Here’s a small study out of India showing that CPAP significantly lowered various markers for metabolic syndrome (high blood pressure, high cholesterol, and insulin resistance). Eighty-six volunteers (87% had metabolic syndrome) with were randomized to be given CPAP or sham CPAP therapy for 3 months. After 3 months, the two group were reversed. People treated with CPAP had an overall drop of 3.9 mm Hg systolic (top number) blood pressure, and 2.5 mm Hg in the diastolic (bottom) number. Total cholesterol went down 13.1 points, and  LDL dropped 9.6 points. Triglycerides also dropped, by 18.7 points. Thirteen percent no longer had metabolic syndrome.

On a side note, this study was funded by Pfizer, which makes many of the popular medications for high cholesterol and high blood pressure. It’s interesting that they would fund a study that would make it less necessary to use their prescription medications. We know that they don’t manufacture CPAP machines, so I wonder why they funded this study. Could they be interested in entering the sleep apnea market?

Mr. Brian Erickson from Apnex joins us to answer your questions.

In this interview, we answer the following questions:

- What is the Hypoglossal Nerve Stimulation Therapy?

- What are the inclusion and exclusion criteria?

- Can I be included if I had a UPPP performed?

- Will I be compensated?

- What were the initial results from the original feasibility study?

- What are the potential complications?

- How long does the study last?

- Is it available near where I live?

- What does it feel like when it’s on?

- And much, much more.

Please enter your information below to receive free access to the MP3 recording and the PDF of the slides:

In this Expert Interview program, Ms. Lisa Brateman will talk to us about the psychology of obstructive sleep apnea. This is an important topic that affects not only those of you with sleep apnea, but also your loved ones, your friends, and family members.

Please enter your information below to receive your download link.

I see the same proportion of high blood pressure, asthma, high cholesterol, depression and heart disease in doctors, and they take the typical medications that are given for these medical conditions. But when it comes to sleep apnea, I’ve noticed 3 common features:

1. Doctors are very reluctant to use the various machines, appliances or even consider surgical options for sleep apnea. Perhaps they’ve been exposed to these options in their career and don’t like the idea of having to do something other than to take a pill.

2. The first thing that they think about when I mention sleep apnea is either a tracheotomy or the stereotypical picture of the morbidly obese man with a CPAP mask and hose attached to a machine. Maybe it reminds them too much of being on a respirator.

3. Just like many non-physicians who may have sleep apnea, not having an official diagnosis means that they can put off having to try the different treatment options. Frequently, they’ll refuse to undergo a sleep study.

Ultimately, it sounds like denial to me. But one requirement that all doctors should experience is to undergo the various treatment options that they prescribe to their own patients. All sleep doctors should undergo a sleep study and experience a CPAP machine. Gastroenterologists should undergo a colonoscopy before starting practice. Undergoing surgery is more difficult, but when needed, can be a valuable experience for experiencing what it’s like to be on the other side of the curtain. Maybe even oncologists should undergo chemotherapy at least once in their lifetime.

Unfortunately (and fortunately), I’ve had the opportunity to be a patient a handful of times, and each one was a valuable learning experience. After undergoing emergency surgery a few years back, I’ve noticed that my demeanor and attitude to patients during and after surgery has improved for the better. A doctor with sleep apnea should set an example for the patient and practice what he or she preaches.

Do you have any doctors that may have undiagnosed sleep apnea?

This month, I answer the following questions (6/14/11):

- Are there travel-sized CPAP machines available?

- What are the surgical options for sleep apnea and what are their success rates?

- What are the benefits of acupuncture for sleep apnea?

- Is it customary for surgeons to perform turbinate surgery along with septum surgery?

- Are there places to check out all the different CPAP masks and machine and read user reviews?

- If someone can’t breathe through their nose, is it dangerous to use a nasal mask and chin straps?

- How commonly is tracheotomy used to treat sleep apnea after exhausting all other options?

- Are there any new developments in sleep apnea treatment that will be available within the next 5 years?

- What can be done about bloating with CPAP use?

- Do over-the-counter boil-and-bite devices for snoring and sleep apnea work?

- Can you design a bed or a pillow to sleep with your face down to prevent your tongue from falling back? Does sleep apnea disappear for astronauts since there’s no gravity?

- And many more questions from the live audience.

Please click here to order the 60 minute MP3 recording.

But one thing that you may be surprised about is that many of his fellow players probably  have sleep apnea, and won’t get diagnosed for years. Basketball players don’t fit the typical profile for sleep apnea (male, overweight, big neck, snorer), but as you can see, many basketball players are not only tall, but somewhat bulky on top.

We already know that up to 1/3 of NFL linemen have significant obstructive sleep apnea. Anecdotally, most bodybuilders and weightlifters probably have undiagnosed obstructive sleep apnea. Now you should add basketball players as well.

It’s well known that some professional basketball players may have gigantism, or acromegaly, which is a disorder where too much growth hormone is secreted by the pituitary gland. We also know that acromegaly patients have up to 75% chance of having obstructive sleep apnea. It makes sense that you don’t have to have formal acromegaly, but only mild gradations.

