The Importance of Treating Sleeping Apnea in MCI: Getting Started

Why are we talking about sleep apnea in MCI?

Sleep apnea is a very common sleep disorder in the general population and also a common sleep disorder in our patients with Mild Cognitive Impairment (MCI). Sleep apnea is a sleep disorder where individuals stop breathing at night (and then gasp themselves into breathing again). Take a look at this link if you want more information on sleep apnea. My husband actually has sleep apnea, finally diagnosed after we were married, and I discovered the extent of his snoring and gasping for breath at night (in between the scary silent pauses when he wasn’t breathing at all).

In our patients with MCI, sleep problems are a significant cause of “excess disability”—it makes a person’s memory or thinking problem worse. One of our major aims in the Mayo Clinic HABIT Healthy Action to Benefit Independence and Thinking © program is to identify and treat anything that could make MCI worse. Sleep apnea is one of those that is very common.

Using a CPAP machine, or continuous positive airway pressure machine, or a related device, is a very common treatment recommendation, and CPAPs are very effective treatment. The problem is many, many individuals, including my husband, have trouble adjusting to using a CPAP machine. But treating your sleep apnea goes beyond just helping your memory: treating sleep apnea also has a major impact on your physical health. Importantly, complications of sleep apnea also increase your risk of heart problems and heart disease...Not to mention sleep deprived bed partners!

First steps to adjusting to a CPAP

Some individuals take to a CPAP or related device right away. For others, it is a struggle. I will get to some behavioral strategies for helping yourself adapt next week, but first, it is important to be sure you’ve done all you can to be sure you have the equipment that is the right fit for you. Sometimes, all it takes is the right mask and voila! CPAP and (quiet) dreamland are all yours. The variety of device options is not my area of expertise, so first, be sure you’ve explored with your physician or device supplier the following:

1. Have you tried a variety of different masks? For my husband, he finally needed to move from a mask that covered his nose to a “nasal pillow” type mask that fit at the bottom of his nose.
2. Have you confirmed that the pressure is set optimally for your needs? This is typically done at your sleep study visit, but it never hurts to ask if you feel that the pressure is too much or too little (if you feel it is too much, but your physician has confirmed it is correct, I’ll be providing some behavioral options next week).
3. Have you explored other device options that may help ease the adjustment? For example, does your device offer a humidifier? Do you even need a humidifier? Does your device offer a “ramp up” period so that the pressure gradually increases when you turn it on? Perhaps you could benefit from a BiPAP rather than CPAP. A CPAP has the same continuous air pressure all the time while a BiPAP has two levels of pressure—one that is harder when you breathe in but lower when you breath out. Do you need a chin strap to help keep the mask on through the night and your mouth closed?

These are just a few observations as a spouse of a loved one who had to explore lots of equipment before finding what was right for him. Turns out, he needed the pressure ramp up because he couldn’t tolerate the full pressure right away. He also really needed the humidifier. We live in Arizona, and his first machine didn’t have one. Talk about a dry mouth in the morning!

Now that you know why it is important, and some important first steps to try with your doctor, check back next week for more behavioral strategies if adjustment is still difficult.