In a previous article here, “Sleep Apnea – Only For Males, Middle-age, Over-weight – Think Again“, I told the story of my new wife, in her early 50’s discovering she had a moderate case of sleep apnea. As I explained in that article, this seemed so unlikely to us because my wife, at 5’2” only weighed 98 pounds and was in excellent physical shape. In other words she did not fit the popular notion that to have sleep apnea you are by definition going to be over weight and more than likely middle-aged. Ok… maybe the middle-age part fit, but none of the rest. From that point we have been leading an interesting journey that is still evolving.
The first step was to acquire a CPAP machine. CPAP stands for Continuous Positive Airway Pressure. The role of this machine is to send air into the patient’s airway to force it to remain open. It is the closed airway that is so dangerous and why the individual stops breathing briefly until they awaken due to the lack of oxygen getting to the brain. Obviously if for a large portion of the night, someone is falling asleep, having their air supply stop, and waking up, they are not going to ever feel very rested. My wife was always complaining about her fatigue, and this fit the circumstances perfectly.
Almost immediately, she felt more rested and began to gain some weight. I wish I could say that solved the entire problem, but there were difficulties with the CPAP machine to overcome. The air is delivered through your nose or mouth based on which face mask you end up choosing. There are many variations. The problem is that it is extremely hard to get used to wearing something over your face all night and dealing with the accompanying hose that goes to the machine. My wife tried three or four masks, but has never been very comfortable for an entire night. Frequently she gets frustrated in the middle of the night and just takes it off, only to have tiredness the next day. It is a vicious cycle.
After several months of using just the CPAP we read about some oral devices worn during sleep that re-align your jaw, positioning it to keep your airway more open at night.
We discovered the number of doctors well versed in this field were limited and went through a long process to find one, and to get the procedure approved by our health insurer. An ear nose and throat doctor, who would be well versed in the use of the CPAP, probably would not be doing work with the oral devices and would need to refer a patient to a dental specialist.
As a layman it seemed to me that the field of knowledge dealing with sleep apnea is growing so rapidly, that insurers seem to be scrambling to keep up with the techniques and procedures evolving to treat the problem. In almost every step of this journey, we have had to go through a review process with the insurer to get approvals to try the recommended procedure. However, to their credit, we have been able to get approval to move forward with the use of our insurance to cover a lot of the costs.
The oral device my wife ended up receiving is called the Klearway. It is a custom molded frame that she wears in her month. Over a period of weeks the doctor increases an adjustment to gradually push the lower jaw into a position that effectively forces the airway to stay open more than it normally does.
The positive side is that she can tell an improvement in her ability to sleep. On the other hand, it has not eliminated the need to wear the CPAP. And, she has had some headaches and sore neck muscles that may be attributed to the adjustment of her jaw.
Her goal has been obviously to do whatever is necessary to alleviate the physical causes of the sleep apnea. To some degree, the CPAP and Klearway have done this. However, as anyone would imagine, neither of these methods has been the perfect solution. So, we expect to continue searching for a better way.
Recently, my wife’s doctor has suggested in light of the results she has gotten that she might want to try a relatively new procedure called the Pillar Technique. To this point we have avoided any idea of using surgery to address sleep apnea. But, the Pillar Technique is very minor out-patient surgery that implants small Dacron supports in the palate to keep the airway stiffer. We may decide it is right move. At this point the ear, nose and throat doctor is asking my wife to be evaluated for allergies before making a recommendation to the insurer.
After hearing about the need to check her allergies, I have started to wonder about a gluten intolerance my wife has and the role of allergies in all this. So, although the physical malfunctions that cause the sleep apnea seem fairly clear, how to fix the problem does not. And, no, it does not just happen to over-weight middle aged males.