You may be asking by now, if they have sleep apnea, how can they be so fit and almost superhuman in their athletic abilities? Perhaps their drive to overcome the fatigue is what leads to intense workouts and 110% effort during competitions. This situation may also apply to professional distance runners. I know for a fact that many top elite runners can’t sleep on their backs and have trouble waking up in the morning.

Sometimes, the sport itself can make sleep apnea worse. Football players or body builders typically bulk up their upper bodies as well their neck muscles, which can narrow your upper airway even more. It’s not only fat that can compress your breathing passageways.

Whenever I watch a top level sports program, whether live or on TV, I always look at the jaw structures of the top athletes. In many cases, you’ll see jaw narrowing or recessed chins. Often the bite is off, and if you can sometimes peek into their mouths, you’ll see a high arched hard palate. One great example of this is Michael Phelps.

Do you know any elite or top level athletes, and if so, how well do they sleep? Ask them which position they like to sleep in. Do either of their parents snore? You’ll be surprised at the consistency of the answers you hear.

As a summary, CPAP stands for continuous positive airway pressure. These machines blow a constant level of positive air pressure through a mask into your nose (or nose and mouth). Bilevel PAP refers to a machine that delivers two different levels, where a higher pressure is used during inhalation and a much lower pressure is given during exhalation. BiPAP is actually a registered brand name from Respironics. Auto-titrating PAP machines adjust your pressures as needed. There are other variations such as auto-bilevel devices and ASV units which are used for complex or central sleep apnea. For this discussion we’ll talk about CPAP, Bilevel and auto-titrating units only.

With so many different models to choose from, people continue to ask me which is the best option. If your insurance company pays for your PAP machine, you don’t have a choice—you have to start with a basic CPAP machine. Most people do well with standard CPAP models, but there will always be people who don’t do well. But before switching to a new machine, you have to first go through the standard trouble-shooting steps to make sure that there’s no leak, mouth breathing, humidity issues, mask fit, etc. It’s also important to use machines that give more objective feedback such as your AHI and leak rates, rather than just the total number of hours used. Some people then end up trying an autoPAP machine and do great, whereas for others, it makes no difference. Sometimes, continuous pressure from a CPAP machine works better than an autoPAP machine. Others do better with bilevel models.

If you look at all the published reports comparing CPAP vs. autoPAP vs. BiPAP machines, there are some differences in terms of compliance, leak rates, or tolerability, but overall, there’s no significant difference between the three in terms of subjective sleepiness, AHI measures, or quality of life scores. This is why some sleep doctors state that essentially, there’s no difference in the overall outcome between these three types of machines.

However, since research studies lump together everyone, including responders and nonresponders, it’s not a true representation of real-life outcomes. There will always be some patients that do better on autoPAP compared to a CPAP machine. Others do better on CPAP than autoPAP. Some others do much better on bilevel devices. So based on evidence based medicine, decisions are being made to downplay the potential advantages of various PAP models. I think that this is not good clinical practice. You should start with the basics first, but for patients that are frustrated and not tolerating PAP therapy, it’s worthwhile to consider other PAP options. In most cases, there are a lot of simple steps that can be taken to fully optimize the patient’s current CPAP machine, but you should never discount other options.

The same argument can be made for oral appliances and for surgery. A significant number of people do well with these options, if done properly. Unfortunately, most people who are given CPAP fall through the cracks, and are never given the opportunity to truly benefit from therapy. This is why the long-term compliance rate is so low for CPAP.

Ultimately, it’s not which model or which form of therapy is better, but start with the CPAP basics and do everything possible make sure that you’re using it properly. If it doesn’t work, talk with you doctor to discuss other PAP options. If PAP therapy doesn’t work, then consider non-PAP options.

If you’re a PAP user, did you try different models? If so, which one works best for you?

1. Do UARS patients progress into obstructive sleep apnea?

2. Given how common sleep apnea is, why hasn’t universal screening been implemented?

3. Despite using CPAP 5 to 8 hours every night, why am I still tired?

4. What do you think about the Pillar implants for snoring and sleep apnea?

5. How do I know when I can come off my CPAP machine as my sleep apnea improves?

6. What comes first, depression or sleep apnea?

7. How do you know if your sleep apnea machine is set for you correctly for you?

8. What surgery is recommended for nasal congestion?

9. Is it possible to underdiagnose sleep apnea in a sleep study?

10. What tips do you have for us dentists regarding UARS?

11. Can nasal congestion alter other areas of the upper airway?

12. Do you do turbinate reduction with the microdebrider?

13. What is UARS?

14. How much does lack of understanding of OSA and its’ consequences play in poor compliance? Are sleep doctors to blame?

15. Where are the best doctors or medical centers to go to on the West coast for fibromyalgia and UARS?

16. Why not add a hyoid procedure to the UPPP?

17. Can white matter lesions on DTI scans be responsible for sleep apnea patients’ symptoms?

18. Can hyperbaric oxygen therapy have a role in treating complications of sleep apnea?

19. What is expiatory sleep apnea?

20. Is bi-level use becoming more common?

21. Does high altitude make sleep apnea worse?

22. Is it worth trying the oral appliance for sleep apnea?

23. Is there any connection between cervical stenosis and sleep apnea?

24. What’s an SV Unit?

Click here to order the MP3 recording ($17).

Click here to order the PDF transcript ($7).