Can O2 be used instead of CPAP in Mild Cases?

[sojka123]

I have mild obstructive sleep apnea.  PO2 only drops into mid 80's sometimes, mostly low 90's, but overnight polysomnogram says I have 13 apneic events per hour.  I've tried O2 overnight (used neighbor's) and PO2 stays in the high 90's.  Is that a sufficient treatment?... or do I need the positive pressure of CPAP.  I've tried the CPAP and I've completely failed.  Mostly keeps me from sleeping well unless I'm on Ambien.  

PO2 the real cause of apnea, or is the obstructive hypopnea? and would just a little O2 be curative?  

[sojka123]

Thank you Dr. Park.  Very kind of you to take this amount of time and explanation.  

I will work on these alternative methods of control.  

[Steven Y Park, MD]

It's not surprising about your experience with CPAP. People with upper airway resistance syndrome, due to their hypersensitive nervous systems, generally can't tolerate anything on their faces or inside their mouths. However, some people can, so the only way to know is to try it. Another option for you may be a dental device, There are various options for mandibular advancement devices, but in general, you have to see a dentist that specializes in these devices. These devices pull you lower jar forward and thereby pulls your tongue base forward.

Another simple and inexpensive option (more as a screening test) is to get one of the over the counter (or over the internet) boil-and-bite models, for about $60 (Somnoguard and Puresleep are two models). They are very low tech, but for the most part, gets the job done. You want to ask two questions: can you tolerate sleeping with a device in your mouth, and does it help you sleep better? If yes to both, then you can justify getting fitted for a more customized, adjustable and sophisticated dental device. There are many dentists that deal with this particular condition.

First of all, how well can you breathe through your nose? If it's not to good, I would address this first, whether medically or surgically.

Secondly, what's your favorite sleep position? People with upper airway resistance syndrome prefer not to sleep on their backs. If for whatever reason you are forced to sleep on your back (neck pain, shoulder injury, etc.) try to take every measure to avoid sleeping on your back.

Do you exercise regularly? This also helps to some degree.

What time do you eat dinner, and how close is it to bedtime? It should be at least 3 hours or more.

Do you drink any alcohol close to bedtime? Alcohol relaxes your muscles and makes this condition worse.

Try yoga or any discipline where breathing is a central component. Deep breathing exercises scientifically has a relaxing property on your nervous system. Dr. Andrew Weil has a great CD on breathing and how it relates to anxiety, stress, and many other health problems that we have. You can find it on Amazon - it's a 2 CD set. In short, the reason why this works is that inhalation is activated by your sympathetic nervous system (the stress half) and exhalation is activated by your parasympathetic nervous system (your relaxing half). So when you take more time exhaling than inhaling, you spend more time relaxing. Interestingly, you do the same thing while singing. This is why people feel better when they sing.

Whatever else that you can do to calm your nervous system and relieve stress will also help. The reason for this is that this condition causes a low-grade physiologic stress response. So anything from the outside that is stressful (psychological, emotional, physical) will aggravate this internal stress).

These are just a few things to start with. Unfortunately, UARS is not an easy condition to control completely. It has to be managed from a wholistic approach, and not as just one particular medical condition with one pill or form of treatment. Ultimately, you'll have to make some major life changes to see any significant improvement.

[sojka123]

It is so nice of you to take the time with your answers.  I've been worked up intensely for cardiac problems and have a completely clean bill of health (even cardiac CT and calcium score of "0", no arrythmias, stress echo good etc etc.) Catecholamines normal etc.  The cardiologist does have me on atenolol.  helps a little and without it the pounding beat is MUCH worse.  He is a great doctor and a friend, but does not know where to go from here.  

My sleep study showed exactly that - 13 micro obstructions w/ arousals per hour.  after the split night CPAP test - none.  

However, I am having a seriously difficult time getting CPAP to work.  He has me on only 6 cm pressure and I mostly struggle with the mask and wake many times because OF the mask etc.  After over two months now I notice no difference in my severe afternoon tiredness or heart beat.  (main two symptoms)

Over 10 days I did try Ambien CR + CPAP and I did seem to notice improvement.  less or no afternoon tiredness - no change in heart.  However, I can't stay on Ambien forever and when I try CPAP without the drug, it causes poor sleep quality.  

I feel like I'm in a real catch 22.  

Thanks again Dr. Park!  

[Steven Y Park, MD]

I meant upper airway resistance syndrome.

[Steven Y Park, MD]

I see this all the time in patients with airway resistance syndrome. Many will have been diagnosed with various heart or cardiac conditions, sometimes even placed on beta-blockers. Of course you need to undergo a full cardiac work-up, but if you can't find any other answers, the your sleep-breathing problem may be a good answer. Take a look at my two articles on obstructive sleep apnea and airway resistance syndrome. People with airway resistance syndrome and mild obstructive sleep apnea will tend to have very hypersensitive nervous systems due to the stress response caused by the multiple micro-obstructions and arousals. Later, on in life, as the nervous system diminishes, longer apneas occur, and you develop into the classic obstructive sleep apnea picture.

[sojka123]

Thank you for the great answer.  That is exactly what I needed to know.  You have peaked my curiosity about mild apena patients having a "Hypersensitive" nervous response.  I have a forceful or pounding heartbeat that cardiologist cannot diagnose, and I seem to be hyper reactionary to normal stimuli - so much so I did all the tests for a pheo - all negative.  Could this mild OSA be causing this hypersensitive (almost adrenergic) response and hence be responsible for the positive inotropy ???  

Where can I go on the web to learn more about the hypersensitivty seen in mild OSA Cases??  

Thanks Again.  

[Steven Y Park, MD]

While it may seem like extra oxygen may help with sleep apnea, that only addresses one particular aspect of obstructive sleep apnea. The problem is not that you're not getting or absorbing enough oxygen, but that you literally stop breathing so you can't get enough oxygen. Ironically, it's the lack of oxygen and the buildup of CO2 that tells your brain to wake up up from deep sleep to tighten your throat muscles. So giving more oxygen may end up confusing your nervous system even more. Having said this, there have been occasional reports of using low-flow oxygen administered via a small nasal cannula.

Even if your oxygen level stay above 90%, it still won't take care of your apneas, which causes a massive stress/sympathetic response, which over time can aggravate high blood pressure and heart disease. Many people have severe sleep apneas with perfectly normal oxygen levels. Plus there are no known studies that I'm aware of showing that giving extra oxygen for sleep apnea can lower the cardiovascular risk factors like CPAP can.

There are many further options using CPAP, including desensitization, support forums (apneasupport.org) and talking to your sleep doctor about it. Dental devices may be another option. The problem with many people with mild sleep apnea is that since your nervous system is so hypersensitive, you won't like anything on your face or in your face. Patients with severe sleep apnea have diminished nervous systems, so that's why they don't wake up from apneas very quickly. If you wait long enough and not treat the apneas now, then later on you'll be better able to tolerate CPAP when your sleep apnea is much more severe.