I come from a family of champion snorers. Mother, father, brothers—we all broadcast nightly like buzz saws. But by 2006, my snorking and snarking took an unhealthy turn. Instead of merely driving everyone nearby to distraction, I began to stop breathing for short periods. Dozens of times per night, my upper airway fell slack like a worn-out garden hose, which pinched off the flow of air and jarred me awake. Blood oxygen plummeted and adrenaline surged into my bloodstream, making blood pressure swing up and down.
After a sleep study in which I slumbered overnight at a special clinic while wired up to various gadgets, my doctor offered an explanation for my increasing fatigue and mental fog: obstructive sleep apnea (OSA).
Not surprisingly, I read with great interest a study published today in the Journal of the American Medical Association (JAMA) which reported that treating OSA can help people with very hard to control blood pressure. Many people with this so-called treatment resistant hypertension take several medications but their pressures remain stubbornly high. Many people with treatment-resistant hypertension also have OSA.
Healthier BP with CPAP
Could treating their OSA help? To find out, researchers in Spain provided the standard treatment for OSA to nearly 200 men and women for 12 weeks. The treatment was continuous positive airway pressure (CPAP), which uses a facemask and bedside air pump to inflate the upper airways enough to prevent the collapse of soft tissue in the upper throat that obstructs airflow.
After 12 weeks of CPAP, average 24-hour blood pressures in the study participants were a few ticks lower. They also had more healthy nighttime blood pressure patterns.
The improvements, though modest, are still important. Nighttime interruptions in breathing, or “apneas,” starve the brain of oxygen and stress out the cardiovascular system. Inadequately treated OSA comes with a higher risk of heart attacks and strokes. Another hazard is next-day drowsiness that predisposes people to accidents.
What it means for those with OSA
To get the bottom line on the study for OSA sufferers, I talked to Dr. Atul Malhotra, an expert on sleep apnea and associate professor of medicine at Harvard Medical. He’s also the chief of Pulmonary and Critical Care Medicine at the University of California San Diego School of Medicine.
“The wrong message is to say CPAP is weak,” Dr. Malhotra says. “Blood pressure medications offer a bigger bang for the buck to reduce daytime blood pressure, but it’s important to say that when you treat sleep apnea there are a lot of other benefits that are not necessarily related to daytime blood pressure.”
I’ll say! I was absolutely miserable pre-CPAP. But now I sleep like a lamb (well, probably more like an helium-inflated Macy’s Day Parade lamb). Every night I strap on the headgear of what I affectionately call my “astronaut machine.” A small high-tech bedside air pump monitors my breathing and adjusts the flow of filtered, humidified air to my nose. A microchip in the machine tracks my breathing patterns and adjusts the flow throughout the night to compensate for shifts in body position.
Overcoming CPAP roadblocks
But not all of my brother and sister CPAPers are as lucky. Some can’t get used to the mask and tend to tear it off in their sleep or simply don’t wear it at all. But most people can adapt to CPAP.
“Strapping a mask to your head is not ideal, but in some people adherence is extremely good,” Dr. Malhotra says. “They wear it all night every night and couldn’t get to sleep without it. Then they get transformative benefits from it.”
How do you get to that point? A critical factor is mask comfort. “The key is just to find one you like,” Dr. Malhotra says. “It’s like going to Baskin Robbins. There are 31 flavors, and you just have to try different flavors before you find one you like.”
Fortunately, the Baskin Robbins of CPAP is well stocked these days with a variety of mask options. It includes nasal masks, full face masks, and twin tubes that deliver air to each nostril.
Mask fitting can be a trial-and-error process, and you may have to try different ones until you find the right match. “If you try pistachio at Basin Robbins the first time and don’t like it you may never come back,” Dr. Malhotra says, “but some people try pistachio the first time and like it.”
Me, I like vanilla—the smaller, lighter nose-only nasal mask. My brain learned quickly to keep my mouth closed and breath through the nose. Later I found better-designed headgear and an accordion-like mask that maintained its seal better despite my occasional tossing and turning.
Dr. Malhotra urges those going on CPAP not to quit if the first taste isn’t pleasing. “Even if the first experience with CPAP doesn’t go well,” Dr. Malhotra says, “it’s very important to keep trying.” Untreated or inadequately treated sleep apnea can have devastating effects on health and quality of life, but there is usually a solution.