I have obstructive sleep apnea. Will CPAP therapy help me?

Question

Hello doctor,

I am a 52 year old male and for the past year I have been snoring loud and stopping breathing for short periods of time while I sleep (as pointed out by my wife).I wake up many times during the night, often gasping for air, and I am excessively sleepy and tired during the day, even after seven to eight hours in bed.I recently had a sleep study (polysomnography) done, and the results showed an Apnea-Hypopnea Index (AHI) of 32 events/hour which is consistent with severe obstructive sleep apnea.My oxygen saturation dropped to 82% during sleep. I am also overweight, with a BMI of 34, and have hypertension, with my blood pressure averaging 150/95 mmHg despite being on medication.I have diabetes too, my fasting blood sugar is about 155 mg/dL and HbA1c is 7.3 %. I have been experiencing morning headaches, difficulty focusing at work and occasional irritability.I have high cholesterol too. My LDL is 160 mg/dL and my triglycerides are 225 mg/dL. Please tell mme, which therapy can save me from long-turm therapy?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

You need to know that your sleep study shows severe obstructive sleep apnea and that the symptoms you describe: loud snoring, witnessed pauses in breathing, gasping awakenings, daytime sleepiness, morning headaches and poor concentration are all classic for this condition.

An apnea-hypopnea index of 32 with oxygen levels dropping to 82 % means that your body is repeatedly deprived of oxygen during the night. This puts a lot of strain on the heart, brain and blood vessels.

This is very likely what is driving your difficult-to-control blood pressure, elevated blood sugar and abnormal cholesterol levels, and it does increase the long-term risk of heart attack, stroke, arrhythmias and worsening of diabetes if left untreated.

The best first treatment for a person with severe sleep apnea is CPAP therapy. CPAP keeps the airway open all night, preventing breathing pauses and oxygen drops.

It is far more effective than any other single treatment in patients with severe disease, and often leads to rapid improvement in daytime energy, concentration, mood, and morning headaches.

It may also reduce blood pressure and improve glucose control in the long run. The key to success is correct mask fit and gradual acclimatization to make it comfortable enough to wear consistently each night.

It is also very important for you to lose weight since a BMI of 34 is a major factor in airway collapse during sleep and in your risk of hypertension and diabetes.

A reduction in body weight of only 5 to 10 % can markedly reduce the severity of sleep apnea and improve metabolic health. Weight loss alone, however, is unlikely to fully treat severe apnea and should be combined with CPAP (continuous positive airway pressure), not used as a substitute.

Surgical treatment is not usually the first line of treatment for adults with severe obstructive sleep apnea, especially when multiple risk factors such as obesity and metabolic disease are present.

If support is not tolerated, even with proper support, surgical procedures may be considered. The success of surgery is more variable and depends on the particular airway anatomy.

In addition to CPAP and weight management, it’s important to optimise control of blood pressure, blood sugar and cholesterol, as these conditions interact with sleep apnea and increase cardiovascular risk.

Treating the sleep apnea often makes these conditions easier to manage.

If you reduce the severity of your apnea by not drinking alcohol before bed, sleeping on your side instead of your back and maintaining regular sleep hours.

So in your situation, the best approach is to start CPAP therapy as soon as possible, institute a structured weight reduction plan and work with your primary physician to optimise treatment of hypertension, diabetes and dyslipidemia.

With regular CPAP use and metabolic control, many patients experience a marked improvement in symptoms and a significant reduction in long-term cardiovascular risk.

I hope this helps.

Thank you.