FAQs about Sleep 

What is OSA?

Obstructive sleep apnea (OSA) means breathing stops several times during sleep due to the collapse of tissues in your upper airway. This blockage stops your breathing and prevents air from getting to your lungs, which reduces the oxygen to your body. This lack of oxygen causes many of the symptoms of OSA, such as morning headaches and high blood pressure. However, these apneas, or pauses in your breathing, also disrupt restful sleep, which is why OSA sufferers are so tired during the day. Often, the bed partner notices these symptoms first. Most suffers don’t know they have a problem and because everybody reacts differently to sleep apnea, it is often overlooked.

What are the signs and symptoms of OSA?

You may have OSA without knowing it. OSA develops over many years.

Signs and symptoms of OSA may include the following:

• Snoring
• High blood pressure
• Pauses in breathing during sleep
• Gasping or choking during sleep
• Morning headaches
• Excessive daytime sleepiness
• Lack of energy
• Depression and/or irritability
• Difficulty concentrating
• Large neck size and/or obesity
• Sexual dysfunction
• Frequent bathroom visits at night

Who suffers from OSA?

Most cases of OSA remain undiagnosed, so sufferers needlessly endure symptoms. OSA affects men, women, some children and it may run in families. Studies indicate that 9% of middle-age women and 24% of middle-aged men suffer from OSA. However, these rates are much higher for people that are overweight and those diagnosed with high blood pressure, heart disease and type 2 diabetes.

What causes OSA?

OSA runs in families, which means the causes of OSA often begin with how we are built. Some of the physical reasons people suffer from OSA include a small upper airway or some other airway blockage during sleep. Such blockages may be caused by airway tissues, which are too large or relax too much when you sleep (e.g. tonsils or a soft palate) or your bone structure may change the shape of your throat (e.g. a recessed chin). As we age, we tend to lose muscle mass, so many of these conditions get worse with time and may cause breathing problems as we sleep.

What makes OSA worse?

Although your genetics may make it more likely for you to get OSA, a number of things make OSA worse in some people.

Obesity: Being overweight is one of the largest risk factors for OSA. Although all family members may share the genetic risk of OSA, overweight people are much more likely to suffer from it.

Alcohol or Sedative Use: Both of these chemicals cause muscle relaxation resulting in the narrowing and collapse of the muscles around the throat at night.

Smoking: Smokers are more likely to suffer from OSA, because smoking irritates the upper airway and causes inflammation.

Hormone Imbalance: Low thyroid hormone (hypothyroidism) increases the risk for OSA. Hypothyroidism shares many symptoms of sleep apnea, and is similarly under-diagnosed. Symptoms include daytime sleepiness and fatigue, weight gain, nighttime snoring, and depression.

Other Medical Conditions: Other medical conditions such as nasal congestion and seasonal allergies can block airflow through the upper airway, which increases the risk for developing OSA.

Other Medications: Although sleep apnea can result in high blood pressure (hypertension), some anti-hypertensive drugs can cause sleep apnea. Similarly, several other drug families have been linked to disrupted sleep, which increases the risk for sleep apnea (e.g. long-acting benzodiazepines, beta-blockers and theophylline).

How does untreated OSA affect my health?

Think about what OSA does; it decreases airflow into the lungs at night and lowers blood oxygen levels. This is the same effect suffocation has on your body, but it happens very slowly and goes unnoticed at night.

Long-term suffering with OSA causes stress-related problems, most commonly hypertension (high blood pressure). Hypertension is a very serious condition and increases the risk of:

• Heart attacks
• Coronary artery disease
• Abnormal heart rates
• Stroke

Also, there is strong evidence that people with untreated OSA have a higher incidence of type 2 diabetes.

OSA sufferers should also be concerned with increased daytime sleepiness. This problem doesn’t simply cause irritability; it may also lead to depression, sexual difficulties, and learning and memory problems.

More importantly, sleepiness means lack of concentration and the likelihood of sufferers falling asleep during the day. This impacts their quality of life and work, but also significantly increases the risk of industrial and automotive accidents.

What does the portable sleep recorder do?

