Obstructive sleep apnea occurs during nighttime breathing and involves respiratory effort against .
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A 48-year-old man comes to your clinic for a follow-up after beginning continuous positive airway pressure (CPAP) therapy to manage obstructive sleep apnea. He says the CPAP device has been successfully managing his condition, but he finds the device cumbersome and is unable to bring it along for his frequent business travels. Which of the following would be the most appropriate recommendation for this patient?
Sleep apnea is a sleep disorder which causes irregular breathing and snoring patterns that can ultimately cause apnea, which is where a person momentarily stops breathing altogether.
The inability to get restful sleep can also lead to severe exhaustion.
Individuals can have obstructive sleep apnea, central sleep apnea, or features of both.
Obstructive sleep apnea is the most common form, and it develops when there’s a blockage of the airways.
Air has to go from the nose through the nasopharynx into the laryngopharynx, through the larynx and then into the trachea. Somewhere along that path, there might be a blockage in the flow of air.
Allergies might cause swelling of the tissue in the nasopharynx, or there might be swollen adenoid glands or tonsils because of an infection.
There might be a severe overbite which pulls the jaw back and blocks the airway.
In individuals that are overweight, there could be too much weight in the soft tissues of the neck, which can weigh down the airway especially when a person is lying down.
These problems are most obvious at night because hormonal changes at night cause the muscles around the airway to becomes slightly less stiff while sleeping.
This means that they are less able to keep the airway open, making it more likely to get a bit squashed or obstructed.
Central sleep apnea refers to the fact that the problem is “central” or related to the central nervous system.
This is where the brain intermittently stops making an effort to breathe for 10 to 30 seconds.
The apnea can persist for several seconds even after waking up, triggering feelings of panic and further disrupting the sleep cycle.
Central sleep apnea starts with an initial episode of hyperpnea, which is when the brain directs the lungs to start hyperventilating during sleep by increasing the respiratory rate.
This rapid breathing causes hypocapnia, a drop in the blood’s carbon dioxide levels.
This causes the carbon dioxide levels to rise back to normal levels and then, as the apnea persists, they keep rising to which is called hypercapnia.
The really high carbon dioxide levels triggers hyperpnea again, and the cycle starts all over.
Essentially, the respiratory system is going rapidly back and forth between two states, first making no effort to breathe and then hyperventilating, with no in-between.