The minute she sat down to watch television or climbed into the passenger seat of a car, Doreen Henry would nod off. Her husband, Michael, was much the same, heading for the couch and a nap as soon as he got home from work.
“I was always tired, I had memory loss and high blood pressure,” said Doreen, who is 51 and lives in Buckingham, Pennsylvania with Michael, 50.
Sleep studies with Doylestown Health’s Sleep Center found each of the Henrys had sleep apnea, a potentially dangerous condition that restricts the airway and stops breathing for several seconds, sometimes hundreds of times throughout the night. The interrupted sleep can lead to an array of health problems, from severe daytime fatigue to heart and liver ailments, sexual dysfunction and sleep-deprived partners.
Dr. Les Szekely, the sleep center’s director, prescribed CPAP machines to the couple. (Doreen got hers several years ago; Michael, a few months ago.) “Within two days of using it, I felt so much better,” Doreen said. “I won’t go anywhere without it, no way.”
CPAP (continuous positive airway pressure) masks use air to open the airway passage and deliver oxygen to the lungs. The device fits securely over the mouth and/or nose. By opening the passage, the apneic episode is prevented, allowing deep sleep to continue uninterrupted. “It’s tolerated by about 80 percent” of patients, said the Doylestown Health sleep specialist. CPAP is the only sleep apnea treatment universally paid for by insurance, added Szekely.
Population studies suggest 8 percent to 10 percent of men and 4 percent to 5 percent of women in the United States have the disorder, with upwards of 80 percent yet to be diagnosed, according to the doctor.
Obstructive sleep apnea, the most common form of the affliction, is typically marked by loud snoring, awakening with a dry mouth or sore throat, morning headache, difficulty staying asleep, attention problems and irritability. The constriction begins when the throat muscles supporting the soft palate, the uvula (that triangular piece of tissue hanging from the soft palate), the tonsils, the side walls of the throat and the tongue all relax during sleep.
It’s that relaxation that narrows and momentarily closes the airway, suppressing the flow of air into the lungs. The brain senses the inability to breathe and rouses one from sleep so breathing can start again. The awakening is usually so quick, it’s not even remembered. But, experts agree, the episodes take a toll on an individual’s health.
During these sleep apnea events, oxygen levels in the blood can be reduced, at times to dangerously low levels, said Dr. Arvind Cavale, an endocrinologist in Yardley, who has been studying the relationship between sleep apnea and diabetes for about 15 years. Untreated, sleep apnea can have long-term health consequences, including progression of diabetes, as apnea can create “a wild ride in glucose levels,” the doctor said.
Michelle Rothstein said sleep apnea played a role in the death of her husband, David, two and a half years ago.
“I knew he had it,” said the Furlong woman, before he was later diagnosed. Still, he wouldn’t wear the mask consistently or throughout the night. “It was uncomfortable and noisy,” she said. “He also wouldn’t admit he had it.”
David Rothstein had spent much of his life overweight, frequently a major risk factor in sleep apnea. He also had lived most of his life unaware of a heart defect he had since birth, explained his widow. While he died of a heart attack shortly after surgery to repair the defect, his wife said sleep apnea “greatly contributed” to his heart’s damage.
“The heart was working much harder” due to the years of untreated apnea, said Rothstein. “The damage that gets done can’t be undone.”
She encourages others not to ignore the condition. “Sleep apnea is more serious than you know,” she said. “Have it treated. It can be a matter of life and death.”
The disorder can pose significant public safety risks, as well. Sleep apnea in engineers contributed to two New York City-area commuter train crashes that injured hundreds and killed one person, according to a 2017 story from Reuters. The U.S. National Transportation Safety Board said its investigation found both engineers had severe sleep apnea. Neither had been tested before the crashes, as required by New Jersey Transit, said the NTSB.
In 2013, a train derailed in New York City, killing four people. The NTSB said the driver of the train had an undiagnosed sleep disorder. The transportation agency has called for stricter screening of drivers and engineers for sleep apnea.
While CPAP masks are the most often recommended treatment, other options include dental devices that can adjust the position of the jaw and tongue, snore wedges and pillows, and various techniques that force patients to sleep on their sides. Surgery that inserts a pacemaker-like device into the trachea and soft pallet can also be an option, although, Szekely said, he believes more conservative therapies are best tried first.
People typically don’t think of snoring as a sign of a potentially serious disorder. And, while not everyone who snores has sleep apnea — and, conversely, not everyone who has sleep apnea snores — sleep experts advise talking to a doctor if you experience loud snoring, especially if it’s punctuated by periods of silence.
Consulting a doctor is also advised if you experience extreme daytime drowsiness that might cause you to fall asleep while working, watching TV or even driving. If you have shortness of breath or wake up and gasp for air, talk to a medical professional, as it may be due to sleep apnea or other sleep disorders.
Anyone, including children, can have sleep apnea. But, certain factors increase the risk. They include excess weight, those with thicker necks, a narrowed airway, being male, being older, family history, use of alcohol, sedatives or tranquilizers, smoking and nasal congestion, according to the Mayo Clinic.
— Freda R. Savana writes for The Intelligencer in Doylestown, Pennsylvania. Email her at firstname.lastname@example.org or follow her on Twitter at @fredasavana