Sleep is common to all human beings. We know we need it, and we know what happens when we don’t get enough or are deprived of sleep for a long period of time. Most of us take a good night’s sleep for granted. We wake up refreshed and ready to start another day.
For a small but growing segment of the population who suffer from a sleep disorder called obstructive sleep apnea, however, lack of quality sleep affects not only lifestyle, but also, as more and more studies are showing, a person’s health.
In sleep apnea, the amount of air going into the body during sleep is restricted by an obstructed upper airway. Individuals with sleep apnea experience pauses in breathing or low breathing during sleep, with episodes lasting seconds or up to minutes, with this happening from 5 to 30 times or more an hour. This results in low night time oxygen levels.
If we don’t get the oxygen our bodies need, the consequences can range from lifestyle annoyances or disruptions, for example low energy levels and sleepiness during the day, to more seriously, increasing our risk for high blood pressure, heart disease, stroke, or Type 2 diabetes.
In the general population, about 10 to 15 percent of persons experience sleep apnea, with the incidence among individuals in the sixth or seventh decade of life about 30 percent or higher. Women typically do not experience sleep apnea until after menopause, at which time the rate equals that of men.
Two main factors affect the growing prevalence of sleep apnea. One is an aging population. As we grow older, the tissues and muscles of our bodies are not as strong as they once were and the throat is more likely to collapse during deep sleep, obstructing the airway. The other factor is weight. Sleep apnea is more common in persons who are overweight; excess fat around the neck area can restrict your airways during sleep. In a kind of a vicious cycle, sleep apnea may actually promote weight gain. When you don’t get enough sleep and don’t feel well, you may overeat to compensate or you may not exercise because you’re too tired. Then, the more weight you gain, the more you experience sleep apnea, which then leads to more weight gain.
Obesity has been identified as one of the leading risk factors in the incidence of diseases such as high blood pressure, heart disease, or Type 2 diabetes. Data shows that 80 to 90% of people who have a stroke have sleep apnea. While we can’t say that apnea causes strokes, we know it definitely contributes. We also know that if you treat sleep apnea, it can improve stroke outcomes and cardiac functions after heart attacks.
Studies have also shown that about 30% of people with high blood pressure, a major risk factor for heart disease and stroke, have sleep apnea. National guidelines for hypertension list sleep apnea as a potentially reversible cause of the condition.
We are starting to see a stronger and stronger link between sleep apnea and diabetes. Low oxygen levels experienced during sleep create stress on the body, which then contributes to insulin resistance, a leading cause of both pre-diabetes and Type 2 diabetes.
How do you know if you have sleep apnea? Some of the clues are waking up with a dry mouth or a headache, or feeling tired and sleepy during the day. Awareness can also begin with a spouse or partner who notices that you stop breathing when you sleep and who has to nudge you to wake up or begin breathing again.
While 40% of heavy snorers have sleep apnea, snoring itself doesn’t necessarily mean the sleeper is having trouble breathing. Actually it’s the quiet period between snores that offers a better clue as to whether sleep apnea is occurring. The converse is also true, you can be a quiet breather and yet have sleep apnea.
Your primary care doctor may also help diagnose the condition, especially if there are other medical conditions present such as allergies, asthma, or acid reflux.
As a specialist in sleep medicine, when I first see a patient, I look at his or her medical history and ask about possible symptoms. Depending on what I find, I either recommend a sleep study that can be done at home or a sleep study done at a sleep center. Once sleep apnea has been diagnosed, depending on the type and severity, the patient and I will then discuss treatment methods. These include weight loss, changing sleeping positions, or possibly upper airway surgery to improve airflow. Historically a positive pressure device, called a CPAP delivered pressurized air via a mask to keep the throat from collapsing. This allows people to breath normally. Many people think that a CPAP mask is the only option for sleep apnea, however many options exist. Many of my patients benefit from dental appliances worn during the night, which moves the jaw forward. Sometimes a combination of treatment modalities will solve the problem.
The prospect of having to wear an appliance or mask should not keep you from seeking treatment for sleep apnea. The role of oral appliances has expanded in the past five years due to the many improvements in these devices. Materials are better, the devices are smaller, adjustable, more comfortable and fit in the mouth better. More patients are able to use these devices and treat their sleep apnea in this way.
The CPAP masks are also more comfortable, with manufacturers offering several choices of shapes and sizes for different faces. For most of my patients, the CPAP mask is the most effective way of treating sleep apnea and offers an amazing quality of sleep.
In my own life, as a person with sleep apnea and also as a South Asian man facing a higher risk of heart disease and Type 2 diabetes, I took the advice I give to my patients and lost 45 pounds. It was the best thing I’ve ever done in my life, causing my sleep apnea to go away and decreasing my risk for heart disease in the process.
Good treatments for sleep apnea are available and offer a big payback for your health and well being now and in the future.
Harish HK Murthy, MD
Dr. Murthy is a board certified specialist in sleep medicine as well as pulmonary and neurocritical care medicine. He received his medical degree from West Virginia University School of Medicine and completed his post graduate training at California Pacific Medical Center. He is in private practice in San Jose, California. He is the medical director of the Neurocritical Care ICU at Good Samaritan Hospital and the Sleep Lab at El Camino Hospital. He can be reached at 408 356 8900.
Constant tiredness, sleepiness, low energy are now in her past
Vibha Chhabra, 38, Pleasanton says that five years ago, she was so tired, that even after a night’s sleep, after her husband left for work in the morning, she would climb back in bed, sometimes sleeping until noon. Whenever they went anywhere in the car, Vibha would immediately fall asleep.
Her husband, who had listened to her gasping for breath during the night, kept telling her to go to the doctor and get checked for sleep apnea. But the prospect of having to wear a sleep a mask at night kept her from taking this first step, she says. “It was just so artificial.”
On a visit to friends, something happened that changed her mind. After lunch, both her husband and her friend’s husband decided to take a nap. When Vibha went upstairs where the two men were sleeping, she noticed that her friend’s husband was wearing a sleep mask during his nap.
“I didn’t realize he had the problem, too,” she says. “When he told me how nicely he slept with it, and how fresh he felt when he awoke, it convinced me to give it a try.”
Vibha used a mask for the first time during a sleep study, Dr. Murthy recommended. “It made such a difference,” she says. “I decided I really needed one of those!”
Now, Vibha says won’t leave home without her mask. When she travels back home to India, she makes sure there will be enough power to keep the mask going at night. She also convinced a favorite uncle into getting treatment. “At a recent family wedding, he spent most of his time sleeping on the couch even with all the activity around. I knew he was probably suffering from lack of sleep so I advised him to get checked out for sleep apnea. It worked. He’s back to his regular energy level now and doesn’t have to drink so many cups of coffee to keep him awake.”
Vibha has lost weight, too, which has improved her blood sugar levels and decreased her changes of getting Type 2 diabetes. She says she loves the way she feels now and is completely accustomed to wearing the sleep mask. “I don’t even think about it.”