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The Risk of Dozing Off - How Is Sleep Apnea Treated?

People say they’re just resting their eyes. Before they know it, they’re asleep. But a study indicates it could mean trouble.

The study says constantly dozing off during the day can forewarn of an increased risk of a stroke among the elderly. The study was presented at the American Stroke Association’s International Stroke Conference 2008.

Bernadette Boden-Albala of Columbia University Medical Center says people who more commonly dozed off had a four-and-a-half times greater risk of a stroke.

That doesn’t necessarily mean you should fear the nap, if napping is your remedy for drowsiness.

"There's no evidence that suggests that, if you feel like taking a nap, you shouldn’t take the nap. Napping is not the risk. The risk here, we believe, is the poor sleep."

The study was supported by the National Institutes of Health.

How Is Sleep Apnea Treated?

Goals of Treatment

The goals of treating obstructive sleep apnea are to:

* Restore regular breathing during sleep
* Relieve symptoms such as loud snoring and daytime sleepiness

Treatment may help other medical problems linked to sleep apnea, such as high blood pressure. Treatment also can reduce your risk for heart disease, stroke, and diabetes.
Specific Types of Treatment

Lifestyle changes, mouthpieces, breathing devices, and/or surgery are used to treat sleep apnea. Currently, there are no medicines to treat sleep apnea.

Lifestyle changes and/or mouthpieces may be enough to relieve mild sleep apnea. People who have moderate or severe sleep apnea also will need breathing devices or surgery.
Lifestyle Changes

If you have mild sleep apnea, some changes in daily activities or habits may be all that you need.

* Avoid alcohol and medicines that make you sleepy. They make it harder for your throat to stay open while you sleep.
* Lose weight if you're overweight or obese. Even a little weight loss can improve your symptoms.
* Sleep on your side instead of your back to help keep your throat open. You can sleep with special pillows or shirts that prevent you from sleeping on your back.
* Keep your nasal passages open at night with nose sprays or allergy medicines, if needed. Talk to your doctor about whether these treatments might help you.
* Stop smoking.

Mouthpiece

A mouthpiece, sometimes called an oral appliance, may help some people who have mild sleep apnea. Your doctor also may recommend a mouthpiece if you snore loudly but don't have sleep apnea.

A dentist or orthodontist can make a custom-fit plastic mouthpiece for treating sleep apnea. (An orthodontist specializes in correcting teeth or jaw problems.) The mouthpiece will adjust your lower jaw and your tongue to help keep your airways open while you sleep.

If you use a mouthpiece, it's important that you check with your doctor about discomfort or pain while using the device. You may need periodic office visits so your doctor can adjust your mouthpiece to fit better.
Breathing Devices

Continuous positive airway pressure (CPAP) is the most common treatment for moderate to severe sleep apnea in adults. A CPAP machine uses a mask that fits over your mouth and nose, or just over your nose. The machine gently blows air into your throat.

The air presses on the wall of your airway. The air pressure is adjusted so that it's just enough to stop the airways from becoming narrowed or blocked during sleep.

Treating sleep apnea may help you stop snoring. But stopping snoring doesn't mean that you no longer have sleep apnea or can stop using CPAP. Sleep apnea will return if CPAP is stopped or not used correctly.

Usually, a technician will come to your home to bring the CPAP equipment. The technician will set up the CPAP machine and adjust it based on your doctor's orders. After the initial setup, you may need to have the CPAP adjusted on occasion for the best results.

CPAP treatment may cause side effects in some people. These side effects include a dry or stuffy nose, irritated skin on your face, sore eyes, and headaches. If your CPAP isn't properly adjusted, you may get stomach bloating and discomfort while wearing the mask.

If you're having trouble with CPAP side effects, work with your sleep specialist, his or her nursing staff, and the CPAP technician. Together, you can take steps to reduce these side effects. These steps include adjusting the CPAP settings or the size/fit of the mask, or adding moisture to the air as it flows through the mask. A nasal spray may relieve a dry, stuffy, or runny nose.

There are many different kinds of CPAP machines and masks. Be sure to tell your doctor if you're not happy with the type you're using. He or she may suggest switching to a different kind that may work better for you.

People who have severe sleep apnea symptoms generally feel much better once they begin treatment with CPAP.
Surgery

Some people who have sleep apnea may benefit from surgery. The type of surgery and how well it works depend on the cause of the sleep apnea.

