For years, a full night’s sleep eluded Peter Palumbo. His snoring woke his wife, so he retreated to another bedroom, an arrangement he “didn’t like at all.” Owner of a busy car repair and sales business in Guilford, he wanted to be energetic and focused at work. But often, by late afternoon, he’d crave a nap.
“Then one night I woke up and couldn’t breathe,” said Palumbo, 50. “I realized this wasn’t just about sleep; this was a real health issue.”
Thanks to new technologies, Palumbo was able to complete a sleep study test at home using a device that recorded his breathing and other key health data throughout the night. Christine Won, M.D., medical director of the Yale Centers for Sleep Medicine, reviewed the data and diagnosed Palumbo with sleep apnea. She prescribed nightly use of a continuous positive airway pressure (CPAP) machine, which is considered a frontline treatment and is nearly 100 percent effective when used properly.
Unfortunately, Palumbo wanted no part of it. He found the mask bulky, embarrassing and “not too romantic.” He then tried a dental appliance but that didn’t relieve his symptoms. “And I didn’t want to have surgery if I didn’t have to,” he said. Such frustrations have long been the problem with sleep apnea. While many patients are happy to spend a night in a sleep lab and try treatment in exchange for a good night’s sleep, others can’t or won’t comply.
More comfortable options
The good news is that diagnosis and treatment for sleep problems has evolved in the last several years. This can be lifesaving if you are one of the estimated 18 million men and women in the United States who have sleep apnea, a condition that can cause the upper airway to collapse during sleep, blocking airflow and interrupting breathing.
New technology has allowed many of these patients to undergo sleep testing in their own homes, “Some people prefer it because they can sleep in their own environment,” said Won, who treats sleep disorders with colleagues Henry Yaggi, M.D., MPH, and Meir Kryger, M.D. “However, she said, there is an advantage to sleep labs—Yale has new sleep labs in Madison and North Haven that offer comprehensive diagnostic testing. “Most of the home devices do not record sleep stages, so we don't know exactly how much of the recording time is sleep. As a result, when we determine how severe the sleep apnea is, based on number of events per hour of sleep, it is often diluted because it is based on hours of recording, not necessarily sleep.”
Those patients who are prescribed a CPAP machine are finding the technology has evolved. Masks are made with more comfortable materials and design features that allow wearers to move more easily. One features a seal with a foam-like material that allows the mask to form around face contours, and a piece that glides from side to side as the person moves in sleep; the headgear moves but the mask doesn’t leak.
There are new options in air pressure delivery systems to treat sleep apnea that use algorithms based on a patient’s breathing pattern “so they breathe with the patients rather than against them,” Won said. Some offer ramping options, so air pressure increases as the person falls asleep.
Palumbo chose a machine with a ramping option, with headgear and two slender tubes to fit into his nostrils. “From the moment I started wearing it, my sleep has been unbelievable. I thought I was sleeping before. I wasn’t,” he said. He spends 10 minutes each night quieting down and breathing slowly to prepare himself to use the machine. He sleeps a full eight hours, contentedly back in his bedroom with his wife. “Everything’s so much better,” he said.
Compliance is still critical
Unfortunately, even with newly designed machines and masks, 30 percent of patients nationally still fail to comply. To counter that, Yale doctors devised a CPAP Management Program. “Data shows the best way to get patients to use their CPAP machine is to have close and frequent contact with their provider,” Won said. A multidisciplinary team of respiratory therapists and psychologists help patients navigate those first crucial weeks, checking the performance of the machines and sharing techniques for getting the mask on and off, among other things.
“Patient management has had a tremendous impact,” said Kryger.
Those with mild sleep apnea who can’t tolerate CPAP can try such alternative treatments as a nasal valve resistor that creates pressure as a person exhales during sleep. Surgery may be recommended for those with anatomical conditions that cause obstruction. Treatment options for those with moderate to severe sleep apnea were once limited, but the FDA recently approved an upper airway stimulator that is surgically implanted in the chest cavity and stimulates tongue muscles to keep the airway open during sleep.
Better sleep has many health benefits
Treatment can lead to such positive health outcomes as a decrease in blood pressure, an increase in metabolism, and improvements in cognition, Kryger said. Once apnea is treated, patients often have more energy, so they work out and lose weight. “Their performance at work changes and interactions with family members improve.”
Palumbo’s noticed the difference his CPAP machine made six months ago when he vacationed in Las Vegas without it. The first night, he struggled to breathe and couldn’t sleep. Several months later, he was in Virginia digging a foundation for a home addition as part of his church’s Appalachia service project. He slept in a room full of bunk beds with other volunteers. “This time I brought it with me,” he said. He put it on and, each night, fell into a good long sleep.
For information or to schedule a consultation a Yale Medical Group sleep medicine physician, please call 203-287-3550.