Oral Appliance and Sleep Apnea

Dental Oral Appliance Therapy is an alternative treatment for those who have mildmoderate
snoring and/or sleep apnea. Oral appliances can also be used in conjunction
with CPAP devices to improve comfort for some cases of sleep apnea.

Oral appliances are a safe and effective snoring and sleep apnea treatment. They are custom fit by a dentist and molded to form to the shape of the patient’s teeth and mouth. They are worn over the teeth throughout the night. The aim of oral appliances is to realign the lower jaw by bringing it forward. The realignment and stabilization of the lower jaw and tongue helps increase muscle tone in the throat and creates more space in the airway, which reduces the air resistance that leads to sleep apnea and snoring.

Sleep Apnea and Glaucoma

The presence of sleep apnea might mean an increased risk of glaucoma. Many medical experts believe that sleep apnea patients face an increased risk of glaucoma. Even some studies show that the optic nerve could be damaged due to hypoxia (low oxygen level) without a spike in eye pressure.

There are both vascular and mechanical factors that are involved in the pathological mechanism of the optic nerve damage:

• Vascular factors are mainly the outcomes of repetitive or prolonged episodes of hypoxia, due to repetitive prolonged upper airway obstruction. This includes direct damage to the optic nerve, oxidative stress and inflammation, increased vascular resistance, autonomic dysfunction, increased intracranial pressure and decreased cerebral perfusion. Hypoxia also triggers an increase in blood pressure and vascular resistance, causing damage in the vascular endothelium. All of these consequences lead to the impairment of autonomic function, an imbalance of vasodilation and vasoconstriction.
• Mechanical factors include supine position and obesity related increased intraocular pressure (IOP), and intracranial pressure at night, and the depletion of fiber in the trabeculum and lamina cribrosa.

In conclusion, treating sleep apnea at an early stage helps to limit your susceptibility to larger health issues such as glaucoma, which is one of the leading causes of blindness worldwide. If you are diagnosed with glaucoma and wondering if you have sleep apnea, contact us at Cansleep services to benefit from our free diagnostic test.

By Bahareh Ezzati (BSc, CPhT, RRT)

Effect of Medications on Sleep

Different medications affect sleep differently. For example, some medications, including those for high blood pressure and asthma, can keep you up all night with insomnia while others, like cough, cold, and flu medications, can disrupt sleep. And certain medications, such as antihistamines, can cause daytime drowsiness. In fact, sleepiness is one of the most common side effects of medications. This is the list of medications that affects sleep with a few examples:

• For heart rhythm: Anti-arrhythmics e.g. Amiodarone, Procainamide, Sotalol
• For high blood pressure
  • Beta blockers e.g. Atenolol, Metoprolol, Propranolol, Nadolol
  • Clonidine
  • Diuretics e.g. Lasix, Microzide
• For inflammation or asthma: Theophylline and Corticosteroids e.g Prednisone, Bethamethasone
• For depression or anxiety SSRIs e.g. Prozac, Celexa, Paxil, Zoloft
• For hypothyroidism: Thyroid hormone e.g. Synthroid, Levothroid
• For colds and allergies: Sedating antihistamines  and medications that contain alcohol
• Pain medications: Narcotics and medications that contain caffeine
• Nicotine replacement products
• For attention deficit disorder: Sympathomimetic stimulants e.g. Amphetamine

If you are on any of the medications that are listed and suspect that a medication is disrupting your sleep or causing you to feel drowsy during the day, talk to your doctor or pharmacist. He or she may be able to switch you to a different one that has a different side effect profile, reduce the dosage of your current prescription, or suggest a different type of treatment altogether so that your sleep isn’t affected.

What you shouldn’t do is attempt to solve the problem on your own. Always discuss the situation in depth with your doctor first, and don’t stop taking the medication until you have decided on an alternative treatment. If you are not on any of the above medications and you are experiencing sleep disturbance, contact Cansleep Services to do a sleep apnea diagnostic test.

