CPAP: Benefits and risks

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    OBSTRUCTIVE Sleep Apnea (OSA) is a condition where the individual stops breathing for a prolonged period while asleep, much longer than the usual 5-second or so pauses between breaths.

    The person wakes up gasping for breath because of lack of oxygen. These episodes could happen a hundred times or more during the night, leading to low oxygen supply to vital organs. And this condition occurs every time the person sleeps, day or night. While many are snorers, not all persons who snore have sleep apnea. Only a sleep study could clinch the definitive diagnosis.

    Prevalence of OSA

    OSA is more common than recognized because many are not aware that such a condition exists, and a significant number do not seek medical attention or refuse a Sleep Study, and still others reject CPAP (Continuous Positive Airway Pressure) treatment as an uncomfortable and  “sleep disturbing” therapy, after the diagnosis is confirmed.

    About 3 to 7 percent of men and 2 to 5 percent of women have sleep apnea, with more than 100 million suffering from OSA around the world, even among those younger than 40.

    The Gold Standard

    While there are gadgets on the market claiming to be “treatments” for sleep apnea, which are ALL unscientific and ineffective since they are not addressing the pathology (collapsing soft tissues in the throat blocking the airway), only CPAP is the evidence-based, gold-standard, effective medical therapy for sleep apnea. The others are just a waste of money and provide a false sense of security, which delays the institution of the proper treatment, CPAP, which has almost 100 percent effectiveness (some individuals are non-compliant).

    Since persons with undiagnosed, untreated, or improperly treated sleep apnea have an increased risk for the development of cardiovascular (heart attack, stroke and metabolic illnesses (diabetes, thyroid disease, etc.), Alzheimer’s, and even cancer, it is prudent to seek medical attention and undergo a Sleep Study without delay if you do not get a restful sleep, a snorer or not, and feel tired and sleepy during the day, lack of concentration, napping while watching the TV, or even while driving, or simply feeling lousy as the day goes on.

    While recent studies (4-year evaluation of 2,700 patients from 80 medical centers around the world) from the Flinders University and The George Institute for Global Health, published in The New England Journal of Medicine, state that CPAP “does not reduce the recurrent strokes and heart attacks,” they show that CPAP tremendously improves the quality of life, mood, and attitude among those with sleep apnea. Also, since apnea (breath-holding) leads to oxygen deficit for the heart, brain, liver, kidneys, etc., during sleep, the use of CPAP normalizes the oxygen level for the person, which is healthy, and it tempers the progression of any illnesses. The researchers also found that “CPAP treatment produced a 20% improvement in severe depression, a two-thirds reduction in severe sleepiness, and 20% less days lost from work.”

    Individuals who have sleep apnea but otherwise healthy, will markedly reduce their chances of developing common major illnesses (high blood pressure, diabetes, heart disease, stroke, and even cancer) with CPAP therapy.

    CPAP machine cleaners

    If not cleaned properly, the CPAP machine, water chamber, tubing, and masks could harbor bacteria, molds, fungus, virus, which could lead to dangerous sinus, lung and stomach infection. Cleaning the mask, tubing, and water chamber with lukewarm water and dishwashing soap, sometimes diluted vinegar everyday could do the job, but a simpler, less tedious, and more efficient method is the use of CPAP cleaning devices. There are basically two types: one that uses ozone and the other uses ultraviolet lamp, for sterilization to kill 99+ percent of bacteria, viruses, molds and fungi, within 30 minutes of exposure. The popular ones are SoClean2, which uses ozone, and the Lumin and SterileTote UV light CPAP cleaner. The portable ozone generators are smaller than a can of soft drink and are about 8-10 times cheaper, ideal for travel.

    Ozone: harmful or safe

    Ozone, also called activated oxygen, is formed when another atom of oxygen is added to regular oxygen (O2) with two molecules of oxygen, which is normally in the air we breathe. Normal oxygen level is harmless, unless in excess. But when another atom of oxygen is added to the O2, it becomes supercharged O3, which can rapidly oxidize and destroy other molecules, including bacteria, viruses, fungi and mold and odors, the reason ozone is used in CPAP cleaner devices.

    There are several layers of ozone that surround earth, and naturally created by lightning storms and by the sun’s ultraviolet rays. The smell we sense immediately after a storm or rain is ozone. Ozone as a cleaning agent has been found to be more effective than chlorine and bleaches as cleansing/sterilizing agents in water filtration systems, air purifiers, hospitals, restaurants, hotels, doctors/dental offices. Handled properly, ozone is reportedly safe. After a 30-minute ozone treatment by the CPAP cleaning device, at least two hours of “airing” is needed to dissipate the residual ozone smell on the mask, tubing, CPAP machine before using. The half-life of ozone is about half an hour.

    After it does its job, it disappears within an hour. When it dissipates, it releases an oxygen molecule and is transformed back into oxygen. Ozone at its original concentration right after being generated by the machine is irritating to the eyes, nose, throat, and dangerous to inhale. Ozone is very powerful but does not last long. After two hours and longer, the CPAP is ready to use.

    UV light CPAP cleaner

    As alluded to earlier the other type of CPAP cleaner uses ultraviolet light for sterilization, like the Lumin and SterileTote, UV light germicidal irradiation (UVGI) uses short-wavelength ultraviolet (UVC) light to kill all microorganisms by destroying their nucleic acids and disrupting their DNA, destroying their bonds and disabling them to perform vital cellular function. This type used for sterilization of CPAP and accessories are safe to human. Other items that could be sterilized in these units are cellphones, toothbrushes, baby pacifier, jewelries, combs, scissors, nail cutters, medical instruments, etc. Lumnin and SoClean CPAP cleaner system cost around $300-$350. SterileTote is about $48.

    The portable travel-size ozone CPAP cleaners are priced between $50 to $150. For more details, consult my friend, Dr. Google. Be sure to do a due diligence and talk to your physician or pulmonologist if you plan to purchase a CPAP machine and CPAP cleaner, after your Sleep Study confirms you have OSA.

    Nature is overflowing with good clean oxygen. It is our obligation to the future generations to make sure that, like us today, they too would be able to enjoy every breath of fresh air.

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    Philip S. Chua, MD, FACS, FPCS, a Cardiac Surgeon Emeritus based in Northwest Indiana and Las Vegas, Nevada, is an international medical lecturer/author, and Chairman of the Filipino United Network-USA, a 501(c)3 humanitarian foundation in the United States. Websites: philipSchua.com and FUN8888.com    Email: [email protected]

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