CPAP Machines

CPAP machines treat sleep apnea by using a mask to place pressurized air in your mouth to keep your airway open. Multiple studies found that CPAP treatment may be able to help address the decline in thinking and memory connected with sleep apnea. Many people report an improvement in their sleeping and functioning after using a CPAP machine.

Next Steps

While these studies don’t prove that sleep apnea causes dementia, they do show a fairly strong correlation. In light of this, as well as the other health risks that sleep apnea has been tied to, identification and treatment by a physician is strongly recommended. Addressing your sleep apnea could be a fairly simple way to improve your current and future health, both for your body and your brain.

You Might Reduce Your Cardiovascular Risks by Walking More and Sitting Less

By Wendy Bumgardner | Reviewed by Richard N. Fogoros, MDUpdated May 23, 2017

If you own a pedometer or fitness band, it likely has a suggested goal of 10,000 steps per day. But would you be smarter to set the goal at 15,000 steps per day if you want to reduce your risks of heart disease and metabolic syndrome? A 2017 study of postal workers in Scotland suggests that the higher number is better, especially if you also spend less time sitting.

15,000 Steps per Day Show Benefits

The study of non-smoking postal workers in Glasgow, Scotland matched 55 office workers who had sedentary jobs with 56 delivery workers who were on their feet most of the workday.

Each wore a sophisticated pedometer for seven days that tracked their steps as well as their walking speed and whether they were standing or sitting. They were tested to see what their indicators were of coronary heart disease risk.

The study found that those who spent more time sitting had a significantly higher risk for coronary heart disease, including larger waist size, more elevated triglycerides, and lower HDL cholesterol. The postal workers who had zero risk factors were those who walked more than 15,000 steps per day or spent more than 7 hours a day standing or walking as opposed to sitting.

How Far Are 15,000 Steps?

In 15,000 steps you would walk 6.5 to 7 miles (10.5 to 11 kilometres) depending on your stride length. At a brisk, continuous walking pace it takes 2 hours or a less. At a more leisurely pace and with starts and stops as would be encountered by mail carriers, it would be about 3 hours a day of walking.

This amount of walking at work was noted as typical for nurses, restaurant servers, and warehouse workers in previous studies. But the average sedentary office worker may only log 1000 to 3000 steps during the workday.

The calories burned in 15,000 steps depends on your weight and stride length, but it’s around 500 calories for a 130-pound person and 600 for a 160-pound person.

That can make a difference in your calorie balance if you control your eating, and it can assist in weight loss or maintaining your weight.

Does This Mean 10,000 Steps Isn’t Enough?

If you’ve been working hard to achieve 10,000 steps each day, don’t think it is for nought. The risks of metabolic syndrome went down in proportion to the amount of Activity each day. It’s just that in this study, the best risk reduction was seen at 15,000 steps or greater.

It’s also important to note that spending less time sitting was shown to reduce risks. It is possible to get 10,000 steps while sitting the rest of the time at work or at home. Many people ensure they get in enough time walking, running, or doing a gym workout to make their step goal for the day. But the time they spend sitting can be working against them and raising their health risks despite those bouts of Activity.

Stop Sitting, Start Stepping?

The study found that less sitting was associated with a smaller waist size as well as a lower risk of coronary heart disease. While the sample size was small, that ties in with other research that links sedentary behaviour with increased risks for cardiovascular disease and diabetes mellitus. Reducing sitting time and replacing it with a couple of minutes of Activity every half hour or hour can help, as can spending more time doing a low-level activity such as slowly walking while using a treadmill desk.

Check How Far You Walk Each Day

If you want to boost your step count, start with where you are right now. You can count your steps using a pedometer or fitness band, or use the pedometer function built into your smartphone. There are several different pedometer apps that can help you access it. For example, if you use an iPhone, search for Activity in the Health Data app to see your daily steps taken while you carried your phone. If you have an Android phone, the Google Fit app is likely already installed, and you can check it for your step count.

