totally refreshed, like a different person.” However, if there was an effective, non-surgical alternative that worked as well, she would “absolutely” try it.
Most people with severe sleep apnea can stop breathing 20, 50, or even 100 times per hour, said Dr. Park, who has been treating sleep apnea patients for the past decade, and is author of Sleep, Interrupted, a well-regarded book on the condition, said untreated sleep apnea significantly affects the body – oxygen levels drop, causing a major stress response on the heart, brain, and other organs. Your body instinctively shuts down non-essential functions, such a blood flow to the extremities, to ensure that core organs get oxygen. Initially that only happens during sleep, but eventually it carries over into the daytime, causing or worsening conditions like hypertension.
“We know from long-term clinical studies that having sleep apnea significantly increases your risk of having high blood pressure,” he said. The stress response also increases a person’s risk of diabetes by raising sugar levels and increasing insulin resistance. “It can also significantly raise cholesterol levels, increase your risk of heart attack two or three-fold, causes memory impairment, results in higher incidence of kidney and liver failure, seizures – almost any condition out there has a link to sleep apnea.”
“There is no one ‘right’ treatment, or ‘typical’ patient,” he added. Surgery is usually a last resort, but before recommending any treatment, he said the first step is to assess a patient’s sleep hygiene. The University of Maryland Medical Center lists good sleep habits, such as not eating right before bedtime, sleeping and waking at the same time daily, avoiding naps, getting regular exercise, and using the bedroom only for sleep and sex.
“Most people have less than stellar sleep hygiene,” Dr. Park explained. “Including those of us that keep the computer, or television, or other electronic device going.” According to a report in the Cleveland Plain-Dealer, the blue light waves from these devices can actually stimulate the brain, making good sleep even more difficult.
Chronic snoring is a common sign of possible OSA. The Mayo Clinic cited other risk factors as being overweight, having a small upper airway, a large neck size (greater than 17 inches for men; 16 inches for women), being male, smoking, using alcohol, over age 65, and having a family history of sleep apnea.
“Don’t rule out sleep apnea if you don’t match the common risk factors,” Dr. Park said. “One of the worst cases I treated was a female, in her late thirties, with a very small jaw, and narrow airway.”
Think you have this condition? Ask your sleeping partner if you are overly restless at night, snore frequently, or gasp for breath while sleeping. Talk to your physician about your symptoms, daytime sleepiness or fatigue, and review any medications you’re taking, including over-the-counter treatments, to rule out possible side effects as a cause. Your doctor may send you for a sleep study, which the National Heart, Lung, and Blood Institute described as “tests that measure how well you sleep, and the severity of any sleep problems.” He or she may ask also you to keep a sleep diary to help with diagnosis and to determine the right treatment option for your situation.
More about OSA, Sleep Apnea, Sleep, Treatment, Snoring
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