By, Lisa Plant

Obstructive sleep apnea has a long list of risk factors, including physical factors such as carrying excess weight, having a large neck circumference, and having a narrow throat or enlarged tonsils. Certain habits and lifestyle factors can increase the risk too. These include the use of alcohol, and certain medications, such as tranquilizers and sedatives. In addition, smoking significantly increases your risk of sleep apnea. In fact, according to The Mayo Clinic, smoking triples the risk of developing obstructive sleep apnea.

Why does Smoking have this Effect?

In general, anything that narrows the airway can increase the risk of obstructive sleep apnea—this is why seemingly unrelated physical features such as enlarged tonsils or adenoids are a risk factor. Cigarette smoking is a risk factor because over time, smoking can cause the airway to become narrower, leading to an increased risk of airway obstruction while sleeping. This airway narrowing occurs because cigarette smoke is an irritant, and smoking can cause the upper airway to become inflamed. In addition, the irritation tends to increase fluid retention in the area. Inflammation and retained fluid combine to narrow the airway, increasing the likelihood of snoring and other sleeping problems. More importantly, smokers are three times more likely than non-smokers to develop obstructive sleep apnea.

Sleep Apnea and Smoking, Statistically Speaking

The American National Sleep Foundation typically carries out a large-scale poll each year, to uncover information about American sleeping habits and health. According to the results of the Sleep in America poll conducted in 2005, 5% of American adults have sleep apnea, and 8% experience at least three episodes of disrupted breathing each week. As part of the Sleep in America poll, participants were asked to complete the Berlin Assessment Questionnaire, a survey which is used to determine whether someone has sleep apnea. The results of this questionnaire, together with the poll results, indicated that 26% of American adults are at risk of developing obstructive sleep apnea. For smokers, therefore, the risk is high. Giving up smoking is difficult for most people—there’s no doubt about that. However, even if smoking itself doesn’t cause any significant health problems such as cancer or emphysema, the effects of sleep apnea, which include an increased risk of stroke and heart attack, are just as serious.

The Effects of Smoking and Sleep Apnea

Many research teams have already shown that people with obstructive sleep apnea have increased levels of cellular oxidative stress and free radicals, and of inflammatory cells and molecules. In addition, endothelial cells—the cells that line blood vessels—die off faster, and are more “sticky” in people with sleep apnea. This “stickiness” is a physiological feature of atherosclerosis, the cardiovascular disease which causes arteries to become stiffened and eventually blocked by plaque buildup. Partial or complete blockage of arteries can then lead to heart attack or stroke. Smoking is also a known cause of all of these signs and symptoms.

In 2007, researchers from the Technion-Israel Institute of Technology published a paper in the journal Sleep Medicine, demonstrating increased levels of these risk markers in smokers with sleep apnea. In this study, 35 smoking and 35 non-smoking participants were separated into categories according to gender, age, body mass index, severity of sleep apnea, and cardiovascular symptoms. Blood samples from each participant were analyzed for several markers of cardiovascular disease, including HDL and LDL cholesterol, inflammatory molecules, and molecules that cause endothelial “stickiness”.

The researchers found that smokers with sleep apnea have a much greater risk of cardiovascular disease and life-threatening cardiovascular events than smokers with mild sleep disorders, and non-smokers with severe sleep apnea. Essentially, smoking and sleep apnea appear to have a synergistic effect, making the combination of the two highly dangerous. The risk is especially great for people who smoke more than 20 cigarettes a day.

Reducing Your Risk Levels

The risks for smokers with sleep apnea are high—and sleep apnea is a disease that can remain undiagnosed for long periods of time. If you’re a smoker, therefore, finding out whether you have sleep apnea, or determining your level of risk, is extremely important. Giving up smoking isn’t easy, but reducing the amount you smoke can have positive health results even if you’re unable to quit completely. Just as important, if you are diagnosed with sleep apnea, getting effective treatment can reduce your risk of cardiovascular disease, at the same time as helping you obtain the many other benefits of restful sleep.


By Lisa Plant

There are proven associations between obstructive sleep apnea and a range of symptoms and diseases. People with this sleeping disorder have an increased risk of high blood pressure, diabetes, irregular heartbeat, heart attack, heart failure, and stroke. They are also more likely to cause or be involved in driving-related and workplace accidents. In addition, there is mounting evidence that in the long term, sleep apnea is related to the development of dementia.

