Mixed or Complex Sleep Apnea – The Treatment Emergent Sleep Apnea

What is CompSA or Mixed Slep Apnea?

There are three forms of sleep apnea: central (CSA), obstructive (OSA), and complex or mixed sleep apnea (i.e., a combination of central and obstructive) constituting 0.4%, 84% and 15% of cases respectively.

In obstructive sleep apnea, the more common form, the throat muscles relax and the airway is narrowed, momentarily cutting off breathing and resulting in noisy snoring. With central sleep apnea, the brain does not send proper signals to the muscles that control breathing. Mixed or complex sleep apnea, is a combination of both obstructive and central sleep apneas.

According to UpToDate, Complex sleep apnea (CompSA, also called “treatment-emergent central sleep apnea”) is the emergence or increase of central apneas and hypopneas during the initiation of continuous positive airway pressure therapy (or bilevel positive airway pressure without a backup respiratory rate) for obstructive sleep apnea (OSA).

As per PMC Patients with complex sleep apnea exhibit OSA, but upon application of positive airway pressure, the patient exhibits persistent central sleep apnea. This central apnea is most commonly noted while on CPAP therapy, after the obstructive component has been eliminated. This has long been seen in sleep laboratories…

As per the results of a study conducted by researchers at Mayo Clinic, patients with complex sleep apnea at first appear to have obstructive sleep apnea and stop breathing 20 to 30 times per hour each night. But unlike typical obstructive sleep apnea patients, their breathing problem is not completely alleviated by a CPAP (continuous airway pressure) machine, which functions like a pneumatic splint to open a patient’s airway.

Instead, once the CPAP is applied to complex sleep apnea patients, the obstruction seems to dissipate, but still they do not breathe properly. Symptoms of central sleep apnea then appear and fragmented sleep results, due to frequent pauses in breathing.

Risk Factors

Complex Sleep Apnea or CompSA is more common among men than women. “This may be due to less stable respiratory control in males than females”, says Timothy Morgenthaler, M.D., Mayo Clinic sleep medicine specialist, pulmonologist and lead study investigator.
CompSA is also more common among patients with heart failure, among patients with severe OSA, and among patients with a mixture of obstructive and central apneas during initial polysomnography.
Additional factors associated with CompSA include non-rapid eye movement sleep, use of higher levels of continuous positive airway pressure (ie, over-titration), use of a high pressure support level, high altitude, oral breathing, opioid narcotics, and, possibly, sleeping in a supine position.

The complex sleep apnea patients have fewer complaints about waking up after initially falling asleep than those with central sleep apnea. Complex sleep apnea could be diagnosed based on patients’ sleep patterns defined at their initial diagnostic exams plus lack of response to CPAP.

According to Dr. Morgenthaler, an effective treatment for Complex Sleep Apnea has not been identified, but research continues to test breathing assistance machines to alleviate this condition’s symptoms.

Jillian Michaels Slams PC Diet Culture: Obesity Shouldn’t Be ‘Glamorized’

Jillian Michaels has never shied away from having an unpopular opinion when it comes to anything health, wellness, or fitness related. She is always the first skeptic of any get-thin-quick diets or workouts, and has an incredibly no-BS way of expressing her viewpoints.

Now, in a new interview with Women’s Health UK, the former Biggest Loser coach takes aim at the politically correct body positive movement that has been sweeping the wellness world over the last few years, claiming that it may be putting people’s health and lives at risk.

“I think we’re politically correct to the point of endangering people,” she told the magazine as part of their January/February issue featuring her on the cover. She points out that she doesn’t encourage excluding anyone and that shaming anyone for their weight is definitely wrong.

“Yes, we want to be inclusive of everyone (and respect that) everyone comes in all different shapes and sizes. That nobody should ever be body shamed or fat shamed or excluded and that everyone is equally deserving and should feel equally valuable.”

However, she worries that encouraging people that excess weight is desirable is more potentially harmful than anything else.