Within that day, were there hours you were less active?

One goal to reduce inactivity is to walk 250 steps each hour, which is two to three minutes of Activity. Spot the waking hours where you were least active and think of how you can build at least a little more activity into that time.

How Can You Walk 15,000 Steps per Day Without an Active Job?

Once you see what your intermediate steps are on workdays as well as weekends, you can start to make changes to increase them. Start with where you are, such as an average of 6,000 steps per day on workdays. Aim to add 2,000 more steps per day to that total most days. That is about an extra mile and 15 to 20 minutes of walking distributed throughout the day.

• Take at least 250 steps each hour, or 100 steps every 30 minutes throughout the day. This is a movement goal built into the newer models of Fitbit and Garmin fitness bands to help people break up stretches of inactivity. Over the course of an 8-hour workday and commute time, those extra bouts can add up to an additional 1,000 to 2,000 steps.
• Spend work breaks moving. You will also need to think about spending your work breaks walking so you can log 10 to 30 minutes of more continuous exercise at a time. If you don’t want to break a sweat at work, these can be easy walks, perhaps even having walking meetings with colleagues or strolling with a fellow employee.
• Make part of your commute on foot. Sitting in the car, or on the bus or train is idle sitting time. Is there a place you can park, or a stop you can use, so you get in extra minutes walking? Is it possible to walk to work and ride home, or vice versa?
• Look for active ways to spend at more of your evening. If you usually spend the evening sitting, how can you be more active? You can start by continuing to ensure you get at least 250 steps each hour. Do a little light housecleaning and decluttering. Go for a quick walk around the block. Be the one who takes out the trash, walks the dog, or goes to get the mail.
• Do more tasks on foot. If you need something from the store or to mail a letter, can you go on foot instead of by car?
• Find an active hobby or sport. Golfing, birding, and playing Pokemon Go on foot are just some of the activities that will log plenty of steps while you are having fun.

These tactics can add 2000 to 4000 more steps to your day. Start with that and after you have a week of consistently achieving your new goal, you can then look for even more ways to build in extra Activity.

Add Moderate-to-Vigorous Intensity Exercise Workouts

The minimum amount of moderate-intensity exercise you need to reduce health risks and help maintain weight is 30 to 60 minutes per day, most days of the week. This is in addition to the steps you take at a leisurely pace. For weight loss and to prevent regaining weight, the goal should be 30 to 90 minutes per day, most days of the week.

These will be sessions of brisk walking, running, shooting hoops, or other Activity. Here is where you’ll log 5,000 to 12,000 steps. You can include cycling time, although you’ll have to convert it to an equivalent number of steps.

Many fitness bands and apps track whether you are exercising at enough intensity for the session to be counted as moderate or vigorous. Making the goal of 30 minutes of moderate-intensity or 15 minutes of vigorous-intensity exercise each day can ensure you are getting the minimum needed to reduce health risks.

A Word From Verywell

Numbers help you focus on a goal, and one study doesn’t prove that 15,000 is a magic number. If you’ve been achieving 10,000 steps per day but would like to reduce your health risks further, look for ways to reduce your sitting time and ensure you get enough moderate-to-vigorous exercise each day. If you struggle to get to 10,000, find a way to add 2,000 steps to your daily average. Every step you take is a step in the right direction.

Sources:

Keeping It Off. CDC. https://www.cdc.gov/healthyweight/losing_weight/keepingitoff.html.

Physical Activity and Health: The Benefits of Physical Activity. CDC. https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm#ControlWeight

Tigbe WW, Granat MH, Sattar N, Lean MEJ. Time spent in sedentary posture is associated with waist circumference and cardiovascular risk. International Journal of Obesity. 2017;41(5):689-696. doi:10.1038/ijo.2017.30.

Young DR, Hivert M-F, Alhassan S, et al. Sedentary Behavior and Cardiovascular Morbidity and Mortality: A Science Advisory From the American Heart Association. Circulation. 2016;134(13). doi:10.1161/cir.0000000000000440.