Cognitive Effects of Apnea-Related Disruption of Sleeping Patterns

Multiple studies have shown that sleep apnea causes cognitive impairment, simply due to the tiredness that is caused by the continual disruption of sleeping patterns. People with sleep apnea just don’t get enough sleep—and this leads to impaired short-term memory, reduced mental flexibility and problem-solving ability, reduced motor coordination, and reduced ability to maintain attention. All of these come under the umbrella term “cognitive effects”, where cognitive refers to mental processes such as memory, language, reasoning, problem-solving, and attention. In short, sleep apnea reduces cognitive function, which negatively affects all of these mental processes. This is a proven relationship which has been well-studied. In contrast, the relationship between sleep apnea and dementia is much less defined. Dementia is a devastating disease that also affects cognitive ability, and people with dementia often develop sleep disturbance disorders, including sleep apnea. Many studies carried out in recent years show that there’s a definite link between sleep apnea and many forms of dementia, including Alzheimer’s disease, but the exact nature of the link is highly uncertain.

Does Sleep Apnea Cause Dementia?

A recent study published in The Journal of the American Medical Association looked at the sleeping habits of nearly 300 women aged 65 and over, on two occasions five years apart. At the time the study began, the women were both physically and mentally healthy. After five years, the results showed that women with disordered sleep were 85% more likely to develop cognitive impairment or dementia. More specifically, this relationship was found only in cases where sleep disruption events caused hypoxia, or reduced oxygen to the brain, as the result of sleep apnea. Simply put, the women in this study were 85% more likely to develop cognitive impairment or dementia if they suffered from sleep apnea. However, this study—and others like it—have not been able to determine whether or not this link proves the existence of a causal relationship between sleep apnea and dementia.

In medical terms, a causal relationship is one where it can be proven that one condition causes another condition, either wholly or partially. The other side of this coin is called correlation: where two medical conditions exist side-by-side, but without any evidence of causality—did one condition cause the other, or were they both caused by a third as-yet unknown factor? Very often, in medical science, it’s impossible to tell whether a relationship indicates causation or correlation, because both situations have the same outcome.

In the study mentioned above, the presence of a causal link would mean that people with sleep apnea have an increased risk of developing dementia—and the study certainly seems to show that. However, if the link is a factor of correlation, and not causation, the results would be exactly the same. As yet, no studies have been able to demonstrate this kind of causal link, so there is currently no evidence to show that sleep apnea specifically causes dementia.

Is it the Other Way Around?

Another possibility is the idea that the relationship works in the opposite direction—that dementia leads to sleep apnea. In another recent study, sleep disordered breathing was examined in conjunction with known medical markers that signify risk factors for Alzheimer’s disease. All of the participants, who ranged in age from 64 to 87, had normal cognitive function. At the conclusion of the study, in some groups of participants, the researchers found links between sleep-disordered breathing, and the presence of one or more early markers for Alzheimer’s. Essentially, they found that people with sleep-disordered breathing were more likely to have at least one of the risk factors tested. As with the previous study, however, there’s no way of knowing the true nature of this relationship. This particular group of researchers plans to take the next step, and try to determine whether the dementia is causing sleep apnea, or whether it’s the other way around. They plan to study patients who have early Alzheimer’s-related risk factors and sleep apnea, to determine whether treating the sleep disorder affects these risk factors.

Sleep Disorder Treatment

Either way—whether dementia causes sleep apnea, or apnea leads to dementia—it’s clear that getting tested and treated for sleep disturbance disorders, and sleep apnea in particular, is important. The development of symptoms such as morning headaches or dry throat, daytime sleepiness, mood problems, depression, or personality changes, and problems with learning, memory, or concentration, are all indicators of sleep apnea, and the health risks associated with the condition make treatment an important matter.

Cover of Respiratory Therapy magazine

Provent is featured in the October-November 2012 issue of Respiratory Therapy. The informative article offers healthcare providers and patients an overview of nasal expiratory positive airway pressure (EPAP) – an important new class of therapy to safely treat sleep-disordered breathing, ranging from primary snoring to all severities of obstructive sleep apnea (OSA).