For your sleep study, you will borrow one of our portable sleep recorders for one night. The sleep recorder will provide RANA with valuable information about your night's sleep. The recorder measures your breathing pattern, what your oxygen levels and heart rate were, if you were snoring and what position you slept in. A physician will interpret this information after it is downloaded from the recorder.

How does the sleep recorder work?

The recorder measures information about your night’s sleep from sensors that are attached to your body. The sensors are connected to the monitor by long cables. The recorder itself should be plugged in and placed on a table close to your bed. Your therapist will show you where to attach the sensors and how to secure them. Usually, only 4 sensors have to be attached for the sleep study. They are:

Microphone: The microphone is taped to the skin over the hollow of your throat. The microphone measures your snoring and how much time you spend sleeping on your back or on your side and stomach.

Nasal Cannula: The nasal cannula are tiny plastic tubes that fit into your nostrils and the tubing is secured behind your ears and under your chin. The nasal cannula measures the airflow you generate with each breath.

Effort Belt: The effort belt is placed around your chest. When correctly fastened the belt should be snug, but not uncomfortable. The belt measures how much your chest expands and contracts with each breath.

Finger Probe: The finger probe is taped to your index finger. The finger probe measures the percentage of oxygen in your blood and records your heart rate.

Watch our video on how to use the Remmers Sleep Recorder for your at-home sleep study with RANA.

How does the physician know I have OSA?

A physician, with experience in the diagnosis and treatment of sleep apnea, reviews the results of your sleep study. Apneas are brief periods of time when you stop breathing during sleep. Everyone experiences small breathing disruptions during sleep, but someone with sleep apnea may have as many as one hundred of these events per hour. The physician will tell you how frequently you stop breathing during sleep. The number of apneas you have per hour of sleep determines how severe your sleep apnea is. If the sleep study test is inconclusive for OSA, the physician will refer you to another professional who can help.

How long will diagnosis take?

As soon as the physician reviews the results of your at-home sleep study, an interpretation and diagnosis can be made. Even though the diagnosis can be made within days of your sleep study, you will have to meet with the physician to find out the results of your sleep study and the physician's diagnosis. Waiting times to meet with the physician vary from city and clinic. Call the RANA office closest to you for more information.

What treatments are available for OSA and snoring?

Depending on the severity of the problem, there are a variety of treatments available including:

• CPAP (Continuous Positive Airway Pressure) therapy
• Bi-Level therapy
• Dental appliance therapy
• Positional therapy (learning to sleep on your side)
• Lifestyle changes (e.g.  improved sleep habits, weight loss counseling)
• Surgery

A physician will meet with you to discuss your diagnosis and treatment choices after the sleep study. The treatment recommended for you will be based on your sleep study results, your lifestyle and your own preferences.

What is the difference between CPAP and Bi-Level therapy?

Both CPAP and Bi-Level therapy are forms of positive airway pressure (PAP) therapy. CPAP therapy delivers one level of pressure when you inhale and exhale. Bi-Level therapy delivers two levels of pressure set to coincide with your inhaled and exhaled breaths. Generally, the inhalation pressure is set higher than the exhalation pressure. Bi-Level therapy is recommended for OSA patients that have problems with CPAP therapy.

When can I start treatment?

Treatment can begin soon after your follow-up appointment with the physician. This means you can start feeling better within days or weeks and you will quickly rediscover the liberation of a good night’s sleep!

What will treatment do for me?

Fortunately, once sleep apnea is treated, the benefits are life-altering. Treatment will reduce or eliminate your snoring therefore both you and your bed partner will sleep better. If you suffer from high blood pressure, diabetes or heart trouble, treatment may also improve these conditions, making you feel better.

Several other symptoms may improve when OSA is treated:

• Tiredness or sleepiness during the day
• Un-refreshing sleep
• Lack of sex drive
• Frequent nighttime bathroom visits
• Lack of concentration & reduced memory
• Irritability
• Mood swings or depression
• Morning headaches or sore throats

What are the main side effects of CPAP treatment?

CPAP safely treats OSA, but occasionally causes side effects.

