Flying with your CPAP

I get asked about this regularly by my patients. This article is about traveling with a CPAP. Since using CPAP therapy with all sleep will maximize effectiveness, you should bring your CPAP with you when you travel. Of course, don't forget to bring all of the accessories, especially the power cord. Most CPAP machines these days come with a canvas bag to carry the device. I advise my patients to carry the device on board, not checking it as luggage. This is because the CPAP may be damaged during luggage handling or transportation in the plane, or your luggage may be lost. You will need to show the TSA agent the CPAP equipment. Nowadays, they will be used to it, and you will see many other travelers with their CPAPs. You may also need to bring a letter from your physician or a specialized luggage tag that says the CPAP is a medical device that has been prescribed for you.

Some travelers, especially on overnight flights, will want to use their CPAP's on the plane. You will need to check with the airline to see if their planes have power sources and if you can sit near enough to one to plug in your CPAP. Be sure to ask what kind of power source the plane has, as you may need an adapter. Some of my patients have gotten small travel CPAPs that operate on battery power.

If you use the humidifier chamber, don't try to bring distilled water on the plane. Best to buy it at your destination, if available.

Depression and obstructive sleep apnea

Depression is a common disorder that exists along with obstructive sleep apnea (OSA). The exact relationship between the two disorders is not known. OSA may contribute to depression due to sleep loss, sleep disruption, and cognitive effects of intermittent low oxygen levels to the brain. Also, weight gain and sleep disruption from depression could exacerbate OSA. Some, but not all of my patients report that their depression gets better with treatment of OSA.

This study is a meta-analysis of research looking at the effects of CPAP and oral appliances on depressive symptoms (as obtained by depression questionnaires) in adults with OSA. The results showed small improvements in depressive symptoms with OSA treatment. The greatest benefit was seen in those patients with the worse depression scores at baseline.

Insomnia and mortality

Chronic insomnia is a frequent problem, and several studies have attempted to link insomnia with medical problems, even death. However, it's not clear from these studies that the relationship is as stated. One methodology problem with these studies is the fact that most of them define insomnia based solely on the research subjects' description of their sleep quality. In other words, secondary causes of insomnia are not ruled out with objective testing like sleep studies. This abstract is about research done on subjects with chronic insomnia. I don't have access to the actual article, so my analysis of the study is limited. I can't tell from the abstract if the research subjects had secondary causes of insomnia ruled out with sleep studies.

Researchers used data from a community-based cohort and categorized subjects into having either persistent, chronic insomnia, only intermittent insomnia, or no insomnia. The researchers defined persistent based on the subjects' description of their sleep quality over a six year period. They then determined when the subject died for up to a 20 year period. The researchers also examined levels of a marker of inflammation called serum C-reactive protein (CRP). There were 1409 research subjects - 249 with intermittent insomnia and 128 with persistent insomnia. The results showed that the subjects with persistent insomnia were 58% more likely to die than those without insomnia. Those with intermittent insomnia were not more likely to die than those without insomnia. Of note, most of the deaths were cardiovascular. CRP levels were higher in those with persistent insomnia than in those with either intermittent or no insomnia. The authors noted that CRP levels were associated with increased mortality by themselves. However, adjustment for CRP levels did not notably change the association between persistent insomnia and mortality. Also, the results were adjusted for confounders such as age, sex, body mass index, smoking, physical activity, alcohol, and sedatives.

Obstructive sleep apnea and exercise capacity

This study is a cross-sectional evaluation of the relationship between obstructive sleep apnea (OSA) and exercise capacity. According to the authors, how OSA affects exercise capacity is not clear, as prior studies have conflicting results. In this study, researchers did sleep studies on participants and put them into two groups. Those with no or mild OSA, and those with moderate or severe OSA. They then measured their exercise capacity and compared the results. The main finding was that OSA was associated with decreased exercise capacity. And more severe OSA was associated with worsening exercise capacity. The mechanism behind why OSA would affect exercise capacity is not clear. The authors speculate that it could be due to changes in energy pathways, changes in muscle fiber structure, and/or changes in blood vessels in muscles - thought to be a result of low oxygen levels associated with OSA.

Smoking and sleep

This article describes research about reducing cigarette smoking in your sleep. The study in the article involves using a psychological concept of learning called respondent conditioning - think of Pavlov and his dog, at outlined in this Wikipedia article. The study participants were all smokers who expressed desire to quit. Researchers paired the smell of cigarettes with a foul odor when participants were asleep. Supposedly, the participants unconsciously associated the foul smell with the smell of cigarettes and ended up smoking 30% less. There was no smoking reduction in participants that were exposed only to cigarette smoke when asleep or if the participants were exposed to both smells, but while awake.

Two other interesting points about this study. The first one is that the participants did not remember the smells they were exposed to in their sleep. Also, it appeared that a light stage of non-dream sleep was was the most effective stage of sleep that was associated with reduced smoking. The authors concluded that conditioning can occur in sleep and that this technique may be used in other addictions.

Adenotonsillectomy and asthma in children

Some research studies have demonstrated an association between obstructive sleep apnea (OSA) and asthma. It's not clear why they are linked - it could be that both involve inflammation. OSA is also associated with obesity, which is linked to asthma. The most common treatment for OSA in children is the surgical removal of adenoids and tonsils, referred to as an adenotonsillectomy (AT). This study looked at historical medical and pharmacy records of children with asthma who did and did not have AT. The data in this study was from quite a large database, and the children who had AT were matched with those without AT.

The results showed that asthma flare-ups were worse in children the year prior to AT. However, after AT, asthma flare-ups declined significantly, to levels similar to the kids with asthma who did not receive AT. A similar decrease was seen in asthma medication refills in those children who underwent AT.

The study authors conclude that the presence of OSA can worsen asthma control in children, and that treatment of the OSA with AT may reduce asthma flare-ups. The authors appropriately caution that prospective studies will be needed to establish a causal relationship.

Sleep apnea and sex

Studies have shown that obstructive sleep apnea (OSA) increases risk of erectile dysfunction (ED), and treating OSA with CPAP can improve ED. And some of my patients with untreated OSA are just too tired to engage in sex. Finally, some of my patients are hesitant to start CPAP therapy because they worry it will interfere with their sex life. This is usually in my younger patients and some of it is a misunderstanding about when CPAP is worn. Some think it's supposed to be worn whenever they are in their bed, as opposed to just sleeping.

This article discusses research presented at a recent meeting. Researchers asked participants about their sexual quality of life. The participants all has OSA and were prescribed CPAP therapy. The researchers divided the participants into two groups - those that used the CPAP regularly and those that did not. Results showed no difference in sexual quality of life between the two groups. The conclusion was that CPAP did not interfere with the participants sexual satisfaction.