Sleep apnea: preserving harmony in your relationship with CPAP

Untreated sleep apnea: a challenge for couples

Nocturnal breathing pauses create constant anxiety in partners who are concerned about their spouse's health. In the long term, untreated sleep apnea can have serious consequences on life expectancy, with an increased risk of cardiovascular disease and hypertension^2,3.

Sleep apnea: what are we talking about?

It is a sleep-disordered breathing condition^6,7 characterized by breathing pauses lasting 10 to 30 seconds or more, which occur more than 10 times per hour. In cases of total airway obstruction during sleep, the lack of airflow causes apnea. In response, the heart races to open the airways and allow the person to breathe again. This causes micro-awakenings. The succession of these micro-awakenings alters the quality of sleep, even if they are not always felt by the person with sleep apnea. However, the consequences of this disease are very real, not only for the person with apnea but also for their partner, as we shall discover.

Can sleep apnea affect a couple's life?

What are the consequences of snoring in a couple? For the spouse in particular...

First of all, the partners' sleep is disturbed by the fact that they witness the apneas and feel the need to monitor the breathing of the person sharing their bed who has untreated sleep apnea. They monitor their breathing during the night to make sure they continue to breathe^8,9. Sleeping next to an untreated person could therefore increase the partner's risk of insomnia, leading both individuals to suffer from a sleep disorder.

Spouses of patients with severe snoring and sleep apnea are three times more likely to report symptoms of insomnia, including difficulty falling asleep and staying asleep, as well as non-restorative sleep, and twice as likely to report fatigue and daytime sleepiness¹⁰.

Symptoms reported by spouses of untreated patients

These sleep deficits shared by both spouses are associated with a deterioration in their physical (daytime sleepiness) and mental (symptoms of anxiety and depression) health, as well as a deterioration in their quality of life and social engagement (relationship problems)¹¹.

Impact on the couple's relationship

If left untreated, this sleep disorder can have a negative impact on the quality of life of partners^12,13. Spouses have reported changing their social activities to take on more household tasks due to the fatigue of the person living with sleep apnea, leading to relationship problems and the feeling of being more of a caregiver than a spouse¹⁴.

More of a caregiver than a spouse

Added to this is the lack of sleep, which profoundly affects the couple's dynamic: irritability, frustration, exhaustion, decreased libido, disruptions at work, and tension in the relationship set in⁹. Many couples opt for separate bedrooms, undermining their intimacy. Wives of untreated patients are almost three times more likely to sleep separately than women living with men who do not snore frequently¹⁵. Others continue to share a bed to avoid social stigma and maintain the feeling of a “healthy” relationship⁸.

Lovers, don’t let sleep apnea come into your couple!

With this claim, Air Liquide Healthcare wishes to raise awareness of the impact of sleep apnea on quality of life and encourage people to seek treatment for this sleep disorder.

How can you preserve harmony in your relationship with a sleep apnea device?

Continuous positive airway pressure (CPAP) is the first-line treatment for sleep apnea, and a growing  body of evidence suggests that CPAP can reduce respiratory disturbances and daytime sleepiness and improve sleep quality, quality of life, and blood pressure in patients^16,17.

In addition, the majority of studies have shown that CPAP treatment in people with sleep apnea also has positive effects on the physical and mental health of their partners, with improvements observed from the start of treatment and maintained for up to one year¹. Specifically, an immediate increase in sleep efficiency and the percentage of REM (paradoxical) sleep, as well as a decrease in the number of awakenings and the percentage of slow-wave sleep, were observed in spouses when patients were treated with CPAP¹⁸.

However, it is interesting to note that some partners were bothered by the noise or cold air expelled by the medical device¹². Others described the experience of no longer hearing their partner snore during the first few nights with CPAP as alarming, but then reported falling asleep more quickly and feeling more energetic⁹.

Noise and nuisance from CPAP machines: myths and realities

Many of you have questions about the nuisance of CPAP devices. In general, they currently emit between 25 and 30 decibels, which is comparable to a soft whisper. Snoring associated with untreated sleep apnea can reach 90 decibels in the most severe cases. The noise nuisance of the medical device therefore has many advantages. For optimal performance, the filter must be cleaned regularly, the connections checked, and a sound-insulating hose can also be used to minimize residual noise. Finally, the device must be placed on a stable support. For some, the slight residual noise is similar to the soothing sound of ocean waves.

The role of the spouse in accepting CPAP

You may be wondering: Can sleep apnea treatment affect my relationship? How can I cope with a CPAP mask as a couple?

Newly diagnosed patients who reported living alone used CPAP less frequently at the start of treatment compared to those living with a partner (3.6 hours vs. 5.0 hours, respectively)²¹. Similarly, people living with a partner are 1.5 times more likely to have an average compliance of ≥ 4 hours per night²².

CPAP adherence for patients living with a partner

In cases of lower CPAP treatment adherence, patients report marital conflicts, particularly negative emotions such as anger, annoyance, and criticism²³. The involvement of the partner plays a crucial role in the implementation of treatment and adherence.

Strategies for the smooth integration of CPAP

The partner can adopt three distinct strategies, but not all of them have the same effect on sleep apnea treatment compliance:

• The patient manages their treatment independently, with minimal or no assistance from their partner.
• The treatment is managed jointly, with the partner providing emotional and practical support.
• The partner takes full responsibility for the treatment, supervising the practical aspects, including giving instructions.

The involvement of partners in patient programs appears to be essential, as suggested by focus groups involving both sleep apnea patients and their spouses. Partners have shown a keen interest in participating in this type of program to better understand the consequences of sleep disorders and the benefits of CPAP^24,25.

Finding solutions as a couple

Shame, interference with intimacy, and the perceived negative impact of CPAP are all situations that require a joint approach.

For skin irritation, the partner can help adjust the mask and offer a facial massage after removal in the morning. Medical-grade silicone pads can also reduce marks upon waking. For dry mouth, a humidifier in the bedroom and a bottle of water on the bedside table are useful tips. Taking a walk together after dinner before bedtime can also be a positive routine.

Communication: the key to accepting treatment

Open and caring communication promotes acceptance of CPAP treatment. As a patient, it is recommended that you share your feelings with your partner from the start of treatment: progress, questions, and successes.

Medical consultations and discussions with your home healthcare provider can be prepared and conducted together. Healthcare professionals will be able to answer questions and suggest solutions tailored to your situation.

Adapting your intimacy with the CPAP device

Wearing a CPAP mask should not get in the way of moments of tenderness. Synchronizing sleep schedules can strengthen marital harmony in the face of sleep apnea, and creating a soft atmosphere with dim lighting can help divert attention away from the medical equipment.

Soothing rituals can be established before bedtime (reading, soft music) to improve your quality of life while normalizing the presence of the CPAP machine. You can give the CPAP a cute or silly nickname... in everyday life, humor will be your best ally!