What Are Obstructive Sleep Apnea and CPAP?
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Some people with COPD develop a condition called Obstructive Sleep Apnea (OSA). When this occurs, it is often referred to as COPD-OSA Overlap Syndrome, or simply “Overlap Syndrome.” A common treatment for this is CPAP. So, what is OSA? What is CPAP? Here’s all you need to know.

What are some statistics?

Up to 70% of men and 56% of women have sleep apnea and many are undiagnosed. Around 10-15% of people diagnosed with COPD also have a diagnosis of OSA.1 Furthermore, one study showed that 65.9% of COPD patients participating in pulmonary rehabilitation have a diagnosis of sleep apnea.2

What is OSA?

You have a normal drive to breathe, but your upper airway collapses and blocks your lower airway. This causes you to stop breathing for periods of 10 seconds to a minute up to 30 times in a typical night. You’ll appear to be holding your breath, and then appear to struggle to inhale. The period will end with you waking just enough to take in a deep inhalation, and this usually occurs with a loud snore. You may also experience hypopnea, or shallow breathing during sleep.2-4

Why does this happen?

It is most likely to happen in overweight individuals, or those with a body mass index (BMI) greater than 28, and especially men with large necks. This condition causes excessive soft tissue in the back of your mouth and throat. The muscles in this area relax when you are sleeping, causing this soft tissue to collapse and fully or partially block your airway. This increases resistance to inhaled air, making you stop breathing. It can also be genetic and occur in people with normal BMIs. This usually occurs in people with abnormal head or facial features, such as a small jaw, large tongue, large tonsils, or deviated nasal septum.3

What are the consequences of these episodes?

Apnea means you aren’t inhaling oxygen (O2) and exhaling carbon dioxide (CO2). Hypopnea means you are not adequately inhaling O2 and exhaling CO2. Both of these can cause low blood O2 levels (hypoxemia) and elevated CO2 levels (hypercapnia). If not diagnosed and treated properly, it may cause long-term consequences such as hypertension, heart failure, heart attacks, strokes, diabetes, depression, and heart rhythm changes.

What are common signs and symptoms?

Family members (such as your spouse) may observe that you snore loudly and have apnea episodes. You may wake up sweaty and with a dry mouth or sore throat. You may experience morning headaches, daytime sleepiness, difficulty concentrating at school or work, and feeling depressed. These signs and symptoms may be prevented with proper diagnosis and treatment. 3-5

How is diagnosis made?

Your physician should suspect and screen you for it if you are obese, have COPD, have abnormal facial features, or have a family history of OSA. This screening should involve asking you if you or your family members have observed any of the above mentioned signs and symptoms. Your doctor may then have you participate in a sleep study either in a sleep lab or in your home. The study may confirm your diagnosis and the need for CPAP. Once the need for CPAP is confirmed, you’ spend a night in a CPAP lab where a sleep tech will titrate the CPAP settings until it’s determined what works best for you. Another method is to send you home with an auto-titrating CPAP machine.

What is CPAP?

This is an acronym for Continuous Positive Airway Pressure. It was first introduced in 1981, and has since become a top line treatment for OSA.  It is only used when you are sleeping, and involves placing a small CPAP machine at your bedside. Tubing from the machine connects to a mask that is applied to your face (usually just over your nose). The machine applies a continuous pressure to your airway to keep it patent, thereby preventing apnea, snoring, hypoxemia, and hypercapnia. It also improves your ability to get a good sleep at nighttime, thereby making you feel better during the daytime. It also reduces your risk for developing the long-term consequences noted above. (3)

Will I like CPAP?

Studies show that about  80% of patients accept CPAP, but only 46% are compliant with it, and miss out on the benefits.3 Most modern machines are small, compact, and are generally quiet and easy to use. There are various types of headgear to choose from, such as nasal masks, full face masks, nasal pillows, and nasal prongs. Your caregiver should allow you to try as many as you like until you find something that works best for you. Most people I’ve interviewed said they felt so much better during the daytime after using it that this made it easier to adjust to wearing it at nighttime.

Are there other treatment options?

There are things you can try, such as sleeping on your sides instead of your back, or sleeping with your head elevated. Your doctor may recommend you see a dietician and begin a weight loss program. You should avoid alcohol or sedatives, as these can relax your throat muscles. Your doctor may have other ideas, such as surgery to repair abnormalities, devices to keep your airway open, or medicine to relieve nasal congestion. 3,5

Conclusion.

It’s never fun to hear you have that you have a sleeping disorder that requires wearing a mask when you’re sleeping. However, by working with your caregiver, and by being patient, you should be able to quickly adjust to using CPAP on a nightly basis. Doing so should should keep you healthier long-term while improving the quality of your life short-term.

view references
  1. COPD Foundation, "Sleep Apnea and COPD: What you should know," https://www.copdfoundation.org/COPD360social/Community/Blog/Article/66/Sleep-Apnea-and-COPD-What-You-Should-Know.aspx, accessed 1/26/17
  2. Solor, Xavier, et al., "High Prevalence of Obstructive Sleep Apnea in Patients with Moderate to Severe Chronic Obstructive Pulmonary Disease," ATS Journals,  August 1, 2015, Vol. 12, No. 8, http://www.atsjournals.org/doi/10.1513/AnnalsATS.201407-336OC, accessed 1/29/17
  3. Kacmarek, Robert M., James K. Stoller, Albert J. Heuer, editors, "Egan's Fundamental's of Respiratory Care," 10th edition, 2013, Elsevier, pages pages 662-671
  4. Wilkins, Robert L., James R. Dexter, "Respiratory Disease: Principles of Patient Care," 1993, F.A. Davis Company, pages 309-315
  5. Des Jardins, Terry, George G. Burton, editors, "Clinical Manifestations and Assessment of Respiratory Disease," 6th edition, Mosby Elsevier, pages 398, 400
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