The Benefits of Treating OSA/UARS

The majority of patients suffering from OSA/UARS probably do not realize all the benefits they may receive from successfully treating their sleep disorder. A particular reason to elaborate on all the relevant outcomes here is that this information can help you clarify how well you are doing with your current sleep apnea treatment or whether to consider making a switch in treatment options: PAP therapy vs. oral appliance therapy (OAT) vs surgery vs very conservative treatments (e.g. side-sleeping, aggressive nasal hygiene, cooler room temperature). Obviously, sleep breathing symptoms should be eliminated in all patients. 

This post will comprise a detailed list with mostly brief annotations about each symptom to clarify why or how this symptom should get better. For some symptoms, I will discuss why there may be more confusion about the role played by OSA/UARS in causing or aggravating the problem.

 

Sleep-Related Symptoms

Sleepiness & Napping

Perhaps most common symptom; improves as sleep consolidation restored; many patients are misled into thinking oxygenation is the biggest issue, but the most damaging element to the majority of patients is the sleep fragmentation effects, which once corrected almost always lead to a decrease in daytime sleepiness or in napping.

Fatigue & Tiredness

These two feelings of lowered energy states overlap somewhat with sleepiness, but they also show distinctive features that speak directly to an inability to accomplish tasks or chores due to low energy; whereas, sleepiness precedes sleep onset, tired or fatigue may have no bearing on when or for how long you sleep; still, some sleep apnea patients unequivocally report a decrease in fatigue or tiredness with treatment.

Unrefreshing sleep

Morning experience changes with higher quality of sleep; you literally feel a sensation of refreshed energy

Depth & Quality of Sleep

Greater sleep consolidation and more delta sleep yields a feeling of deeper slumber; any persistence of sleep fragmentation or the sense of lighter sleep means a problem persists; most patients report improvement in both depth and quality of sleep when PAP is working well.

Nighttime Awakenings & Insomnia

Consolidated sleep means fewer awakenings at night; successfully treated sleep apnea patients are often capable of sleeping all through the night and eliminating insomnia

Nocturia

Amazingly, trips to the bathroom decrease, because your over-active kidneys are lulled back to sleep with sleep apnea therapy; even a single trip to the bathroom at night might be one too many; among patients with known bladder or prostrate problems, reduction in trips to the bathroom still occur with successfully treated sleep apnea.

Leg Jerks

The most common association with leg jerks are sleep breathing events, thus in the largest proportion of cases where leg jerks appeared on a diagnostic sleep study, those leg jerks will typically disappear with sleep apnea treatment; if leg jerks persist, it suggests an independent problem that needs its own treatment.

Nightmares & Other Parasomnias

It is extremely common to see some reductions in nightmares, sleep talking, sleep walking and other forms of disruptive motions and sounds when sleep apnea is treated.

 

Cognitive Benefits

Attention and Concentration

Restoration of sleep brain waves to cycle through the normal stages of sleep, including delta (deep) sleep and REM sleep often results in a capacity for sharper focus the next day and improvements may be noticeable during the initial weeks and months of treatment. 

Memory

This cognitive set includes many different aspects of memory, short and long-term as well as types of memory. While many aspects may be improved, the more noticeable one is benefits in short-term memory; however, the memory capacity appears to be greatly influenced by age; thus, a 40 year-old is much likely to notice key enhancements in short-term memory if he or she had been suffering from a problem; whereas, a 60 year-old might see fewer gains. A good reason to treat sleep apnea as soon as it is diagnosed.

 

    Emotional Benefits

    Mood

    Co-occurring depression is extremely common in sleep apnea, and there is definitely some evidence that treatment of the sleep breathing disorder will improve mood; but, the evidence is not definitive; most sleep physicians have seen anecdotal cases of depressed patients eliminating all of their anti-depressants after starting with PAP therapy; but, this also raises the question of whether or not the diagnosis of depression was accurate or whether the patients’ daytime fatigue and sleepiness manifested as a form of depression.

    Anxiety

    Similar to depression, there is no conclusive evidence, but there are patients who report improvements in generalized anxiety. And, among posttraumatic stress patients (a type of anxiety disorder), there is also anecedotal evidence of improvement; rare cases have also been reported of a decrease in panic attacks (another anxiety disorder) with PAP therapy.

    Bipolar

    The most likely benefit for bipolar patients is that consistent use of PAP therapy for sleep apnea patients may lead a more consistent sleep schedule, which has been shown to be a positive behavioral pattern for these patients; however, in rare circumstances, case reports have described patients who entered into a manic phase after using a PAP device.