By Bahareh Ezzati (BSc, CPhT, RRT)

Travel Devices

If you are looking to get a travel device and wondering which one is the most suitable device for you, you can check this chart out to compare the features.

Travel CPAPs		Z1	DreamStation Go	Transcend
Weight	0.66 lbs	0.62 Ibs	1.8 Ibs	1 Ib
Back up battery	Yes**	Yes	Yes	Yes
Modes	Fixed, Auto, Auto For Her (all in one device)	Auto and fixed separate devices	Auto and fixed (in one device)	Auto and fixed Separate devices
Masks	Only ResMed  masks	International	International	International
Humidifier	Built in HME***	No	No	Yes
App/Bluetooth	Yes	No	Yes	No
Warranty	3 yrs	3 yrs	3 yrs 1 yr for battery	2 yrs

Z1 back up battery **: Can work with Mediusterm back up battery at the moment.

HME***: Heat and Moisture Exchange. It takes humidity from your exhalation and return it back on your inhalation. It is inactive form of humidity, that’s why special connected and ResMed masks are required. Replace 30 days after opening.

Feel free to call Cansleep at 1.844.Sleep40 to get more information.

By Bahareh Ezzati (BSc, CPhT, RRT)

CPAP and Gastroesophagus Side Effects

Some of the rare side effects of CPAP are nausea, vomiting, acid reflux, gastric distension (bloating), flatulence (passing wind or farting), and belching (burping).

These CPAP side effects can be caused by GERD  (Gastroesophageal Reflux Disease), where the valve at the end of esophagus doesn’t close properly, allowing the stomach contents to leak into the throat or mouth.

Generally in patients with obstructive sleep apnea, CPAP reduces GERD by eliminating the suction built up behind the blocked airway due to the chest attempting to breathe in. However in some cases, especially in patients with severe OSA, CPAP can exacerbate GERD.

If the CPAP air comes with enough high pressure and is swallowed into the esophagus, the muscular valve of the esophagus can be opened allowing the air to enter the stomach (aerophagia). Also, the stomach liquid can exit back where it came from or gives you bloating or other GI discomforts.

GI problems associated with CPAP usually goes away by the esophageal muscles gradually strengthening with nightly “resistance workouts” introduced by Positive Air Pressure therapy. However, some patients can’t escape this uncomfortable feeling because they probably have other conditions that cause air swallowing. The common solutions to eliminate aerophagia are as follows:

• Treat GERD, talk to your physician to start treatment.
• Eliminate mask leak. Mask leak causes increase in pressure which could cause excess air to get into your mouth and therefore there is a higher tendency to swallow it.
• Raise the head of your bed by 4 inches or more, or use more pillows to elevate your head and upper body when you sleep. A sleep wedge pillow, which are specially designed for relieving acid reflux can also be very helpful.
• Alter your diet, eat light suppers and do not eat for two hours before bedtime.
• Switch to a BiPAP machine instead of using the CPAP. In some cases BiPAP can be helpful in eliminating aerophagia.

• Try teaching yourself to fall asleep with your tongue touching the back of your front teeth and the roof of your mouth. When the tongue is in this placement, it helps keep the CPAP air inside the upper airway and prevents the swallowing of air.

If you are experiencing any GI discomforts discuss the matter with your clinical therapist at CanSleep services. Your therapist could titrate your pressure. If you have a high CPAP pressure, the pressure could be reduced for awhile and then gradually build back to your titrated pressure.

By Bahareh Ezzati (BSc, CPhT, RRT)

Alzheimer & Sleep Apnea

According to new research published in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine, older adults who have obstructive sleep apnea may be at increased risk of Alzheimer’s disease. They found a link between sleep apnea and high levels of the amyloid protein that is associated with Alzheimer’s disease. In fact, it is reported that biomarkers for amyloid beta, the plaque-building peptides associated with Alzheimer’s disease, increase over time in elderly adults with Obstructive Sleep Apnea (OSA) in proportion to OSA severity. Thus, individuals with more apneas per hour had greater accumulation of brain amyloid over time.