Sleep Studies Identify Different Patterns Based on Brain Waves on EEG

The function of normal sleep and how various sleep disorders occur, it is necessary to understand the basics of sleep stages. For example, what is the difference between non-REM and REM sleep?

What stage of sleep is the deepest? When is the body restored or memory processed? When do vivid dreams occur? Discover the answers to these common questions.

The various sleep stages are distinctive, and they can be identified through the use of a limited EEG.

The EEG, which is performed during a standard sleep study (polysomnogram), is a measurement of the brain’s continuous brain wave patterns or electrical activity. This is done by placing electrodes on the scalp with a conducting paste that helps detect electrical patterns.

The recorded activity can be categorized into two basic stages – non-rapid eye movement (NREM) and rapid eye movement (REM) sleep.

An electrooculogram, or EOG, measures the electrical activity associated with eye movements during sleep. It can monitor eyeball movement during both REM and non-REM sleep.

What Is NREM Sleep?

Non-rapid eye movement (NREM) sleep, or Non-REM sleep, consists of three stages (N1, N2, and N3), each having recognizable electrical brain wave patterns. NREM makes up the largest portion of the sleep cycle.

NREM is characterized by decreased blood flow to the brain and skeletal muscle.

There is also decreased heart rate, blood pressure, and air volume moving in and out of the lungs.

Stage 1 (N1) involves slow rolling eye movements and partial relaxation of voluntary muscles. It is a very light stage of sleep and is often misinterpreted as wakefulness by the person asleep.

Stage 2 (N2) shows characteristic patterns on the EEG, including K complexes and sleep spindles. The K complex is a high-amplitude wave, meaning that it is tall and wide. Sleep spindles are closely spaced high-frequency waves, meaning they are not as tall and occur quickly over a short period. These are recognized in sleep studies by trained individuals and are used to identify sleep stages. Stage 2 makes up about 50 percent of our sleep on average.

Stage 3 (N3) shows high amplitude activity consisting of tall and wide waves on EEG and is recognized as the deepest of the three NREM stages of sleep. This is the stage in which growth hormone is released, especially in children. It is very hard to wake the person and usually occurs in the first one-third of the night. It is important for the restoration of the body’s tissues.

What Is REM Sleep?

Rapid eye movement (REM) occurs several times during sleep, but it comprises the smallest portion of your sleep cycle. It is notable for the presence of rapid eye movements (REM), which is the fast movement of your eyes in different directions while you are asleep. This is a stage of sleep with intense activity in certain parts of the brain.

The EEG recordings, more patterned in earlier stages, become desynchronized during REM and appear a lot like wakefulness.

This is the stage of sleep when vivid dreaming occurs, like a movie going through your mind. It is important for memory processing and learning.

Except for your eye muscles and diaphragm, you have no motor function during REM. This loss of muscle tone during REM sleep may conserve energy and protect you from acting out your dreams. It also may worsen the risk of sleep apnea in susceptible individuals.

In addition, REM leads to changes in blood pressure, heart rate, and breathing rate.

Blood flow is increased to the brain and penis, and clitoris, resulting in engorgement. This is the cause of morning erections in men.

Dividing Sleep into Patterns Using a Hypnogram

Sleep architecture represents the structure of your sleep and is generally composed of a cyclical pattern of the various NREM and REM sleep stages.

There are four to six cycles of NREM sleep per night, followed by brief intervals of REM sleep. Each cycle lasts about 90 minutes. As the night progresses, the periods of NREM become shorter, and the periods of REM become longer. Most REM sleep occurs in the last third of the night, towards morning. The average adult will spend about 20 to 25 percent of the night in REM sleep, but this may decrease as we age.

Source:

Mowzoon, N et al. “Neurology of Sleep Disorders.” Neurology Board Review: An Illustrated Guide. 2007;720-722.

Do People With Rheumatoid Arthritis Have an Increased Risk of Sleep Apnea?

