New ways to con­quer sleep ap­nea com­pete for place in bed­room

Santa Fe New Mexican - - NATION - By Carla K. John­son

Ev­ery night with­out fail, Paul Blum­stein straps on a mask that pre­vents him from re­peat­edly wak­ing up, gasp­ing for air.

It’s been his rou­tine since he was di­ag­nosed with a con­di­tion called sleep ap­nea. While it helps, he doesn’t like wear­ing the mask.

“It’s like an oc­to­pus has clung to my face,” said Blum­stein, 70, of An­nan­dale, Va. “I just want to sleep once in a while with­out that feel­ing.”

It’s been two decades since doc­tors fully rec­og­nized that breath­ing that stops and starts dur­ing sleep is tied to a host of health is­sues, even early death, but there still isn’t a treat­ment that most peo­ple find easy to use.

Air­way pres­sure masks, the most com­mon rem­edy, have im­proved in de­sign, get­ting smaller and qui­eter, but pa­tients still com­plain about sore nos­trils, dry mouths and claus­tro­pho­bia.

Now, new ways of con­quer­ing sleep ap­nea, and the ex­plo­sive snor­ing that comes with it, are vy­ing for a place in the bed­rooms of mil­lions of peo­ple crav­ing a good night’s sleep. Prod­ucts range from a $350 re­straint meant to dis­cour­age back sleep­ing to a $24,000 sur­gi­cal im­plant that pushes the tongue for­ward with each breath.

Mouth­pieces, fit­ted by den­tists, work for some peo­ple but have their own prob­lems, in­clud­ing jaw pain. Some pa­tients try surgery, but it of­ten doesn’t work. Doc­tors rec­om­mend weight loss, but diet and ex­er­cise can be chal­leng­ing for peo­ple who aren’t sleep­ing well.

So far, no pills for sleep ap­nea ex­ist, but re­searchers are work­ing on it. One drug con­tain­ing THC, the ac­tive in­gre­di­ent in mar­i­juana, showed prom­ise in a study this year.

What is sleep ap­nea? In peo­ple with the con­di­tion, throat and tongue mus­cles re­lax and block the air­way dur­ing sleep, caused by obe­sity, ag­ing or fa­cial struc­ture. They stop breath­ing, some­times for up to a minute and hun­dreds of times each night, then awake with loud gasp­ing and snor­ing. That pre­vents them from get­ting deep, restora­tive sleep.

They are more likely than oth­ers to have strokes, heart at­tacks and heart rhythm prob­lems, and they’re more likely to die pre­ma­turely. But it’s hard to tease out whether those prob­lems are caused by sleep ap­nea it­self, or by ex­cess weight, lack of ex­er­cise or some­thing else en­tirely.

For spe­cial­ists, the first-choice, most-stud­ied rem­edy re­mains con­tin­u­ous pos­i­tive air­way pres­sure, or CPAP. It’s a mo­tor­ized de­vice that pumps air through a mask to open a sleeper’s air­way. About 5 mil­lion Amer­i­cans have tried CPAP, but up to a third gave up dur­ing the first sev­eral years be­cause of dis­com­fort and in­con­ve­nience.

Martin Braun, 76, of New York City, stopped us­ing his noisy ma­chine and awk­ward mask, but now he’s try­ing again af­ter a car crash when he fell asleep at the wheel. “That’s when I re­al­ized, OK this is se­ri­ous stuff al­ready,” said Braun, who has or­dered a qui­eter CPAP model.

Sleep medicine is a rel­a­tively new field. The most rig­or­ous stud­ies are small or don’t fol­low pa­tients for longer than six months, said Dr. Alex Krist of Vir­ginia Com­mon­wealth Uni­ver­sity, who served on a fed­eral guide­lines panel that re­viewed sleep ap­nea treat­ments be­fore rec­om­mend­ing against screen­ing adults who have no symp­toms.

“We don’t know as much about the ben­e­fits of treat­ing sleep ap­nea as we should,” said Krist, vice chair­man of the U.S. Pre­ven­tive Ser­vices Task Force.

While sci­en­tists haven’t proved CPAP helps peo­ple live longer, ev­i­dence shows it can re­duce blood pres­sure, im­prove day­time sleepi­ness, lessen snor­ing and re­duce the num­ber of times a pa­tient stops breath­ing. CPAP also im­proves qual­ity of life, mood and pro­duc­tiv­ity.

With no­tice­able re­sults, many CPAP users, even those like Blum­stein with a love-hate re­la­tion­ship with their de­vices, per­sist.

Blum­stein was di­ag­nosed about 15 years ago af­ter he fell asleep be­hind the wheel at a traf­fic light. He shared his frus­tra­tions with us­ing a mask at a re­cent pa­tient-or­ga­nized meet­ing with the Food and Drug Ad­min­is­tra­tion, as did Joelle Do­brow of Los An­ge­les, who said it took her seven years to find one she liked.

“I went through 26 dif­fer­ent mask styles,” she said. “I kept a spread­sheet so I wouldn’t du­pli­cate it.”

Re­searchers are now fo­cused on how to get peo­ple to use a mask more faith­fully and pre­dict­ing who is likely to aban­don it and could start in­stead with a den­tal de­vice.

REED SAXON/AS­SO­CI­ATED PRESS

Joelle Do­brow demon­strates how she puts on her sleep ap­nea breath­ing de­vice Thurs­day at her home in Los An­ge­les. Do­brow said it took her seven years to find one she liked. ‘I went through 26 dif­fer­ent mask styles,’ she said. ‘I kept a spread­sheet so I wouldn’t du­pli­cate it.’

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