“Obesity in itself is not something that should be glamorized,” she continued. “But we’ve become so politically correct that no one wants to say it.”

Michaels also added that she doesn’t believe that the return of the Biggest Loser this January is going to be welcomed with open arms.

"I think the world has shifted to a place where that format and messaging is considered fat shaming," she shared. "But it isn’t, and it’s not meant to be. Now we’ve gone so far in the opposite direction."

Many people expressed outrage over Michaels’ comments, including body positivity advocate Jameela Jamil.

“Elitist ignorance from a renowned long time bully of fat people. Don’t just shame and blame,” The Good Place star shared in a series of tweets. “Cheap food, which most can afford is full of hormones and sugars. Many work too many jobs to have time/money to work out. There’s PCOS, Insulin resistance, Medication side effects.. etc.”

“Just existing, or even DARING to post a nice picture of yourself feeling beautiful and sexy isn’t glamorizing ANYTHING,” she continued. “It’s just existing and loving yourself. Not a crime. Not a threat to anyone. Shame and erasure doesn’t work. If it did, we’d be a *very* thin world by now.”

This isn’t the first time Michaels has ruffled feathers with her controversial opinions. She has lashed out at the high-fat, low-carb keto diet (favored by celebrities such as Kourtney Kardashian, Jenna Jameson, and Al Roker) a number of times, calling it a “bad plan” for “a million reasons.”

“I don’t understand. Like, why would anyone think this is a good idea?” Michaels said in a video for Women’s Health. “Don’t do keto,” she continued “How much time do I have? And I’m not allowed to swear? Yes, keto is a diet fad. The reason that keto has been getting so much attention is because it helps significantly to manage your insulin levels. Very high insulin, very bad thing.”

She continued to explain that the reason people lose weight on the diet, is because they are basically starving themselves by depriving their bodies of nutrients. Instead, Michaels encourages a healthy, balanced diet. “You don’t eat processed sugar, you don’t eat processed grains, and to make a very long story short: avoid the keto diet,” she added. “Common sense. Balanced diet is key.”

To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter

https://www.health.com/weight-loss/jillian-michaels-obesity-glamorized-controversy

Jenna Jameson Says She Took a ‘Break’ From Keto—and Gained 20 Pounds

Jenna Jameson has been one of the biggest advocates of the keto diet. The 45-year-old self-proclaimed “keto queen” first started the diet nearly two years ago, meticulously detailing her drastic transformation on social media. However, in recent months her Instagram account has been relatively keto-free.

On Thursday, she revealed to fans why: Because she is back on the carb wagon—and she’s gained 20 pounds. She also confessed that she isn’t sure if she will return to the restrictive diet, because it is too hard to maintain.

“Confession. I’ve gained 20 pounds. Ugh. I decided to take a break from #keto and live my best carby life,” Jameson said in her Instagram caption.

“The weight came back fast and furious,” she admitted. “I know a lot of people are quitting keto because it’s hard to maintain and after a year and a half I concur. Not sure if I’m going to go back full force or just calorie count. What are your thoughts?”

Since starting keto after giving birth to daughter Batel Lu in March 2018, Jameson has shed around 80 pounds. In addition to frequent before-and-after photos showcasing her progress, she has also filled her feed with lots of keto recipes, tips, and exercises that helped her get back into shape.

Jameson wasn't the only celebrity who has endorsed the keto diet. Kourtney Kardashian, Halle Berry, and Vanessa Hudgens are among the many famous faces who claim keto did their body good. But while many claim the restrictive way of eating has helped them shed tons of weight, many health experts have spoken out against it—including Jillian Michaels.

RELATED: 7 Dangers of Going Keto

“Your cells, your macro molecules, are literally made up of protein, fat, carbohydrates, nucleic acids. When you do not eat one of the three macro nutrients — those three things I just mentioned — you’re starving yourselves,” she previously fumed. “Those macro nutrients serve a very important purpose for your overall health and wellbeing. Each and every one of them.”