       

      Cardiovascular Benefits

      Hypertension

      This single condition may be the primary key to how sleep apnea adversely affects heart health; whether due to chronic sleep fragmentation or oxygen desaturations or both, the relationship between sleep apnea and high blood pressure is reasonably well established; many patients report great control of BP when treating their sleep apnea; and among new hypertensives, it is not unusual to hear that medication for BP control is eliminated a few months into PAP treatment.

      Heart Attacks

      For well more than a decade, untreated sleep apnea has been described as if one is smoking a pack of cigarettes/day; thus informed cardiologists routinely order sleep testing for patients following cardiac events; undoubtedly, the hypertension effect is a critical component, but additional research suggests that sleep apnea damages the inner line of blood vessels, including the coronary arteries, and therefore leads directly to atherosclerosis and heart disease.

      Congestive Heart Failure

      Perhaps more than any other cardiac link, save hypertension, more cardiologists want to see their heart failure patients tested and treated for sleep apnea; whether PAP therapy improves the pumping action of the heart or prevents a decay in the pumping function, research already suggests that PAP use will decrease time in the hospital when a patient is admitted for congestive heart failure. 

      Cardiac Arrhythmias

      There are many different types of rhythm disturbances of the heart, but the most widely researched is the relationship between atrial fibrillation and sleep apnea, so much so that most cardiologists nowadays order sleep testing for a sleep apnea evaluation in new onset atrial fibrillation; other arrhythmias may also improve with PAP therapy, but research is not well-established in this area; oddly, we see rare cases where PAP therapy appears to trigger isolated PVCs of unknown clinical relevance in some patient.

      Enlarged Heart

      The ventricles, or the two largest chambers of the heart, may either thicken or dilate or both when sleep apnea goes untreated; a finding of right ventricular hypertrophy (thickening) is one of the most common findings in at-risk cardiac patients with undiagnosed sleep; the finding is seen on an echocardiogram, and once documented, the cardiologist will almost invariably order sleep testing for sleep apnea; remarkably, some patients treated for sleep apnea with PAP therapy will see the thickening subsided within the initial 6 to 12 months of treatment.

         

        Sexual function

        Erectile Dysfunction

        There is evidence of improved sexual function following the use of PAP therapy, including reversal of impotence; but, overall, it remains unknown what the long-term impact might be for patients successfully treating their sleep apnea; not surprisingly, one study showed enhanced mental health benefits for women after their male partners used CPAP and experienced improvements in erectile dysfunction.

        Libido

        Libido or sexual drive can certainly change for the better in any circumstance where someone feels more energy or a more optimistic mood; but there is scant research on the specifici relationship between sleep apnea and libido or its change following the use of PAP therapy.

           

          Miscellaneous Benefits

          Younger Appearance

          Remarkably, it is extremely common for new PAP users in the first few months to receive notice or outright compliments on how much younger or healthier they appear. While there may be no research on this question, obverse condition of aging is frequently examined in the scientific literature and clearly supports the view that sleep apnea aggravates if not causes the aging process.

          Menopause

          Although there may be no research in this area, it is well-documented that pre-, peri- and post-menopausal women suffer higher rates of insomnia and sleep apnea, with two conditions frequently linked; therefore successful treatment of sleep apnea may markedly improve the sleep problems in menopausal women.

            Will an individual gain improvement in all these conditions? It is certainly possible, although much depends on how well you are responding to PAP therapy and what degree of objective improvement is observable when your are retested in the sleep lab.

             

            As I have recently described in a post on specifically rating your experiences with PAP therapy, it often is a very worthwhile experience to review the night time and daytime symptoms you may be experiencing to determine whether or not you should be questioning how well you are currently responding to treatment.

            Have I missed anything? Almost definitely. Sleep apnea is a multi-system disease process in ways similar to conditions like diabetes or depression. Thus, the potential to adversely influence so many different organ systems in the body means a broad array of symptoms may emerge from undiagnosed sleep apnea. Just so, we hope that receiving solid treatment in the form of evidence-based PAP therapy will go a long way in reducing many, perhaps all of these symptoms.

             


            Barry Krakow MD

            Author

            Dr Krakow’s 27 years of sleep research have focused on the complex relationship between physiological and psychological sleep disorders. Dr Krakow currently operates private sleep medical center, Maimonides Sleep Arts & Sciences, Ltd., and serves as Classic SleepCare’s paid Medical Director.



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