Lifestyle Measures for Individuals with Obstructive Sleep Apnea

Pathophysiology of Obstructive Sleep Apnea

  1. Obstructive sleep apnea is a relatively more common type of sleep apnea, arising due to poorly functioning airway muscles in the throat.
  2. Appropriate tension in these muscles is needed to properly support anatomical structures in the throat, such as, the soft palate (the posterior portion of roof of the mouth), uvula (the soft tissue hanging from the soft palate in the back of the mouth), and the tongue.
  3. For many reasons, the airway muscles in the throat could become lax, lose the tension, and remain relaxed.
  4. Loss of tension in these muscles could poorly support the soft palate, uvula, and the tongue, which can narrow or close the respiratory airway.
  5. Narrowing or closure of the respiratory airway can also occur secondary to factors, such as, excessive fat deposits around the airways closing in on them, enlarged tonsils in the neck exerting pressure on the airways and closing in on them, and/or chronic nasal congestion leading to narrowing of airways.
  6. This narrowing or closure of the respiratory airways can result in interrupted breathing pattern and respiratory pause, contributing to development of sleep apnea.
  7. So, obstructive sleep apnea is a type of sleep apnea with narrowing or closure of respiratory airways being the major contributory factor.

Lifestyle Measures for Individuals with Obstructive Sleep Apnea

  1. Breathing devices, such as, positive airway pressure machines, could be recommended to individuals with sleep apnea. Use of positive airway pressure machines, such as, CPAP and BiPAP during sleep time can help maintain airways patent and prevent episodes of sleep apnea from happening. Observe compliance with recommendations made for use of breathing devices, if any. Observe compliance with doctor visits, as scheduled. Do not forget to take your breathing device for the visit, as the chip reading could provide a lot of input regarding the management of sleep apnea.
  2. Positive airway pressure machines could be poorly tolerated by many individuals. In such instance, use of oral appliances could be recommended for individuals with sleep apnea. These oral appliances work variedly. Some oral appliances help reposition the lower jaw during sleep, thus preventing the lower jaw from blocking the airway. Some oral appliances help hold the tongue in a forward position, thus preventing the tongue from falling back during sleep, closing the airway, and contributing to precipitating an episode of sleep apnea. These oral appliances could be custom-fit and need the intervention of dentist to make one that appropriately fits one’s mouth. Individuals using oral appliances for sleep apnea management must periodically check with their dentist to ensure proper fit of the device or if it needs any adjustment or the appliance totally replaced.
  3. Individuals with sleep apnea could also choose to have a stimulation device surgically implanted in one’s body. Stimulation devices study the breathing pattern of the individual through the night and stimulate appropriate muscles that help keep airways patent, as needed. Stimulation devices are also available to help position the tongue and prevent the tongue from falling back during sleep. This results in maintaining the airway patent and contributes towards preventing an episode of sleep apnea. Individuals with implanted stimulation device for sleep apnea management & prevention must check periodically with the doctor regarding the functionality of the device, remaining battery life, and timely replacement of the battery.
  4. Individuals poorly responding to breathing devices and oral appliances, could choose to undergo tracheostomy. Tracheostomy is a surgical procedure of making a hole through the front of neck into the trachea or windpipe and inserting a trach tube through the hole directly into the trachea. Placement of trach tube helps an individual with poorly controlled sleep apnea breathe, irrespective to the patency of airways. Individuals with tracheostomy must observe compliance with appropriate trach care instructions, as recommended.
  5. Appropriate tension in the airway muscles of the throat is needed to properly support anatomical soft structures in the throat, such as, the soft palate (the posterior portion of roof of the mouth), uvula (the soft tissue hanging from the soft palate in the back of the mouth), and the tongue. Obese individuals can have excessive fat deposits around the airways, soft palate, and uvula. This fat deposition contributes to increased weight of the soft tissues in the throat, resulting in poorly supported soft tissues with loss of tension. This leads to the soft tissues in the throat being relaxed, fall into the airway, cause obstruction to the airflow, and thus contribute to development of obstructive sleep apnea. Obese individuals must seek investigation into factors contributing to their overweight situation. Obese individuals due to excessive calorie intake must slowly scale down, observe compliance with intake of recommended calorie intake, and cut down some extra pounds, which can help improve the outcome for sleep apnea. Obese individuals due to hypothyroidism must observe compliance with periodical labs ordered for thyroid function evaluation and intake of thyroid supplement, as recommended. Observing compliance with recommended physical exercise, as tolerated, can also contribute towards losing some extra pounds, control obesity, and improve the outcome for sleep apnea.
  6. Narrowing or closure of the respiratory airways can also occur secondary to factors, such as, enlarged tonsils or adenoids, especially in young children. Enlarged tonsils can lead to closing in on the airways, resulting in obstruction to the airflow pattern, and thus contribute to development of obstructive sleep apnea. These individuals could consider undergoing surgical removal of tonsils or adenoids, which can result in opening of the airways, relieve obstruction to the airflow pattern, reduce the severity of snoring and other symptoms of sleep apnea, and thus contribute to improved outcome.
  7. Individuals with history of stroke & incomplete recovery of motor skills can present with relaxed airway muscles with poor tension in them. Lack of tension in the airways contribute to airway collapse, result in obstruction to the airflow pattern, thus leading to development of obstructive sleep apnea. Appropriate tension in the airway muscles of the throat is needed to maintain them patent and open for the air to flow unobstructed. Compliance with recommended physical & speech therapy interventions for the muscles of the face and mouth can help improve tension in the airways, improve tongue positioning, strengthen the muscles that control the soft palate & uvula, maintain the airways patent, and contribute to unobstructed airflow. This free airflow pattern can help reduce the risk for presentation with episodes of obstructive sleep apnea.