Surgery is done to widen breathing passages. It usually involves removing, shrinking, or stiffening excess tissue in the mouth and throat or resetting the lower jaw.

Surgery to shrink or stiffen excess tissue in the mouth or throat is done in a doctor's office or a hospital. Shrinking tissue may involve small shots or other treatments to the tissue. A series of such treatments may be needed to shrink the excess tissue. To stiffen excess tissue, the doctor makes a small cut in the tissue and inserts a small piece of stiff plastic.

Surgery to remove excess tissue is only done in a hospital. You're given medicine that makes you sleep during the surgery. After surgery, you may have throat pain that lasts for 1 to 2 weeks.

Surgery to remove the tonsils, if they're blocking the airway, may be very helpful for some children. Your child's doctor may suggest waiting some time to see whether these tissues shrink on their own. This is common as small children grow.

Living With Sleep Apnea

Obstructive sleep apnea can be very serious. However, following an effective treatment plan can often improve your quality of life quite a bit.

Treatment can improve your sleep and relieve daytime tiredness. It also may make you less likely to develop high blood pressure, heart disease, and other health problems linked to sleep apnea.

Treatment may improve your overall health and happiness as well as your quality of sleep (and possibly your family's quality of sleep).
Ongoing Health Care Needs

Follow up with your doctor regularly to make sure your treatment is working. Tell him or her if the treatment is causing side effects that you can't handle.

This ongoing care is especially important if you're getting continuous positive airway pressure (CPAP) treatment. It may take a while before you adjust to using CPAP.

If you aren't comfortable with your CPAP device or it doesn't seem to be working, let your doctor know. You may need to switch to a different device or mask. Or, you may need treatment to relieve CPAP side effects.

Try not to gain weight. Weight gain can worsen sleep apnea and require adjustments to your CPAP device. In contrast, weight loss may relieve your sleep apnea.

Until your sleep apnea is properly treated, know the dangers of driving or operating heavy machinery while sleepy.

If you're having any type of surgery that requires medicine to put you to sleep, let your surgeon and doctors know you have sleep apnea. They might have to take extra steps to make sure your airway stays open during the surgery.
How Can Family Members Help?

Often, people with sleep apnea don't know they have it. They're not aware that their breathing stops and starts many times while they're sleeping. Family members or bed partners usually are the first to notice signs of sleep apnea.

Family members can do many things to help a loved one who has sleep apnea.

* Let the person know if he or she snores loudly during sleep or has breathing stops and starts.
* Encourage the person to get medical help.
* Help the person follow the doctor's treatment plan, including CPAP.
* Provide emotional support.

Key Points

* Sleep apnea is a common breathing disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.
* Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep 3 or more nights each week.
* Sleep apnea often goes undiagnosed. Doctors usually can't detect the condition during routine office visits. Also, there are no blood tests for the condition. Most people who have sleep apnea don't know they have it because it only occurs during sleep.
* The most common type of sleep apnea is obstructive sleep apnea. This most often means that the airway has collapsed or is blocked during sleep. This may cause shallow breathing or breathing pauses.
* Sleep apnea can cause daytime sleepiness, increase the risk for or worsen some medical conditions, and increase the chance of having a work- or driving-related accident.
* It's estimated that more than 12 million American adults have sleep apnea. More than half of the people who have this condition are overweight.
* The most common signs of sleep apnea are loud snoring and choking or gasping during sleep and being very sleepy during the day.
* Doctors diagnose sleep apnea based on your medical and family histories, a physical exam, and results from sleep studies.
* Treatment is aimed at restoring regular breathing during sleep and relieving symptoms. Treatment also may help other medical problems linked to sleep apnea.
* Lifestyle changes, mouthpieces, breathing devices, and/or surgery are used to treat sleep apnea. Continuous positive airway pressure (CPAP) is the most common treatment for moderate to severe sleep apnea.
* Sleep apnea can be very serious. However, following an effective treatment plan can often improve your quality of life quite a bit. Follow up with your doctor regularly to make sure your treatment is working. Tell him or her if the treatment causes side effects that you can't handle.
* Family members can help a person who snores loudly or stops breathing during sleep by encouraging him or her to get medical help.
* Treatment may improve your overall health and happiness as well as your quality of sleep (and possibly your family's quality of sleep).



The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies.

Copyright Information: Public domain information with acknowledgement given to the U.S. National Library of Medicine.

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