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Stop Waking Up! (Part 2)

David Spero

January 23, 2008

Last week, we talked about how sleep apnea (SA) is common in people with diabetes and may even be a major cause of Type 2 diabetes. This week, we’ll focus on treatment.

In the recent Diabetes Self-Management article “Sleep Apnea and Type 2 Diabetes: A Vicious Circle,” SA expert Ralph Pascualy, M.D. writes that treating SA can:

• Lower blood pressure
• Raise insulin sensitivity (a good thing)
• Reduce inflammation
• Reduce risk of cardiovascular events (such as heart attacks)
• Reduce utilization of health-care resources, and
• Improve quality of life

Treating SA also helps people lose weight and gain energy and reduces the risk of auto accidents (because you’re less sleepy). But how do you treat it?

SA Self-Management
If you have SA, there are things you can do for yourself.

• Get as much sleep as you can. Sleep deprivation increases snoring. Your sleep will be rough enough anyway, so get enough bed time, and do all the things you can to prevent insomnia.
• Try not to sleep on your back.
• Cut back on or stop smoking and drinking.
• Do not take sleeping pills (they can increase snoring and may increase SA).
• See a doctor about clearing up nose congestion or nose anatomy problems. Options can occasionally include surgery. Mouth breathing increases your chance of SA.
• Raise the head of your bed.

If your SA is mild, self-care may be all you need. But if you still feel bad or snore loudly after self-management, you should ask your doctor about a CPAP.

The Magic Machine
Many people with SA benefit from CPAP (continuous positive airway pressure). CPAP can be delivered by a nose, mouth, or face mask attached to an air pump. The air flow acts like a splint, keeping the airways open.

Lyle D. Victor, M.D., writes that the pressure can be set to the user’s comfort level. Some machines have variable pressure settings so patients can “ramp up” to a level that stops SA but keeps them comfortable. These may be called “BiPAP” (for “bilevel”) or APAP (for “auto-adjustable”) positive airway pressure.

Complications of CPAP use can include nasal dryness and congestion, claustrophobia, and eye irritation. It’s important to try several masks to find the most comfortable fit. There are dozens of shapes and fits. (See more at www.cpap.com.)

Dr. Victor advises adding humidification to the air flow. The humidification helps the nose and throat irritation that can be CPAP’s main side effect. You may also need some emotional support as you get used to it.

Getting Used to It
A report from the University of Maryland says that “All patients should be warned that the first few nights of CPAP therapy are unnerving. The device often produces anxiety, primarily because of the mask. Starting out with low pressure to get used to the mask may help.”

Some people find that their chest feels sore in the morning at first. This is because of having more air in their lungs.

CPAP is not curative. It’s symptomatic relief. You may have to wear it for a long time, even for life. But thousands of people are finding it incredibly valuable. And as you get healthier and stronger, and perhaps lose some weight, you may be able to stop.

What have been your experiences with CPAP? What self-management measures have you tried, and how have they worked? How is it going for you? Let us know by commenting here.

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