The study included 208 participants, age 55 to 90. None of the participants was referred by a sleep center, used continuous positive airway pressure (CPAP) to treat sleep apnea, was depressed, or had a medical condition that might affect their brain function. The researchers performed lumbar punctures (LPs) to obtain participants’ cerebrospinal fluid (CSF) soluble amyloid levels, and then used positron emission tomography, or PET, to measure amyloid deposits directly in the brain in a subset of participants. The study found out that more than half the participants had OSA, including 36.5 percent with mild OSA and 16.8 percent with moderate to severe OSA.

The researchers concluded that addressing sleep apnea in its early stages could reduce the number of amyloid beta deposits occurring in the brain and consequently delay cognitive impairment and dementia.

If you have been diagnosed with Alzheimer’s and are wondering if you have sleep apnea, contact CanSleep to do a free diagnostic test, so that if you do have sleep apnea, there is a chance of slowing down the progression of Alzheimer’s by properly treating the sleep apnea.

By Bahareh Ezzati (BSc, CPhT, RRT)

Sleep Disorders and Headache

Did you know that at least 50% of people who wake up with headaches might have sleep apnea? In general sleep apnea, sleep deprivation, and insomnia are common sleep problems that are associated with headaches.

When you suffer from sleep apnea, your airway is partially or completely blocked during sleep. Because of this closure, the amount of oxygen in your blood being transported to your brain is reduced, which initiates the widening of blood vessels and can cause vascular headaches. These headaches are generally located in the frontal areas but can be diffuse, involving the entire head.

People who suffer from sleep apnea don’t get enough of REM, the deepest stage of sleep, since the brain kicks them out of the REM stage of sleep so they could breathe. Not getting enough of REM could trigger migraines, because of changes in the neurotransmitter or chemical systems in the brain and hormonal influences. Cluster headaches are one-sided severe headache attacks that are usually accompanied by nasal stuffiness and eye tearing, and frequently occur during nighttime, and are linked to the REM sleep cycle.

Beside sleep apnea, insomnia (difficulty falling asleep or staying asleep) is another sleep disorder that leads to headaches. Insomnia leads to irritability and ultimately stress, which is the most common migraine trigger. Teeth grinding (bruxism) which could be from stress caused by sleep apnea could also trigger headaches.  On the other hand, chronic migraines, chronic tension-type headaches, and medication overuse headaches may cause sleep disturbance and insomnia.

Sleep deprivation, which could be the result of insomnia and/or sleep apnea also triggers headaches, but sleeping longer hours is not the solution. Either too much sleep or too little sleep can aggravate headaches in any individual. Taking naps doesn’t help morning headaches either. Taking naps causes fluctuations in serotonin and other brain neurotransmitters occur during sleep, which in turn can influence the onset or aggravation of head pain. Frequent naps during the day may reduce sound sleep at night resulting in a morning headache as well. To prevent migraine headaches, you have to solve the underlying problems, which could be sleep apnea or insomnia. Contact CanSleep to discuss your options to treat sleep apnea or book an appointment with Roxanne or Alison who are our insomnia specialists.

An unfortunate connection between sleep apnea and migraines is centred on gradual brain damage. When left untreated, these two medical conditions may lead to hypertension, depression, or stroke. Each time a patient who suffers from obstructive sleep apnea experiences a breathing cessation episode that lasts longer than 10 seconds, the blood oxygen levels in the brain are impacted negatively. The cumulative effect of irregular snorts and sudden gasps may result in brain damage that is difficult to reverse. If you are experiencing more headaches, don’t wait, contact CanSleep to get tested for sleep apnea.

By Bahareh Ezzati (BSc, CPhT, RRT)