Instead, Michaels maintains eating a balanced, healthy, and sustainable diet is the key to long-term weight loss. “You don’t eat processed sugar, you don’t eat processed grains, and to make a very long story short: avoid the keto diet,” she said. “Common sense. Balanced diet is key.”

Others like Health contributing nutrition editor Cynthia Sass, RD, aren’t totally opposed to keto, but point out that it isn’t realistic for most people.

“Intermittent fasting and keto are both big commitments that will impact your social life, and for many people are not sustainable long term,” Sass previously said. “If a method of losing weight feels like a struggle and does not make you feel well both physically and emotionally, it's not right for you, no matter how popular it is.”

In January 2019, U.S. News and World Report released their annual rankings of the best overall diets along with the best diets for specific goals or criteria. While the Mediterranean Diet, followed by the DASH Diet and the Flexitarian Diet, were found to be the best diets, keto was ranked one of the worst, again, pointing to its lack of sustainability.

“We have basically no evidence that this diet is consistent with human health over time,” panelist David Katz, MD, director of the Yale-Griffin Prevention Research Center said at the time. “All of the evidence we have points toward a plant-predominant diet with an emphasis on vegetables, whole grains, fruits, nuts, and seeds—all of the very things that the ketogenic diet avoids.”

So could Jameson ditching the keto diet be the beginning of the end for the keto craze? Only time will tell, but props to her for listening to her body and doing what she feels is best for it.

To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter

https://www.health.com/weight-loss/jenna-jameson-quit-keto-diet-weight-gain

Whole30 Cofounder Melissa Urban On How a Better Relationship With Food Can Improve Mental Health

Even though Whole30 started as an eating plan, there’s much more than just food on your blog, podcast, and Instagram feed. Was that a conscious choice?

It’s been a natural evolution, stemming from my own experience. Developing a healthy relationship with food and my body spilled over into other areas of my life, helping me tackle trauma, process stressful life events, develop self-care practices, and dive deeper into the issues my community also struggles with.

You’ve been very open about your recovery from drug addiction and other challenges, including single parenting and mental health issues. How come?

The best way I know to remove the stigma that often surrounds these issues is by dragging conversations into the light and giving them the respect, compassion, and support they deserve. By sharing openly, I hope to show people they don’t have to be ashamed and that seeking help is strong and brave.

You see Whole30 as a gateway to bigger things for people who practice it. What do you mean by that?

A person’s relationship with food is foundational to every other area of their life. If you feel like you’re in control of your food—not in an overly rigid, disordered way, but in an empowered, “I know I’m feeding myself well as an act of self-care” way—the confidence and energy that brings will spill over into every area of your life.

How can exercise and yoga impact people’s lives?

Any activity that involves moving your body can remind you of your power and give you something to focus on that isn’t just weight- or size-related. Can you lift more? Can you do it faster? Can you hold the pose longer? Can you enjoy the process and not just the results? Yoga in particular can be transformational—it teaches you that you are capable of so much more than you gave yourself credit for.

What do you think is missing when we talk about wellness?

Mental health is often omitted from the equation, and I am a big believer in therapy. There are some things that are just too big to unpack by yourself—and no amount of keto meals or CrossFit sessions is going to take the place of getting in touch with our feelings and processing past hurts.

Your latest cookbook, Whole30 Friends & Family, is about how to practice Whole30 during social occasions like holidays and parties. Why was that important to you?

Even with all the resources we offer and recipes available, people still said it was hard to socialize on the program. We want you to be social on the Whole30 and prove to yourself that you can still have fun, make memories, and celebrate traditions even without cake on your plate or wine in your glass. And that’s a life lesson that sticks. It helps people entertain, host, or attend social events in a way that feels effortless.

To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter

https://www.health.com/weight-loss/melissa-urban-whole-30