Home care professionals play an important role in the care of sleep apnea patients. Most patients with sleep apnea do not know that they have the disorder, and home care professionals can play a key role in helping us to reach the undiagnosed. In considering which of your patients have undiagnosed sleep apnea, you may want to read Sleep Apnea and BMI: The Majority of OSA Patients Are Not Obese. For more information specific to sleep apnea in home care patients, read Uncovering A 'Silent' Problem: Sleep-Disordered Breathing In Homecare Patients.
In addition, home care professionals, whether assisting with a sleep study or when providing the patient with CPAP, can also help educate patients about sleep apnea: an educated patient may be more compliant with prescribed therapy. The ASAA can help you easily and efficiently help your patients understand sleep apnea. The ASAA offers numerous patient educational publications, as well as brochures to explain sleep apnea, a video, and newsletter reprints on specific topics. For more information about communicating effectively with patients, visit the website of the Partnership for Clear Health Communication and learn more about its Ask Me 3 program.
Moreover, CPAP users often turn to home care professionals with questions and problems about the CPAP machine. To learn more about increasing CPAP compliance, read If Your Patient Is Not Complying with CPAP. Often there are only minor adjustments to be made with the mask and headgear, and improving compliance is a concern for everyone involved in treating sleep apnea patients.
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Defining Apnea: "without breath"
An apnea is clinically defined in adults as a cessation of breath that lasts at least ten seconds and in children as a cessation of breath that lasts the equivalent of two-and-a-half missed breaths. People with untreated sleep apnea stop breathing repeatedly during sleep, as frequently as hundreds of times during the night and sometimes for a minute or longer. Blood oxygen levels typically drop with each apnea and hypopnea.
Prevalence
It is conservatively estimated that at least 12 million Americans suffer from sleep apnea, most of whom are undiagnosed.
Types of Apnea
- Central (where the airway is not blocked and with no neurological signal to breathe, there is no respiratory effort)
- Obstructive (the most common)
- Mixed (a combination of the above which begins as central and becomes obstructive and is treated as obstructive)
Risk Factors for Sleep Apnea
- A family history of sleep apnea
- Excess weight
- A large neck
- A recessed chin
- Male sex
- Abnormalities in the structure of the upper airway
- Smoking
- Alcohol use
- Age
Yet sleep apnea can affect both males and females of all ages (including children) and any weight.
Presenting Symptoms
- Loud snoring
- Excessive daytime sleepiness (i.e., falling asleep easily and sometimes inappropriately)
- High blood pressure and other cardiovascular complications
- Morning headaches
- Memory problems
- Feelings of depression
- Reflux
- Nocturia
- Impotence
Treatments for Sleep Apnea
- Avoidance of alcohol and medications that relax the airway and/or reduce respiratory drive
- Weight loss
- Positional therapy, i.e., avoiding sleeping on the back (for adults)
- Oral appliances
- Surgery (a tonsillectomy and adenoidectomy is the most common treatment for pediatric patients)
- Continuous positive airway pressure (CPAP)
The most appropriate treatment depends on an individual’s medical history and the severity of the disorder.
