Improving Use of Continuous Positive Airway Pressure for Obstructive Sleep Apnea
Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.
What is the problem and what is known about it so far?
During sleep, some people stop breathing for short periods because of blockage of air passages in the upper respiratory tract. This condition, called obstructive sleep apnea, prevents restful sleep. People with sleep apnea sometimes feel bad, have difficulty thinking clearly, or report daytime sleepiness. The usual treatment involves wearing a special mask during sleep. The mask is part of a device that uses air pressure to keep the air passages open (continuous positive airway pressure, or CPAP). People who either find CPAP uncomfortable or do not feel immediate benefit from it often discontinue therapy. Doctors who treat sleep apnea need approaches that help these people tolerate and continue CPAP. One idea is short-term use of a mild sedative that helps promote sleep when people are first trying CPAP.
Why did the researchers do this particular study?
To see whether a short course of a nonbenzodiazepine sedative (eszopiclone) when starting therapy improves long-term CPAP adherence more than placebo in adults with obstructive sleep apnea.
Who was studied?
160 adults with severe obstructive sleep apnea.
How was the study done?
Researchers recruited patients with newly diagnosed obstructive sleep apnea. They randomly assigned the patients to take eszopiclone, 3 mg, or a matching placebo (pill without any active ingredient) every night for the first 2 weeks of CPAP therapy. Neither the patients nor their doctors knew who received which pill. At the end of the 2 weeks, patients were asked whether they had side effects, such as headaches or dizziness. The researchers then followed patients for 6 months. They measured use of CPAP with an electronic “smart card” embedded in the device and asked patients about such symptoms as daytime sleepiness.
Patients receiving eszopiclone discontinued CPAP therapy less often and reported improved symptoms more often than patients receiving placebo. They also used CPAP more often (more nights) and for more hours per night than did patients given placebo. Reported side effects of pills were uncommon and did not differ from those with placebo.
The study was small and some patients did not complete it. It was conducted at a specialized sleep center. Patients’ reasons for discontinuing CPAP were not assessed.
Eszopiclone given during the first 2 weeks of therapy may help improve long-term use of CPAP in some patients with severe obstructive sleep apnea.
November 23rd, 2009 at 8:43 am
A Dreamhelmet makes using a CPAP mask a lot easier. Here’s my story:
I’ve been a snorer for a long time. As I got older, my snoring has gotten more frequent and louder. I also noticed I was tired a lot and liked to take naps during the day. I was overweight. People complained about my snoring and I did not want to sleep in the same room with other people for fear of keeping them awake.
Finally, I asked my doctor about the problem. He sent me home with a machine to check my breathing and pulse while I slept. The results really shocked me! The doc said my airway was closing off up to 70 times each hour, and that I stopped breathing for as long as one full minute at a time! I had severe apnea. He strongly recommended I start using the CPAP machine, since I was risking damage to my heart due to lack of oxygen.
I had read about CPAP machines before and always thought I would never be able to sleep with one, since I am a little claustrophobic. Surprisingly, it only took me a few minutes to get used to, and I was able to start sleeping comfortably right away.
The mask part is just a small nose manifold that covers the nostrils to blow in air. That keeps the throat inflated like a balloon, preventing throat closures and snoring. One problem is the straps over the head that keep the nose piece in place. They can be a little annoying at first, and if you change sleeping positions at night, it is possible for these straps to move, causing the nose piece to slip off.
I have been using a Dreamhelmet (a combination sleep mask sound-muffling pillow) for years now, to sleep at night and for napping during the day. I always find it hard to sleep without the Dreamhelmet, and was afraid I would not be able to use it with the CPAP mask, but I was wrong about that too.
After using the CPAP machine and mask for a short while, I tried wearing the Dreamhelmet over the CPAP mask, covering up the straps – voila, it worked like a charm! I found that the Dreamhelmet actually helps keep the straps in place when I change positions, so now I can sleep all night in comfort, not being bothered by sound, light, or changing positions. The CPAP combined with the Dreamhelmet are the perfect sleeping combo for me.
Now I don’t snore, I wake up rested, and I have energy that lasts all day long. I’m still overweight, but I don’t feel so run down all the time or feel like I need an afternoon nap, but I still carry an extra Dreamhelmet in the car with me just in case I do need a nap.
December 4th, 2009 at 4:33 am
Please, can you PM me and tell me few more things about this, I am really fan of your blog! I just subscribed to your feed.