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CPAP Compliance Inadequate for Diabetes

Diabetes Kit via Jessica Merz on WikicommonsWe know that compliance with CPAP therapy is notoriously bad. Some studies show compliance rates as low as 20% for CPAP therapy. Now it seems that even if patients are meeting the standard for compliance according to the technical definition, it’s not enough to help with important metabolic effects of sleep apnea, such as diabetes.

REM vs. NREM Sleep Apnea

Researchers from the University of Chicago looked at whether sleep apnea disturbances during rapid eye movement (REM) sleep were more important for regulation of diabetes than disturbances during  non-REM (NREM) sleep.

It turns out that sleep apnea events occurring during REM sleep cause more metabolic disturbance than those that occur during NREM sleep. Researchers measured the hemoglobin A1C levels in patients and compared it to the amount of sleep disturbance people experienced during REM sleep. Hemoglobin A1C, or glycated hemoglobin, is a measure of glycemic levels that gives an overall estimate of a person’s average blood sugar over the previous three or four months.

Results showed that apneic events during REM sleep were independently correlated with higher hemoglobin A1C levels. People with the lowest level of sleep disturbance during REM sleep had a hemoglobin A1C score of 6.3%, while those with the highest level had a score of 7.3%.

Why CPAP May Not Be Effective

The problem with sleep apnea is that even when people comply with treatment, they typically are only getting four hours of CPAP a night, which means they’re being treated during the first part of the night, but not the second. However, REM sleep occurs predominantly in the second half of the night, meaning that most people miss out on the benefits of CPAP treatment when they need it most.

In this study, researchers estimated that four hours of CPAP treatment would only cover 40% of REM events, while improving the compliance measurement to seven hours of CPAP would cover a full 85% of REM sleep, resulting in significantly improved hemoglobin A1C levels.

The Importance of REM Sleep

This study analyzed the effectiveness of CPAP for treatment of REM sleep disturbances for diabetes control, but disturbing REM sleep may have many other potential impacts, including:

  • Interference with brain development

  • Depletion of brain resources

  • Memory problems

  • Increased anxiety

  • Cognitive disorders

In order to effectively avoid these problems, we need to target sleep apnea events during both NREM and REM sleep.

There Is an Alternative

Fortunately, there are more treatment options than just CPAP for sleep apnea. Oral appliance therapy may work better for some people who do not get good results from CPAP.

To learn whether oral appliance therapy may help you, please contact Strober Dental in San Diego today.

By |February 26th, 2014|Sleep Apnea|