By Carol Eustice | Reviewed by a board-certified physician

Updated January 27, 2017

Sleep disorders are prevalent among people who have rheumatoid arthritis. Fatigue is recognized as a huge problem for those living with the disease. At one time, it was said to be unclear if obstructive sleep apnea was associated with rheumatoid arthritis. Obstructive sleep apnea is one of three types of sleep apnea.

What’s the current thinking? Is there a higher risk of developing obstructive sleep apnea if you have rheumatoid arthritis?

Is obstructive sleep apnea the cause of sleep disturbance and fatigue which are common complaints of people with rheumatoid arthritis? Let’s consider what researchers have determined.

What Is Rheumatoid Arthritis?

Rheumatoid arthritis is a chronic, autoimmune, inflammatory type of arthritis. While symmetric joint pain and joint damage are characteristic of rheumatoid arthritis, there may be systemic effects and extracurricular manifestations as well. About 1.5 million people in the United States have rheumatoid arthritis, according to the Centers for Disease Control and Prevention (CDC).

What Is Sleep Apnea?

Sleep apnea is the most common sleep-related breathing disorder. With sleep apnea, a person’s breathing is interrupted or essentially stops, during sleep. In North America, the estimated prevalence—when obstructive sleep apnea is defined as apnea-hypopnea index (AHI) of greater than 5 events per hour as determined by polysomnogram—is 20 to 30 percent in males and 10 to 15 percent among females.

While apnea refers to the temporary suspension of breathing, hypopnea refers to slow or shallow breathing. Episodes of sleep apnea result in reduced oxygen saturation.

Risk factors associated with sleep apnea include:

• Advancing age
• Male gender
• Obesity
• Craniofacial or upper airway soft tissue abnormalities

Other risk factors that have been identified include smoking, nasal congestion, menopause, and family history of sleep apnea. Certain medical conditions have been linked to a higher rate of sleep apnea, including pregnancy, end-stage renal disease, congestive heart failure, chronic lung disease, and stroke. Researchers have also found a link between rheumatoid arthritis and an increased risk of obstructive sleep apnea.

How Are Sleep Apnea and Rheumatoid Arthritis Connected?

According to study results published in BMJ Open (2016), the overall incidence rate of obstructive sleep apnea was 75 percent higher in the cohort of people with rheumatoid arthritis compared to those without rheumatoid arthritis. The findings were derived from the first retrospective cohort study that utilized nationwide population-based data. Previous studies of sleep apnea and its possible association with rheumatoid arthritis were based on case reports or case studies with small sample size.

The BMJ Open study discussion states that the risk of obstructive sleep apnea is greater in men than women, in older people compared to younger people, and in those with comorbidity. The risk of sleep apnea is known to be associated with hypertension, hyperlipidemia, ischemic heart disease, and obesity.

With regard to rheumatoid arthritis, certain factors appear to contribute to the higher risk of sleep apnea, including micrognathia, cervical spine abnormalities, involvement of the temporomandibular joint, the involvement of the cricoarytenoid joint, and obesity.

• Micrognathia is a condition where the lower jaw is smaller than normal. This is often characteristic of juvenile idiopathic arthritis. It also can occur as adult-acquired micrognathia associated with rheumatoid arthritis, in some cases due to destruction of the temporomandibular joint, leading to obstruction of the upper airway and obstructive sleep apnea.
• Cervical spine issues can occur with rheumatoid arthritis, specifically, instability of the occipital-cervical junction, misalignment of the occipital-cervical region, as well as other abnormalities, such as the presence of osteophytes. Cervical misalignment can cause upper airway narrowing, brainstem compression, and can affect the severity of sleep apnea. Occipital-cervical (surgical) fusion may help to correct that particular abnormality and improve sleep apnea.
• Temporomandibular joint involvement—Destruction of the temporomandibular joint related to rheumatoid arthritis can reduce the size of the upper airway and contribute to sleep apnea in those who are affected.
• Cricoarytenoid joint involvement—The cricoarytenoid joints are located between the cricoid and paired arytenoid cartilages in the back wall of the larynx. The cricoarytenoid joints open, close, and tighten the vocal cords during speaking and breathing. Abnormalities can contribute to sleep apnea in people with rheumatoid arthritis.

