What physical ailment is rarely discussed, often ignored, receives very little attention and affects 1 in 15; a total of an estimated 18.0 million Americans, and….it is life threatening?
Give up? It is Sleep Apnea!
Yes, it is more than the simple interruption of sleep. One must understand the interruption to a sleep apnea sufferer is they actually stop breathing. Often times for up to 20 to 30 times per hour, and without the patient (sleeper) even knowing. Symptoms can include morning headaches, dry mouth, and a feeling of tiredness throughout the day, but the underlying issues can be much more serious.
The health risks are many and can be grave.
High Blood Pressure: Sleep Apnea will often contribute to increased blood pressure for those suffering from it. Frequent episodes will elevate the hormonal balance and make them high speed, resulting in high blood pressure levels at night. It will lower your blood oxygen levels. However, if you begin receiving treatment for sleep apnea and you are already being treated for high blood pressure, you may be able to cut back on your blood pressure medication.
Heart Disease: Sleep Apnea increases your risk of a heart attack that often results in death during the night. The reduced oxygen level caused by apnea can interrupt the blood flow to the brain.
Diabetes: There isn’t any clear link, but up to 80% of diabetics suffer from some form of sleep apnea;
Acid Reflux (GERD); Because of the way the throat closes during sleep for apnea sufferers, it may suck the contents of the stomach up to the esophagus causing GERD;
Headaches: There is a connection between apnea, morning headaches and insomnia;
Excess Weight Up to 50% of overweight people also have sleep apnea; the excess weight often collects around the neck thus making it harder to keep breathing at night.
Afib or Atrial Fibrillation: One of the resulting health issues sleep apnea sufferers often experience is AFib, or Atrial Fibrillation. This often manifests itself with rapid and erratic heart rate including heart palpitations, dizziness and shortness of breath.
Mental Health: High percentages of people who snore has sleep apnea, and have a daytime sleepiness issues and often times suffer depression or anxiety symptoms.
We can see these very serious health problems that include hypertension, Afib, increased cardiovascular mortality and morbidity, brain damage, strokes and brain lesions and obesity, can be related to sleep apnea.
Diagnosis and Treatment
How do you know if you are suffering from sleep apnea? The symptoms may be obvious, but a diagnosis is necessary for treatment and for your insurance company to approve the purchase of a CPAP machine (Continuous Positive Airway Pressure) if required. A definitve diagnosis is a sleep study test that requires enjoying a night’s sleep at a sleep lab while you are “wired up” to diagnostic machine. Painless, but a pain!
You may find the results shocking. The sleep apnea standard for diagnosis is you stop breathing for 10 seconds at least five times per hour. It is not uncommon for an apnea sufferer to find they are incurring an apnea event 30 to 40 times each hour. As one can imagine, you can’t possibly be getting your necessary rest with that many interruptions. This level per hour can be routinely reduced to less than one per hour with treatment, thus allowing a much healthier sleep.
You can’t just make an appointment with a sleep specialist; you need to start with your primary care physician who may first refer you to a pulmonologist who will then make the referral to a sleep lab. Once your sleep lab has confirmed the diagnosis, you will have your CPAP shortly thereafter, which is generally covered by health insurance, and then you can quit counting sheep and stay awake during the day.
The better news is most cases are curable. The single best cure….that’s right the old time remedy of diet and exercise. Many cases of sleep apnea are caused by obesity, which in turn partially closes your throat, thus restricting your ability to breath. Your body then reacts to the lack of oxygen and allows the throat to open and begin breathing again, only to stop once again, and again. Since excess weight often settles in your neck area (remember how those shirts keep getting tighter at the neck) lose weight and this often improves the obstruction by allowing your throat to open up permitting uninterrupted sleep.
One of the more threatening health conditions, atrial fibrillation, has a 70% chance to virtually disappear if you correct your sleep apnea. This condition alone should be enough to encourage one to lose weight and exercise.
Absent diet and exercise for treatment of AFib you can use drug therapy or choose to surgically correct it with a process called Ablation. The ablation procedure requires a catherized insertion into the heart with a laser instrument the Laser then “burns” certain electrical tracks in the heart muscle, which will not longer allow the electrical impulse to “jump” ahead and thus cause an arrhythmia. While relatively safe, it is still heart surgery, it calls for the laser treatment directly to your heart muscle, and the really bad news it requires a second procedure more than 50% of the time to accomplish the objective.
The best, most immediate and painless treatment for sleep apnea is the use of a CPAP machine. This treatment has risen to prominence in the last decade along with the diagnosis of the condition itself. This treatment is relatively inexpensive, covered by most health insurance and painless. However, there are two downsides to the use of a CPAP. First and foremost, it is a treatment, not a cure, and many never really become accustomed to wearing a mask with a hose attached to a machine while sleeping.
The recommendation by most providers is twofold: treat the condition with a CPAP and work hard to cure it, usually through diet and exercise.
First, be certain you are suffering from sleep apnea. If you have the telltale signs of drowsiness during the day, perhaps needing a daily afternoon nap, general fatigue, not feeling restful, etc. Often times you are well aware that your sleep has been disturbed many times during the night, but you cannot imagine how high the frequency of the interruption. If you have these signs or even think you might be suffering from this condition, see your primary care doctor (PCP) and discuss it.
Your PCP will refer you to a pulmonologist for further testing. That testing will almost certainly be a sleep test(s). This test would confirm you have the condition, and the degree of your condition. The specialist would then write a script for treatment, which most commonly would be a CPAP. You should have insurance company or Medicare approval in next two weeks, and be given a CPAP by your local Durable Medical Equipment (DME) supplier. The DME will fit you for your mask, explain how to use the device and be your supplier of future needs such as filers, replacing the mask, hoses, etc. (And, to think you didn’t even know what a DME was before)
Again, the CPAP is the treatment, not the cure. The cure if often diet and exercise, so get at it. And if you need an incentive, think how much you would enjoy not having to put a mask tethered to a machine every night when you go to bed. If you don’t know the answer to those questions, ask your sleeping partner/spouse.