Nasal irritation may occur due to the air blowing into the nose. A mouth leak makes nasal irritation worse. CPAP users sometimes complain of cold, dry, painful or stuffy noses. Other side effects from CPAP are associated with the mask rubbing on the nose or air blowing into the eyes from a poorly fitting mask

Tips to prevent some of these side effects:

• A heated humidifier, which warms and humidifies the air blowing into your nose
• Some inexpensive over-the-counter medications to help prevent nasal irritation and congestion
• Changing the size of style of your mask

What are the dental appliance’s side effects?

Short-term side effects are common and include excess salivation, dry mouth, tooth pain and jaw pain. These symptoms easily correct with time or by adjusting the appliance.

Long-term side effects are less common. The literature reports as many as half of dental appliances change teeth positions and sometimes, jaw positions. The dentist will recommend daily bite exercises to minimize these complications. Remember, the positive effects of dental appliance therapy probably outweigh the possible side effects of the appliance.

What can I do to improve my night's sleep?

Getting a good night’s sleep is important to feel good during the day. But, for many people, a good night’s sleep does not come easily. Un-refreshing sleep may be caused by several conditions, some of which are serious and should be treated by a physician. Try these sleep tips, and record the results in a sleep journal. If they don’t help you get a good night’s sleep speak to your physician.

• Maintain a regular bedtime and wake time schedule, including weekends
• Establish a relaxing bedtime routine such as listening to peaceful music, relaxation exercises or reading a book
• Keep your bedroom dark, quiet and a little cooler
• Use your bedroom for sleeping and sex only; get rid of the TV and computer!
• Sleep on a comfortable mattress and pillow
• Finish eating at least two to three hours before your regular bedtime
• Exercise regularly; it is best to complete your workout at least a few hours before bedtime
• Try to shorten or eliminate your naps
• Avoid all forms of caffeine (e.g. coffee, tea, cola beverages, chocolate) six to eight hours before bedtime
• Avoid consuming alcohol and nicotine close to bedtime- it is best to quit smoking!
• Check with your doctor before using over-the-counter medications that may help you fall asleep, since they may cause side effects

What lifestyle changes will help me?

Sleep on your side: Some people suffer from OSA only when lying on their back. Pillows placed behind your back or tennis balls attached to the back of your pajamas help you to sleep on your side.

Avoid alcohol and sleeping pills: These substances relax the muscles of the throat, this makes the pauses in your breathing (apneas) longer and more severe. Prescription medications for anxiety, headaches and other common problems can affect your breathing and the quality of your sleep. Talk to your doctor if you use any of these medications and have OSA.

Prevent or minimize nasal congestion: Medications or nasal dilator devices (e.g. Breathe Right nasal strips) used to treat nasal congestion or stuffiness can help to reduce snoring and may help OSA slightly.

Lose weight if you are overweight: OSA is worse if you are overweight, therefore a weight loss diet should always be a part of your treatment plan. Even small amounts of weight loss (e.g. 20-30 pounds) can reduce sleep apnea symptoms and help you feel better.

What is CPAP therapy and how does it work?

CPAP (Continuous Positive Airway Pressure; pronounced see-PAP) therapy is the most common treatment for sleep apnea and is the treatment most physicians recommend first.

CPAP is a simple mechanical aid, which helps to keep your airway open at night when you sleep. CPAP prevents your airway from closing through positive pressure. It works a bit like blowing up a deflated balloon. Pressure is created by air blowing through the nose into the upper airway. This gentle pressure, applied continuously throughout the night, allows for normal breathing and peaceful sleeping patterns.

What generates the air that blows into the airway?

A CPAP blower or CPAP pump generates the flow of air. This machine generates a high flow of air, but at a low pressure. The first CPAP pumps were actually vacuum cleaners operated in reverse. Today CPAP machines are small (shoe-box size or smaller), quiet and extremely reliable.

How is pressure applied to the airway?

The most common method for applying the pressure to the airway is with a soft mask shaped to fit over the nose and seal against the face. A comfortably fitting mask is the most important part of your CPAP therapy. A comfortable mask ensures effective treatment. If you have trouble adapting to your first mask, there are many other shapes and styles to choose from. Other devices are sometimes used, such as nose tubes, which seal inside the nostrils, or full-face masks, which fit over the mouth and nose.

Will the air blow out of my mouth?