Genetic factors, exposure to certain environmental conditions, other comorbidities, and lifestyle choices or behaviours, such as a less-than-optimal diet (e.g., too much sugar or fat), heavy drinking or smoking, and insufficient exercise may also be contributing factors.

It was also suggested that the known association between cardiovascular disease and rheumatoid arthritis may, in part, be due to sleep apnea. Obstructive sleep apnea has been tied to inflammation, coagulation, and endothelial dysfunction. As contributing factors have been identified, the cause and effect become more apparent and the need for managing each factor is obvious.

The factors must be considered from the perspective of how rheumatic diseases are related to sleep apnea. For example, it has been determined that people with obstructive sleep apnea have elevated acute-phase reactants (CRP, sedrate) and pro-inflammatory cytokines. It has been reported that some interleukins, specifically, IL-1, IL-2, IL-6, Il-8, IL-18, and TNF-alpha promote non-REM (rapid eye movement) sleep. IL-4, IL-10, IL-13, and TNF-beta inhibit non-REM sleep.

Inflammatory cytokine levels are proportionate to the severity of sleep apnea. Higher levels of TNF-alpha have been associated with more severe obstructive sleep apnea and hypoxia. This may explain why people with rheumatoid arthritis who are treated with TNF blockers find that their fatigue level improves. More study would be needed to draw a conclusion regarding the impact of specific rheumatoid arthritis treatments.

How Should It Be Managed?

The association of rheumatoid arthritis and sleep apnea may significantly contribute to increased morbidity and mortality in people who have both conditions. That the association may contribute to the increased risk of cardiovascular disease in rheumatoid arthritis patients is perhaps most noteworthy.

Rheumatologists should look for signs of sleep apnea in their patients when interviewing and evaluating them and, if indicated, refer to a sleep specialist or sleep clinic. Sleep apnea is typically managed by utilizing CPAP devices. Compliance with CPAP devices is a problem for some though. It might be best described as cumbersome. Other possible means for the management of sleep apnea involve specific body position during sleep to keep the airway open, weight loss, and the use of devices to move the mandible forward thereby reducing airway obstruction. For certain, the problem should not be ignored.

The Bottom Line

When someone with rheumatoid arthritis complains to their doctor about fatigue, it should not initially be dismissed as a common characteristic associated with the disease. It should not be assumed that fatigue is simply related to sleep disruption and sleep fragmentation associated with pain. While that may be true in most cases, the hard work of determining the cause must be undertaken. Sleep apnea must be ruled in or out. The potential consequences of untreated sleep apnea are too great otherwise.

Sources:

Ataka, H. et al. Occipitocervical Fusion Have Potential to Improve Sleep Apnea in Patients With Rheumatoid Arthritis and Upper Cervical Lesions. Spine. 2010 Sept 1;35(18):E971-5.

Shen, Te-Shun et al. Risk of Obstructive Sleep Apnoea in Patients With Rheumatoid Arthritis: A Nationwide Population-Based Retrospective Cohort Study. BMJ Open. 2016; 6(11): e013151.

Shoda, Naoki et al. Sleep Apnea in Rheumatoid Arthritis Patients With Occipitocervical Lesions: The Prevalence and Associated Radiographic Features. European Spine Journal. 2009 June; 18(6): 905-910.

Strohl, Kingman P MD. Overview of Obstructive Sleep Apnea in Adults. UpToDate. Updated June 24, 2016.

Taylor-Gjevre, Regina M., Nair, Bindu V., and Gjevre, John A. Obstructive Sleep Apnoea in Relation to Rheumatic Disease. Rheumatology (2013) 52(1):15-21.