Nasal EPAP for the Treatment of Obstructive Sleep Apnea (Provent) and Snoring (Theravent)

Provent invites you to view Dr. Glenn D. Adams’ Provent Industry Product Theater presentation “Nasal EPAP Therapy and In-Lab Polysomnography: A Clinical Practice Perspective” from SLEEP 2012.

As a solo practitioner at Sleep Medicine Specialists in Florida, Dr. Adams diagnoses 800 new OSA patients a year. He started prescribing Provent Therapy in September 2009. Today, Provent is offered to all his OSA patients, including compliant CPAP users as well as CPAP failures.

The video provides valuable insight into his patient protocol to ensure patient buy-in and successful acclimation of Provent Therapy.

In this video, Dr. Ronald A. Popper shows why some people benefit from wearing a chin strap with Provent. Dr. Popper explains why a “home made” chin strap could be more effective in enhancing AHI reduction results in patients with OSA using Provent.

by Ronald A. Popper, MD

Having Trouble Acclimating to Provent Therapy?

Here are some helpful tips for successfully using Provent Therapy for Obstructive Sleep Apnea

Prior to applying Provent, make sure all makeup is removed and your face is thoroughly washed so all of your facial oils have been removed. This will assure that the adhesive provides complete occlusion of your nostrils. Provent will not work properly if air can escape around the bandage.

Use a mirror while applying Provent for the best results. Angle the valve in the same direction as your nostril. Pull your upper lip down with your lower lip. Place the valve into one nostril. Gently pat the adhesive around your nostril. The tab should be on the outside of your nose. Repeat the same procedure for the other nostril. When you think you have secured each Provent properly, test for air leakage by gently exhaling through your nostrils and feeling for the escape of air. If there is no air leak, you have properly applied Provent. If air escapes, press down on all sides of the adhesive until no air escapes.

Remember, Provent works by making it harder to exhale through you nose. This is what creates the positive airway pressure required to successfully treat your sleep apnea. It should be harder to exhale through your nose while you are awake. If it is uncomfortable, take a few breaths through your mouth to relieve the pressure you are feeling. Then go back to slowly inhaling and exhaling trough your nose. Do not try to forcibly exhale…you should be able to slowly exhale with minimal extra effort, although you will feel the pressure from the Provent.

Rest assured that if you are able to breath in and out through your nostrils while awake, it is natural for you to do so once you fall asleep, even with the extra effort required while wearing Provent. If you are a mouth breather while awake, you are may also be a mouth breather during sleep and require a chinstrap to keep your mouth closed. If you open your mouth while asleep and using Provent, it will not work, as the positive pressure will simply escape through your mouth.

It may take a few nights of using Provent to acclimate to the pressure sensation. Do not give up after just one night. If you cannot wear it the whole night, take it off and try again the next night. Most patients will acclimate to the increased effort to exhale within 2-3 nights. Some patient may require up to 2 weeks. Each night should become easier, allowing longer wear times until you are finally wearing Provent all night.

by Ronald A. Popper, MD

Provent Therapy for Obstructive Sleep Apnea is an exciting alternative to traditional CPAP therapies for those who won’t use or can’t tolerate them.

OSA is a serious medical condition characterized by repetitive episodes of blockage of the airflow to the lungs during sleep. This is caused by the complete collapse of the airway and stoppage of airflow (known as apnea) or a reduction of airflow caused by a partial collapse of the airway (known as hypopnea). These breathing interruptions can cause a person to momentarily wake in order to resume normal breathing. For many sufferers this can happen dozens of times during the night and greatly affect the quality of sleep. OSA has been associated with a wide range of other health issues such as hypertension, diabetes, obesity, heart disease and stroke. Fortunately, successful treatment of OSA has been shown to reduce the risk of developing these associated health issues.

Provent® Sleep Apnea Therapy utilizes small, single-use adhesive devices that attach to the nostrils, providing an effective, FDA-cleared, nonsurgical treatment to reduce the effects of OSA. Provent Sleep Apnea Therapy has shown to be both SAFE and EFFECTIVE in 10 different clinical trials involving more than 750 people with OSA. Trial results have been published in international peer-reviewed journals including the medical journal Sleep. Provent Sleep Apnea Therapy is currently commercially available in the United States, Australia, New Zealand, Hong Kong and Canada.

In the months ahead, this blog will offer insight and experience from sleep physicians and healthcare professionals involved in sleep-disordered breathing, as well as patients who are benefiting from this technology. So check back often and join in the conversations.