When a pressure is applied to the nose, the uvula and soft palate partially block off the mouth. Some air may escape from the mouth, called a “mouth leak,” which can be uncomfortable for the CPAP user. Most CPAP users learn to sleep with their mouth closed, even if they have been mouth breathers and snorers. Unfortunately, larger mouth leaks will cause the CPAP pressure in your airway to drop. This drop in pressure may allow your airway to collapse and apneas to reoccur. However, various devices, such as chinstraps, may gently hold your mouth closed.

How long does CPAP take to work?

CPAP instantly stops sleep apnea. Some people notice immediate improvement in daytime symptoms, such as sleepiness. Others find it takes time to get used to CPAP and gain maximum benefit. Your clinician closely monitors your progress to ensure you are comfortable and beginning to feel better.

How long will I need to use CPAP?

Unfortunately CPAP does not cure sleep apnea; it simply controls the symptoms by keeping the airway open. If you stop using CPAP your airway will once again close and you will experience apnea. For most people with OSA, CPAP is a life-long treatment. Weight loss can improve your overall health and may decrease the number of apneas during sleep. The pressure needed to keep your airway open may also decrease, but it is rare to completely stop CPAP treatment. Your clinician regularly assesses your progress. If your weight has changed, your CPAP pressure will be adjusted to ensure effective treatment.

Do I need to use CPAP all night?

Almost as soon as you stop using your CPAP, apneas will reoccur. So, whenever you sleep (even an afternoon nap) you should use CPAP. This means eight hours a night, seven days a week. In the beginning, you may have trouble adjusting to CPAP and will be unable to use it all night. This is normal and shouldn’t discourage you. Be positive, over time you will increase your use of CPAP. Recent studies show that the more you use your CPAP, the more benefit you experience. The bottom line is, CPAP doesn’t work if it isn’t used.

What happens if I can’t use CPAP for a night or two?

Although a night or two without CPAP should not cause a major problem, some symptoms, such as daytime sleepiness may return. If you can’t use your CPAP equipment, take care the following day when driving or operating machinery. If a cold or the flu causes nasal symptoms, you may be advised to suspend use of CPAP until you feel better.

How is my CPAP therapy monitored?

Your clinician routinely checks your CPAP machine throughout therapy for as long as you use it. Inside the machine a smart card collects information, such as how often the machine was used and for how long. The card also tells us what pressures were needed to keep your apnea controlled. This information, along with sleepiness scores and quality of life surveys, give your clinician the information they need to help you achieve the best sleep possible and get you back on the road to health.

If you experience any of these signs or symptoms, your CPAP therapy may need to be adjusted or your mask replaced - please call your RANA clinician.

• Snoring during sleep
• Increasing sleepiness during the day
• Waking up at night (except to visit the bathroom)
• Waking up with a very dry mouth
• Waking up with a headache
• Waking up without feeling refreshed
• Tenderness where your mask or interface touches your face

How can I maximize mask comfort?

The key to successful CPAP therapy is a good mask fit. Your mask needs to be comfortable. Follow these tips:

• Your headgear should be secure but not tight
• Tightening your headgear to minimize leaks is a sign that you may need a new or different mask
• Your mask cushion should not be crushed against your face
• Leaks may actually increase if your mask is too tight

RANA has a large variety of mask sizes and styles available. Please contact us if your mask is causing discomfort or leaking regularly - we will find the right mask for you.

When should I replace my mask and tubing?

Generally, masks and tubing should be replaced every year, however this will vary based on your skin type, daily usage and mask fit.

Replace your mask or tubing if you experience or notice any of the following:

• Regular pressure leaks
• Tightening your headgear/mask to avoid leaks
• Cracking or hardening of your mask's cushion or silicone
• Cracking of your mask's hard, clear shell
• Broken attachments
• Pressure sores or redness at the bridge of your nose, upper lip or cheek that does not go away after removing your mask for 10 minutes

Why should I take my CPAP with me when I travel?

CPAP therapy works best when you use it every night—especially when traveling so you can wake up energized for your fun-filled days and nights! Traveling should never limit your CPAP use. Use a portable power supply with your CPAP to ensure uninterrupted use during your vacation or when unexpected power outages occur at home.

How should I prepare my CPAP machine for travel?

