Diabetes Complications

Successful Sleep Apnea Therapy

If you have diabetes, it’s likely that you have sleep apnea too. Almost half of us have sleep apnea, and most of us don’t know it.

When you temporarily stop breathing in your sleep, you’ve got it. Being sleepy during the day is the most common result. When you are too sleepy to stay awake at the wheel, the indirect result can be running your car off the road or into someone else.

Sleep apnea can also lead to memory changes, depression, and irritability. Sometimes it contributes to high blood pressure, heart failure, stroke, and heart attack.

The good news about sleep apnea is that we can treat it without surgery, injections, or even pills. For about a quarter of a century we have been able to treat it by using a continuous positive airway pressure device or CPAP.

I’ve used one every night but one for the past three years. Southwest Airlines temporarily lost my CPAP device on one flight, and I had my worst night’s sleep in years.

Using a CPAP has made a huge difference for me, even though I got no help from the busy sleep lab in Santa Cruz, California, where I was then living. The people at the sleep lab said that I had to get my CPAP from Apria Healthcare, the country’s largest durable medical equipment supplier. Eventually, they send me the CPAP, but they gave me only begrudging and limited help.

Only a couple of months ago did I understand what I was doing. I travelled to ResMed Corp in the San Diego area, where I met with four ResMed officials, including Susie Justus, the company’s clinical patient advocate. ResMed is the leader in the field and the only one that seems to care about sleep apnea’s link to diabetes.

Susie spent several hours teaching me about successful treatment. I learned much of what I know about sleep apnea from her and almost all of what I know about how to treat it successfully. Here are some of her biggest tips.

What happens the first night that you use a CPAP? Typically, Susie says, that once you leave the therapist and are alone with the device, the trauma begins.

“The patient is now ready for bed and looks over at the night stand and is intimidated by a ‘medical device’ there,” Susie explains. “The patient turns on the unit, places the mask, and now the issues begin.”

You fight to maintain a seal. The pressure is blowing all over the place. It feels claustrophobic, and you give up after an hour or two. This routine may go on night after night. Soon it’s three weeks or so since the sleep study. With little to no sleep in that time, you’re ready to quit therapy. You think to yourself, “Why can’t I just take a pill?”

What could you have insisted that the people at the sleep lab or durable medical equipment company teach you when you got your CPAP?

Maybe they didn’t even tell you about the best type of CPAP. Nobody told me about alternatives when I got my first CPAP. The sleep lab and Apria set the pressure on my original CPAP too high. Now that I have a CPAP that adjusts the pressure automatically, I sleep much more soundly. Susie says that they have proven that ResMed AutoSet Vantage I’m using allows us to use an average of 37 percent less than our prescribed CPAP pressure.

She says that you should know whether your therapist measured you with a mask template to verify the correct size of mask that they ordered for you. Do you have any problems with seasonal or chronic allergies? Does the therapist know about your deviated septum? Do you awaken with a dry mouth? Are you using heated humidification? How would you describe your nasal bridge – average, tall, wide, narrow, or flat?

These are general questions that Susie suggests that anyone getting a CPAP system consider. A specific consideration that I have had is that my mask doesn’t keep a seal well when I turn from sleeping on my back to my left or right side.

“Your pillow can be your culprit,” Susie says. “You might want to invest in a cervical memory foam pillow, which will let you sleep on your side and maintain great head and neck support without disturbing the seal of the mask.” As soon as she told me this I ordered one of these pillows.

The mask is just a small part of the CPAP system. But it’s the only part that we come into direct contact with. In my experience these questions that Susie suggest we consider are the key ones. I only wish that I knew her back when I got my first CPAP.

This article is based on an earlier version of my article published by HealthCentral.

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