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Section 12
Treatment of Obstructive Sleep Apnea

Question 12 | Test | Table of Contents

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In the last section, we discussed four mental imagery techniques.  Four mental imagery techniques that we will discuss are the ‘Float Along,’ ‘Drifting Downward.’ ‘Count Down to Relaxation,’ and the ‘On Vacation’ techniques. 

In this section, we will discuss behavioral interventions for breathing related sleep disorders.  There are several types of breathing related sleep disorders for which exist a limited number of treatment options. As you listen to this section, consider your role in helping your client cope with a breathing related sleep disorder.

First, let’s begin our discussion by examining types of breathing related sleep disorders.  The DSM recognizes three abnormal respiratory events which occur during sleep and lead to sleep disorders.  These three abnormal respiratory events are apneas, or breathing cessation, hypopneas, or slow, shallow breathing, and hypoventilation. 

♦ 3 Types of Breathing Related Sleep Disorders
These three abnormal respiratory events occur in one of three forms of breathing related sleep disorders.  You may already know that the three forms of breathing related sleep disorders are:
1. Obstructive sleep apnea syndrome,
2. Central sleep apnea syndrome, and
3. Central alveolar hypoventilation syndrome. 
As you are aware, you can consult the DSM for more information.  Which type of breathing related sleep disorder does your client have? 

Wade, age 36, suffered from obstructive sleep apnea syndrome.  Wade was an obese man, which contributed to his breathing related sleep disorder.  However, as you may know, not all obstructive sleep apnea syndromes are caused by obesity.  Other causes may include certain physical characteristics regarding the face and mouth.  For example, clients with a high palates, receding chins, overbites, narrow jaws, et cetera, may experience obstructive sleep apnea syndrome as well. 

To diagnose Wade, it was necessary that he undergo a sleep study in a special lab.  The study revealed that Wade slept for a couple minutes before waking up gasping for air.  Each time Wade fell back to sleep, he would wake up about 30 seconds later gasping for air.  By morning, Wade had totaled 379 separate awakenings and about 64% of his sleep was spent not breathing. When Wade was told that he had sleep apnea, he was surprised.  Wade only recalled waking up "2 or 3 times."   Wade initially declined treatment for what he called a ‘mild sleep problem.’  However, Wade later scheduled a session with me to discuss his sleep disorder. 

♦ Treatment Options
Unfortunately, not many behavioral treatments are available for sleep apneas. However, I discussed a number of steps Wade could take to help him sleep better. As you may already know, weight problems are often a leading factor regarding sleep apnea. First, I stated, "Wade, can I recommend that you consider a weight loss program?"  Wade responded by informing me that he was already aware that he needed to lose weight. 

However, Wade also stated, "It’s just so hard for me lose weight.  I feel embarrassed when I exercise and I’ve never been any good on a diet."  How would you have responded to Wade?  Think of your sleep disorder client like Wade.  Could your method of behavioral treatment perhaps benefit your client by focusing on resultant or satellite feelings? 

After discussing weight loss with Wade, I offered him some additional recommendations I felt may be helpful.  I stated, "Consider avoiding alcohol and sleeping pills.  Death from sleep apnea often involves the heavy use of sedatives."  Wade then asked if he could die from a lack of sleep.  I stated, "No, but because you stop breathing shortly after going to sleep, you are not getting the quality of sleep that you need.  For temporary relief, try using more pillows to elevate your head or sleep in a reclining chair.  Also, an air purifier may benefit you."      

At a later session, Wade stated, "I’m trying hard to start losing some weight."  Wade had also received a continuous positive pressure airway device that helped keep his airway open during sleep.  Hirshkowitz notes that 50 percent of clients who receive a similar device don’t use it.  Regarding the continuous positive pressure airway device, Wade remarked, "The CPAP took some getting used to, but after the first couple nights, I was amazed."  Think of your Wade.  Could a combination of medical technology and psychotherapy benefit your client?

In this section, we have discussed behavioral interventions for breathing related sleep disorders.  There are several types of breathing related sleep disorders for which exist a limited number of treatment options. 

In the next section, we will discuss techniques for relaxation.  For the purposes of sleep disorders, we will discuss three techniques for relaxation.  The three techniques for relaxation that we will discuss are stretching, mind games, and autogenic training.
Reviewed 2023

Peer-Reviewed Journal Article References:
Carleton, E. L., & Barling, J. (2020). Indirect effects of obstructive sleep apnea treatments on work withdrawal: A quasi-experimental treatment outcome study. Journal of Occupational Health Psychology. Advance online publication.

Colvonen, P. J., Drummond, S. P. A., Angkaw, A. C., & Norman, S. B. (2019). Piloting cognitive–behavioral therapy for insomnia integrated with prolonged exposure. Psychological Trauma: Theory, Research, Practice, and Policy, 11(1), 107–113.

Dong, L., Soehner, A. M., Bélanger, L., Morin, C. M., & Harvey, A. G. (2018). Treatment agreement, adherence, and outcome in cognitive behavioral treatments for insomnia. Journal of Consulting and Clinical Psychology, 86(3), 294–299.

Nanthakumar, S., Bucks, R. S., Skinner, T. C., Starkstein, S., Hillman, D., James, A., & Hunter, M. (2017). Assessment of the Depression, Anxiety, and Stress Scale (DASS-21) in untreated obstructive sleep apnea (OSA). Psychological Assessment, 29(10), 1201–1209.

Olaithe, M., Nanthakumar, S., Eastwood, P. R., & Bucks, R. S. (2015). Cognitive and mood dysfunction in adult obstructive sleep apnoea (OSA): Implications for psychological research and practice. Translational Issues in Psychological Science, 1(1), 67–78.

Whited, M. C., Olendzki, E., Ma, Y., Waring, M. E., Schneider, K. L., Appelhans, B. M., Busch, A. M., Chesebro, J., & Pagoto, S. L. (2016). Obstructive sleep apnea and weight loss treatment outcome among adults with metabolic syndrome. Health Psychology, 35(12), 1316–1319.

QUESTION 12
What is a leading contributing factor regarding breathing related sleep disorders such as sleep apnea? To select and enter your answer go to Test.

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