Pain and sleep - the relationship

Obstructive sleep apnea (OSA) is a very common but as of now an underdiagnosed sleep disorder. It is the most common sleep disorder seen at sleep centers. It could be that 20-50 million people in the USA have OSA.

OSA is life-threatening; there are repeated collapses of one’s upper airway during sleep. This causes the breathing to stop and this in turn robs the person of life-giving oxygen. In addition to death, OSA has a great impact on the quality of life of those with the condition.

Many of the patients with OSA have all kinds of pain, and this pain disturbs their sleep even more. Therefore it is imperative that health caregivers who are managing pain in their patients know about OSA, its causes, and its treatment.

Studies have shown that obstruction in the nose leads to a tendency have OSA. Any obstruction above the upper airway will cause the airway to have more of a tendency to collapse.

Management of OSA with nonsurgical methods

Managing OSA includes modification of the patient’s lifestyle, continuous positive airway pressure (CPAP), and use of dental devices (oral appliances). Lifestyle modifications include avoiding alcohol, sedative drugs, and cigarettes, changing sleep position to avoid sleeping on the back, having good sleep habits, and losing weight.

Continuous Positive Airway Pressure

CPAP works by keeping the collapsible upper airway open with air pressure. It essentially blows the patient up like a balloon. CPAP pressure in the mask doesn’t stay constant at night because patients change position. The various stages of sleep also require different breathing pressures. So the sleep clinician may select a pressure setting for the patient that is high enough to guarantee the airway stays open under all these conditions. This means the pressure is too high during the periods of sleep when a lower pressure is all that is required.

The result of this in many cases is mask leakage, uncomfortability, and feelings of claustrophobia. Therefore, patient compliance remains a significant problem. Studies have found that up to 50 percent of patients discontinue CPAP therapy within 12 months.

Dryness in the mouth also contributes to CPAP noncompliance. The high pressure used with the CPAP can exceed the ability of the nose to warm and humidify the air. Adding to this problem of high pressure is “mouth leak,” when air exits through the mouth. In normal breathing, air breathed out of the lungs gives up heat and moisture to the tissue in the nose. This can occur even though there is a humidifier on the CPAP machine.

To compensate for this “mouth leak” problem, nasal blood vessels dilate, or get larger, and make the airway in the nose even smaller, resulting in more resistance to breathing through the nose as well as increased congestion in the nose.

There are also some conditions that may indicate that the use of CPAP therapy is not to be used for some patients. These should be carefully weighed by the health care personnel.

Oral appliances

A great option for those with OSA is an oral appliance fitted by a qualified dentist in coordination with the patient’s medical doctor. It is a comfortable alternative to CPAP for those who travel, camp, hunt, etc. An oral appliance is a small dental device, like a mouth guard, worn in the mouth during sleep to prevent the collapse of the airway.

Oral appliances, called mandibular advancement devices, reduce OSA and snoring by advancing the lower jaw during sleep. Since the tongue is attached to the lower jaw only behind the lower front teeth, this advancement will keep the tongue from collapsing the airway.

Pain and sleep

Pain usually goes with sleep disorders; this has been known for a long time. But how the two relate is very complicated. Obviously, pain affects a patient’s ability to get a good night of restful sleep. And, this sleep loss changes the perception and level of pain. This can result in a cycle of pain and sleeplessness, causing reduced performance at one’s career or job, increased absences at the job, more disabilities, increased cost for health care, and dangerous driving, resulting in more accidents. Therefore, it is imperative that these conditions be treated.

The first step to manage the patient with pain and a sleep disorder is to find out what the sleep disorder is so that any treatment can be appropriate for the cause of the disorder. The quality of one’s life will always suffer when pain and a sleep disorder are present. The quality of life for all those associated with the individual with the pain/sleep problem is also affected. Relationship problems many times result from this.

The consequences of pain and OSA can be great both for the patient affected, bed partners, and family members. Optimal treatment will always depend on accurate diagnosis and proper treatment. Therefore, both the pain and the sleep disorder must be diagnosed and treated. Consultation with a qualified medical doctor or dentist would be a great place to start.

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Dr. Donald Johnson founded Northwest Treatment Center for Snoring & Sleep Apnea in Coeur d’Alene to help patients stop their snoring/sleep apnea and live free with no limits. Sometimes treatment of a sleep disorder can stop the pain. His office is at 114 W. Neider Ave. in Coeur d’Alene, near Costco. More information at www.NWSleepDoc.com or by calling (208) 667-4551. Schedule a free consultation appointment today.