  8. Poorly controlled Type-2 diabetes is a serious risk factor for development of obesity and contributes to excessive fat deposition around various body organs. This fat deposition around the soft tissues in the throat contributes to their increased weight, loss of tension, and results in them being poorly supported. This leads to the soft tissues in the throat being relaxed, fall into the airway, cause obstruction to the airflow, and thus contribute to development of obstructive sleep apnea. Individuals with history of Type-2 diabetes must observe compliance with intake of oral medications and/or insulin administration, as recommended, to help improved control of blood sugar numbers. Compliance with regular eating habits, recommended dietary & calorie intake limitations can help regulate blood sugar numbers in the target range. Compliance with recommended physical exercise, as tolerated, can help improve insulin resistance, resulting in improved glucose uptake into the cells and adjust blood glucose numbers into the desired range. Improved blood glucose control in type-2 diabetics can help control obesity and prevent excess fat deposition around soft tissues in the throat. This can result in these soft tissues being well-supported, prevent them falling into the airway, thus offering relief from episodes of obstructive sleep apnea.
  9. Some individuals can have history of poorly controlled allergies and repeated exposure to upper respiratory infections. Chronic nasal congestion due to allergies and infections can lead to narrowing of airways. This can result in obstruction to the airflow pattern, thus contributing to development of obstructive sleep apnea. Avoiding exposure to triggering allergens and compliance with intake of anti-histamines and antibiotics, as recommended, can help effective control the allergies and infections. This can result in relief from nasal congestion and improved airflow pattern, which can contribute to reduced incidence of obstructive sleep apnea.
  10. Excessive intake of psychotropic medications, such as, sedative-hypnotics, anti-anxiety medications, antidepressants, antipsychotics, and mood stabilizers, as a side-effect to the medication intake, can result in poorly tensed and relaxed airway muscles. Appropriate tension in the airway muscles of the throat is needed to maintain them patent and open for the air to flow unobstructed. Lack of tension in the airways contribute to airway collapse, result in obstruction to the airflow pattern, thus leading to development of obstructive sleep apnea. Individuals with history of chronic psychotropic medication intake can seek assistance with behavioral therapy and alternative measures for anxiety control to help reduce dependence on medication. Compliance with prescribed physical exercise, as tolerated, can help release of chemicals called endorphins. Endorphins enhance feelings of pleasure & well-being and also contribute to reducing pain & discomfort, which in long run leads to behavior changes and reduced need for intake of psychotropic medications.
  11. Individuals with chronic smoking history can present with increased risk for inflammation of upper airways, with narrowing and collapse of airways. This can result in obstruction to the free airflow during breathing, thus leading to increased risk for presentation with episodes of obstructive sleep apnea. Individuals with history of smoking must observe compliance with recommendations for smoking cessation. Identifying the triggers and social associations that are associated with continuing the smoking habit can help towards controlling the habit effectively. Seeking assistance with rehab centers & behavioral counselling can help towards smoking cessation. Measures such as, progressively delaying the first smoke of the day, gradually lengthening the time period between two incidents of smoking, reducing the frequency of meeting people individual’s commonly smoke with, avoiding visiting the designated smoking areas, and taking only a few puffs on every smoke, can all help towards controlling the habit. Nicotine replacement therapies, such as, skin patches, gums, and inhalers, can help nicotine administration via alternative routes and control the cravings during the initial phase of smoking cessation. Individuals resorting to smoking as a stress control measure can practice alternative measures for stress relief, such as, deep breathing & relaxation, listening to soothing music, physical exercise, meditation, and practicing yoga.
  12. Individuals with history of poorly controlled obstructive respiratory disorders, such as, asthma and COPD, can present with increased risk for narrowed or collapsed airways. This can result in obstruction to the free airflow, thus leading to increased risk for presentation with episodes of obstructive sleep apnea. Individuals with history of respiratory disorders must observe compliance with use of inhaler & nebulizer medications, as prescribed. Avoiding environmental triggers that contribute to exacerbation of asthma & COPD symptoms can also help.
  13. Individuals must exercise caution of letting their medical team know about their history of sleep apnea, before undergoing any surgical procedures. Anesthesia administered at the time of surgery and some medications taken for pain management can set the ground for fresh episodes of sleep apnea, in individuals with history. Letting the medical team know of your sleep apnea history would give them an opportunity to adopt alternative measures.
  14. Individuals with history of chronic alcoholism and/or alcohol abuse can present with relaxed airway muscles with poor tension in them. Appropriate tension in the airway muscles of the throat is needed to maintain them patent and open for the air to flow unobstructed. Lack of tension in the airways contribute to airway collapse, result in obstruction to the airflow pattern, thus leading to development of obstructive sleep apnea. Individuals with history of chronic alcoholism and/or alcohol abuse must observe compliance with recommendations for abstinence from alcohol intake or alcohol consumption in moderation to help prevent episodes of obstructive sleep apnea. Seeking assistance with rehab centers & behavioral therapy interventions to control the alcohol addiction can help. Enrolling & participation in alcoholics anonymous programs can also contribute to addiction control. 24/7 free and confidential SAMHSA national helpline is also available for addiction control assistance.

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