Empty all the water from your chamber before packing your CPAP equipment inside your carrying bag. This prevents water damage to your machine’s internal components.

When traveling by air, is my CPAP machine considered carry-on or checked baggage?

Always take your CPAP machine on an airplane as carry-on baggage. This prevents damage or loss in the event your checked baggage is mishandled or misplaced. Your CPAP machine is a medical device, so the limit of one carry-on bag and one personal bag (e.g. purse or briefcase) per traveler may not include your CPAP machine. Make sure to check with your airline prior to your flight.

Most airlines allow the use of the in-flight power supply to operate your CPAP machine. However, be sure to contact your airline ahead of time for the rules and regulations regarding in-flight CPAP use.

Can I use the cigarette lighter adapters in vehicles to power my CPAP machine?

Yes, but here are a few helpful hints:

• Make sure the cigarette lighter socket works
• In a motorhome, check if the outlet is connected to a separate battery or if it uses the coach or engine battery. Use of your CPAP machine may drain your engine battery and prevent you from starting the motor if the outlet connects to the engine battery.
• Review how to operate your inverter
• Check your CPAP machine’s operations manual to find out if your humidifier will work on 12 volt power

Is there extra CPAP equipment I should take with me?

Yes. Here is a list of some travel essentials:

Fuses: Your CPAP machine uses a variety of fuses (e.g. 110, 220 and 12 volt). Make sure you have replacements.

CPAP Wipes: Alcohol-free wipes make cleaning of your mask and machine easy and convenient.

Portable Power Supplies: Portable power supplies ensure uninterrupted use of your CPAP when conventional power supplies are not available. We recommend a rechargeable battery, power inverter, battery adapter cable and battery charger. Your RANA therapist will tell you where to purchase these supplies and teach you how to use them.

Universal Plug Adapters: If traveling outside Canada or the U.S., research your destination to find out if your CPAP machine plug is compatible with the local electrical outlets. If not, you will need to purchase a set of universal plug adapters to ensure your machine will work with the electrical outlets at your hotel or resort.

Note: Once plugged in using the power adapter, all of RANA’s CPAP machines adjust automatically to the power supply. No manual adjustments are necessary.

Extension Cord: Electrical outlets at your destination may not be conveniently located, so you should carry an extension cord.

CPAP Wallet Card: The information on this card details the type of CPAP equipment you use and your settings for any healthcare professional providing you assistance during your trip. Ask your RANA therapist to update your card before you leave.

Copy of Your CPAP Prescription: Some airlines may ask for documents verifying your need for CPAP. Ask your RANA therapist for a copy of your CPAP prescription or a letter stating you are an OSA client on CPAP therapy.

Are there travel-sized CPAP machines?

Yes, CPAP machines are now available in smaller, more compact sizes ideal for travel and the active CPAP client’s lifestyle. Talk to your RANA therapist to rent or purchase a travel-sized CPAP machine for your next vacation.

What is dental appliance therapy?

Dental appliance therapy effectively treats snoring and mild to moderate sleep apnea. Dental appliances are also a secondary treatment choice for sleep apnea patients who are unable to tolerate CPAP.

A dental appliance fits partially or completely in your mouth. These appliances look similar to orthodontic retainers or athletic mouthguards. Dentists with training in dental appliance therapy can design, construct, and fit these special appliances to meet their patient’s individual needs. The dentist will guide your selection of an appliance, which both fits your lifestyle and best treats your sleep apnea and snoring. Follow-up with the dentist is important to ensure your appliance is comfortable and effectively treating your condition.

How do dental appliances work?

When you sleep, the appliance holds your jaw and soft throat tissues in a position to allow easier breathing. Some appliances move your jaw forward slightly to increase the amount of airway space. Others stabilize your jaw and prevent it from falling back towards your throat. For people without teeth, appliances can be used to shift your tongue forward while you sleep, which also increases airway space.

What are the benefits of dental appliances?

Dental appliances are small, lightweight and easy to carry. They are convenient for people who travel or like to go camping.

Have appliances been proven to stop snoring or OSA?

