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Advanced Sleep Apnea Advice: A Doctor Discusses CPAP, Health Risks, More

sleepapnea-3If you have sleep apnea or know someone does, you need more than basic information. You need in-depth advice. Here, sleep doctor Louis S. Libby addresses common problems. From making your CPAP mask more comfortable to easing your fears about long-term health risks, these are the frequently asked questions you need answers to.

Note: Only your doctor can give you personal advice. Please see the bottom for our disclaimer.

3 Questions and Answers About CPAP

Question 1: My CPAP mask isn't comfortable. Any tips?
For many, the hardest part of adjusting to CPAP is adjusting to the mask. Fortunately, CPAP manufacturers and researchers have put enormous efforts into making a variety of masks.

There are now masks that go solely over the nose, those that cover the nose and mouth, and a few that just connect with the mouth. If you hate your mask, there are probably more than 20 other models available, and most of those come in four to six sizes (petite, small, medium and large) and configurations (wide, medium and narrow).

You should have the option of trying on many of these briefly before taking one home. If you find it intolerable at home, bring it back and exchange it for another that feels right for you.

I recommend gradually getting used to any new mask. Make sure you can tolerate it for 20 to 30 minutes while awake first.

Question 2: Are there treatments besides CPAP for sleep apnea? Do they work as well?
There are many other treatments, but few are as effective, easy to administer and acceptable for most sleep apnea patients. Here's a rundown of what's out there and how well they work.

  • Years ago, we used something we still use in drastic situations today: tracheostomy. This entails surgically placing a hole into the windpipe at the base of the neck. Although it works almost every time, it has obvious drawbacks, and doctors rarely use it today.
  • Weight loss for people who are significantly overweight can cure sleep apnea. We usually see a 75-percent improvement when people who are at least 33 percent above their ideal weight lose more than 15 percent.
  • Simple upper airway surgery can occasionally be very effective. The best results are on young people who aren't significantly overweight and have massively enlarged tonsils that are the main source of the nighttime obsctruction. Otherwise, the results of this surgery are frequently disappointing.
  • Office-based surgeries, such as with lasers, offer no benefit for sleep apnea, although they may help simple snoring.
  • Occasionally, people only have sleep apnea when they lie on their back. They can use specialized shirts with balls sewn into the back to make sure they don't lie on them. This is very effective for a small number of people.
  • The most under used treatment for sleep apnea is a dental appliance—basically, a device that opens up the back of the throat. It's similar to the mouth guard football players wear. A dentist needs to make it. For people with mild to moderate sleep apnea, this can be as effective as CPAP.

Question 3: Are there other things I can do at home for sleep apnea, in addition to CPAP?

  • If you're overweight, try to lose weight. At least do your best to maintain it. Gaining weight can worsen sleep apnea and require adjustments in your treatment program.
  • Avoid smoking. Cigarette smoking worsens sleep apnea. It causes upper-airway tissues to swell, making obstruction more likely. More importantly, it's another risk factor for many of the worst sleep apnea complications: heart attacks, strokes and early death.
  • Minimize alcohol intake, especially in the hours before going to bed. Alcohol relaxes the muscles in the upper airway and leads to collapse and obstruction more easily. In some cases, it can worsen sleep apnea so much that CPAP is no longer effective.
  • Be aware that some medications may worsen your tendency for sleep apnea—specifically narcotics and medications for nerves (like Valium and other benzodiazepines). If you need these, make sure your doctor is aware of your sleep apnea.
  • Cultivate appropriate sleep habits to avoid complicating sleep apnea effects. Get enough sleep. (Most adults need eight hours nightly). Get up at the same time every morning to keep your internal clock set correctly. And avoid excessive caffeine, especially after lunch, if you have any tendency for insomnia.

Sleep Apnea and Weight

Question: I'm not overweight. Why do I have sleep apnea?

Answer: A significant minority of people with sleep apnea don't have a weight problem. They have an air passage that's unusually narrow or prone to collapse.

In children, this is most commonly because of very large tonsils. A relatively small jaw or an overbite can also cause problems by narrowing the upper airway.

Nasal obstruction can aggravate sleep apnea but is never the primary cause. Occasionally, an underactive thyroid (hypothyroidism) can bring out sleep apnea. Rarely, we see patients with cancerous or noncancerous throat tumors that cause airway obstruction. In 25 years, I've seen this only once.

Sleep Apnea and Health Risks

Question: My sleep apnea is under control. Has my risk of death decreased?

Answer: To the best of our knowledge, yes! All the research done to date strongly supports the fact that patients with significant sleep apnea (moderate to severe) who use CPAP regularly have a markedly reduced risk of death from all causes and specifically from heart attacks and strokes.

We're awaiting further studies that are looking at whether CPAP also protects people with more mild forms of sleep apnea. Until that data is available, the prudent patient will try to get his or her sleep apnea under control even if it's mild.



LOUIS S. LIBBY, M.D., is a board-certified sleep specialist with The Oregon Clinic in Portland. He's also board certified in internal, pulmonary and critical-care medicine.

Last updated and/or approved: April 2010. Original article appeared in March/April 2009 former print magazine. Bio current as of March 2009. This article is not meant as individual advice. Please see our disclaimer.

Comments (5)add comment
Advanced Sleep Apnea Advice
written by CpapGuide , July 21, 2017

A very urgent issue these days. Thanks for the info!
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Muscle Relaxation
written by Morge Heymann , March 14, 2011

I hear it's vital for these type of problems. I've never had it myself, but i've had friends with it who never took it seriously, as Leonard says. It's sad, actually. My best friend was prescribed with a muscle relaxant, but I don't know what he's taking really, I could ask tho.

Im really intrested in this subject, i don't think enough people know about this and it's really important to highlight it as a more and more common health issue nowadays.

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Re: Sleep Apnea and Life Insurance
written by Leigh Ann , March 08, 2011

Interesting, Leonard. That demonstrates how serious the disorder really is. Thanks for the insight.

Leigh Ann Otte
Managing Editor,

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Sleep Apnea and Life Insurance
written by Leonard Robbins , March 05, 2011

As an independent life insurance agent, I have found more and more clients suffering from this problem. In many instances I find potential applicants don't take their diagnosis seriously until they are "declined" for coverage due to non-compliance with physician's instruction.
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Sleep Apnea Chin Straps
written by Sleep Apnea Chin Strap , July 29, 2010

Another new type of device that's helped in some cases outside of CPAP are sleep apnea chin straps that help with snoring and in some cases sleep apnea.

There are some medical studies that have shown improvements in patients.

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