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Sleeping With Darth Vader

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Not having lived through the late '70s, it's difficult for me to personally attest to this notion, but I have it on good authority that even in his day, Darth Vader was not widely accepted as a sex symbol. He was, after all, "more machine than man," a trait that doesn't typically translate well into the bedroom. So what if he was the love of your life, and you had promised to try to get some sleep next to his ominous hulllll-purrrr until death did you part? This is the perceived dilemma faced by many patients diagnosed with obstructive sleep apnea (OSA) and prescribed continuous positive airway pressure (CPAP).

For those unfamiliar with OSA, the disorder is characterized by the repeated obstruction of a person's airway during sleep. Causes can vary, but often involve weight bearing on the relaxed muscles of the airway. One of the main indicators of OSA is snoring, which is the noise made when air is pushed through an obstructed airway and rattles everything in its path. The National Institute of Health has noted that OSA "causes chronic elevation in daytime blood pressure," may contribute to obesity, and is associated with cardiovascular disease, impaired glucose tolerance, stroke, and diabetes (see http://www.ncbi.nlm.nih.gov/books/NBK19961/). The preferred treatment is CPAP therapy, which involves a device that uses air pressure to suspend the airway open during sleep.

CPAP therapy delivers its pressure via a small bedside machine that runs air through a hose and into a mask that fits over the nose, a point which brings us back around to our decidedly-unsexy friend Darth Vader, who also sported the mask-and-hose look. While he wasn't attractive, a lot of that was his personality, and it should be noted that once the mask was removed, he was not long for this world. If you or someone you love has been diagnosed with OSA, I hope that you'll consider some of the advantages that this look provides before dismissing it based on its appearance.

First, any recently-produced CPAP working properly eliminates the obstruction in one's airway and is itself no louder than having a small fan in the room. Compare this to loud, incessant snoring. Certainly, the sexier of the two (and the one most likely preferred by one's bed partner) is CPAP. Second, as noted above, untreated OSA causes increased daytime blood pressure, can contribute to obesity, and is associated with several other conditions, including stroke and diabetes. The unattractiveness of this speaks for itself. While CPAP cannot cure these conditions, it can be an essential therapeutic step in addressing or preventing them. Finally, other treatment options exist (oral devices, uvulopharyngopalatoplasty, hypoglossal nerve stimulation, etc.), but CPAP is the only therapy that supports both the upper and lower airway simultaneously. This presents a tremendous treatment advantage, particularly for severe OSA, which often features obstructions in portions of the airway not addressed by oral appliances or surgery.

So if your CPAP has left you feeling a little "Vader-ish" around bedtime, I encourage you to look at the big picture. Don't allow the momentary itch of vanity to inspire a rash of unhealthy choices. If you're having trouble with CPAP, remember that there are hundreds of masks and machines designed to address most imaginable comfort issues. Shop around on the internet and talk to your durable medical equipment provider to seek out the right combination of machine settings and masks. Bear in mind that most insurance plans have replacement schedules set up for CPAP machines and equipment that include a new mask every six months. There's really no need to struggle with old, worn-out equipment. Most of all, give it a little time. It can take anywhere from a couple of weeks to a month of therapy for your body to fully adjust to breathing with pressure and having adequate amounts of oxygen during sleep. Making lifestyle changes is never easy, but remember: An ounce of Darth Vader each night can prevent a pound of Jabba the Hutt.

Sam Cross, Registered Polysomnographic Technologist, is the lab manager for Parkway SleepHealth Centers, a comprehensive sleep health facility and innovative leader in the diagnosis and treatment of sleep disorders. Parkway's sleep center allows patients to be observed and assessed during overnight sleep sessions to determine the cause of their sleep problems; patients may also participate in daytime sleep sessions when appropriate. In his role, Cross conducts all of the home and daytime testing for the sleep clinic's patients and maintains the standards, equipment and personnel of the sleep lab. In addition, he is responsible for reviewing the recorded data of each study performed.

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