How to Avoid Water, Rainout, and Moisture in CPAP Tubing and Masks

How to Avoid Water, Rainout, and Moisture in CPAP Tubing and Masks. As you sleep soundly, aided by the use of continuous positive airway pressure (CPAP), a sputtering noise begins and soon the water is splashing you in the face through your mask, waking you up. Moisture in the CPAP tubing or mask is a frequent (and annoying) occurrence with the use of a heated humidifier, but how can it be avoided? Discover how heated tubing, wraps, and changes in the humidifier setting may help to eliminate this occurrence.

The Role of the Humidifier in Causing Water Condensation

In most cases, moisture in the CPAP tubing or mask is secondary to the use of a heated humidifier. Without a humidifier in place, exhalation may also cause a small amount of water to condense within these plastic parts. The heated humidifier increases the comfort of using CPAP, reducing dryness within the nose or mouth and making nosebleeds and infections less likely. There is a trade-off to introducing this additional water to the treatment, however.

When the humidity enters an unheated tube, the difference in temperature may cause condensation to occur. Small beads of water may form within the tubing. As these coalesce, rivulets of the water may make their way to the mask and splash your face. The warmer the humidifier air—and the colder the tubing (or room)—the more condensation occurs. If the humidity setting is turned up, more moisture may be in the air to rain out within the tubes or mask.

If you have the humidifier set to the highest setting, this is very likely to occur.

How to Avoid Moisture in the CPAP Mask and Tubing

What can be done to eliminate this from happening? Any of the various options basically involve trying to closer match the temperature inside and outside of the tubing.

• Heated Tubing

Perhaps the most desirable option is to use a heated tube that delivers the warm, moist air from the heated humidifier to the CPAP mask. This will maximize the benefit of the humidifier. All of the major manufacturers of CPAP equipment now offer heated or climate line tubing as part of their latest models. These have a heated coil that runs the length of the tube and keeps the air inside warmed. The power is integrated into the back of the CPAP machine and the tubing easily connects to the various mask interfaces. In addition, it is possible to purchase a separate heated tubing component called Hybernite to use with older machines. In general, it is recommended to set the temperature of the tubing between 78 and 82 degrees to reduce the likelihood of water forming in the equipment.

• Changing the Temperature Difference

A less expensive and simple option is to adjust the temperature of the heated humidifier or your bedroom. Turn down the temperature of the humidifier or turn up the thermostat in your bedroom. You may find that it is more comfortable to sleep in a cool room, so you might start by adjusting the humidifier.

• Covering the CPAP Tubing

Another popular option is to put the CPAP tubing under the bed covers.

This will warm the tube and reduce the condensation. There are also various fabric coverings sold that can insulate the tubing as well. The most popular brand is sold as Snuggle Hose. These come in various colours, patterns, and fabrics. If you are crafty, similar covers can be made easier with a long piece of fabric and a sewing machine or needle and thread.

• Placing the CPAP on the Floor

Another helpful option is to put the CPAP machine on the floor. By putting it in a lower position than where you are lying in bed, the moisture that does collect within the tubing will run back to the humidifier, rather than dousing you in the face in the middle of the night.

Finding the Right Solution to Reduce Water in CPAP Tubing and Masks

There are a number of highly effective options to reduce the condensation that can collect in CPAP tubing with the use of a heated humidifier. The benefits of the moisture largely outweigh the inconvenience, and a few accommodations will ensure that your sleep continues to be benefited by CPAP without any unnecessary disruptions.

If you continue to have problems, speak with your board-certified sleep physician or durable medical equipment about additional options that might be helpful to you.

Source: “Humidifier settings.” ResMed.

What Is the Purpose of the CPAP Humidifier?

Is Using the CPAP Humidifier Necessary?

How to Stop Using the CPAP Humidifier

In newer models, such as ResMed’s AirSense series, you can simply turn the humidifier’s heating element and the heated tubing off. This can be deactivated within the patient settings menu. The air can then pass through without smells developing from a heated, dry and empty chamber.

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