Many appliances are commercially available. However, the Food and Drug Administration have accepted only a few for the treatment of OSA. Many dentists make their own appliances, few of which have been tested for effectiveness. The dentist that works with RANA only uses appliances with a proven track record of treating snoring or sleep apnea.

How long does it take to get used to my appliance?

Everybody responds differently to his or her dental appliance, therefore adjustment periods vary from person to person. You must be patient and listen to your body. Some people adjust very quickly to the appliance and are able to wear it all night after the first week. Others may have to gradually increase the hours of use each night over several weeks. This means the effectiveness of your appliance will be limited during this adjustment period.

How do I care for my dental appliance?

The lifespan of an appliance depends on its design. They will last anywhere from six months to three years. Some require more repairs than others, some must be sent back to the laboratory to be repaired, others can be repaired in the office. Grinding your teeth dramatically shortens your appliance’s lifespan.

Am I a good candidate for a dental appliance?

The following factors increase your chance of responding favorably to a dental appliance:

• Normal body weight or moderately overweight
• Older than 18 and younger than 65
• Healthy teeth
• Patients who have failed throat surgery
• Patients who have mild or moderate OSA

What does the dentist look for during my oral exam?

The dentist examines your teeth and mouth to determine if you are a good candidate for a dental appliance. The dentist looks at:

• The position of your jaw
• Jaw stiffness and tenderness
• Evidence of teeth grinding (bruxism)
• How many teeth you have
• The condition of your teeth and gums
• The presence of extensive restorations (e.g. crowns, bridges, implants, veneers)
• The size of your tongue and other tissues in the back of your throat

Many successful dental appliance users do not fall within these guidelines, but the more criteria a patient meets, the more successful dental therapy should be.

Which dental appliance is best for me?

The dentist is experienced with many different appliances. He or she will guide your selection of an appliance, which both fits your lifestyle and best treats your sleep apnea and snoring. Every appliance is different, so it is likely you will find a comfortable one to effectively treat your condition. All appliances allow you to breathe through your mouth if your nose is stuffy. The best appliance for you depends on the shape of your mouth and if you have allergies to certain substances such as metal or plastic.

Learn more about dental appliances for sleep apnea and snoring.

How many times do I see the dentist?

After the dentist inserts your dental appliance, you need to return several times during the first few months for dental exams and adjustments. Once your appliance is properly positioned and your dentist is happy with the treatment outcome, an annual visit is recommended. During the follow-up visits, the dentist will ask how you are feeling and answer your questions.

How will I know my dental appliance is working?

Another at-home sleep study is the only way to be sure your appliance is resolving your OSA and snoring. The dentist recommends retesting after your snoring stops and your symptoms decline.

What if my dental appliance doesn’t work?

Your dentist will first ensure that your appliance fits well and is comfortable. The more you wear your appliance, the greater the benefits are likely to be. If you use your appliance all night, every night and still do not feel better, the appliance may need further adjustments, which your dentist will perform. If you cannot wear the appliance, the dentist may suggest a different appliance or may refer you to the RANA doctor to discuss other treatment options. The staff at RANA continually work to find the best treatment so you will feel better.

Your Sleep Study

Unfortunately, most insurance programs don’t cover the cost of the sleep study, but usually they will cover your sleep apnea treatment. Check with your insurance provider to confirm your level of coverage. Low income patients may qualify for RANA’s financial assistance program. Call the RANA office closest to you for more information.

Your CPAP Equipment

Your clinician will review the costs of CPAP therapy with you. CPAP costs vary depending on the type of machine and style of mask you use.

Unfortunately, most provincial health care programs do not cover the costs of CPAP. However, most extended health care insurance providers (e.g. Blue Cross, Great West Life, Sunlife, etc.), cover a percentage of CPAP costs. RANA will contact your insurance provider to find out about your CPAP coverage. If you do not have extended health care insurance, RANA has affordable payment options and financial assistance programs for low income families.

Your Dental Appliance

Dental appliances vary in cost depending on style, design and whether they are used to treat OSA or snoring. The dentist will talk to you about the costs for your specific appliance.

Dental appliance therapy is considered medical, not dental treatment. Many extended healthcare insurance companies (e.g. Blue Cross, Great West Life, Sunlife) cover much of the cost. Contact your provider to find out about your coverage.