Leslie Orr started experiencing a series of symptoms a few years ago that affected her quality of life.
She often has migraines. As a diabetic, she cannot control A1C blood sugar levels even if she takes medication and pays attention to her diet.
Even though she slept all night, she was very tired-always there. That kind of fatigue made her rely on naps most of the time. Only she never really felt sleepy. No matter how much caffeine she consumes, she never feels energetic.
She has been working with her primary care provider to resolve her health issues. Desperate, she is ready to try Botox as a treatment for migraines.
A friend who was worried about her taking a nap suggested that Orr take a sleep apnea test. Orr was surprised.
It is estimated that 4% of American men and 2% of women suffer from sleep apnea. People with sleep apnea stop breathing multiple times every night when the upper airway collapses. Because sleep is often interrupted, people with obstructive sleep apnea can never enter a deep restorative sleep state.
As a respiratory therapist, Orr knows that excessive daytime sleepiness is a symptom of sleep apnea. But she convinced herself that her fatigue and sleepiness were because she was a working mother of six children.
"I ignored myself, thinking it was because I was busy," Orr said.
Not to mention that she is not suitable for the typical sleep apnea patient: a middle-aged obese man who snores. Orr is in her early 40s, and in the rare cases when she snores, she snores gently.
She has other symptoms that she has not considered. The National Institutes of Health pointed out that women are more likely to report headaches, depression, anxiety, insomnia, and sleep interruptions. Children may experience bedwetting, hyperactivity, and learning problems.
Orr already knew about the complications of sleep apnea, including high blood pressure, stroke, heart failure and heart attack. Her grandmother snored loudly and died of a heart attack. Orr suspected that she had undiagnosed sleep apnea. Orr thinks it is worth discussing with her doctor about taking a sleep apnea test.
Her doctor ordered a home sleep study, and sure enough, Orr was diagnosed with obstructive sleep apnea. Her condition is milder and there are fewer incidents of stopping breathing at night. However, her doctor was worried that Orr's blood oxygen level would severely drop to his 70s during sleep.
Her doctor prescribed a continuous positive airway pressure, CPAP for short. This is a machine that uses pressurized air to keep people's airways open while they sleep.
"I am very grateful that I got that machine," Orr said.
According to the Eastern Iowa Sleep Organization (eisleep.com) in Cedar Rapids, treatment for sleep apnea includes specially designed mouthpieces or surgical removal of tissue, tonsils, adenoids, or uvula. But the most common treatment is to use a CPAP machine.
CPAP is a small machine with a tube connected to a certain type of mask. Some patients even refuse to try CPAP. They don't want to pack machines for travel, nor do they want to fall asleep with anything on their faces.
"It's just something we are not used to doing," Orr said.
Others, such as Orr, have discovered the most suitable combination of machine and mask over time. Because she often equips patients with CPAP and masks, she knows where to start. The first machine she tried was too loud for Orr, who was sleeping very lightly. She now uses a quieter machine.
Polysomnography: a study of night sleep. Options include laboratory sleep studies or home sleep apnea testing.
Obstructive sleep apnea (OSA): A sleep disorder in which breathing stops during sleep. For untreated patients with sleep apnea, the frequency of these interruptions can range from 5 to more than 100 per hour.
Continuous Positive Airway Pressure (CPAP): This machine is the most common treatment for sleep apnea. CPAP uses a mask and hose to blow pressurized air into the airway to keep it open during sleep. Specially designed mouthpieces or surgical removal of tissue, tonsils, adenoids, or uvula are also options for solving sleep apnea problems.
Bi-level positive airway pressure (BiPap): Provides positive pressure flow through inhalation (inspiration) and expiration (exhalation) pressure.
Source: Eastern Iowa Sleep Center, Iowa State Physician Clinic, University of Iowa Hospital and Clinic Sleep Disorder Center
The most common complaint from CPAP users involves having to wear a mask. Patients can choose to try different masks until they find a mask that is more comfortable and more suitable for their sleeping style.
Orr recommends calling your insurance company or having your provider check with them how often you can try new masks. Usually, there is a 30-day trial period. Orr says that by taking advantage of this, patients can understand which type of mask they prefer.
When patients receive their first CPAP, a respiratory therapist like Orr will help them with the setup. The therapist will ask them about their sleeping position, nasal problems, and whether they tend to breathe through their mouths. The respiratory therapist will choose a mask based on these answers and fit it to the patient.
Masks are divided into three basic types:
The hose can be connected near the mouth or on the top of the head; the headgear holds it in place.
A full face mask for people who tend to breathe through their mouths, have a deviated nasal septum, or have nasal problems. The nasal mask will make them feel unable to breathe. People who are prone to claustrophobia, watching TV in bed, or walking around at night may start with a nasal mask or nasal pillow cover.
The respiratory therapist works with the mask until the patient feels it is in the correct position. Then the mask is connected to the CPAP via a hose and the machine is turned on.
Facial structure, wearing dentures and facial hair will affect the fit of the mask. "Even sensitive skin can be a problem," Orr said.
A common fit problem is that the mask is worn too tightly, which prevents the mask or cushion from fully inflating. Orr uses a two-finger technique to test how much space is between the patient's skin and equipment.
Another fit issue is wearing a full face mask under the chin when it should be worn on the chin. Orr says that a respiratory therapist can teach you how to adjust and tighten the mask when the machine is turned on.
Finding the right mask and machine helps patients comply until they realize the benefits of using CPAP. She started using CPAP for four hours a night and now uses an average of seven or eight hours.
Most CPAPs have an app or SD card that allows providers and patients to track their sleep patterns. The provider can explain any changes in the pattern and make suggestions for improving sleep.
Around the same time Orr was diagnosed with sleep apnea, her husband was also diagnosed with sleep apnea. They all sleep better now.
Orr's doctor was shocked by the changes she had experienced. She has lost weight, her laboratory results have improved, and her overall health has improved.
"I have more energy. My migraine is gone," Leslie said.
Overall, she feels more refreshed and doesn't need the caffeine she used to rely on. Even more surprising is that her A1C is under control, and she no longer takes diabetes medications.
"I don't have enough strength to exercise, but now I have it," Leslie said.
Her family noticed that she was more energetic.
"I'm gardening now and doing more things with my little girls," Leslie said.
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